Assessing the Quality of Single-Case Designs in Occupational Therapy: A Scoping Review

IMPORTANCE

Single-case designs (SCDs) offer a powerful research methodology for demonstrating the effectiveness of occupational therapy interventions for diverse clients with individualized needs. However, the current state of the use of SCDs in occupational therapy remains unclear.

OBJECTIVE

To summarize the current state of and challenges associated with the use of SCDs in occupational therapy.

DATA SOURCES

Articles were retrieved from the following databases: PubMed, Web of Science, PsycINFO, OTDBASE, and CINAHL. Related articles were manually searched to identify relevant studies, with the publication year restricted to 1990 to 2023.

STUDY SELECTION AND DATA COLLECTION

This scoping review adhered to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. The search terms used were occupational therapy, single-case design, and synonyms for single-case design. The search was restricted to journals specifically dedicated to occupational therapy.

FINDINGS

Eighty-eight studies met the inclusion criteria for this review. Existing research has focused on the practice areas of children and youth and physical disabilities or rehabilitation. Moreover, AB designs, ABA designs, and visual analysis that do not meet the What Works Clearinghouse standards are frequently used as research methods.

CONCLUSIONS AND RELEVANCE

Although SCDs can be highly useful in demonstrating the effectiveness of occupational therapy interventions for diverse clients with individualized needs, considering the quality of SCDs when designing studies is crucial. Plain-Language Summary: This scoping review delved into the current landscape and challenges of single-case designs (SCDs) in occupational therapy. The findings revealed the pervasive adoption of low-quality designs and the predominant use of visual analysis methods in this field. In light of these findings, it is imperative for future research and development efforts to embrace established guidelines, paving the way for enhanced methodological rigor and robust outcomes.

Effects of active video games on mental health among college students: a systematic review

BACKGROUND

Mental health significantly impacts college students' academic performance and overall happiness. Active video games (AVGs) have gained popularity among college students due to their ample entertainment, and there is growing interest in utilizing them to address mental health issues. However, there has not been a comprehensive summary and systematic review of research on the effects of AVGs on college students' mental health.

METHODS

As of October 18th, 2024, searches were conducted in six internationally renowned databases (PubMed, SCOPUS, Web of Science, CINAHL Plus, EBSCOhost, Cochrane Library). Inclusion and exclusion criteria were developed based on the PICOS principles. A systematic review was conducted following the PRISMA guidelines, and compliant studies using randomised controlled trial design (RCT) were included. The methodological quality of the included studies was evaluated using the PEDro scale.

RESULTS

A total of 3471 articles were retrieved, of which 17 met the criteria inclusion. The PEDro scores of the 17 studies ranged from four to nine. The results indicate that AVGs can effectively improve college students' poor mental health, such as stress, anxiety, and depression, as well as increase their happiness and psychological satisfaction. Moreover, AVGs have been shown to increase motivation for exercise, improve college students' attitudes toward other forms of exercise, and promote sustained physical activity. Additionally, AVGs have demonstrated efficacy in improving sleep quality.

CONCLUSION

Overall, AVGs can serve as an effective intervention to reduce dysphoria and promote positive psychological states among college students, thus improving mental health. Using the theory-based design of AVGs will further increase the effect. However, the effects of AVGs vary depending on their type and initial design purpose. Therefore, when using AVGs to improve college students' mental health, it is necessary to carefully consider the students' original state, select AVGs with rich game content that can provide at least moderate-intensity physical activity, and adopt the correct intervention strategy to achieve good results. AVG can potentially become a valuable tool for improving college students' mental health.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/prospero , identifier: CRD42024510488.

Effects of active video games on physical activity among overweight and obese college students: a systematic review

Background

The purpose of this study was to critically review the existing literature on the effects of active video games (AVGs) on physical activity in overweight and obese college students to determine whether AVGs can promote and achieve recommended levels of physical activity. The results should provide constructive input for future research.

Methods

A total of five international databases including PubMed, SCOPUS, Web of Science, CINAHL Plus, and EBSCOhost were searched with keywords related to "active video games," "physical activity," and "obese college students" from July 2022. A systematic review was conducted using the PRISMA guidelines and randomised controlled trial (RCT) studies that met the inclusion criteria were included. Furthermore, the quality assessment of the studies was measured using the PEDro scale.

Results

One thousand and twenty-three articles were retrieved, of which eight randomised controlled trial studies met the inclusion criteria. AVGs can reduce sedentary behaviour and positively affect physical activity, time spent on moderate-to-vigorous physical activity (MVPA), positive psychological factors, and game attendance rate. Combining AVGs with other assistive devices (such as mini-trampolines and stationary bikes) can enhance the effects of AVGs and provide greater physiological stimulation. Different types of AVGs and game modes can achieve different emotional responses, physiological stimulation, and physical activity levels.

Conclusion

The research findings prove that AVGs can be a viable intervention to increase physical activity in overweight or obese college students, ultimately reaching the recommended physical activity level(PAL). Physical activity can be further increased by incorporating assistive devices or using features supported by self-determination theory (SDT). As a new modality, AVGs could be a potential alternative to traditional physical activity.Systematic Review Registration:https://www.crd.york.ac.uk/prospero, identifier: CRD42022363993.

Development of a Novel Home-Based Exergame With On-Body Feedback: Usability Study

BACKGROUND

With more than 1.4 billion adults worldwide classified as physically inactive, physical inactivity is a public health crisis leading to an increased risk of cardiometabolic diseases. Motivating and engaging training strategies are needed to tackle this public health crisis. Studies have shown that exergames, games controlled by active body movements, are potentially usable, attractive, and effective tools for home-based training. The ExerCube (by Sphery Ltd) has been developed as a physically immersive and adaptive functional fitness game. The development of a home-based version of the ExerCube could increase accessibility, reduce barriers to exercise, and provide an attractive solution to improve physical and cognitive health.

OBJECTIVE

The aim was threefold: (1) to develop a usable home-based exergame system, (2) to evaluate the usability and training experience of the home-based exergame and its early-stage on-body feedback system, and (3) to identify avenues for further user-centered design iterations of the system.

METHODS

A total of 15 healthy participants (mean age 25, SD 3 years) completed 2 laboratory visits consisting of four 5-minute exergame sessions. In each session, the on-body feedback system provided a different feedback modality (auditory, haptic, and visual feedback) to the participant. Following the second visit, participants completed a range of assessments, including the System Usability Scale (SUS), the Physical Activity Enjoyment Scale (PACES), the Flow Short Scale (FSS), the Immersive Experience Questionnaire (IEQ), and a rating of perceived exertions (RPEs) both physically and cognitively. Participants answered questions regarding the on-body feedback system and completed a semistructured interview.

RESULTS

Usability was rated as acceptable, with a SUS score of 70.5 (SD 12). The questionnaires revealed medium-to-high values for the training experience (FSS: 5.3, SD 1; PACES: 5.3, SD 1.1; IEQ: 4.7, SD 0.9. Physical (mean 4.8, SD 1.6) and cognitive (mean 3.9, SD 1.4) RPEs were moderate. Interviews about the on-body feedback system revealed that the majority of participants liked the haptic feedback and the combination of haptic and auditory feedback the best. Participants enjoyed the distinct perceptibility, processing, and integration of the exergame and its supportive and motivating effect. The visual feedback was perceived less positively by participants but was still classified as "potentially" helpful. The auditory feedback was rated well but highlighted an area for further improvement. Participants enjoyed the training experience and described it as motivating, interactive, immersive, something new, interesting, self-explanatory, as well as physically and cognitively challenging. Moreover, 67% (n=10) of the participants could imagine exercising at home and continuing to play the exergame in the future.

CONCLUSIONS

The home-based exergame and its early-stage on-body feedback system were rated as usable and an enjoyable training experience by a young healthy population. Promising avenues emerged for future design iterations.

Promoting Sports Engagement during the COVID-19 Pandemic via Virtual Reality Games

Objective

To examine sports engagement and health changes of young adults when utilizing a VR sports game and investigate the relationship between sports engagement and health.

Method

This study used a single-group design with 20 participants, aged 19–29 years, with no preexisting health conditions. The VR game “Sports Scramble” was used thrice within a span of one week. Outcomes sought include sports engagement and health, measured through the Sports Engagement Scale (SES) and Short Form 36 (SF-36), respectively.

Results

A significant difference (p < 0.001) was found between the pre-posttest scores of the SES. Moreover, a positive trend was observed in terms of health with a significant difference (p < 0.05) between pre-posttest scores of the SF-36's vitality dimension. There were positive correlations among the dedication and vigor subscales of the SES with the dimensions of health.

Conclusion

This study showed the potential of VR sports games in positively influencing sports engagement and health among participants with the vigor and dedication positively influencing health. Future studies may involve the exploration of the effectiveness of VR to promote engagement and health through a randomized controlled trial with a longer timeframe and across various populations.

Determinants of academic stress amongst engineering students

BACKGROUND

Academic stress is one of the active research domains in engineering institutions. As it can result in ill health of students, it is important to monitor the level of academic stress in students.

OBJECTIVE

The objective of this study was to determine the academic stress factors in the engineering universities in Punjab state of India. This study also aimed to check the determinants of academic stress.

METHODS

The data was collected through a questionnaire survey conducted on engineering students of two different universities. The collected data out of 400 surveys is subjected to factor analysis and ANOVA.

RESULTS

Factor analysis revealed various factors that influence the academic stress. It was also found that the academic stress in students is most influenced by Engineering Streams and Nature of Universities.

CONCLUSIONS

The study projected the effects of Academic Stress on Gender, Age, Engineering Streams, Nature of Universities.

Impact of Active Video Games on Body Mass Index in Children and Adolescents: Systematic Review and Meta-Analysis Evaluating the Quality of Primary Studies

OBJECTIVE

To study the impact of active video games on Body Mass Index (BMI) in children and adolescents.

DESIGN AND METHODS

A systematic review and meta-analysis. Data were pooled in meta-analysis using the method of random effects or fixed effects, as appropriate, after examination of statistical heterogeneity. Data sources and eligibility criteria for selecting studies. A comprehensive literature research was conducted in Medline (PubMed), ISI web of Knowledge, and SCOPUS up to April 2018, in relation to clinical trials (both controlled and non-controlled) in children and adolescents, whose intervention was based on active video games.

RESULTS

The overall intragroup effect of the intervention based on active video games was in favor of the intervention, reaching statistical significance using the fixed effects model: (standardized mean difference (SMD) = -0.138; 95% CI (-0.237 to -0.038), p = 0.007 and was of borderline statistical significance in the random effects model: SMD= -0.191; 95% CI (-0.386 to 0.003), p = 0.053. The individual results of the determinations of the 15 included studies for this analysis showed a high heterogeneity among them (I2 = 82.91%). When the intervention was applied to children and adolescents with greater than or equal to 85 (overweight or obese) BMI percentile showed a greater effect in favor of the active video games: SMD= -0.483, p = 0.012. The overall intra-group effect in the control group was close to zero (SMD = 0.087). With respect to the non-standardized mean difference (MD) between groups, it was also in favor of active video games for both BMI (Kg/m2): DM = -0.317, 95% CI (-0.442 to -0.193), p = < 0.001 and BMI z-score: DM = -0.077, 95% CI (-0.139 to -0.016), p = 0.013.

CONCLUSIONS

Our meta-analysis show a statistically significant effect in favor of using active video games on BMI in children and adolescents. The clinical relevance of this positive effect must be evaluated.

Occupational Therapy for Adults with Overweight and Obesity: Mapping Interventions Involving Occupational Therapists

Background

Worldwide obesity rates are increasing. The effectiveness of occupational therapy in overweight and obese adults has not yet been clarified.

Objectives

The scoping review aimed at examining the evidence on interventions involving occupational therapists in the treatment of adults with overweight and obesity.

Methods

Data on interventions involving occupational therapists and reporting on lifestyle-related outcomes in overweight and obese adults was extracted from the databases Cochrane, PubMed, CINAHL, and Embase, including hand and reference search. The scoping review methodology of Arksey and O'Malley was used. Conclusions were based on numerical and narrative analysis.

Results

Thirteen articles reporting on eleven studies met the inclusion criteria. Several studies showed significant weight loss. However, the studies possessed high heterogeneity and showed insufficient explication of the role and contribution of occupational therapy to the outcomes.

Conclusions

The interventions with involvement of occupational therapists were suggested to help short-term weight loss. Occupational therapists contributed to the outcomes with a holistic approach, educating on the role of activity, providing technological support, and promoting enjoyment of being active. There is a need for further documentation of the effectiveness, role, and contributions of occupational therapy in the treatment of overweight and obese adults in all settings.

The contribution of Nintendo Wii Fit series in the field of health: a systematic review and meta-analysis

Background

Wii Fit was originally designed as a health and fitness interactive training experience for the general public. There are, however, many examples of Wii Fit being utilized in clinical settings. This article aims to identify the contribution of Wii Fit in the field of health promotion and rehabilitation by: (1) identifying the health-related domains for which the Wii Fit series has been tested, (2) clarifying the effect of Wii Fit in those identified health-related domains and (3) quantifying this effect.

Method

A systematic literature review was undertaken. The MEDLINE database and Games for Health Journal published content were explored using the search term “Wii-Fit.” Occurrences resulting from manual searches on Google and material suggested by experts in the field were also considered. Included articles were required to have measurements from Wii Fit activities for at least one relevant health indicator. The effect of Wii Fit interventions was assessed using meta-analyses for the following outcomes: activity-specific balance confidence score, Berg balance score (BBC) and time-up-and-go test (TUG).

Findings

A total of 115 articles highlighted that the Wii Fit has been tested in numerous healthy and pathological populations. Out of these, only a few intervention studies have focused on the prevention of chronic diseases. A large proportion of the studies focus on balance training (N = 55). This systematic review highlights several potential benefits of Wii Fit interventions and these positive observations are supported by meta-analyses data (N = 25). For example, the BBC and the TUG respond to a similar extend to Wii Fit interventions compared with traditional training.

Conclusion

Wii Fit has the potential to be used as a rehabilitation tool in different clinical situations. However, the current literature includes relatively few randomized controlled trials in each population. Further research is therefore required.

Effects of Exergaming on Physical Activity in Overweight Individuals

BACKGROUND

The majority of patients with overweight and type 2 diabetes show insufficient levels of daily physical activity (PA) and usually are among the least likely to engage in or adhere to any form of generic PA. Active video games (exergames) may be a solution to motivate these individuals to overcome their sedentary lifestyle.

OBJECTIVES

This systematic review was conducted to review the current evidence for the effectiveness of exergaming in overweight and type 2 diabetes mellitus and thus to evaluate the suitability of these games to be used as tools for exercise promotion that meet current PA guidelines.

METHODS

We searched electronic bibliographic databases (PubMed, Embase, Web of Science, OpenGrey, and the Cochrane Central Register of Controlled Trials) up to March 2015. Randomized controlled trials (RCT) and cross-sectional studies published in English in a peer-reviewed journal and analyzing the effects of exergames on objectively measured intensity parameters of PA in overweight (body mass index [BMI] ≥25 kg/m(2)) adults (mean age ≥18 years) with and without type 2 diabetes were included. Study selection, data extraction, and quality assessment were performed independently by two review authors. Primary outcomes included changes in oxygen uptake (VO2), energy expenditure (EE), heart rate (HR), or activity counts. Secondary outcomes were enjoyment of treatment, exercise adherence, ratings of perceived exertion (RPE), changes in body composition, and changes in blood parameters (serum glucose, long-term blood glucose, blood cholesterol, triglycerides, or serum lactate).

RESULTS

Of 2845 records, 14 publications (11 studies) met the inclusion criteria. All included studies (ten experimental, cross-sectional laboratory studies and one RCT) were able to show increases in either VO2, EE, HR, or activity counts. However, effects of exergaming in terms of changes in these intensity parameters varied significantly between game modes and consoles as well as because of the vastly differing durations of exergame activity between studies. One of the included studies had a low risk of bias, and three had a high risk of bias; seven studies had an unclear risk of bias as the study description was insufficient. No studies were found investigating the changes in objectively measured PA intensity parameters in patients with type 2 diabetes.

CONCLUSION

This review suggests that exergames are able to increase PA among overweight individuals. However, the inconsistent results and the overall poor or moderate methodological quality do not permit judgment on whether exergames are suitable to meet PA guidelines in this target group. The lack of research regarding the effects of exergames in type 2 diabetes indicates a great need for future research.

Wii Fit U intensity and enjoyment in adults

Background

The Wii Fit series (Nintendo Inc., Japan) provides active video games (AVGs) to help adults to maintain a sufficient level of daily physical activity (PA). The second generation of home AVG consoles is now emerging with new game modalities (including a portable mini screen in the case of the new Wii U). The present study was performed to investigate the intensity and enjoyment of Wii Fit U games among adults.

Findings

Metabolic equivalent (METs, i.e., intensity) of the Wii Fit U activities were evaluated using metabolic chambers in 16 sedentary adults (8 women and 8 men). A short version of the physical activity enjoyment scale was completed for each activity. Wii Fit U activities were distributed over a range from 2.2  ±  0.4 METs (Hula dance) to 4.7  ±  1.2 (Hip-hop dance). Seven activities were classified as light-intensity PA (<3 METs) and 11 activities as moderate-intensity PA (3 – 6 METs). The new portable mini screen game modality does not induce higher METs. Men exercised at higher intensities than women. There was no correlation between enjoyment and MET values in women or men.

Conclusions

More and more moderate-intensity activities are available through video gaming, but the average intensity (3.2  ±  0.6) is still low. Users should be aware that AVGs alone cannot fulfill the recommendations for PA, and the video games industry still must innovate further to enhance gaming intensity and make the tool more attractive to health and fitness professionals.

Competing for ideal bodies: a study of exergames used as teaching aids in schools

Since the development of the welfare state, the Swedish school subject Health and Physical Education (HPE) has been regarded as an important site for public health work, and still assumes a central role in promoting the health of the coming generation. A specific type of health intervention, promoted by researchers in recent years, is the use of so-called exergames. In some countries, these fitness games are used as teaching aids in physical education classes and can be seen as examples of how public health issues and popular culture are shaping HPE in schools. The aim of the study reported in this paper is to examine which messages about health and body are offered, and how these are expressed in some of the fitness games used as teaching aids in school. The results of the study highlight the dangers of using exergames in the teaching of HPE in schools. The messages communicated by the games have a number of potentially harmful consequences, particularly with regard to the creation of specific health and bodily norms based on a measurable ideal. The use of this tool in education is thus far from value free, and the problems that might be solved when using the games are not necessarily the ones that education should privilege.

Self-Presence and the Effects of the Avatar on Health and Appearance

Self-presence, defined as the degree of connectedness with one's avatar as well as the effects of the avatar on perceptions of oneself, suggests that interactions with an avatar may have real implications for how one perceives and treats the body offline. A study examining the influence of the "Second Life" avatar on "Second Life" users' offline appearance, health, and well-being is discussed, along with the importance of examining self-presence as a theoretical mechanism. This research engages with the idea that immersion with an avatar via social virtual play has an influence on our health offline.

The Use of the Wii Fit in Forensic Mental Health: Exercise for People at Risk of Obesity

Introduction:

Side effects of psychotropic medication often lead to rapid weight gain, having detrimental effects on forensic mental health patients' health, wellbeing, occupational performance and quality of life. Virtual reality technology could provide novel environments and motivating forums for exercise, which are otherwise unavailable to patients in such secure settings. This exploratory study aimed to evaluate the use of the Nintendo Wii Fit in changing engagement in physical activity for patients at risk of obesity at a secure hospital.

Method:

Two participants used a Wii Fit for 8 weeks in individual or group sessions. A mixed methods approach was taken, because participants' use of the Wii Fit was compared with their attitudes towards it (reported during interviews) and their daily physical activity levels (measured using an accelerometer). Researcher field notes were also used to gather contextual data.

Findings:

Participants played Wii Fit up to four times a week in sessions ranging from 7 to 127 minutes. When using the Wii Fit, participants increased their overall time spent actively moving their bodies in physical activity, as measured by the accelerometer. Using the Wii Fit also changed participants' attitudes towards exercise as they realised that it could be ‘fun’ and ‘challenging’, especially if staff members also participated.

Conclusion:

The Wii Fit encouraged patients to attempt physical activities and to learn about their bodily response to exercise. It provided a meaningful occupational intervention in a secure setting and demonstrated a potential use of the technology in mental health settings.