Feasibility of a Sensor-Controlled Digital Game for Heart Failure Self-management: Randomized Controlled Trial

Abstract

Background Poor self-management of heart failure (HF) contributes to devastating health consequences. Our innovative sensor-controlled digital game (SCDG) integrates data from sensors to trigger game rewards, progress, and feedback based on the real-time behaviors of individuals with HF. Objective The aim of this study is to compare daily weight monitoring and physical activity behavior adherence by older adults using an SCDG intervention versus a sensors-only intervention in a feasibility randomized controlled trial. Methods English-speaking adults with HF aged 55 years or older who owned a smartphone and could walk unassisted were recruited from Texas and Oklahoma from November 2019 to August 2020. Both groups were given activity trackers and smart weighing scales to track behaviors for 12 weeks. The feasibility outcomes of recruitment, retention, intervention engagement, and satisfaction were assessed. In addition to daily weight monitoring and physical activity adherence, the participants’ knowledge, functional status, quality of life, self-reported HF behaviors, motivation to engage in behaviors, and HF-related hospitalization were also compared between the groups at baseline and at 6, 12, and 24 weeks. Results A total of 38 participants with HF—intervention group (IG; 19/38, 50%) and control group (CG; 19/38, 50%)—were enrolled in the study. Of the 38 participants, 18 (47%) were women, 18 (47%) were aged 65 years or older, 21 (55%) had been hospitalized with HF in the past 6 months, and 29 (76%) were White. Furthermore, of these 38 participants, 31 (82%)—IG (15/19, 79%) and CG (16/19, 84%)—had both weight monitoring and physical activity data at the end of 12 weeks, and 27 (71%)—IG (14/19, 74%) and CG (13/19, 68%)—participated in follow-up assessments at 24 weeks. For the IG participants who installed the SCDG app (15/19, 79%), the number of days each player opened the game app was strongly associated with the number of days the player engaged in weight monitoring (r=0.72; P=.04) and the number of days with physical activity step data (r=0.9; P<.001). The IG participants who completed the satisfaction survey (13/19, 68%) reported that the SCDG was easy to use. Trends of improvement in daily weight monitoring and physical activity in the IG, as well as within-group improvements in HF functional status, quality of life, knowledge, self-efficacy, and HF hospitalization in both groups, were observed in this feasibility trial. Conclusions Playing an SCDG on smartphones was feasible and acceptable for older adults with HF for motivating daily weight monitoring and physical activity. A larger efficacy trial of the SCDG intervention will be needed to validate trends of improvement in daily weight monitoring and physical activity behaviors. Trial Registration ClinicalTrials.gov NCT03947983; https://clinicaltrials.gov/ct2/show/NCT03947983

Sensor-Controlled Digital Game for Heart Failure Self-management: Protocol for a Randomized Controlled Trial

“…Current digital health interventions with unobtrusive monitoring capabilities allow the gathering of relevant contextual data to tailor and adapt interventions without overburdening participants through cumbersome data collection [ 59 ]. This study protocol was informed by our feasibility randomized controlled trial study, in which we demonstrated the remote implementation of a smartphone-based intervention using a digital game and sensors among participants in 18 counties in Texas and Oklahoma [ 29 ]. Combining digital games and sensors holds the potential to offer a powerful way to improve treatment adherence [ 60 , 61 ]; sustain healthy behaviors; and make health care more participatory, personalized, predictive, and preventive, as defined by precision medicine [ 62 ].…”

“…The design of the game was guided by behavioral change mechanisms using the concepts of motivation, ability, and trigger from the Fogg behavioral model and self-determination theoretical frameworks, as described in detail in a previous study [ 33 ]. This app has already been developed by a multidisciplinary team and tested through initial usability and feasibility studies and is described in detail elsewhere [ 28 , 29 ]. Several screenshots from the SCDG are pictured in Figure 1 .…”

“…Participants in both groups will receive remote training from a member of the study team on how to install and use the devices. This remote training (ie, over Zoom [Zoom Video Communications] or FaceTime [Apple iOS]) was also successfully provided in our feasibility study [ 29 ]. After 3 days, both the groups will receive a follow-up email from the interventionist to summarize participants’ study tasks and provide contact information in case of troubleshooting needed while using the devices and apps.…”

“…Thus, SCDGs offer an immersive and accessible way to objectively measure self-management behaviors and improve adherence [ 28 ]. Our previous research [ 29 ] conducting an SCDG intervention with 38 adults (aged ≥55 years) with HF from Texas and Oklahoma demonstrated improvements in weight monitoring and physical activity, and the intervention showed a high rate of acceptability (92%) from participants.…”

Benefits and Harms of Digital Health Interventions Promoting Physical Activity in People With Chronic Conditions: Systematic Review and Meta-Analysis

“…Furthermore, 13 RCTs offered rehabilitation as part of the intervention [64,75,80,82,147,149,151,152,157,160,163,169,178]. mHealth solutions (eg, telephone calls, text messages, and apps) were primarily used in 56 RCTs [53,56,57,59,63,67,69,78-80, 83-86,90,92,93,96,99,101,102,105,108,110,112-115,119, 120,124,128-130,134,136,140-142,146-148,150,155,157,161,163, 164,167,168,172,176,177,179,181,185], whereas 22 RCTs [58,60,61,65,70,81,87,111,116,117,126,133,134,145,149,151,154,156,165,171,173,174] used mHealth combined with a device (eg, wearable, pedometer, activity tracker, or Bluetooth-connected pulse oximeter or glycosometer). Furthermore, 6 RCTs [75,89,118,158,169,183]…”