Department of Medical Psychology and Social Work, Urology, Wilhelmina Children's Hospital, University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, the Netherlands.
Pediatric Urology, University Children's Hospitals UMC Utrecht and Amsterdam UMC, the Netherlands.
J Pediatr Urol. 2019 Feb;15(1):36.e1-36.e7. doi: 10.1016/j.jpurol.2018.09.003. Epub 2018 Sep 19.
Urotherapy is considered the treatment of choice for children suffering daytime urinary incontinence (DUI). Urotherapy intends to improve bladder dysfunction for children with DUI. For children with refractory DUI, an intensive inpatient bladder training program exists, which focuses on relearning, concentration on, and awareness of the bladder. Children's motivation and adherence are key determinants of a successful training outcome. It is hypothesized that motivation endurance throughout the treatment process may be enhanced by a serious game training tool, which could make the training more appealing and rewarding.
The study explores intrinsic motivation in children receiving bladder training for DUI and whether using a serious game improves their intrinsic motivation.
In this pragmatic study, 50 children were allowed to choose among receiving bladder training with (intervention group) or without the application of a serious game (control group). At 4, 8, and 12 weeks of training, children and parents were asked to complete the Intrinsic Motivation Inventory (IMI). Children also completed the Pediatric Urinary Incontinence Quality of Life Tool (PinQ) before the start of the training and 6 months thereafter. At 6-month follow-up, patients were ask to participate in two focus groups, wherein the children discussed how they used the serious game and which improvements they would prefer.
Children who received standard bladder training with the addition of a serious game did not differ in terms of intrinsic motivation from children who underwent standard bladder training only. Training results were equal in both the groups, with 80% good or improved. Incontinence-related quality of life (QoL) improved accordingly.
In contrast to the study expectations, this game did not increase intrinsic motivation. Findings on training and QoL results are consistent with those of previous studies in both interventions. Although a randomized design could have yielded more valid results than this preference-based approach, the latter is more congruent with clinical practice. In contrast to existing bladder diary apps, this game offers a combination of child-friendly instructions, explanation of bladder (dys)function, and keeping a bladder diary. Mobile devices are playing an increasingly important role in health care; therefore, an urotherapy app can be a complementary therapeutic tool.
Most children find it attractive to combine bladder training with a serious game. However, no added value was found regarding intrinsic motivation and training results. All children with persistent DUI in this cohort were highly motivated to complete an intensive bladder training program.
尿疗被认为是治疗日间尿失禁（DUI）儿童的首选方法。尿疗旨在改善 DUI 儿童的膀胱功能障碍。对于难治性 DUI 儿童，存在强化住院膀胱训练计划，该计划侧重于重新学习、专注和感知膀胱。儿童的动机和坚持是成功训练结果的关键决定因素。假设通过严肃游戏训练工具可以增强整个治疗过程中的动机耐力，从而使训练更具吸引力和回报。
本研究探讨接受 DUI 膀胱训练的儿童的内在动机，以及使用严肃游戏是否可以提高他们的内在动机。
在这项实用研究中，允许 50 名儿童选择接受（干预组）或不接受严肃游戏应用（对照组）的膀胱训练。在训练的第 4、8 和 12 周，儿童及其父母被要求完成内在动机量表（IMI）。在训练开始前和 6 个月后，儿童还完成了小儿尿失禁生活质量工具（PinQ）。在 6 个月的随访中，患者被要求参加两个焦点小组，其中儿童讨论他们如何使用严肃游戏以及他们希望改进哪些方面。
接受标准膀胱训练并附加严肃游戏的儿童在内在动机方面与仅接受标准膀胱训练的儿童没有差异。两组的训练结果相同，80%为良好或改善。相应地，与失禁相关的生活质量（QoL）得到了改善。
与研究预期相反，该游戏并没有增加内在动机。在训练和 QoL 结果方面的发现与这两种干预措施的先前研究一致。尽管随机设计可能会产生比基于偏好的方法更有效的结果，但后者更符合临床实践。与现有的膀胱日记应用程序相比，该游戏提供了儿童友好的指令、膀胱（功能）障碍的解释和保持膀胱日记的组合。移动设备在医疗保健中发挥着越来越重要的作用；因此，尿疗应用程序可以成为一种补充治疗工具。
大多数儿童发现将膀胱训练与严肃游戏结合起来很有吸引力。然而，在内在动机和训练结果方面没有发现附加价值。本队列中所有持续性 DUI 儿童都非常有动力完成强化膀胱训练计划。
