Effectiveness of Serious Gaming During the Multidisciplinary Rehabilitation of Patients With Complex Chronic Pain or Fatigue: Natural Quasi-Experiment

Background: Current evidence for the effectiveness of specialist multidisciplinary programs for burdensome chronic pain and functional somatic syndromes drives the effort to improve approaches, strategies, and delivery modes. It remains unknown to what extent and in what respect serious gaming during the regular outpatient rehabilitation can contribute to health outcomes.Objective: The objectives of our study were to determine the effect of additional serious gaming on (1) physical and emotional functioning in general; (2) particular outcome domains; and (3) patient global impressions of change, general health, and functioning and to determine (4) the dependency of serious gaming effects on adherence.Methods: We conducted a naturalistic quasi-experiment using embedded qualitative methods. The intervention group patients received an additional guided (mindfulness-based) serious gaming intervention during weeks 9-12 of a 16-week rehabilitation program at 2 sites of a Dutch rehabilitation clinic. Simultaneously, 119 control group patients followed the same program without serious gaming at 2 similar sites of the same clinic. Data consisted of 10 semistructured patient interviews and routinely collected patient self-reported outcomes. First, multivariate linear mixed modeling was used to simultaneously estimate a group effect on the outcome change between weeks 8 and 16 in 4 primary outcomes: current pain intensity, fatigue, pain catastrophizing, and psychological distress. Second, similar univariate linear mixed models were used to estimate effects on particular (unstandardized) outcomes. Third, secondary outcomes (ie, global impression of change, general health, functioning, and treatment satisfaction) were compared between the groups using independent t tests. Finally, subgroups were established according to the levels of adherence using log data. Influences of observed confounding factors were considered throughout analyses.Results: Of 329 eligible patients, 156 intervention group and 119 control group patients (N= 275) with mostly chronic back pain and concomitant psychosocial problems participated in this study. Of all, 119 patients played >= 75% of the game. First, the standardized means across the 4 primary outcomes showed a significantly more favorable degree of change during the second part of the treatment for the intervention group than for the control group (beta=-0.119, SE= 0.046, P=. 009). Second, the intervention group showed a greater outcome change in depressive mood (b=-2.748, SE= 1.072, P=. 011) but not in "insufficiency" or concentration problems. Third, no significant group effects on secondary outcomes were found. Fourth, adherence was generally high and invariant.Conclusions: The findings of this study suggest a very small favorable average effect on relevant health outcomes of additional serious gaming during multidisciplinary rehabilitation. The indication that serious gaming could be a relatively time-efficient component warrants further research into if, when, how, and for which patients serious gaming could be cost-effective in treatment and why

Serious gaming during multidisciplinary rehabilitation for patients with complex chronic pain or fatigue complaints: study protocol for a controlled trial and process evaluation

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Self-management interventions for people with intellectual disabillities: a systematic review

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The effectiveness of various computer-based interventions for patients with chronic pain or functional somatic syndromes: A systematic review and meta-analysis

Computer-based interventions target improvement of physical and emotional functioning in patients with chronic pain and functional somatic syndromes. However, it is unclear to what extent which interventions work and for whom. This systematic review and meta-analysis (registered at PROSPERO, 2016: CRD42016050839) assesses efficacy relative to passive and active control conditions, and explores patient and intervention factors. Controlled studies were identified from MEDLINE, EMBASE, PsychInfo, Web of Science, and Cochrane Library. Pooled standardized mean differences by comparison type, and somatic symptom, health-related quality of life, functional interference, catastrophizing, and depression outcomes were calculated at post-treatment and at 6 or more months follow-up. Risk of bias was assessed. Sub-group analyses were performed by patient and intervention characteristics when heterogeneous outcomes were observed. Maximally, 30 out of 46 eligible studies and 3,387 participants were included per meta-analysis. Mostly, internet-based cognitive behavioral therapies were identified. Significantly higher patient reported outcomes were found in comparisons with passive control groups (standardized mean differences ranged between -.41 and -.18), but not in comparisons with active control groups (SMD = -.26 - -.14). For some outcomes, significant heterogeneity related to patient and intervention characteristics. To conclude, there is a minority of good quality evidence for small positive average effects of computer-based (cognitive) behavior change interventions, similar to traditional modes. These effects may be sustainable. Indications were found as of which interventions work better or more consistently across outcomes for which patients. Future process analyses are recommended in the aim of better understanding individual chances of clinically relevant outcomes.FSW - Self-regulation models for health behavior and psychopathology - ou

Psychometric properties of FSS and CIS-20r for measuring post-stroke fatigue

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Fatigue after traumatic brain injury: a systematic review.

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Zorgwijzer Vermoeidheid. Praktische gids voor mensen met vermoeidheid door niet-aangeboren hersenletsel (NAH)

Contains fulltext : 90520.pdf (publisher's version ) (Closed access)72 p

Brittle brain power: Post-stroke fatigue, explorations into assessment and treatment

Contains fulltext : 112927.pdf (publisher's version ) (Open Access)Radboud Universiteit Nijmegen, 17 oktober 2013Promotores : Fasotti, L., Geurts, A.C.H., Kessels, R.P.C.194 p

Protocol 'Omgaan met beperkte belastbaarheid: Behandelprotocol voor ambulante hersenletselpatiënten met (ernstige) vermoeidheid'

Item does not contain fulltextHelft van patiënten met NAH last van vermoeidheid: Vermoeidheid is een van de meest voorkomende verschijnselen bij niet-aangeboren hersenletsel (NAH): ongeveer de helft van alle patiënten krijgt ermee te maken. Vermoeidheid heeft grote impact op alle terreinen van het leven, zoals werk, sociale relaties en hobby's. Hiernaast beïnvloedt vermoeidheid vaak ook de concentratie, het geheugen en de stemming. Hoe besteed je de beschikbare energie efficiënter? Het uitgangspunt van dit behandelprotocol is dat de vermoeidheid primair door het hersenletsel zelf wordt veroorzaakt. Het doel van de behandeling is dan ook niet om het energieniveau te herstellen tot het premorbide niveau, maar om de beschikbare energie efficiënter te besteden en patiënten te leren omgaan met de bestaande vermoeidheid. Meer energie door een betere lichamelijke conditie: De behandeling 'Omgaan met beperkte belastbaarheid' bestaat uit twee behandelsporen: een cognitieve behandeling en een Graded Activity Training. De Graded Activity Training richt zich op het vergroten van de lichamelijke conditie van de cliënt. Hierdoor hebben de deelnemers meer energie voor hun dagelijkse bezigheden, waardoor de vermoeidheid structureel vermindert. Opbouw van de behandeling: De behandeling duurt twaalf weken en wordt in kleine groepen (maximaal vier deelnemers) gegeven. De cognitieve behandeling vindt eenmaal per week plaats, gedurende twee uur. Deze kan worden gegeven door een psycholoog met neuropsychologische en cognitief gedragstherapeutische kennis en ervaring. De Graded Activity Training vindt tweemaal per week gedurende anderhalf uur plaats. Deze wordt gegeven door een fysiotherapeut met kennis van NAH. Beide behandelsporen omvatten een nauwgezet behandelprotocol en wekelijkse huiswerkopdrachten