Department of Nursing, Tan Tock Seng Hospital, National Healthcare Group, Singapore.
Department of Nursing, National University Hospital, National University Health System, Singapore.
Games Health J. 2021 Dec;10(6):371-382. doi: 10.1089/g4h.2020.0203.
Self-management is essential for individuals with diabetes. However, traditional self-management interventions may be hard to follow for other patients. Although games can stimulate extrinsic motivations, its application on self-management remains unclear. This review aims to evaluate the effects of game-based self-management interventions on health outcomes. We utilize PubMed, CINAHL, Cochrane Central, EMBASE, ProQuest Dissertation and Theses, PsycINFO, and Scopus from their inception until January 20, 2020. Meta-analyses are performed using Comprehensive Meta-analysis 3.0 software. The overall effect is measured using Hedges' and determined using -statistics at significance level of < 0.05. Heterogeneity is assessed using and statistics. The risk of bias tool and the grades of recommendation, assessment, development, and evaluation system are used to assess individual and overall quality of evidence, respectively. A total of 2150 records are identified, and 13 randomized controlled trials are selected. Meta-analyses revealed that game-based self-management interventions significantly improved patients' change in glycated hemoglobin (HbA1c) level ( = 0.18, = 0.02), adherence to physical activities ( = 0.59, < 0.001), balance ( = 0.94-1.14, < 0.001), and fall efficacy ( = 1.01, < 0.001). Significant results were only found for the three-trial meta-analysis for HbA1c changes, but not for the two other HbA1c meta-analyses that included more trials. Furthermore, negligible improvements were observed in glycated hemoglobin at postintervention and follow-up assessments, diabetes knowledge, and self-efficacy. Game-based self-management can consider a supplementary intervention. Overall evidence is ranging from very low to low. Future studies can consider a large sample size with high-quality design according to the Consolidated Standards of Reporting Trials statement criteria.
自我管理对于糖尿病患者至关重要。然而，对于其他患者来说，传统的自我管理干预措施可能难以遵循。虽然游戏可以激发外在动机，但它在自我管理中的应用尚不清楚。本综述旨在评估基于游戏的自我管理干预对健康结果的影响。
我们使用 PubMed、CINAHL、Cochrane Central、EMBASE、ProQuest 论文和论文、PsycINFO 和 Scopus，从其成立到 2020 年 1 月 20 日。使用 Comprehensive Meta-analysis 3.0 软件进行荟萃分析。使用 Hedges' 和 -统计量在显著性水平 < 0.05 下测量总体效果。使用 和 统计量评估异质性。使用偏倚风险工具和推荐、评估、发展和评估系统的等级来分别评估个体和总体证据质量。
共确定了 2150 条记录，选择了 13 项随机对照试验。荟萃分析显示，基于游戏的自我管理干预显著改善了患者糖化血红蛋白（HbA1c）水平的变化（ = 0.18， = 0.02）、身体活动的依从性（ = 0.59，< 0.001）、平衡（ = 0.94-1.14，< 0.001）和跌倒效能（ = 1.01，< 0.001）。仅在 HbA1c 变化的三项试验荟萃分析中发现了显著结果，而在另外两项包含更多试验的 HbA1c 荟萃分析中则没有。此外，在干预后和随访评估时，糖化血红蛋白、糖尿病知识和自我效能的改善可以忽略不计。
基于游戏的自我管理可以考虑作为一种补充干预措施。总体证据质量从极低到低不等。未来的研究可以根据 CONSORT 声明标准考虑采用大样本量和高质量设计。
