Effectiveness of Serious Gaming During Multidisciplinary Rehabilitation for Patients with Complex Chronic Pain or Fatigue: A Natural Quasi-experiment (Preprint)
Authors: Vugts Miel AP , Joosen Margot CW , Mert Agali , Zedlitz Aglaia ME , Vrijhoef Hubertus JM 
Published: December 2017

BACKGROUND

Current evidence for the effectiveness of specialist multidisciplinary programs for burdensome chronic pain and functional somatic syndromes drive effort to improve approaches, strategies, and delivery modes. It is unknown to what extent and in what respect serious gaming during regular outpatient rehabilitation can contribute to health outcomes.

OBJECTIVE

Study objectives are: to determine the effect of additional serious gaming on 1) physical and/or emotional functioning in general, 2) particular outcome domains, and 3) patient global impressions of change, general health, and functioning; and to determine 4) dependency of serious gaming effects on adherence.

METHODS

A naturalistic quasi-experiment with embedded qualitative methods was conducted. Intervention group patients received an additional guided (mindfulness based) serious gaming intervention during week 9-12 of a 16-week rehabilitation program at 2 sites of a Dutch rehabilitation clinic. Simultaneously, 119 control group patients followed the same program without serious gaming at 2 similar sites of the same clinic. Data consisted of 10 semi-structured patient interviews and routinely collected patient self-reported outcomes. First, multivariate linear mixed modeling was used to estimate a group effect on outcome change between week 8 and 16 in 4 primary outcomes simultaneously: current pain intensity, fatigue, pain catastrophizing, and psychological distress. Secondly, similar univariate linear mixed models were used to estimate effects on particular (unstandardized) outcomes. Third, secondary outcomes (i.e. global impression of change, general health, functioning, and treatment satisfaction) were compared between groups by means of independent t-tests. Fourth, subgroups by levels of adherence were established from log-data. Influences of observed confounding factors were considered throughout analyses.

RESULTS

Out of 329 eligible patients, 156 intervention group and 119 control group patients (N=275) with mostly chronic back pain and concomitant psychosocial problems participated in the study. By 119 patients, the game was played for 75% or more. First, standardized means across the 4 primary outcomes showed a significantly more favorable degree of change during the second part of treatment for the intervention group than for the control group (β=-.119, SE=.046, P=.009). Second, the intervention group showed a greater outcome change in depressive mood (b=-2.748, SE=1.072, P=.011), but not in ‘insufficiency’ or concentration problems. Third, no significant group effects on secondary outcomes were found. Fourth, adherence was generally high and invariant.

CONCLUSIONS

Present findings suggest a very small favorable average effect on relevant health outcomes of additional serious gaming during multidisciplinary rehabilitation. The indication that serious gaming could be a relatively time-efficient component warrants further research into if, when, how, and for which patients serious gaming could be cost-effective in treatment, and why.

CLINICALTRIAL

www.trialregister.nl NTR6020