Feasibility of a sensor-controlled digital game for heart failure self management: Randomized controlled trial

Authors: RADHAKRISHNAN, KAVITA - University Of Texas At Austin; JULIEN, CHRISTINE - University Of Texas At Austin; BARANOWSKI, TOM - Children'S Nutrition Research Center (CNRC); O'HAIR, MATTHEW - Good Life Games, Llc; LEE, GRACE - University Of Texas At Austin; SAGNA DE MAIN, ATAMI - University Of Texas At Austin; ALLEN, CATHERINE - University Of Texas At Austin; VISWANATHAN, BINDU - University Of Texas At Austin; THOMAZ, EDISON - University Of Texas At Austin; KIM, MIYONG - University Of Texas At Austin

Submitted to: JMIR Serious Games
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 6/28/2021
Publication Date: 11/8/2021
Citation: Radhakrishnan, K., Julien, C., Baranowski, T., O'Hair, M., Lee, G., Sagna De Main, A., Allen, C., Viswanathan, B., Thomaz, E., Kim, M. 2021. Feasibility of a sensor-controlled digital game for heart failure self-management: Randomized controlled trial. JMIR Serious Games. 9(4). Article e29044. https://doi.org/10.2196/29044.
DOI: https://doi.org/10.2196/29044

Interpretive Summary: Poor self-management of heart failure (HF) contributes to devastating health consequences. To make HF behavioral self-management more interesting, even fun, and thereby increase compliance, we created an innovative sensor-controlled digital game (SCDG) that integrates data from sensors to trigger game rewards, progress, and feedback based on the real-time behaviors of individuals with HF. This study compared daily weight monitoring and physical activity behavior adherence by older adults using an SCDG intervention versus a sensors-only intervention in a feasibility trial at baseline, 6, 12, and 24 weeks. The intervention group participants reported that the SCDG was easy to use with trends of improvement in daily weight monitoring and physical activity in the intervention group, and improved HF functional status, quality of life, knowledge, self-efficacy, and HF hospitalization in both groups. Playing an SCDG on smartphones was feasible and acceptable for older adults with HF for motivating daily weight monitoring and physical activity. Identifying feasible intervention practices in this population are potentially transferable to children that are addressing similiar health risks.

Technical Abstract: Poor self-management of heart failure (HF) contributes to devastating health consequences. Our innovative sensor-controlled digital game (SCDG) integrates data from sensors to trigger game rewards, progress, and feedback based on the real-time behaviors of individuals with HF. The aim of this study is to compare daily weight monitoring and physical activity behavior adherence by older adults using an SCDG intervention versus a sensors-only intervention in a feasibility randomized controlled trial. English-speaking adults with HF aged 55 years or older who owned a smartphone and could walk unassisted were recruited from Texas and Oklahoma from November 2019 to August 2020. Both groups were given activity trackers and smart weighing scales to track behaviors for 12 weeks. The feasibility outcomes of recruitment, retention, intervention engagement, and satisfaction were assessed. In addition to daily weight monitoring and physical activity adherence, the participants' knowledge, functional status, quality of life, self-reported HF behaviors, motivation to engage in behaviors, and HF-related hospitalization were also compared between the groups at baseline and at 6, 12, and 24 weeks. A total of 38 participants with HF—intervention group (IG; 19/38, 50%) and control group (CG; 19/38, 50%)—were enrolled in the study. Of the 38 participants, 18 (47%) were women, 18 (47%) were aged 65 years or older, 21 (55%) had been hospitalized with HF in the past 6 months, and 29 (76%) were White. Furthermore, of these 38 participants, 31 (82%)—IG (15/19, 79%) and CG (16/19, 84%)—had both weight monitoring and physical activity data at the end of 12 weeks, and 27 (71%)—IG (14/19, 74%) and CG (13/19, 68%)—participated in follow-up assessments at 24 weeks. For the IG participants who installed the SCDG app (15/19, 79%), the number of days each player opened the game app was strongly associated with the number of days the player engaged in weight monitoring (r=0.72; P=.04) and the number of days with physical activity step data (r=0.9; P<.001). The IG participants who completed the satisfaction survey (13/19, 68%) reported that the SCDG was easy to use. Trends of improvement in daily weight monitoring and physical activity in the IG, as well as within-group improvements in HF functional status, quality of life, knowledge, self-efficacy, and HF hospitalization in both groups, were observed in this feasibility trial. Playing an SCDG on smartphones was feasible and acceptable for older adults with HF for motivating daily weight monitoring and physical activity. A larger efficacy trial of the SCDG intervention will be needed to validate trends of improvement in daily weight monitoring and physical activity behaviors.