Sensor-controlled digital game and heart failure self-management behaviors: A feasibility randomized controlled trial study (Preprint)

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 HF individuals’ real-time behaviors. OBJECTIVE To compare daily weight-monitoring and physical activity behavior adherence by older adults using a SCDG intervention versus a sensor-only intervention, in a feasibility randomized controlled trial. METHODS English-speaking HF adults aged ≥55 years 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 tracker and smart weight scale sensors to track behaviors for 12 weeks. Feasibility outcomes of recruitment, retention, intervention engagement, and satisfaction were assessed. Besides daily weight-monitoring and physical activity adherence, participants’ knowledge, functional status, quality of life (QoL), self-reported HF behaviors, motivation to engage in behaviors, and HF-related hospitalization were also compared between the groups at baseline, 6, 12, and 24 weeks. RESULTS Participants (N=38; intervention n=19; control n=19) with HF were enrolled (47% female, 47% ≥65 years, 55% HF hospitalization in past 6 months, 76% White); 82% of patients (n=31; intervention, 15/19, 79%; control, 16/19, 84%) had both weight monitoring and physical activity data at the end of 12 weeks and 71% (n =27; intervention, 14/19, 74%; control, 13/19, 68%) participated in follow-up assessments at 24 weeks. For the intervention group participants who installed the SCDG app (n=15), 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=0.04) and with the number of days with physical activity step data (r=0.9, P < 0.001). Participants who completed the satisfaction survey (intervention, n=13) reported that the SCDG was easy to use. Trends of improvement in daily weight-monitoring and physical activity in the intervention group and within-group improvements in HF functional status, QoL, 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. CLINICALTRIAL Clinicaltrials.gov NCT03947983; https://clinicaltrials.gov/ct2/show/NCT03947983

Abstract 13122: Sensor-controlled Digital Game May Improve Weight Monitoring Among Older Adults With Heart Failure

Introduction: Poor self-management of heart failure (HF) has contributed to poor health outcomes with an annual loss of $32 billion. Our innovative sensor controlled digital game (SCDG) integrates data from weight scale and physical activity sensors to trigger rewards, progress, changes in avatar’s health status and feedback based on HF individuals’ real-time behaviors (Fig1). Hypothesis: Weight monitoring and physical activity by participants receiving both the SCDG app and sensors will be higher than participants receiving only the sensors (CG). Methods: English-speaking HF adults aged >55 years, own a smartphone, and walk unassisted were recruited from cardiac settings in Texas. Both SCDG and CG participants were given ‘Withings’ activity tracker and smart weight scale sensors to track behaviors for 12 weeks. Physical activity goal was tailored to the participant’s ability. Results: In early results over six weeks on 12 participants (58% women, white, and 65+ years age), the mean days with weight monitoring in the SCDG group was 34 and 27 in the CG. Daily average steps were 2195 (53% of goal) in SCDG group and 3187 in CG (75% of goal). 100% of participants found the SCDG easy and enjoyable to play. Study adaptations in response to the COVID19 crisis will allow us to present results on 30 participants at conference time. Conclusion: SCDG had trends of higher weight monitoring but lower physical activity among older adults with HF. Participants in the study continue to engage in weight-monitoring and physical activity even during the COVID19 crisis. This presents opportunities to tailor digital health interventions to remotely motivate self-management behaviors.

Usability Testing of a Sensor-Controlled Digital Game to Engage Older Adults with Heart Failure in Physical Activity and Weight Monitoring

Background Poor self-management of heart failure (HF) has contributed to poor health outcomes. Sensor-controlled digital games (SCDGs) integrates data from behavior-tracking sensors to trigger progress, rewards, content, and positive feedback in a digital game to motivate real-time behaviors. Objectives To assess the usability of an SCDG prototype over a week of game-playing among 10 older adults with HF in their homes. Methods During initial play, participants' SCDG experiences were observed in their homes using a checklist based on the seven-item Serious Game User Evaluator (SeGUE) instrument. After a week of game-playing, participants completed a survey guided by the Intrinsic Motivation Inventory, to provide their perceptions of the SCDG's usability. Qualitative analysis via semistructured interview-derived themes on experiences playing the SCDG, perceptions regarding engaging with the SCDG, and any usability issues encountered. Results Ten HF participants (50% women and 50% White) played the SCDG for an average of 6 out of 7 days. Nine found the SCDG to be interesting, satisfying, and easy to play. The average step count over a week was 4,117 steps (range: 967–9,892). Average adherence with weight monitoring was 5.9 days in a week. Qualitative analysis yielded outcomes regarding attitudes toward SCDG, and barriers and facilitators that influenced participants' engagement with the SCDG. Conclusion To the best of the authors' knowledge, this usability and feasibility study is the first to report an SCDG designed to improve HF self-management behaviors of older adults in their homes. Future research should consider several issues, such as user profiles, prior game-playing experiences, and network conditions most suitable for connected health interventions for older adults living in the community.