Effect of Behaviorally Designed Gamification With a Social Support Partner to Increase Mobility After Hospital Discharge: A Randomized Clinical Trial.
Effect of Behaviorally Designed Gamification With a Social Support Partner to Increase Mobility After Hospital Discharge: A Randomized Clinical Trial.
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出院后与社会支持伙伴的行为设计游戏化对提高活动能力的影响：一项随机临床试验。
DOI：
10.1001/jamanetworkopen.2021.0952
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发表时间：
2021-03-01
影响因子：
13.8
通讯作者：
Patel MS
中科院分区：
文献类型：
--
作者：
Greysen SR;Changolkar S;Small DS;Reale C;Rareshide CAL;Mercede A;Snider CK;Greysen HM;Trotta R;Halpern SD;Patel MS
与社会支持伙伴进行行为设计的游戏化是否与出院患者的活动性增加和功能下降减少相关？在这项随机临床试验中，232名在普通内科和肿瘤科住院的成年患者，在12周的干预期间，与对照组相比，游戏化与社会激励并没有增加出院后的活动性（每天的步数）或功能下降。然而，在基线时具有较高社会参与度的76名患者的亚组中，活动性增加，功能下降减少。游戏化与社会激励并没有影响所有参与者的流动性或功能下降，但可能有利于社会参与水平较高的患者。这项随机临床试验测试了一种行为设计的游戏化干预，与社会支持合作伙伴一起增加患者出院后的流动性。住院治疗与活动能力下降和功能下降有关。行为设计的游戏化可以增加社区环境中的流动性，但尚未在住院后高风险过渡期内有功能下降风险的患者中进行测试。与社会支持伙伴一起测试行为设计的游戏化干预，以增加患者出院后的活动性。这项研究是一项为期12周的随机临床试验，没有随访。2018年1月至2019年6月在一家转诊医院进行了入组，主要居住在3个州（宾夕法尼亚州、新泽西和特拉华州）的患者接受了远程家庭监测干预。参与者包括从普通内科和肿瘤科出院回家的成年患者。数据分析于二零一九年十月至二零二零年三月进行。所有参与者都收到了一个可穿戴设备来跟踪每天的步数。对照组接受器械反馈，但没有其他干预措施。干预组进入了一个为期12周的游戏，由行为经济学提供信息，为实现步骤目标分配分数和级别，并由一名支持伙伴加强，该伙伴收到了参与者进展的最新信息。主要结果是通过12周的干预，平均每日步数从基线的变化。次要指标是在此期间功能状态和紧急护理利用（即急诊室就诊和再次入院）的变化。共有232名参与者参加了这项研究（118名随机分配到对照组，114名随机分配到干预组）。参与者的平均（SD）年龄为40（14）岁，141（61%）为女性，101（43%）为白色，103（44%）的家庭年收入低于50 000美元。在干预参与者中，每日步数从3795步增加到4652步（差异，857步; 95%CI，488到1224步），在对照参与者中，每日步数从3951步增加到4499步（差异，548步; 95%CI，193到903步）。干预组与对照组受试者的平均每日步数较基线的变化无显著差异（校正差异，270步; 95% CI，-214至754步; P = 0.27）。在76名社会参与水平较高的参与者的亚组中，事后探索性分析显示，干预组与对照组相比，活动性显著增加（调整后差异为1125步; 95% CI为409至1841步; P = 0.002）。该亚组中较少的参与者发生功能下降（干预组36名参与者中的1名[4%] vs对照组40名参与者中的5名[12%]）和30天时再次入院（干预组36名参与者中的3名[8%] vs对照组40名参与者中的6名[15%]），但差异无统计学意义。总体样本的这些次要结局无显著差异。与社会激励的游戏化并没有影响所有参与者的流动性或功能下降，但事后分析表明，对于具有较高社会参与度的患者，这两种结果都有积极的发现。ClinicalTrials.gov标识符：NCT 03321279
Is behaviorally designed gamification with a social support partner associated with increased mobility and reduced functional decline among patients discharged from the hospital? In this randomized clinical trial of 232 adult patients hospitalized in general medicine and oncology units, gamification with social incentives did not increase postdischarge mobility (steps per day) or functional decline compared with control during the 12-week intervention. However, the subgroup of 76 patients with higher social engagement at baseline had an increase in mobility and a decrease in functional decline. Gamification with social incentives did not affect mobility or functional decline in all participants but may be beneficial for patients with higher levels of social engagement. This randomized clinical trial tests a behaviorally designed gamification intervention with a social support partner to increase patient mobility after hospital discharge. Hospitalization is associated with decreased mobility and functional decline. Behaviorally designed gamification can increase mobility in community settings but has not been tested among patients at risk for functional decline during a high-risk transition period after hospitalization. To test a behaviorally designed gamification intervention with a social support partner to increase patient mobility after hospital discharge. This study is a randomized clinical trial of a 12-week intervention without follow-up. Enrollment occurred from January 2018 to June 2019 at a referral hospital with a remote at-home monitoring intervention among patients living predominantly in 3 states (Pennsylvania, New Jersey, and Delaware). Participants included adult patients discharged from general medicine and oncology units to home. Data analysis was performed from October 2019 to March 2020. All participants received a wearable device to track daily steps. The control group received feedback from the device but no other interventions. The intervention group entered into a 12-week game informed by behavioral economics to assign points and levels for achieving step goals and reinforced by a support partner who received updates on participant progress. The primary outcome was change in mean daily steps from baseline through the 12-week intervention. Secondary measures were change in functional status and urgent care utilization (ie, emergency department visits and hospital readmissions) within this period. A total of 232 participants were enrolled in the study (118 randomized to control and 114 randomized to the intervention). Participants had a mean (SD) age of 40 (14) years, 141 (61%) were female, 101 (43%) were White, and 103 (44%) had an annual household income less than $50 000. Daily step counts increased from 3795 to 4652 steps (difference, 857 steps; 95% CI, 488 to 1224 steps) among intervention participants and increased from 3951 to 4499 steps (difference, 548 steps; 95% CI, 193 to 903 steps) among control participants. The change in mean daily step count from baseline was not significantly different for participants in the intervention group vs the control group (adjusted difference, 270 steps; 95% CI, −214 to 754 steps; P = .27). Among the subgroup of 76 participants with higher levels of social engagement, post hoc exploratory analyses showed a significant increase in mobility for intervention vs control (adjusted difference, 1125 steps; 95% CI, 409 to 1841 steps; P = .002). Fewer participants in this subgroup experienced functional decline (1 of 36 participants [4%] in the intervention group vs 5 of 40 participants [12%] in the control group) and hospital readmission at 30 days (3 of 36 participants [8%] in the intervention group vs 6 of 40 participants [15%] in the control group), but the differences were not statistically significant. There were no significant differences in these secondary outcomes for the overall sample. Gamification with social incentives did not affect mobility or functional decline in all participants, but post hoc analysis suggests positive findings for both outcomes for patients with higher social engagement. ClinicalTrials.gov Identifier: NCT03321279
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DOI：
10.15585/mmwr.mm6429a2
发表时间：
2015-07-31
期刊：
MMWR. Morbidity and mortality weekly report
影响因子：
--
作者：
Courtney-Long EA;Carroll DD;Zhang QC;Stevens AC;Griffin-Blake S;Armour BS;Campbell VA
通讯作者：
Campbell VA
影响因子：
39.2
作者：
Brown RT;Diaz-Ramirez LG;Boscardin WJ;Lee SJ;Steinman MA
通讯作者：
Steinman MA
影响因子：
5.4
作者：
Dai, Hengchen;Milkman, Katherine L.;Riis, Jason
通讯作者：
Riis, Jason
影响因子：
5.7
作者：
Chodos, Anna H.;Kushel, Margot B.;Pierluissi, Edgar
通讯作者：
Pierluissi, Edgar
DOI：
10.1111/j.1532-5415.1997.tb00986.x
发表时间：
1997-01-01
影响因子：
6.3
作者：
Fried, LP;Guralnik, JM
通讯作者：
Guralnik, JM