A Serious Game for Performing Task-Oriented Cervical Exercises Among Older Adult Patients With Chronic Neck Pain: Development, Suitability, and Crossover Pilot Study

Abstract

Background There is sparse research on the effectiveness of therapeutic exercise for the treatment of neck pain in older adult populations. Moreover, there is a lack of research on the use of serious games or virtual reality for the treatment of neck pain in this population. Objective The primary aim of this study was to develop and assess the suitability of a serious game for performing task-oriented cervical exercises in patients with neck pain. Methods A serious game was designed based on the key features identified by previous studies that designed serious video games for physical and cognitive rehabilitation or exercise. The game in this study was designed to provide an interactive scenario, with the main functionality of the software solution to control a virtual airplane to reach targets using head motions. At the end of the exercise, the application stores the targets reached and missed and the airplane’s trajectory. A crossover pilot study was carried out for preliminary evaluation of the suitability of the technology in the older adult population. Men and women over 65 years of age with chronic neck pain were included. Subjects were randomly assigned to two study arms; each arm consisted of a sequence of two 4-week treatments with an intermediate washout period of 4 weeks. The total study duration was 16 weeks due to a final follow-up measure 4 weeks after the end of all treatments. Treatment A consisted of the use of the serious game developed in this study, and treatment B consisted of conventional exercises. Subjects allocated to the A-B study arm received treatment A first, followed by treatment B, and vice versa in the B-A arm. The following variables were assessed: Suitability Evaluation Questionnaire (SEQ) scores, Visual Analog Scale scores, and the number of targets reached in the serious game. Results A total of 18 subjects were assessed for eligibility. A total of 13 subjects, aged between 71 and 92 years (mean 81.85, SD 6.82), were finally included and completed the study protocol. The global mean SEQ score was 50.38 (SD 5.35) out of 65 points, showing good suitability of the serious game. Most patients considered the experience very enjoyable and “real” in terms of the virtual environment and found the information provided to be clear. Also, they believed that the game could be very helpful for their rehabilitation. None of the patients felt any neck pain or discomfort when playing the game, and only 2 patients out of 13 (15%) reported some degree of dizziness, eye discomfort, or disorientation, which did not limit their capacity to finish the session. Conclusions The serious game developed in this study showed good suitability for use in adults over 70 years of age with chronic neck pain. The game was a safe method for performing task-oriented cervical exercises, and patients reported very high levels of satisfaction and acceptance after the use of this technology.

Effects of Exergaming on Musculoskeletal Pain in Older Adults: Systematic Review and Meta-analysis

“…Figures 2 and 3 summarized the risk of bias assessment for the 7 studies that were included. One study (14%) was classified as “low risk” [ 44 ], 2 studies (29%) as “some concerns” [ 31 , 32 ], and 4 studies (57%) as “high risk” [ 21 , 22 , 45 , 46 ]. All studies were judged “low risk” for the domains “Deviations from intended interventions,” “Missing outcome data,” and “Selection of the reported result.” Four studies (57%) were assessed as “high risk” for the domain “Randomization procedure” due to no report allocation concealment approaches, while 1 research (14%) was evaluated as “some concerns” related to baseline imbalance.…”

“…Seven included studies were published in years from 2011 to 2022. They were conducted in Spain [ 22 ], England [ 31 ], Canada [ 21 , 45 ], Brazil [ 44 ], Germany [ 46 ], and Australia [ 32 ]. Study designs were RCTs (n=4) [ 31 , 32 , 44 , 45 ], pilot RCTs (n=1) [ 46 ], and crossover pilot RCTs (n=2) [ 21 , 22 ].…”

“…They were conducted in Spain [ 22 ], England [ 31 ], Canada [ 21 , 45 ], Brazil [ 44 ], Germany [ 46 ], and Australia [ 32 ]. Study designs were RCTs (n=4) [ 31 , 32 , 44 , 45 ], pilot RCTs (n=1) [ 46 ], and crossover pilot RCTs (n=2) [ 21 , 22 ]. The sample size ranged from 14 to 60, with a total of 264, of which 137 were in the intervention groups and 127 were in the control groups.…”

“…All participants had musculoskeletal pain, participants in 5 studies [ 22 , 31 , 32 , 44 , 46 ] had chronic pain, and participants in the 2 studies [ 21 , 45 ] had nonchronic pain. The average age of the participants ranged from 67.8 (SD 6) years [ 32 ] to 81.85 (SD 6.82) years [ 22 ]. The majority of participants were female, accounting for around 69% of the total.…”

Effects of Serious Games on Depression in Older Adults: Systematic Review and Meta-analysis of Randomized Controlled Trials

“…In addition, the composition or content of serious games was altered to fit the purpose of the intervention. For instance, if a serious game is designed to improve physical function, older adults require to move their bodies during the game [ 39 ]. In a previous study, a serious game was used and evaluated to enhance spatial memory in older adults by implementing the appearance of a real-world city and systematically applying a virtual environment [ 40 ].…”