’Gamification’ -Kommenteret litteraturliste - UC Viden€¦ · ’Gamification’ -Kommenteret litteraturliste 2014 Udarbejdet for UCL.DK – Forskning og innovation; Jette Damgaard

Danish University Colleges

'Gamification' -Kommenteret Litteraturliste

Jeppesen, Jette Damgaard

Publication date:2014

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Citation for pulished version (APA):Jeppesen, J. D. (2014, jan). 'Gamification' -Kommenteret Litteraturliste.

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’Gamification’ -Kommenteret litteraturliste 2014

Udarbejdet for UCL.DK – Forskning og innovation; Jette Damgaard Jeppesen, januar 2014

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Denne kommenterede litteraturliste er udarbejdet for Center for velfærdsteknologi, Forskning og

Innovation, University College Lillebælt. Ønsket var et materiale, der kunne belyse tilgængeligt litteratur

vedrørende Gamification indenfor sundhedssektoren. Tidsrammen for udarbejdelsen har været 75 timer.

Der blev først foretaget en bevidst tilfældig søgning på ”Gamification” på nettet uden resultatet.

Efterfølgende er der søgt i Pubmed og Cochrane databaser. Følgende søgetermer er anvendt (Gamification,

Game*, Health AND/OR Healthcare, Rehabilitation, Compliance AND/OR Adherence, Physiotherapy

AND/OR Physical therapy, Nursing, Occupational therapy). Artikler blev efterfølgende udvalgt på baggrund

af titler og efterfølgende på baggrund af abstracts. Der er prioriteret reviews til at indgå i denne

litteraturliste, endvidere er der inddraget editorials, som ligger lavt i evidenshierakiet, men som er nyligt

udgivet og belyser muligheder og problematikker vedrørende ”Gamification”. Herfra er der foretaget

søgning på enkelte artikler, som har været præsenteret i referencelisten.

Enkelte artikler har i søgningen ikke været tilgængelige i abstract format og enkelte har krævet betaling,

hvorfor de ikke er inkluderet i denne litteaturliste.

Artiklerne(Reviews, editorials, studies) er listet efter relevans og information, vurderet af forfatteren.

Således er de artikler, som bidrager med størst viden i fht. effektivitet af gamification og yderligere

kildehenvisninger, præsenteret først. Litteraturlisten står frit til at blive revideret fremadrettet, mht.

korrigeret søgning og tilføjelse af litteratur, ved godkendelse fra Forskning og Innovation, Mette Syse.

Kommentarer tilføjet de enkelte artikler er frit fortolket af forfatteren.



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Ind

enti

fice

ret

Scre

enet

In

klu

de

ret

Pubmed

14

Cochrane

310

Titel

9

Abstract

6

Titel

73

Abstract

11

Artikler frasorteret

pga. manglende

relevans og

tilgængelighed.

Artikler inkluderet

4

Artikler inkluderet

10

Yderligere artikler på

baggrund af referencer

2

Total

16



3

Artikler:

Role of Video Games in improving Health-Related Outcomes -A Systematic Review - side 3

The Effectiveness of Virtual Reality on Reducing Pain and Anxiety in Burn Injury Patients - A Systematic

Review - side 3

Virtual reality for stroke rehabilitation (Review) – side 4

Active Video Games to Promote Physical Activity in Children and Youth (Review) – side 5

Interactive Health Communication Applications for people with chronic disease (Review) – side 6

'Gamification': Influencing health behaviours with games (Editorial) – side 7

Energy Expenditure and Exercise Intensity of Interactive Video Gaming in Individuals Poststroke – side 7

Prevalence and Correlates of Exergaming in Youth – side 8

Design of an mHealth App for the Self-management of Adolesvent Tpe 1 Diabetes: a Pilot Study – side 9

Sports and games for post-traumatic stress disorder (PTSD) (Review) – side 10

Exergames for health and fitness: the roles of GPS and geosocial apps (Editorial) – side 11

A Meta-Analytic Review of eHealth Interventions for Pediatric Health Promoting and Maintaining

Behaviors – side 12

Remote and web 2.0 interventions for promoting physical activity (Review) - side 12

Designing Attractive Gamification Features for Collaborative Storytelling Websites (Study) – side 14

Educational games for mental health professionals (Review) – side 14

Educational games for health professionals (Review) – side 15

Bilag – side 17



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Role of Video Games in improving Health-Related Outcomes -A Systematic Review

Primack BA, Carroll MV, McNamara M, Klem ML, King B, Rich M, Chan CW, Nayak S. American Journal

of Preventive Medicine 2012;42(6):630-638

Abstract

Context: Video games represent a multibillion-dollar industry in the U.S. Although video gaming has

been associated with many negative health consequences, it also may be useful for therapeutic

purposes. The goal of this study was to determine whether video games may be useful in improving

health outcomes.

Evidence acquisition: Literature searches were performed in February 2010 in six databases: the

Center on Media and Child Health Database of Research, MEDLINE, CINAHL, PsycINFO, EMBASE,

and the Cochrane Central Register of Controlled Trials. Reference lists were hand-searched to identify

additional studies. Only RCTs that tested the effect of video games on a positive, clinically relevant

health consequence were included. Study selection criteria were strictly defıned and applied by two

researchers working independently. Study background information (e.g., location, funding source);

sample data (e.g., number of study participants, demographics); intervention and control details;

outcomes data; and quality measures were abstracted independently by two researchers.

Evidence synthesis: Of 1452 articles retrieved using the current search strategy, 38 met all criteria for

inclusion. Eligible studies used video games to provide physical therapy, psychological therapy,

improved disease self-management, health education, distraction from discomfort, increased physical

activity, and skills training for clinicians. Among the 38 studies, a total of 195 health outcomes were

examined. Video games improved 69% of psychological therapy outcomes, 59% of physical therapy

outcomes, 50% of physical activity outcomes, 46% of clinician skills outcomes, 42% of health education

outcomes, 42% of pain distraction outcomes, and 37% of disease self-management outcomes. Study

quality was generally poor; for example, two thirds (66%) of studies had follow-up periods of _12 weeks,

and only 11% of studies blinded researchers.

Conclusions: There is potential promise for video games to improve health outcomes, particularly

in the areas of psychological therapy and physical therapy. RCTs with appropriate rigor will help

build evidence in this emerging area.

(Am J Prev Med 2012;42(6):630–638) © 2012 American Journal of Preventive Medicine

Kommentarer:

Review som systematisk har fundet 38 artikler ud fra PRISMA standarder.

Konklusionen er en tendens til positiv effekt af Gamification på forskellige sundhedsrelaterede

outcomes, især gældende for professioner vedr. psyko- og fysioterapi. På hjemmesiden henvises til

outcomes(www.ajpmonline.org).

I bilag 1 er de 38 artikler præsenteret, som indgår i reviewets resultater.

The Effectiveness of Virtual Reality on Reducing Pain and Anxiety in Burn Injury Patients - A

Systematic Review

Morris LD, Louw QA, Grimmer-Somers K. The Clinical Journal of Pain 2009;25(9):815-826

Abstract

Objective: To systematically review the current evidence for the effectiveness of Virtual Reality (VR), in conjunction with pharmacologic analgesia on reducing pain and anxiety in burn injury patients



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undergoing wound dressing changes and physiotherapy management compared with pharmacologic analgesia alone or other forms of distraction. METHODS: A comprehensive search was conducted between December 2007 and January 2008, and updated in January 2009, before publication. Computerized bibliographic databases were individually searched using specifically developed search strategies to identify eligible studies. RESULTS: Nine studies were deemed eligible for inclusion in this review. Wound dressing changes was the most common procedure during which VR was trialed. Pain was the primary outcome measure in all of the studies included. Anxiety was a secondary outcome measure in 3 of the 9 included studies. VR, in conjunction with pharmacologic analgesics, significantly reduced pain experienced by burn injury patients during wound dressing changes and physiotherapy. There is equivocal evidence for the effect of VR in conjunction with pharmacologic analgesics on reducing anxiety in burn injury patients during wound dressing changes and physiotherapy. DISCUSSION: This is the first known systematic review to report on the effectiveness of VR, in conjunction with pharmacologic analgesia on reducing pain and anxiety in burn injury patients undergoing wound dressing changes and physiotherapy management compared with pharmacologic analgesia alone or other forms of distraction. Used as an adjunct to the current burn pain management regimens, VR could possibly assist health professionals in making the rehabilitation process for burn patients less excruciating, thereby improving functional outcomes. Further research investigating the effect of VR on anxiety in burn injury patients is warranted.

Kommentarer

Reviewet anvender 9 studier til at belyse effekten af Virtural Reality til patienter med brandsår. Der

findes effekt på reduceret smerteangivelse i forbindelse med forbindingsskift (sygepleje) og fysioterapi.

Et studie præsenterede 88 deltagere, de øvrige studier havde få deltagere. Reviewet belyser behovet

for større RCT-studier til at bekræfte den effekt de finder, ud fra de inkluderede studier, på nedsat

smerte ved en kombinationsbehandling af analgesia og Virtual Reality.

Virtual reality for stroke rehabilitation (Review)

Laver KE, George S, Thomas S, Deutsch JE, Crotty M. Cochrane Database of Systematic Reviews 2011;9:

Art. No.: CD008349. DOI: 10.1002/14651858.CD008349.pub2

Abstract

Background Virtual reality and interactive video gaming have emerged as newtreatment approaches in stroke rehabilitation. In particular, commercial gaming consoles are being rapidly adopted in clinical settings; however, there is currently little information about their effectiveness. Objectives To evaluate the effects of virtual reality and interactive video gaming on upper limb, lower limb and global motor function after stroke. Search methods We searched the Cochrane Stroke Group Trials Register (March 2010), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2010, Issue 1), MEDLINE (1950 to March 2010), EMBASE (1980 toMarch 2010) and seven additional databases. We also searched trials registries, conference proceedings, reference lists and contacted key researchers in the area and virtual reality equipment manufacturers. Selection criteria



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Randomised and quasi-randomised trials of virtual reality (’an advanced form of human-computer interface that allows the user to ’interact’ with and become ’immersed’ in a computer-generated environment in a naturalistic fashion’) in adults after stroke. The primary outcomes of interest were: upper limb function and activity, gait and balance function and activity and global motor function. Data collection and analysis Two review authors independently selected trials based on pre-defined inclusion criteria, extracted data and assessed risk of bias. A third review author moderated disagreements when required. The authors contacted all investigators to obtain missing information. Main results We included 19 trials which involved 565 participants. Study sample sizes were generally small and interventions and outcome measures varied, limiting the ability to which studies could be compared. Intervention approaches in the included studies were predominantly designed to improve motor function rather than cognitive function or activity performance. The majority of participants were relatively young and more than one year post stroke. Primary outcomes: results were statistically significant for arm function (standardised mean difference (SMD) 0.53, 95% confidence intervals (CI) 0.25 to 0.81 based on seven studies with 205 participants). There were no statistically significant effects for grip strength or gait speed. We were unable to determine the effect on global motor function due to insufficient numbers of comparable studies. Secondary outcomes: results were statistically significant for activities of daily living (ADL) outcome (SMD 0.81, 95% CI 0.39 to 1.22 based on three studies with 101 participants); however, we were unable to pool results for cognitive function, participation restriction and quality of life or imaging studies. There were few adverse events reported across studies and those reported were relatively mild. Studies that reported on eligibility rates showed that only 34% (standard deviation (SD) 26, range 17 to 80) of participants screened were recruited. Authors’ conclusions We found limited evidence that the use of virtual reality and interactive video gaming may be beneficial in improving arm function and ADL function when compared with the same dose of conventional therapy. There was insufficient evidence to reach conclusions about the effect of virtual reality and interactive video gaming on grip strength or gait speed. It is unclear at present which characteristics of virtual reality are most important and it is unknown whether effects are sustained in the longer term. Furthermore, there are currently very few studies evaluating the use of commercial gaming consoles (such as the Nintendo Wii).

Kommentarer:

Reviewet forholder sig tidligere reviews i fht dette emne og problematiserer den, i de inkluderede

artikler, store forskel på intervention og outcomes, samt manglende follow-up over tid. Reviewet

diskuterer problematikken omkring økonomiske forhold i fht. effekterne på sigt ved gamification.

Relevant diskussion i fht. hvor mange ressourcer der skal anvendes i forbindelse med gamification og

skabelsen heraf, hvis de eksisterende ”behandlingsformer” etc. udgør samme effekt på sigt, om end

gamification giver bedre effekt på kort sigt.

Active Video Games to Promote Physical Activity in Children and Youth (Review)

Biddiss E, Irwin J. Archives of Pediatrics and Adolescent Medicine 2010;164(7):664-672

Abstract

Objectives: To systematically review levels of metabolic expenditure and changes in activity patterns associated with active video game (AVG) play in children and to provide directions for future research efforts. Data Sources: A review of the English-language literature (January 1, 1998, to January 1, 2010) via ISI Web



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of Knowledge, PubMed, and Scholars Portal using the following keywords: video game, exergame, physical activity, fitness, exercise, energy metabolism, energy expenditure, heart rate, disability, injury, musculoskeletal, enjoyment, adherence, and motivation. Study Selection: Only studies involving youth (_21 years) and reporting measures of energy expenditure, activity patterns, physiological risks and benefits, and enjoyment and motivation associated with mainstream AVGs were included. Eighteen studies met the inclusion criteria. Articles were reviewed and data were extracted and synthesized by 2 independent reviewers. Main Outcome Exposures: Energy expenditure during AVG play compared with rest (12 studies) and activity associated with AVG exposure (6 studies). Main Outcome Measures: Percentage increase in energy expenditure and heart rate (from rest). Results: Activity levels duringAVGplay were highly variable, with mean (SD) percentage increases of 222% (100%) in energy expenditure and 64% (20%) in heart rate. Energy expenditure was significantly lower for games played primarily through upper body movements compared with those that engaged the lower body (difference, −148%; 95% confidence interval, −231% to −66%; P=.001). Conclusions: The AVGs enable light to moderate physical activity. Limited evidence is available to draw conclusions on the long-term efficacy of AVGs for physical activity promotion.

Kommentarer:

Reviewet konkluderer at der opnås en øget let til moderat effekt på øget aktivitetsniveau – især ved

spil, som inkluderer underekstremiteter og hele kroppen. Reviewet præsenteres problematikken

omkring manglende viden i forhold til follow-up. Præsenterer endvidere at ikke alle spil medfører at

børn efterlever anbefalinger omkring fysisk aktivietet.

Interactive Health Communication Applications for people with chronic disease (Review)

Murray E, Burns J, See Tai S, Lai R, Nazareth I. Cochrane Database of Systematic Reviews 2005;4: Art.

No.: CD004274. DOI: 10.1002/14651858.CD004274.pub4

Abstract

Background Interactive Health Communication Applications (IHCAs) are computer-based, usually web-based, information packages for patients that combine health informationwith at least one of social support, decision support, or behaviour change support.These are innovations in health care and their effects on health are uncertain. Objectives To assess the effects of IHCAs for people with chronic disease. Search methods We designed a four-part search strategy. First, we searched electronic bibliographic databases for published work; second, we searched the grey literature; and third, we searched for ongoing and recently completed clinical trials in the appropriate databases. Finally, researchers of included studies were contacted, and reference lists fromrelevant primary and review articles were followed up. As IHCAs require relatively new technology, the search time period commenced at 1990, where possible, and ran until 31 December 2003. Selection criteria Randomised controlled trials (RCTs) of IHCAs for adults and children with chronic disease. Data collection and analysis One review author screened abstracts for relevance. Two review authors screened all candidate studies to determine eligibility, apply quality criteria, and extract data from included studies. Authors of included RCTs were contacted for missing data. Results of RCTs were pooled using random-effects model with standardised mean differences (SMDs) for continuous outcomes and odds ratios for binary



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outcomes; heterogeneity was assessed using the I2 statistic. Main results We identified 24 RCTs involving 3739 participants which were included in the review. IHCAs had a significant positive effect on knowledge (SMD 0.46; 95% confidence interval (CI) 0.22 to 0.69), social support (SMD 0.35; 95% CI 0.18 to 0.52) and clinical outcomes (SMD 0.18; 95% CI 0.01 to 0.35). Results suggest it is more likely than not that IHCAs have a positive effect on self-efficacy (a person’s belief in their capacity to carry out a specific action) (SMD 0.24; 95% CI 0.00 to 0.48). IHCAs had a significant positive effect on continuous behavioural outcomes (SMD 0.20; 95% CI 0.01 to 0.40). Binary behavioural outcomes also showed a positive effect for IHCAs, although this result was not statistically significant (OR 1.66; 95% CI 0.71 to 3.87). It was not possible to determine the effects of IHCAs on emotional or economic outcomes. Authors’ conclusions IHCAs appear to have largely positive effects on users, in that users tend to become more knowledgeable, feel better socially supported, and may have improved behavioural and clinical outcomes compared to non-users. There is a need for more high quality studies with large sample sizes to confirm these preliminary findings, to determine the best type and best way to deliver IHCAs, and to establish how IHCAs have their effects for different groups of people with chronic illness.

Kommentarer:

De forskellige studier anvendt i reviewet måler effekterne af IHCA på forskellige parametre og

forskellige patientkategorier, dette medfører at det bliver problematisk at sammenligne studierne.

Reviewet konkluderer, at der er god effekt for flere de enkeltstående studier på både kognitive,

adfærdsrelaterede og sunhedsrelaterede outcomes. Belyser at gamification kan anvendes til forskellige

målgrupper og måles på forskellige parametre, omvendt fremstår også klart problematikken ved at

opnå sammenlignelighed/overførbarhed, som følge heraf.

'Gamification': Influencing health behaviours with games (Editorial)

King D, Greaves F, Exeter C, Darzi A. Journal of the Royal Society of Medicine 2013;106:76-78

Kommentarer

En Leder-artikel, som præsenterer positive effekter og muligheder ved brug af Gamification i forhold til

sundhedsadfærd. Det præsenteres ligeledes at det, i udviklingen af Gamification, er vigtigt at arbejde

med, at de forskellige spil har et formål og at man måske videreudvikler eller justerer allerede

eksisterende spil, som er populære i befolkning til specifikke sundhedsrelaterede

adfærdsændringer/behandlinger.

Energy Expenditure and Exercise Intensity of Interactive Video Gaming in Individuals Poststroke

Kafri M, Myslinski MJ, Gade VK, Deutsch JE. Neurirehabil Neural Repair 2014;28(1):56-65

Abstract

Background. Off-the-shelf activity-promoting video games (AVGs) are proposed as a tool for promoting

regular physical activity among individuals poststroke.

Objective. To characterize the energy expenditure (EE), exercise intensity, and energy metabolism of

individuals poststroke, while playing AVGs in different positions, from different consoles, and to compare

the performance with comfortable walking and with able-bodied individuals.

Methods. Eleven poststroke and 8 able-bodied participants played in standing Wii-Boxing Xbox-Boxing,

Wii-Run and Penguin, and also Wii-Boxing in sitting. EE (expressed as metabolic equivalents [METs]);

exercise intensity (expressed as %predicted maximal heart rate [HR]), rate of perceived exertion (RPE),



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and respiratory exchange ratio (RER) were used to characterize the games.

Results. Participants’ poststroke EE ranged from 1.81 ± 0.74 to 3.46 ± 1.3 METs and was lower

compared with able-bodied participants for Xbox-Boxing (P = .001), Wii-Boxing in standing (P = .01),

Run (P < .001), and Penguin (P = .001). Participants’ poststroke exercise intensity ranged from 49.8 ±

9.3 to 64.7 ± 9.3 %predicted maximal HR and was lower compared with able-bodied participants for

Xbox-Boxing (P = .007) and Run (P = .005). For participants poststroke, EE of walking at a comfortable

did not differ from boxing games in standing or Run. For able-bodied participants only, the EE for Xbox-

Boxing was higher than Wii- Boxing (6.5 ± 2.6 vs 4.4 ± 1.1, P = .02). EE was higher in standing versus

sitting for poststroke (P = .04) and able-bodied (P = .03) participants. There were no significant group

differences for RPEs. RER of playing in sitting approached anaerobic metabolism.

Conclusions. Playing upper extremity (ie, Boxing) or mobility (ie, Run) AVGs in standing resulted in

moderate EE and intensity for participants poststroke. EE was lower for poststroke than for able-bodied

participants.

Kommentarer

Studiet er fundet efter kædesøgning fra litteraturlisten til ”'Gamification': Influencing health behaviours

with games (Editorial)”. Studiet er foretaget I USA. Deltagerne er ikke tilfældigt indsamlet og stikprøven

består af 11 post-stroke patienter og 8 kontrolpt (som ikke har nogen diagnose eller fysiske handicap).

Formålet er at se på forbruget af energi hos post-stroke patienter ved anvendelse af forskellige

gamification-spil Xbox/Wii.

Studiet måler på flere fysiologiske outcomes og forholder sig kritisk til dets egne mangler og

problematikker i fht. ekstern validitet.

Prevalence and Correlates of Exergaming in Youth

O'Loughlin EK, Dugas EN, Sabiston CM, O'Loughlin JL. Pediatrics 2012;130:806-814

Abstract

OBJECTIVES: Less than 15% of children and adolescents participate regularly in physical activity (PA)

and, with ever-increasing obesity, strategies to improve PA levels in youth are urgently needed.

Exergaming offers a PA alternative that may be especially attractive in our increasingly technophilic

society. However, there are no observational studies of exergaming in population-based samples of

adolescents. The purpose of this study was to investigate potential sociodemographic, lifestyle,

psychosocial, weight-related, and mental health correlates of exergaming as well as describe the type,

timing, and intensity of exergaming in a population-based sample of adolescents.

METHODS: Data on exergame use and potential sociodemographic, lifestyle, psychosocial, weight-

related, and mental health correlates of exergaming were collected in mailed self-report questionnaires

completed by 1241 grade 10 and 11 students from the Montreal area with a mean age of 16.8 years

(SD = 0.05 years; 43% male) participating in the AdoQuest study. The independent correlates of

exergaming were identified in multivariable logistic regression models.

RESULTS: Nearly one-quarter (24%) of participants reported exergaming. Exergamers played 2 days per

week on average, for ∼50 minutes each bout; 73% of exergamers played at a moderate or vigorous

intensity. Exergamers were more likely than nonexergamers to be girls, to play nonactive video games,

to watch $2 hours of television per day, to be stressed about weight, and to be nonsmokers.

CONCLUSIONS: Many adolescents exergame at intensity levels that could help them achieve current

moderate-to-vigorous PA recommendations. Interventions that encourage exergaming may increase PA

and decrease sedentary behavior in select youth subgroups, notably in girls.



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Kommetarer

Studiet er fundet efter kædesøgning fra litteraturlisten til ”'Gamification': Influencing health behaviours

with games (Editorial)”. Studiet er foretaget i Montreal, Canada. Designet er et cross-sectional studie,

med 1209 tilfældigt udvalgte elever i alderen 14-19 år. Formålet er ud fra en større population at

beskrive brugen af exergaming (Xbox/Wii) og identificere evt. sammenhænge mellem forskellige

outcomes og exergaming.

Studiet bygger på selvrapporterede data, hvilket medfører risiko for overestimering af forekomst,

varighed og intensitet af exergaming. Studiet perspektiverer at anvendelsen af exergaming måske ikke

opfylder anbefalingerne omkring fysisk aktivitet, men at det muligvis modvirker sedentarisme og

dermed har en sundhedsmæssig effekt.

Design of an mHealth App for the Self-management of Adolesvent Tpe 1 Diabetes: a Pilot Study

Cafazzo JA, Casselman M, Hamming N, Katzman DK, Palmert MR. Journal of Medical Internet Research

2012;14(3):e70

Abstract

Background

The use of mHealth apps has shown improved health outcomes in adult populations with type 2 diabetes mellitus. However, this has not been shown in the adolescent type 1 population, despite their predisposition to the use of technology. We hypothesized that a more tailored approach and a strong adherence mechanism is needed for this group. Objective

To design, develop, and pilot an mHealth intervention for the management of type 1 diabetes in adolescents. Methods

We interviewed adolescents with type 1 diabetes and their family caregivers. Design principles were derived from a thematic analysis of the interviews. User-centered design was then used to develop the mobile app bant. In the 12-week evaluation phase, a pilot group of 20 adolescents aged 12–16 years, with a glycated hemoglobin (HbA1c) of between 8% and 10% was sampled. Each participant was supplied with the bant app running on an iPhone or iPod Touch and a LifeScan glucometer with a Bluetooth adapter for automated transfers to the app. The outcome measure was the average daily frequency of blood glucose measurement during the pilot compared with the preceding 12 weeks. Results

Thematic analysis findings were the role of data collecting rather than decision making; the need for fast, discrete transactions; overcoming decision inertia; and the need for ad hoc information sharing. Design aspects of the resultant app emerged through the user-centered design process, including simple, automated transfer of glucometer readings; the use of a social community; and the concept of gamification, whereby routine behaviors and actions are rewarded in the form of iTunes music and apps. Blood glucose trend analysis was provided with immediate prompting of the participant to suggest both the cause and remedy of the adverse trend. The pilot evaluation showed that the daily average frequency of blood glucose measurement increased 50% (from 2.4 to 3.6 per day, P = .006, n = 12). A total of 161 rewards (average of 8 rewards each) were distributed to participants. Satisfaction was high, with 88% (14/16 participants) stating that they would continue to use the system. Demonstrating improvements in HbA1c will require a properly powered study of sufficient duration. Conclusions

This mHealth diabetes app with the use of gamification incentives showed an improvement in the frequency of blood glucose monitoring in adolescents with type 1 diabetes. Extending this to improved



11

health outcomes will require the incentives to be tied not only to frequency of blood glucose monitoring but also to patient actions and decision making based on those readings such that glycemic control can be improved. Keywords: Type 1 diabetes mellitus, adolescent, cellular phone, self-care, chronic disease

Kommentarer

Pilotstudie, som præsenterer en adfærdsændring, hos unge diabetes mellitus 1-patienter, efter

intervention med en diabetes app, som anvender Gamification-elementer, især i form af

belønningssystemer ved anvendelse af app’en og positive anerkendelse ved adfærdsændring i forhold

til regulering af blodsukker. Pilotstudiet opnår en 50% øgning i egen-kontrol af blodsukker. Artiklen

belyser både positive outcomes, samt uventede og problematiske outcomes, som der bør justeres i fht.

i fremtiden. Artiklen kan således bruges til idegenerering i fht. anvendelse af Gamification, samtidig

med at den forholder sig til diverse problematikker i forbindelse hermed.

Sports and games for post-traumatic stress disorder (PTSD) (Review)

Lawrence S, De Silva M, Henley R. Cochrane Database of Systematic Reviews 2010;1: Art. No.:

CD007171. DOI: 10.1002/14651858.CD007171.pub2

Abstract

Background Traumatic experiences evoke emotions such as fear, anxiety and distress and may encourage avoidance of similar situations in the future. For a proportion of those exposed to a traumatic event, this emotional reaction becomes uncontrollable and can develop into Post Traumatic Stress Disorder (PTSD) (Breslau 2001).Most of those diagnosed with PTSD fully recover while a small proportion develop a chronic PTSD a year after the event (First 2004). Sports and games may be able to alleviate symptoms of PTSD. Objectives Primary objective: 1. To assess the effectiveness of sports, and games in alleviating and/or diminishing the symptoms of PTSD when compared to usual care or other interventions. Secondary objective: 2. To assess the effectiveness of different types of sports and games in alleviating and/or diminishing symptoms of PTSD. Search methods The Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Registers (CCDAN-CTR) were searched up to June 2008. The following databases were searched up to June 2008: the Cochrane Central registry of Controlled Trials; MEDLINE; EMBASE; CINAHL; PsycINFO. Reference lists of relevant papers were searched and experts in the field were contacted to determine if other studies were available. Selection criteria To be included, participants had to be diagnosed with PTSD using criteria outlined in the Diagnostic and Statistical Manual for Mental Disorders (DSM IV) and/or ICD criteria. Randomised controlled trials (RCTs) that considered one or more well-specified sports or games for alleviating and/or diminishing symptoms of PTSD were included. Sports, and games were defined as any organized physical activity done alone or with a group and non-physical activities such as computer games and card games done alone or with a group. Psychological interventions such as music therapy, art therapy and play therapy and behavioural therapy were excluded. Data collection and analysis



12

Two reviewers (SL and MD) separately checked the titles and abstracts of the search results to determine which studies met the predetermined inclusion criteria. A flow chart was used to guide the selection process. No studies met the inclusion criteria. Main results The search strategy identified five papers but none of the studies met inclusion criteria. Authors’ conclusions No studies met the inclusion criteria. More research is therefore required before a fair assessment can be made of the effectiveness of sports and games in alleviating symptoms of PTSD.

Kommentarer

Reviewet inkluderer ikke nogen studier på baggrund af deres in- og eksklusionskriterier. Således finder

de ingen viden i fht. behandling af PTSD med sport og spil. Reviewet præsenterer 5 artikler, i et tillæg,

som er relevante i fht. emnet, men som ikke møder inklusionskriterier.

Exergames for health and fitness: the roles of GPS and geosocial apps (Editorial)

Boulos MNK, Yang SP. International Journal of Health Geographics 2013;12:18

Abstract

Large numbers of children and adolescents in Canada, UK and USA are not getting their recommended daily dose of moderate to vigorous physical activity, and are thus more prone to obesity and its ill health effects. Exergames (video games that require physical activity to play) are rapidly gaining user acceptance, and may have the potential to increase physical activity levels among young people. Mobile exergames for GPS (global positioning system)-enabled smartphones and mini-tablets take players outdoors, in the open air, unlike console exergames, e.g., Xbox 360 Kinect exergames, which limit players to playing indoors in front of a TV set. In this paper and its companion ‘Additional file 1’, we review different examples of GPS exergames and of gamified geosocial apps and gadgets (mobile, location-aware apps and devices with social and gamification features), and briefly discuss some of the issues surrounding their use. Further research is needed to document best practices in this area, quantify the exact health and fitness benefits of GPS exergames and apps (under different settings and scenarios), and find out what is needed to improve them and the best ways to promote their adoption by the public. Keywords: GPS (global positioning system), Geosocial apps, Location-based games, Exergames, Physical activity, Smartphones

Kommentarer

En Leder-artikel, som præsenterer mulighederne for at inkludere GPS i de spil, som man skaber i

fremtiden, for at skabe en øget lyst til aktivitet udendørs. Formålet hermed er også at skabe et

alternativ til kendte/traditionelle sportsgrene, for at imødegå de målgrupper, som ikke finder disse

sportsgrene interessante, som er opvokset med mobilteknologi og de målgrupper, som præsent har

tendens til inaktivitet. I en additional file præsenterer flere mobile exergames, link hertil:

http://www.ij-healthgeographics.com/content/12/1/18/additional

A Meta-Analytic Review of eHealth Interventions for Pediatric Health Promoting and Maintaining

Behaviors

Cushing CC, Steele RG. Journal of Pediatric Psychology 2010;35(9):937-949

Abstract

Objective The current study quantitatively evaluated the impact of eHealth interventions on pediatric

http://www.ij-healthgeographics.com/content/12/1/18/additional



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health promoting and maintaining behaviors believed to impact the development or worsening of a physical disease and their associated outcomes. Method PsycINFO, PUBMED/MEDLINE, Educational Resources Information Center (ERIC), and reference sections of identified articles were searched. Results An omnibus weighted mean effect size for all identified eHealth interventions revealed a small, but significant, effect (mean d¼.118, 95% confidence interval [CI] ¼.066–.171).However, when considered independently, educational interventions demonstrated no significant effect on pediatric health behavior or health outcomes. Behavioral eHealth interventions produced relatively homogeneous effects that were small but significantly different from zero (mean d¼.354, 95% CI¼.232–.475). Conclusion eHealth interventions that incorporate behavioral methods (e.g., self-monitoring, goal setting, immediate feedback, contingency management) produce larger effect sizes for health behaviors and their associated outcomes than interventions that rely solely on education. Key words adolescent; behavior change; child; eHealth; health behavior; meta-analysis.

Kommentarer

Reviewet belyser betydningen af eHealth (herunder virtual reality/Gamification) I fht. forebygge og

vedligeholde sundhed hos børn og unge. Reviewet finder det vigtigt at interventioner indeholder

elementer, som bygger på adfærdsændrende teori og ikke udelukkende er oplysende og undervisende,

hvis der skal opnås effekt.

Remote and web 2.0 interventions for promoting physical activity (Review)

Foster C, Richards J, Thorogood M, Hillsdon M. Cochrane Database of Systematic Reviews 2013;9: Art.

No.: CD010395. DOI: 10.1002/14651858.CD010395.pub2

Abstract

Background Remote and web 2.0 interventions for promoting physical activity (PA) are becoming increasingly popular but their ability to achieve long term changes are unknown. Objectives To compare the effectiveness of remote and web 2.0 interventions for PA promotion in community dwelling adults (aged 16 years and above) with a control group exposed to placebo or no or minimal intervention. Search methods We searched CENTRAL,MEDLINE, EMBASE, CINAHL, and some other databases (from earliest dates available to October 2012). Reference lists of relevant articles were checked. No language restrictions were applied. Selection criteria Randomised controlled trials (RCTs) that compared remote and web 2.0 PA interventions for community dwelling adults with a placebo or no or minimal intervention control group.We included studies if the principal component of the intervention was delivered using remote or web 2.0 technologies (for example the internet, smart phones) or more traditional methods (for example telephone, mail-outs), or both. To assess behavioural change over time, the included studies had a minimum of 12 months follow-up from the start of the intervention to the final results. We excluded studies that had more than a 20% loss to follow-up if they did not apply an intention-to-treat analysis. Data collection and analysis At least two authors independently assessed the quality of each study and extracted the data.Non-English language papers were reviewed with the assistance of an interpreter who was an epidemiologist. Study authors were contacted for additional information where necessary. Standardised



14

mean differences (SMDs) and 95% confidence intervals (CIs) were calculated for the continuous measures of self-reported PA and cardio-respiratory fitness. For studies with dichotomous outcomes, odds ratios and 95% CIs were calculated. Main results A total of 11 studies recruiting 5862 apparently healthy adults met the inclusion criteria. All of the studies took place in high-income countries. The effect of the interventions on cardiovascular fitness at one year (two studies; 444 participants) was positive and moderate with significant heterogeneity of the observed effects (SMD 0.40; 95% CI 0.04 to 0.76; high quality evidence). The effect of the interventions on self-reported PA at one year (nine studies; 4547 participants) was positive and moderate (SMD 0.20; 95% CI 0.11 to 0.28; moderate quality evidence) with heterogeneity (I2 = 37%) in the observed effects. One study reported positive results at two years (SMD 0.20; 95% CI 0.08 to 0.32; moderate quality evidence). When studies were stratified by risk of bias, the studies at low risk of bias (eight studies; 3403 participants) had an increased effect (SMD 0.28; 95% CI 0.16 to 0.40; moderate quality evidence). The most effective interventions applied a tailored approach to the type of PA and used telephone contact to provide feedback and to support changes in PA levels. There was no evidence of an increased risk of adverse events (seven studies; 2892 participants). Risk of bias was assessed as low (eight studies; 3060 participants) or moderate (three studies; 2677 participants). There were no differences in effectiveness between studies using different types of professionals delivering the intervention (for example health professional, exercise specialist). There was no difference in pooled estimates between studies that generated the prescribed PA using an automated computer programme versus a human, nor between studies that used pedometers as part of their intervention compared to studies that did not. Authors’ conclusions We found consistent evidence to support the effectiveness of remote and web 2.0 interventions for promoting PA. These interventions have positive, moderate sized effects on increasing self-reported PA and measured cardio-respiratory fitness, at least at 12 months. The effectiveness of these interventions was supported by moderate and high quality studies. However, there continues to be a paucity of cost effectiveness data and studies that include participants from varying socioeconomic or ethnic groups. To better understand the independent effect of individual programme components, longer term studies, with at least one year follow-up, are required.

Kommentarer

Reviewet beskriver ikke Gamification eksplecit. Det fremgår i stedet hvorledes betydning er af web-

baseret/interaktiv kommunikation i modsætning til face-to-face kommunikation indenfor

interventioner med formål om at øge fysisk aktivitet. Reviewet finder effekt af web-baserede løsninger i

fht at opnå øget aktivitetsniveau.



15

Designing Attractive Gamification Features for Collaborative Storytelling Websites (Study)

Hsu SH, Chang J, Lee C, 2013, Cyberpsycology, Behavior, and Social Networking

Abstract

Gamification design is considered as the predictor of collaborative storytelling websites’ success. Although aforementioned studies have mentioned a broad range of factors that may influence gamification, they neither depicted the actual design features nor relative attractiveness among them. This study aims to identify attractive gamification features for collaborative storytelling websites. We first constructed a hierarchical system structure of gamification design of collaborative storytelling websites and conducted a focus group interview with eighteen frequent users to identify 35gamification features. After that, this study determined the relative attractiveness of these gamification features by administrating an online survey to 6333 collaborative storytelling websites users. The results indicated that the top 10 most attractive gamification features could account for more than 50% of attractiveness among these 35 gamification features. The feature of unpredictable time pressure is important to website users, yet not revealed in previous relevant studies. Implications of the findings were discussed. Kommentarer

Dette studie er ikke målrettet sundhedsadfærd. Men beskriver Gamification i fht. blogs. Årsagen til

medinddragelse i listen her er, at det beskriver overvejelser vedrørende hvordan Gamification

anvendes i fht. at opnå adfærdsændringer. Studiet præsenterer således en konstruktiv

fremgangsmetode til at opnå viden om hvilke behov målgruppen har og hvorledes disse kan

understøttes med gamification-elementer.

Educational games for mental health professionals (Review)

Bhoopathi PS, Sheoran R. Cochrane Database of Systematic Reviews 2010;1: Art. No.: CD001471. DOI:

10.1002/14651858.CD001471.pub2

Abstract Background In traditional didactic teaching, the learner has a passive role, digesting the knowledge presented by the teacher. Stimulating and active teaching processes may be better at instilling information thanmore pedestrian approaches. Games involving repetition, reinforcement, association and use of multiple senses have been proposed as part of experiential learning. Objectives To assess the effects of educational games on the knowledge attainment and clinical skills of mental health professionals compared to the effects of standard teaching approaches. Search methods We searched the Cochrane Schizophrenia Group Trials Register (November 2005), AMED (1998 - November 2005), British Nursing Index (November 2005), Cochrane Library (Issue 3, 2005), CINAHL (November 2005) EMBASE (November 2005), Educational Resources Information Centre on CSA (1966 - November 2005), MEDLINE (November 2005) and PsycINFO (November 2005). Selection criteria We included randomised controlled trials comparing any educational game aiming at increasing knowledge and/or skills with a standard educational approach for mental health professionals. Data collection and analysis We extracted data independently. For individual person data we calculated the Odds Ratio (OR) and their 95% confidence intervals (CI) based on a fixed effectsmodel. For dichotomous data we calculated relative risks (RR) and their 95%confidence intervals (CI) on an intention-to-treat basis based on a fixed



16

effects model.We calculated numbers needed to treat/harm (NNT/NNH) where appropriate. For continuous data, we calculated weighted mean differences (WMD) again based on a fixed effects model. Main results We identified one trial (n=34) of an educational game for mental health nursing students of only a few hours follow up. For an outcome we arbitrarily defined (’no academically important improvement [a 10% improvement in scores]’) those allocated to educational games fared considerably better than students in the standard education techniques group (OR 0.06 CI 0.01 to 0.3, NNT 3 CI 2 to 4). On average those in the games group scored six more points than the control students on a test of questions relevant to psychosis set to the standard of the mental health nursing curriculum of the day (WMD 6.00 CI 2.6 to 9.4). Authors’ conclusions Current limited evidence suggests educational games could help mental health students gain more points in their tests, especially if they have left revision to the last minute. This salient study should be refined and repeated.

Kommentarer

Reviewet ender med at anvende et studie ud fra deres in- og eksklusionskriterier. Der er tendens til ud

fra det anvendte data at spil har en positiv effekt som undervisningsredskab til sundhedsprofessionelle.

Educational games for health professionals (Review)

Akl EA, Kairouz VF, Sackett KM, Erdley WS, Mustafa RA, Fiander M, Gabriel C, Schünemann H. Cochrane Database of Systematic Reviews 2013;3: Art. No.: CD006411. DOI: 10.1002/14651858.CD006411.pub4 Abstract Background The use of games as an educational strategy has the potential to improve health professionals’ performance (e.g. adherence to standards of care) through improving their knowledge, skills and attitudes. Objectives The objective was to assess the effect of educational games on health professionals’ performance, knowledge, skills, attitude and satisfaction, and on patient outcomes. Search methods We searched the following databases in January 2012: MEDLINE, AMED, CINAHL, Cochrane Central Database of Controlled Trials, EMBASE, EPOC Register, ERIC, Proquest Dissertations & Theses Database, and PsycINFO. Related reviews were sought in DARE and the above named databases. Database searches identified 1546 citations. We also screened the reference lists of included studies in relevant reviews, contacted authors of relevant papers and reviews, and searched ISI Web of Science for papers citing studies included in the review. These search methods identified an additional 62 unique citations for a total of 1608 for this update. Selection criteria We included randomized controlled trials (RCT), controlled clinical trials (CCT), controlled before and after (CBA) and interrupted time-series analysis (ITS). Study participants were qualified health professionals or in postgraduate training. The intervention was an educational game with “a form of competitive activity or sport played according to rules”. Data collection and analysis Using a standardized data form we extracted data on methodological quality, participants, interventions and outcomes of interest that included patient outcomes, professional behavior (process of care outcomes), and professional’s knowledge, skills, attitude and satisfaction. Main results



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The search strategy identified a total of 2079 unique citations. Out of 84 potentially eligible citations, we included two RCTs. The game evaluated in the first study used as a reinforcement technique, was based on the television game show “Family Feud” and focused on infection control. The study did not assess any patient or process of care outcomes. The group that was randomized to the game had statistically higher scores on the knowledge test (P = 0.02). The second study compared game-based learning (“Snakes and Ladders” board game) with traditional case-based learning of stroke prevention and management. The effect on knowledge was not statistically different between the two groups immediately and 3 months after the intervention. The level of reported enjoyment was higher in the game-based group. Authors’ conclusions The findings of this systematic review neither confirm nor refute the utility of games as a teaching strategy for health professionals. There is a need for additional high-quality research to explore the impact of educational games on patient and performance outcomes.

Kommentarer

Reviewet anvender 2 studier på baggrund af deres in- og ekslusionskriterier. Studiet kan på baggrund af

et smalt evidensgrundlag ikke be- eller afkræfte effekten af spil i forhold til undervisning af

sundhedsprofessionnelle.



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Bilag

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Documents

’Gamification’ -Kommenteret litteraturliste - UC Viden€¦ · ’Gamification’ -Kommenteret litteraturliste 2014 Udarbejdet for UCL.DK – Forskning og innovation; Jette Damgaard