Langlet Billy Sundström, Odegi Dorothy, Zandian Modjtaba, Nolstam Jenny, Södersten Per, Bergh Cecilia
Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
Mandometer Clinic, Stockholm, Sweden.
JMIR Serious Games. 2021 Apr 13;9(2):e24998. doi: 10.2196/24998.
BACKGROUND: Anorexia nervosa is one of the more severe eating disorders, which is characterized by reduced food intake, leading to emaciation and psychological maladjustment. Treatment outcomes are often discouraging, with most interventions displaying a recovery rate below 50%, a dropout rate from 20% to 50%, and a high risk of relapse. Patients with anorexia nervosa often display anxiety and aversive behaviors toward food. Virtual reality has been successful in treating vertigo, anxiety disorder, and posttraumatic stress syndrome, and could potentially be used as an aid in treating eating disorders. OBJECTIVE: The aim of this study was to evaluate the feasibility and usability of an immersive virtual reality technology administered through an app for use by patients with eating disorders. METHODS: Twenty-six participants, including 19 eating disorder clinic personnel and 5 information technology personnel, were recruited through emails and personal invitations. Participants handled virtual food and utensils on an app using immersive virtual reality technology comprising a headset and two hand controllers. In the app, the participants learned about the available actions through a tutorial and they were introduced to a food challenge. The challenge consisted of a meal type (meatballs, potatoes, sauce, and lingonberries) that is typically difficult for patients with anorexia nervosa to eat in real life. Participants were instructed, via visual feedback from the app, to eat at a healthy rate, which is also a challenge for patients. Participants rated the feasibility and usability of the app by responding to the mHealth Evidence Reporting and Assessment checklist, the 10-item System Usability Scale, and the 20-point heuristic evaluation questionnaire. A cognitive walkthrough was performed using video recordings of participant interactions in the virtual environment. RESULTS: The mean age of participants was 37.9 (SD 9.7) years. Half of the participants had previous experience with virtual reality. Answers to the mHealth Evidence Reporting and Assessment checklist suggested that implementation of the app would face minor infrastructural, technological, interoperability, financial, and adoption problems. There was some disagreement on intervention delivery, specifically regarding frequency of use; however, most of the participants agreed that the app should be used at least once per week. The app received a mean score of 73.4 (range 55-90), earning an overall "good" rating. The mean score of single items of the heuristic evaluation questionnaire was 3.6 out of 5. The lowest score (2.6) was given to the "accuracy" item. During the cognitive walkthrough, 32% of the participants displayed difficulty in understanding what to do at the initial selection screen. However, after passing the selection screen, all participants understood how to progress through the tasks. CONCLUSIONS: Participants found the app to be usable and eating disorder personnel were positive regarding its fit with current treatment methods. Along with the food item challenges in the current app, participants considered that the app requires improvement to offer environmental and social (eg, crowded room vs eating alone) challenges.
背景:神经性厌食症是较为严重的饮食失调症之一,其特征为食物摄入量减少,导致消瘦及心理失调。治疗效果往往不尽人意,大多数干预措施的康复率低于50%,退出率为20%至50%,且复发风险高。神经性厌食症患者常表现出焦虑及对食物的厌恶行为。虚拟现实已成功用于治疗眩晕、焦虑症和创伤后应激综合征,有可能被用作治疗饮食失调症的辅助手段。 目的:本研究旨在评估通过一款应用程序管理的沉浸式虚拟现实技术供饮食失调症患者使用的可行性和可用性。 方法:通过电子邮件和个人邀请招募了26名参与者,包括19名饮食失调症诊所工作人员和5名信息技术人员。参与者使用包括头戴式耳机和两个手持控制器的沉浸式虚拟现实技术在一款应用程序上处理虚拟食物和餐具。在该应用程序中,参与者通过教程了解可用操作,并被引入一项食物挑战。该挑战包括一种餐食类型(肉丸、土豆、酱汁和越橘),这通常是神经性厌食症患者在现实生活中难以食用的。通过应用程序的视觉反馈指导参与者以健康的速度进食,这对患者来说也是一项挑战。参与者通过回答移动健康证据报告与评估清单、10项系统可用性量表和20分启发式评估问卷对该应用程序的可行性和可用性进行评分。使用虚拟环境中参与者互动的视频记录进行了认知走查。 结果:参与者的平均年龄为37.9(标准差9.7)岁。一半的参与者以前有过虚拟现实体验。移动健康证据报告与评估清单的答案表明,该应用程序的实施将面临一些基础设施、技术、互操作性、财务和采用方面的小问题。在干预实施方面存在一些分歧,特别是关于使用频率;然而,大多数参与者同意该应用程序每周至少使用一次。该应用程序的平均得分为73.4(范围55 - 90),总体评级为“良好”。启发式评估问卷单项的平均得分为3.6(满分5分)。得分最低的项目(2.6分)是“准确性”项目。在认知走查过程中,32%的参与者在初始选择屏幕上难以理解要做什么。然而,通过选择屏幕后,所有参与者都理解了如何完成任务。 结论:参与者认为该应用程序可用,饮食失调症工作人员对其与当前治疗方法的契合度持积极态度。除了当前应用程序中的食物项目挑战外,参与者认为该应用程序需要改进,以提供环境和社交(例如,拥挤的房间与独自进食)方面的挑战。
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