Games4Health Europe, Utrecht, NL 1.11.2016

Exergames in acute care settings: A Systematic Review

Ruud H. Knols, PhDUniversity Hospital Zurich, Directorate of Research and Education, Zurich, Switzerland

ruud.knols@usz.chTom Vanderhenst, MSc

University Hospital Zurich, Physiotherapy / Occupational Therapy, Zurich, Switzerlandtom.vanderhenst@gmail.com

Martin Verra, PhDUniversity Hospital Berne, Institute for Physiotherapy, Berne, Switzerland

martin.verra@insel.chEling D. de Bruin, PhD

ETH, Department of Health Science and Technology, Zurich, Switzerlandeling.debruin@hest.ethz.ch

Abstract Knols R et al. Exergames in acute care settings: A systematic review

OBJECTIVE:This study summarized: (1) the evidence from studies investigating the use of exergames in acute care settings, (2) the reporting of frequency, intensity, time, and type (FITT) of exergaming components and adherence, and (3) reporting of intervention details enabling study replication.

METHODS:The usual libraries were consulted. Two authors independently selected and systematically reviewed the included reports. Study quality was scored. RESULTS:Nine reports (representing 5 RCT‘s, 1 CCT, and 3 single group pré-post studies) included 365 patients. Energy expenditure, 6-Minute Walking Test, Timed Up and Go Test, Modified Berg Balance Scale, Level of enjoyment, Transitional Dyspnea Index, Upper limb activity, Cognitive performance, and length of hospital stay favored exergaming in hospital patients. Two studies reported all four FITT components. No studies reported adherence. The median of descriptions intervention details was 5 (of 12), range 2-7.

CONCLUSIONS:The included studies suggest that patients in acute care settings may benefit from exergaming. Future studies should pay attention to the description of FITT components and adherence to the intervention. Attention to include details of the used exergaming intervention is important for replication purposes. The relationship between exergaming and patient outcomes requires, however, further exploration.

De Bruin ED, Stoller O, PT Congress Basle, 2016

De Bruin ED, Stoller O, PT Congress Basle, 2016

Definitions

Physical activity: Any body movement carried out by the skeletal muscles and requiring energy

Physical Exercise: Planned, structured, repetitive movement of the body designed to improve or maintain physical fitness

Physical fitness: Set of physical attributes that allows the body to respond or adapt to the demands and stress of physical effort

Hoffman J (Ed.): Physiological Aspects of Sport Training and Performance. Champaign, Illinois: Human Kinetics; 2002.

Is this patient on an intensive care unit exergaming or is he (just) physically active ?

Abdulsatar et al. J Pediatr Rehabil Med, 2013

http://www.bootcampeffect.com

Exercise = work (frequency x Intensity) vs. recovery

General Considerations for Exercise Prescription

Hoffman J (Ed.): Physiological Aspects of Sport Training and Performance. Champaign, Illinois: Human Kinetics; 2002.

• Specificity• Progression• Overload• Initial values• Reversibility• Diminishing returns

General Considerations for Exercise Prescription

Optimal Physical exercise addresses health-related physical fitness components of

• Cardiorespiratory (aerobic) fitness (FITT)

• Muscular strength (FITT)

• Neuro-motor fitness (Gentiles Taxonomy)

Modified `Dance Dance Revolution` game for elderly

Pichieri et.al. BMC Geriatr., 2012

General Considerations for Exercise Prescription 2

FITT principles of exercise prescription (e.g.: Aerobic performance)

• Frequency: how often (2x/wk., 48-72 hrs. recovery)

• Intensity: how hard (60-70% peak oxygen capacity or 60-70% of max. heartrate, during 15 minutes, songs with max. 90 beats /min.)

• Time: duration or how long (up to 20 Minutes)

• Type: mode or what kind : Dance Dance Revolution Interval, 2 minutes pause between songs

• Total Volume: amount (12 wks.)

• Progression: advancements (up to 30 minutes in week 8) etc.

´´The evaluation of (exercise-) interventions is a major research activity, yet the quality of descriptions of interventions in publications remains remarkably poor.``

``Without a complete published description of the intervention, other researchers cannot replicate or build on research findings. For effective interventions, clinicians, patients, and other decision makers are left unclear about how to reliably implement the intervention.´´

Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide Hofmann et al. 2014

Aim of the review

To summarize:

-Evidence from studies investigating use of exergames in acute care settings

-Reporting of Frequency, Intensity, Time, and Type (FITT) of exergaming & adherence

-Reporting of intervention details enabling study replication (TIDIER)

Knols et al. Games4Health J., 2016

Studies eligible:(1) Computerized training methods ‘‘exergames,’’ and / or virtual reality training games

(2) RCT’s, CCT’s and one-group pre–post-intervention studies

(3) Patients in hospital of all ages

(4) Aiming to improve physical function and/or psychosocial outcomes (quantitative primary or secondary)

Methods 1

Knols et al. Games4Health J., 2016

Systematic search, Medline-Ovid, EMBASE, CINAHL, PsychInfo, Cochrane Library (by a librarian)

2 authors independently selected and systematically reviewed reports

Non-English and distraction studies were excluded

Methods 2

Knols et al. Games4Health J., 2016

Methods 3

Years of publication: 2010 - 2014 (n = 9, 3 with children).

365 patients in selected articles, Sample sizes: n = 12 - 122.

Australia (2), North America (2), Asia (2), Europe (3).

RCT (5), CCT (1), single-group designs (3)

Commercial Wii platform (6) Nintendo (Redmond, WA)

Results 1

Knols et al. Games4Health J., 2016

Game settings: Intensive care unit 1Surgery department 1(Early-) stroke rehabilitation unit 1 Pediatric oncology unit 2Pulmonary rehabilitation unit 2 Pediatric rehabilitation hospital 1Otorhinolaryngologie Department 1

Sign. improved outcomes:Upper limb activity 6-Minute walking TestWorking memory capacity DyspnoeDepression Timed up and goEnergy expended Modified Berg Balance ScaleVisual Analogue Scale Days in hospital

Results 2

Knols et al. Games4Health J., 2016

Kappa FITT components 0.86, (95%CI 68-100)Kappa Adherence 0.92, (95%CI 77-100)

Results 3

Knols et al. Games4Health J., 2016

Reported + items /study 0-8 (median 2) Total reported item numbers per study 0-7 (median 5). Kappa: 0.86, 95CI% 0.77–0.96.

Results 4

Knols et al. Games4Health J., 2016

Exergaming using commercially available consoles may improve physical function and well-being in acute care patients

Consider and report in detail general intervention / specific FITT components of training program and how patients adhere to training plan

Collaboration between game designers & health-care professionals when developing serious games

Conclusions

Thank you for your attentionDiscussion