Ossenbrink Linda, Haase Tina, Timpel Patrick, Schoffer Olaf, Scheibe Madlen, Schmitt Jochen, Deckert Stefanie, Harst Lorenz
Center for Evidence-based Healthcare, University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
JMIR Serious Games. 2023 Jun 1;11:e44132. doi: 10.2196/44132.
Games and game components have become a major trend in the realm of digital health research and practice as they are assumed to foster behavior change and thereby improve patient-reported and clinical outcomes for patients with type 2 diabetes.
The aim of this systematic review was to summarize and evaluate the current evidence on the effectiveness of digital health interventions containing game components on behavioral, patient-reported, and clinical outcomes for patients with type 2 diabetes.
An electronic search was conducted in MEDLINE and PsycINFO in April 2020; updated in April 2022; and supplemented by additional searches via Google Scholar, Web of Science (which was used for forward citation tracking), and within the references of the included records. Articles were identified using predefined inclusion and exclusion criteria. In total, 2 reviewers independently conducted title, abstract, and full-text screening and then individually performed a critical appraisal of all the included studies using the Cochrane risk-of-bias tool version 2. A consensus was reached through discussion.
Of 2325 potentially relevant titles (duplicates excluded), 10 (0.43%) randomized controlled trials were included in this review. Quality assessment revealed a high risk of bias for all randomized controlled trials except for 10% (1/10), with performance bias due to the lack of blinding being the major source of bias. There is evidence suggesting that digital health interventions containing game components can substantially improve motivation for physical activity (1/1, 100% of the studies dealing with PA motivation), exercise intensity (3/5, 60%), dietary behavior (4/4, 100%), health literacy (1/3, 33%), mental quality of life (2/2, 100%), glycated hemoglobin level (2/6, 33%), BMI (1/3, 33%), fasting plasma glucose level (1/2, 50%), waist circumference (1/1, 100%), and aerobic capacity (1/1, 100%).
Published studies indicated that digital health interventions containing game components might improve health behavior patterns, quality of life, and clinical outcomes in patients with type 2 diabetes. However, the intervention types and outcomes studied were heterogeneous, and study quality was mostly low, which translates to ambiguous results. Future research should focus on sound methodology and reporting as well as on identifying game components that contribute to significant positive effects.
PROSPERO CRD42020209706; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=209706.
游戏及游戏组件已成为数字健康研究与实践领域的一大主要趋势，因为人们认为它们能够促进行为改变，从而改善2型糖尿病患者的患者报告结局及临床结局。
本系统评价旨在总结和评估当前关于包含游戏组件的数字健康干预措施对2型糖尿病患者的行为、患者报告结局及临床结局有效性的证据。
于2020年4月在MEDLINE和PsycINFO数据库进行电子检索；2022年4月更新；并通过谷歌学术、科学网（用于向前追溯引文）以及纳入记录的参考文献进行补充检索。使用预定义的纳入和排除标准识别文章。总共2名评审员独立进行标题、摘要和全文筛选，然后使用Cochrane偏倚风险工具第2版对所有纳入研究进行单独的严格评价。通过讨论达成共识。
在2325个可能相关的标题（排除重复项）中，本评价纳入了10项（0.43%）随机对照试验。质量评估显示，除10%（1/10）的试验外，所有随机对照试验均存在较高的偏倚风险，主要偏倚来源是因缺乏盲法导致的实施偏倚。有证据表明，包含游戏组件的数字健康干预措施可大幅提高身体活动动机（1/1，涉及身体活动动机的研究的100%）、运动强度（3/5，60%）、饮食行为（4/4，100%）、健康素养（1/3，33%）、心理生活质量（2/2，100%）、糖化血红蛋白水平（2/6，33%）、体重指数（1/3，33%）、空腹血糖水平（1/2，50%）、腰围（1/1，100%）和有氧运动能力（1/1，100%）。
已发表的研究表明，包含游戏组件的数字健康干预措施可能改善2型糖尿病患者的健康行为模式、生活质量和临床结局。然而，所研究的干预类型和结局存在异质性，且研究质量大多较低，这导致结果不明确。未来的研究应侧重于合理的方法和报告，以及识别能产生显著积极效果的游戏组件。
PROSPERO CRD42020209706；https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=209706。
