Objective Smartphone games that aim to alter health behaviours are common, but there is uncertainty about how to achieve this. We systematically reviewed health apps containing gaming elements analysing their embedded behaviour change techniques.
Methods Two trained researchers independently coded apps for behaviour change techniques using a standard taxonomy. We explored associations with user ratings and price.
Data sources We screened the National Health Service (NHS) Health Apps Library and all top-rated medical, health and wellness and health and fitness apps (defined by Apple and Google Play stores based on revenue and downloads). We included free and paid English language apps using ‘gamification’ (rewards, prizes, avatars, badges, leaderboards, competitions, levelling-up or health-related challenges). We excluded apps targeting health professionals.
Results 64 of 1680 (4%) health apps included gamification and met inclusion criteria; only 3 of these were in the NHS Library. Behaviour change categories used were: feedback and monitoring (n=60, 94% of apps), reward and threat (n=52, 81%), and goals and planning (n=52, 81%). Individual techniques were: self-monitoring of behaviour (n=55, 86%), non-specific reward (n=49, 82%), social support unspecified (n=48, 75%), non-specific incentive (n=49, 82%) and focus on past success (n=47, 73%). Median number of techniques per app was 14 (range: 5–22). Common combinations were: goal setting, self-monitoring, non-specific reward and non-specific incentive (n=35, 55%); goal setting, self-monitoring and focus on past success (n=33, 52%). There was no correlation between number of techniques and user ratings (p=0.07; rs=0.23) or price (p=0.45; rs=0.10).
Conclusions Few health apps currently employ gamification and there is a wide variation in the use of behaviour change techniques, which may limit potential to improve health outcomes. We found no correlation between user rating (a possible proxy for health benefits) and game content or price. Further research is required to evaluate effective behaviour change techniques and to assess clinical outcomes.
L’application des nouvelles technologies au domaine de la santé ne se limite pas nécessairement aux transferts et au partage de données de santé. Après la formation en ligne ou e-learning, focus sur un nouveau moyen de formation pour médecins et patients : les serious games.
Via Vigipharm, Philippe Marchal
It is drizzling and cold in Salford, but a class of eight- and nine-year-olds from Lewis Street school in Patricroft are buzzing as their teachers lead them down the streets of terraced houses between classes. They stride through a park, dodging an abandoned car seat, to swipe lanyards against three street sensors before returning to lessons.
It’s called “going fobbing” in Salford – walking or cycling to sensors on lampposts all round the city and swiping them to get points. It’s part of a health and community building scheme called Beat The Street (BTS) and it’s taken Lewis Street by storm. Pupils and parents have travelled 3,288 miles (scoring a mighty 66,490 points) on fobbing expeditions over two months to outwalk all Salford’s other 23 participating schools and 13 community groups.
Patricroft is a struggling area, where unemployment is high and the number of people describing their health as bad or very bad is well above the national average. But there’s a clear sense of purpose here as the warmly wrapped youngsters line up to swipe their fobs near the school. “I did all the 50 fobs in three days over half term,” says one little girl excitedly. Her teacher reveals that this previously inactive child now goes to an after-school sports club almost every night of the week.
The school has undergone a mini revolution. A detailed and constantly changing online content plan, social media and incentives such as tickets to local amenities, keep the players engaged – not to mention the sense of competition.
Rachael Hall, the school’s sports coach, says: “I’ve never known anything like it – children are going out walking every evening and weekend. Teaching assistants take the children out at lunchtime three times a week and take whole classes out twice a week. I’ve had parents telling me how happy they are to be spending time with their children going fobbing rather than sitting in front of the TV.”
She says a little boy with cerebral palsy with walking problems has made big progress because of the peer pressure to participate in BTS. Another pupil has become so fascinated by the project that he has taken to writing down where he has been, which has improved his school work.
‘I’ve never known anything like it – children are going out walking every evening and weekend.’ Photograph: Beat the Streets
This is exactly what Beat the Street founder and Reading GP, Dr William Bird is after – galvanising whole communities, with the health message almost a side issue. He says: “I want to get the whole of the UK walking, starting with the cities where it is easiest. Walking creates vibrancy – take it away and you create a flat and dying city full of underpasses where no one wants to go.”
Intelligent Health, which Dr Bird set up to operate BTS, works by turning a town or community into a game where people of all ages earn points by walking, cycling or running between sensors placed on lampposts. In the process, no-go areas are opened up to pedestrians, people have fun together and develop healthier habits.
Jennifer Dodd-Power, engagement manager for BTS in Salford, has convinced 5,500 people to take part so far – (though not a patch on Belfast which boasted 36,000 players). She says: “People are not seeing BTS as exercise but as a fun way of going out with the family. We are not saying to people ‘go and join a gym or get yourself to an exercise class’ we are saying ‘go out and meet your friends’.”
Part of her work has been to link fobbing with community events – such as the Eccles Makers Market – where BTS participants could gain extra points on the day of the event at a temporary sensor set up nearby.
The two-month games are preceded by three months’ community engagement, where people such as Dodd work with GPs, local NHS organisations, community groups, sports clubs and schools to build up the enthusiasm. Then the activities requested by a community are set up, whether that be women-only bike riding classes in Asian-dominated Handsworth in Birmingham, or just the incentive to walk into town for previously immobile elderly members of Banham Drive, Sudbury. There elderly residents walked more than 1,500 miles together and have now set up organised walks.
BTS is proving successful in health terms according to results from 53,000 participants. During the game phase the proportion of adults meeting the physical activity guidelines increased from 46% to 57% and the percentage of adults reported walking on five to seven days per week increased from 47% to 61%.
Intelligent Health’s research shows that people are put off by the NHS’s health messages, because they feel they are being lectured. So the year-long health programmes targeting areas of deprivation put the emphasis on enjoying activity with others – and last year 175,198 people travelled more than 1.5m miles with BTS in 21 areas.
The scheme is not working for everyone, though. Head of Lewis Street School, Gemma Lavelle, says: “Even though BTS has raised our activity levels we know that some parents have not signed up. What do we have to do to get some of the really hard-to-reach families involved?”
Dr Max Ortiz Catalan at Chalmers University of Technology has developed a novel method of treating phantom limb pain using machine learning and augmented reality. This approach has been tested on over a dozen of amputees with chronic phantom limb pain who found no relief by other clinically available methods before. The new treatment reduced their pain by approximately 50 per cent, reports a clinical study published in The Lancet.
People who lose an arm or leg often experience phantom limb pain, as if the missing limb was still there. Phantom limb pain can become a serious chronic condition that significantly reduces the patients' quality of life. It is still unclear why phantom limb pain and other phantom sensations occur.
Several medical and non-medical treatments have been proposed to alleviate phantom limb pain. Examples include mirror therapy, various types of medications, acupuncture, and implantable nerve stimulators. However, in many cases nothing helps. This was the situation for the 14 arm amputees who took part in the first clinical trial of a new treatment, invented by Chalmers researcher Max Ortiz Catalan, and further developed with his multidisciplinary team in the past years.
"We selected the most difficult cases from several clinics," Dr Ortiz Catalan says. "We wanted to focus on patients with chronic phantom limb pain who had not responded to any treatments. Four of the patients were constantly medicated, and the others were not receiving any treatment at all because nothin
Cet automne, des patients de l’Hôpital Charles-Lemoyne de Longueuil, en banlieue de Montréal, ont fait une première expérience en réalité virtuelle en voyageant ailleurs dans le monde tout en restant bien en place lors de séance de dialyse.
VERA is an all-in-one device that utilizes a tele-rehab platform to help patients perform prescribed in-home exercise programs while monitoring their compliance and reporting results back to their physical therapists. The goal is to increase patient access to rehabilitation services while also improving patient adherence.
Via Philippe Marchal
[UN JOUR, UNE START-UP] La start-up montpelliéraine Revinax veut optimiser la formation médicale grâce à la réalité virtuelle. Son application Surgevry, couplée à un casque VR, fait vivre à la place du chirurgien des opérations auparavant filmées en bloc opératoire. Revinax, qui souhaite lancer sa plateforme VR à la rentrée 2017, compte gagner en visibilité au CES 2017 de Las Vegas.
Before an operation, surgeons have to obtain the most precise image possible of the anatomical structures of the part of the body undergoing surgery. University of Basel researchers have now developed a technology that uses computed tomography data to generate a three-dimensional image in real time for use in a virtual environment.
Mobile apps combining game play with physical activity lead to substantial short-term activity increases and, in contrast to many existing interventions and mobile health apps, have the potential to reach activity-poor populations. Future studies are needed to investigate potential long-term effects of these applications.
Via Philippe Marchal
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