JMIR Publications

ABSTRACT

Background:

Thoracic trauma accounts for 10–15% of trauma-related hospital admissions and contributes significantly to morbidity and mortality. Rib fractures, the most common thoracic injury, often result in pulmonary complications such as pneumonia and atelectasis due to impaired respiratory mechanics. Incentive spirometry (IS) is a widely used, non-invasive technique aimed at improving pulmonary function post-injury, yet patient compliance remains a challenge. Gamification of respiratory therapy has emerged as a promising approach to enhance engagement and adherence.

Objective:

This study evaluates the feasibility, safety, and efficacy of gamified IS using the OmniFlow Breathing Therapy BioFeedback System in trauma patients.

Methods:

A single-center, prospective, observational phase II pilot study was conducted at Wake Forest Baptist Medical Center. Adult patients (age ≥18 years) admitted to the Trauma Intensive Care Unit (TICU) with rib fractures and a Glasgow Coma Scale (GCS) of 15 were eligible for inclusion if their first intervention session could occur within 48 hours of admission. Patients requiring mechanical ventilation, those with baseline lung disease, and those with contraindications to IS were excluded. Enrolled patients participated in at least one gamified respiratory therapy session daily, lasting 15–20 minutes, with the possibility of additional sessions based on patient preference and tolerance. Primary endpoints included the feasibility of enrolling 20 patients and their participation in at least one session. Secondary endpoints evaluated patient adherence, number of completed sessions, and session interruptions due to predefined safety criteria (e.g., pain score >8/10, oxygen desaturation <92%, new cardiac arrhythmia, or respiratory distress). If five consecutive patients failed to complete a session due to adverse events, the intervention was deemed unsafe.

Results:

The study was approved by the IRB committee of Atrium Health Wake Forest Baptist Medical Center and was registered in ClinicalTrials.gov. However, no subjects were ever enrolled, as the OmniFlow partners did not supply the device for the study. Despite this, it remains a potentially beneficial tool, and future studies may confirm its benefits once the device becomes available.

Conclusions:

In conclusion OmniFlow offers a promising solution for promoting patient adherence to breathing exercises in the much-needed population of thoracic trauma patients. Our study will evaluate its safety and feasibility in patients with thoracic trauma and rib fractures. Looking ahead, incorporating multiplayer games into the platform could further enhance its effectiveness, allowing patients to engage in group activities while working toward their individual therapeutic goals. Clinical Trial: registered at clinical trials.gov (NCT06090279).