JMIR Publications

ABSTRACT

Background:

Fatigue is a common and debilitating side effect of chronic diseases substantially impacting quality of life of patients. Physical exercise and psychological treatments are known to be able to reduce fatigue but in clinical practice patients often face difficulties adhering to these interventions. Game-based eHealth interventions are thought to overcome these adherence issues by presenting the intervention in a more accessible and motivating way.

Objective:

The objective of this study was to collate empirical evidence for game-based eHealth interventions for fatigue in people with chronic diseases and to determine their effectiveness in alleviating fatigue.

Methods:

A comprehensive literature search of EMBASE, Medline ALL, PsycINFO, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, and on google scholar was conducted in August 2021. Study characteristics and outcomes from the included studies were extracted and a random-effects meta-analysis was conducted. Sensitivity and subgroup analyses were conducted to identify sources of heterogeneity.

Results:

From 1742 studies identified seventeen were included for the meta-analysis. Studies covered five different chronic diseases: Multiple Sclerosis (n=10), cancer (n=3), renal disease (n=2), stroke (n=1) and Parkinson’s disease (n=1). The interventions employed were exergaming interventions for all but one study. The meta-analysis revealed a significant moderate effect size in the reduction of fatigue in favor of the experimental interventions (SMD -0.65; 95% CI -1.09 to -0.21, P=.003) as compared to control conditions consisting of conventional care and no care. However, heterogeneity was high (I2 85.87%). Subgroup analyses were done for the two most prevalent diseases. Effect size for the MS subgroup showed a trend in favor of the eHealth interventions as well (SMD -0.47; 95% CI -0.95 to 0.01; P=.05, I2 63.10%), but not for the cancer group (SMD 0.61; 95% CI -0.36 to 1.58; P=.22). Balance exercises seemed to be particularly suited for the reduction of fatigue (SMD -1.19; 95% CI -1.95 to -0.42; P=.002).

Conclusions:

Game-based eHealth interventions seem to be effective in reducing fatigue in people with chronic diseases. More research is needed to further support our results and to determine the effect for the individual diseases. Furthermore, interventions other than exergaming have been scarcely examined within the realm of game-based learning.