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Effect of Gamification With Social Incentives on Increased Mobility After Hospital Discharge


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In a single-institution study reported in JAMA Network Open, Greysen et al found that a strategy of behaviorally designed gamification with social support did not increase mobility among patients discharged from inpatient general medicine or oncology units, although benefit was observed in a subgroup of patients with higher levels of social engagement.

Study Details

In the trial, 232 adult patients recruited from four inpatient general medicine and three oncology units at the Hospital of the University of Pennsylvania between January 2018 and June 2019 were randomly assigned to a gamification with social support intervention (n = 114) or a control group (n = 118). All patients received a wearable device to track daily steps. The control group received feedback from the device with no other interventions. The intervention group participated in a 12-week behaviorally designed game that assigned points and levels for achieving step goals, with reinforcement provided by a support partner who received updates on patient progress. The primary outcome measure was change in mean daily steps from baseline through 12 weeks. Functional decline was assessed using scoring in five activities of daily living domains (eating, dressing, bathing, transferring, and toileting).

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.
— Greysen et al

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Key Findings

Mean daily step counts increased from 3,795 to 4,652 steps (difference = 857 steps, 95% confidence interval [CI] = 488–1,224 steps) in the intervention group vs an increase from 3,951 to 4,499 (difference = 548, 95% CI = 193–903) in the control group. The change in mean daily step count from baseline did not significantly differ for the intervention group vs control group (adjusted difference = 270 steps, 95% CI = −214 to 754 steps, P = .27).

No differences in the secondary outcome measures of functional decline or use of urgent care were observed between groups.

In a post hoc analysis including 36 intervention group patients and 40 control group patients with higher levels of social engagement (top one-third of scores in the Lubben Social Network Scale), the intervention group patients exhibited a significant improvement in mobility vs the control group patients; mean daily steps increased from 3,866 to 5,218 in the intervention patients and from 3,476 to 3,800 in the control group patients, with an adjusted difference of 1,125 steps (95% CI = 409–1,841 steps, P = .002).

In the subgroup with higher levels of social engagement, functional decline was observed in one patient (4%) in the intervention group vs five (12%) in the control group; hospital readmission within 30 days after discharge occurred for three patients (8%) vs six patients (15%), although the differences were not statistically significant.

The investigators concluded, "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."

S. Ryan Greysen, MD, MHS, MA, of the Center for Evidence-based Practice, University of Pennsylvania Perelman School of Medicine, is the corresponding author for the JAMA Network Open article.

Disclosure: The study was supported by the National Institute of Aging and others. For full disclosures of the study authors, visit jamanetwork.com.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
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