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Saragih ID, Suarilah I, Saragih IS, et al. Efficacy of serious games for chronic pain management in older adults: A systematic review and meta-analysis. J Clin Nurs. 2024 Mar;33(3):1185-1194. doi: 10.1111/jocn.17012. Epub 2024 Jan 30. (Systematic review)
Abstract

AIMS AND OBJECTIVES: To synthesise and appraise the evidence of the efficacy of serious games in reducing chronic pain among older adults.

BACKGROUND: Chronic pain in older adults generally results in a substantial handicap due to decreased mobility, exercise avoidance and various concerns that affect their overall quality of life. While serious games have been widely used as a pain management approach, no reviews have thoroughly examined their efficacy for chronic pain management in older adult populations.

DESIGN: A systematic review and meta-analysis.

METHODS: The CINAHL, the Cochrane Library, Embase, Medline, PubMed and Web of Science databases were comprehensively searched to find articles published from their inception until 17 April 2023. RoB-2 was used to assess the risk of bias in the included studies. The efficacy of serious games for pain management in older individuals was investigated using pooled standardised mean differences (SMDs) in pain reduction using a random effect model.

RESULTS: The meta-analysis comprised nine randomised controlled trials that included 350 older adult patients with pain. Serious games effectively alleviated pain in this group (pooled SMD = -0.62; 95% confidence interval: -1.15 to -0.10), although pain-related disability and fear require further investigation.

CONCLUSIONS: Serious games tended to effectively reduce pain in this older adult group; however, due to a lack of randomised controlled trials, the analysis found lower effectiveness in reducing pain-related disability and fear. Further studies are accordingly required to confirm these findings.

RELEVANCE TO CLINICAL PRACTICE: The findings of the study emphasise the importance of serious games to increase the motivation of older adults to exercise as one of the safe and extensively used pain management strategies. Serious games that effectively reduce chronic pain in older adults are characterised as consisting of diverse physical activities delivered through consoles, computer-based activities and other technologies.

PATIENT OR PUBLIC CONTRIBUTIONS: Serious games are recommended as being potentially useful and practical for reducing pain in older adults.

Ratings
Discipline Area Score
Rehab Clinician (OT/PT) 6 / 7
Physician 4 / 7
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Comments from MORE raters

Physician rater

I wish the authors gave a more in-depth explanation of "serious games."

Physician rater

The study populations were small and pain was evaluated only after the intervention. Thus, this does not show any evidence about clinical significance related to chronic pain. If they had measured acute pain, it could have some significance. Paying attention to different object is known to reduce pain.

Physician rater

Serious games that include a variety of physical activities delivered through consoles, as well as computer-based activities and other technologies (e.g. Xbox, Nintendo, Wii, Kinect, Tabletop, and Chinese GO), are effective in reducing chronic pain in older adults through physical, cognitive, and psychological rehabilitation compared with standard therapy involving conventional exercise or regular activities. Because of the small number of studies included in the analyses and a few methodological biases, there is a lower effectiveness of serious games in reducing pain-related disability and fear. The implementation of serious games is a useful strategy for managing pain and increasing motivation to exercise in older adults with chronic pain; however, further studies with stronger methodologies are required to provide more rigorous evidence given the various types of serious games available. Costs, possible side effects, and patient preferences should also be analysed.

Physician rater

Serious games that involve physical activities delivered through consoles, computers, and other technologies can be a more effective option for reducing chronic pain in older adults than standard therapy involving conventional exercise or regular activities. This approach can be particularly helpful for those who may have difficulty with traditional exercise programs. By incorporating technology and fun activities, serious games can provide a more engaging and enjoyable experience for older adults. Additionally, serious games can increase motivation to exercise and can be tailored to individual needs and abilities, making them a flexible and personalized option for pain management. It is also important to consider costs, possible side effects, and patient preferences when analyzing the use of serious games. Overall, they have the potential to be a valuable tool in managing chronic pain in older adults.

Rehab Clinician (OT/PT) rater

The article's methodology appears thorough, examining existing literature on Serious Games for pain management among the elderly, filling a crucial gap in treatment. It's particularly relevant for those with mobility issues or sedentary lifestyles. As a psychologist, I see it as a catalyst for research in Serious Games for chronic pain in the elderly, promising therapeutic benefits. The link between chronic pain and depression highlights its importance for overall well-being in the elderly. Beyond analysis, the article suggests broader implications for holistic care, addressing mental health challenges alongside chronic pain.
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