A neurofeedback-based intervention to reduce post-operative pain in lung cancer patients: study protocol for a randomized controlled trial

Who Engages and Why It Matters?

While the use and benefits of serious games in health care are increasingly recognized, the impact of individuals' game engagement remains understudied, limiting the potential for impact. This pilot study aims to describe game engagement and its associations with learning outcomes, sociodemographics, and health factors in women with advanced cancer receiving a 12-week self-advocacy serious game intervention. Game engagement was collected from study tablets and weekly self-reported surveys. Participants' game engagement was overall high but with large amounts of variation and did not differ by their sociodemographics and health factors. Participants with lower baseline symptom severity were more likely to repeat game scenarios, and those who engaged in all scenarios had higher connected strength post-intervention. Knowing what prevents patients with advanced cancer from engaging in the serious game enlightens ways to refine the gamified interventions. Future research is suggested to evaluate patients' engagement to deepen understanding of its impacts on learning outcomes.

Source localized infraslow neurofeedback training in people with chronic painful knee osteoarthritis: A randomized, double-blind, sham-controlled feasibility clinical trial

Persistent pain is a key symptom in people living with knee osteoarthritis (KOA). Infra-slow Neurofeedback (ISF-NF) training is a recent development focusing on modulating cortical slow-wave activity to improve pain outcomes. A parallel, two-armed double-blinded, randomized sham-controlled, feasibility clinical trial aimed to determine the feasibility and safety of a novel electroencephalography-based infraslow fluctuation neurofeedback (EEG ISF-NF) training in people with KOA and determine the variability of clinical outcomes and EEG changes following NF training. Eligible participants attended nine 30-min ISF-NF training sessions involving three cortical regions linked to pain. Feasibility measures were monitored during the trial period. Pain and functional outcomes were measured at baseline, post-intervention, and follow-up after 2 weeks. Resting-state EEG was recorded at baseline and immediate post-intervention. Participants were middle-aged (61.7 ± 7.6 years), New Zealand European (90.5%), and mostly females (62%) with an average knee pain duration of 4 ± 3.4 years. The study achieved a retention rate of 91%, with 20/22 participants completing all the sessions. Participants rated high levels of acceptance and “moderate to high levels of perceived effectiveness of the training.” No serious adverse events were reported during the trial. Mean difference (95% CI) for clinical pain and function measures are as follows for pain severity [active: 0.89 ± 1.7 (−0.27 to 2.0); sham: 0.98 ± 1.1 (0.22–1.7)], pain interference [active: 0.75 ± 2.3 (−0.82 to 2.3); Sham: 0.89 ± 2.1 (−0.60 to 2.4)], pain unpleasantness [active: 2.6 ± 3.7 (0.17–5.1); sham: 2.8 ± 3 (0.62–5.0)] and physical function [active: 6.2 ± 13 (−2.6 to 15); sham: 1.6 ± 12 (−6.8 to 10)]. EEG sources demonstrated frequency-specific neuronal activity, functional connectivity, and ISF ratio changes following NF training. The findings of the study indicated that the ISF-NF training is a feasible, safe, and acceptable intervention for pain management in people with KOA, with high levels of perceived effectiveness. The study also reports the variability in clinical, brain activity, and connectivity changes following training.

Cancer patients' participation and commitment to psychological interventions: a scoping review

OBJECTIVE

Some psychological interventions have been developed to improve cancer patients' and survivors' quality of life, well-being, and health engagement. However, studies are usually focused on effectiveness and less on factors influencing survivors' decision to participate, both subjective (e.g., needs) and contingent (e.g., factors related to participation/non participation). This scoping review identifies factors influencing participation, decline to participate, attrition and adherence in psychological interventions.

METHODS

3 electronic databases were searched for published studies on psychological interventions. Retrieved publications were scanned by authors against inclusion criteria and forty-two articles were selected. Relevant information were summarized narratively.

RESULTS

More information is available on attrition and factors related to participation/non participation, so that future psychological interventions may employ ad-hoc tools to take into consideration patients' reasons to adhere to psychological interventions. Secondarily, non-participation/dropout is often linked to factors related to intervention' commitment and its interference with daily life. On the contrary, patients' reasons to participate often identify with the value they find in the intervention according to their personal needs and experience of illness.

CONCLUSION

We suggest that future research should analyze patients' representation of psychological interventions and take them into account to tailor the interventions on participants' lived experience, to improve participation.

Digital health & low-value care

Digital health advances offer a multitude of possibilities to improve public health and individual wellbeing. Little attention has been paid, however, to digital health's potential to create low-value care - the reduction of which is increasingly appreciated as a policy priority. This commentary provides a framework to illustrate the potential for consumer-facing digital health to generate three distinct categories of low-value care; 1) ineffective care because it is underdeveloped, 2) inefficient care because it supplements rather than substitutes, or 3) unwanted care because it is not aligned with clinician and patient preferences. We offer specific policy recommendations to reduce each type of low-value care.

Mapping Behavioral Health Serious Game Interventions for Adults With Chronic Illness: Scoping Review

BACKGROUND

Serious games for health are increasingly being used to address health outcomes in patients with chronic illnesses. These studies vary in their study designs, patient populations, frameworks, outcome variables, and degree of specificity of the serious game intervention.

OBJECTIVE

This scoping review aims to clarify the conceptual features of the existing research related to serious games designed to improve cognitive and behavioral outcomes in adults with chronic illness.

METHODS

We applied the Preferred Reporting Items of Systematic Reviews and Meta-Analysis for scoping reviews (PRISMA-ScR) methodology, including an a priori research question. We searched 4 electronic databases to identify articles published through November 2019. Inclusion criteria encompassed (1) adults 18 years or older; (2) patients with a diagnosis of chronic illness; (3) a serious game intervention; and (4) defined patient outcomes that assess patients' behavioral, cognitive, or health outcomes.

RESULTS

Of the 3305 articles identified, 38 were included in the review. We charted and analyzed the theoretical frameworks, key concepts, and outcome variables of these studies with summaries of features across articles. The majority of studies used a randomized controlled trial design (23/38, 61%), included a custom serious game intervention (22/38, 58%), and lacked a theoretical framework (25/38, 66%). Common outcome variables included quality of life (16/38, 42%), mood (15/38, 39%), cognitive function (13/38, 34%), symptoms (12/38, 32%), and physical activity (9/38, 24%). Key differences between studies included whether or not serious games aimed to train versus teach patients, be widely accessible versus tailored interventions, or replace versus complement current treatments.

CONCLUSIONS

This scoping review defines the current landscape of research in serious games for health research targeting behavioral and cognitive outcomes in adults with chronic disease. Studies have addressed a variety of patient populations and diverse patient outcomes. Researchers wanting to build on the current research should integrate theoretical frameworks into the design of the intervention and trial to more clearly articulate the active ingredients and mechanisms of serious games.

A Systematic Review of the Effect of Neurofeedback in Cancer Patients

Introduction: Neurofeedback (NF) or electroencephalogram (EEG)-Biofeedback is a drug-free form of brain training to directly alter the underlying neural mechanisms of cognition and behavior. It is a technique that measures a subject’s EEG signal, processes it in real time, with the goal to enable a behavioral modification by modulating brain activity. The most common application of the NF technology is in epilepsies, migraine, attention-deficit/hyperactivity disorder, autism spectrum disorder, affective disorders, and psychotic disorders. Few studies have investigated the use of NF in context of psychosomatic illnesses. Little is known about the use in cancer patients or postcancer survivors despite the high number of this patient group. Objectives: We here provide a systematic review of the use and effect of NF on symptoms and burden in cancer patients and long-term cancer survivors. Methods: In conducting this systematic review, we followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Statement. Results: Our search resulted in only 3 experimental studies, 1 observational study, and 2 case reports. Given the heterogeneity of the intervention systems and protocols, no meta-analysis was conducted. Conclusion: Altogether, there is initial evidence that NF is a complementary, drug-free, and noninvasive therapy that has the potential to ameliorate symptoms in this patient group, such as pain, fatigue, depression, and sleep. Further studies are highly needed.

COMPLEX TREATMENT OF AMYOTROPHIC LATERAL SCLEROSIS PATIENT

Amyotrophic lateral sclerosis is a progressive and fatal degenerative neuromuscular disease with few if any treatment options and physical rehabilitation addressing specific deficits is the most frequent form of therapy. Patients also suffer from depression and increased anxiety. Our purpose was to assess the neurorehabilitation effectiveness in a patient with amyotrophic lateral sclerosis who underwent stem cell transplantation but refused physiotherapy due to depression. Disease progression was followed using the revised Amyotrophic Lateral Sclerosis Functional Rating Scale bimonthly for six months pre- and then post-stem cell transplantation. Psychological traits were assessed using six standardized tests. Quantitative electroencephalogram diagnostics was performed before the first and after the last neurofeedback session, and sessions were conducted on a 3-times-a-week basis. The physiotherapy protocol included proprioceptive neuromuscular facilitation, electrical modalities unit applied to the lumbar spine area, and breathing, relaxation and walking exercises, among others. Increased motivation and marked decrease in the pain level was associated with the patient's willingness to complete physiotherapy, which resulted in improvements in most neuromuscular deficits and in increased respiratory capacity. During the 12 post-rehabilitation months, progression of the disease decelerated, and a positive behavioral change was noted. The study suggested that neurofeedback could be used as a neurorehabilitation component of the personalized complex rehabilitation protocol in patients with amyotrophic lateral sclerosis.

The Effect of Comedy Films on Postoperative Pain and Anxiety in Surgical Oncology Patients

Objectives: To determine the effect of watching Turkish comedy films on postoperative pain and anxiety in oncology surgical patients. Design: This study was conducted using a pre- and post-test randomized controlled trial model. Materials and Methods: The study was conducted in a general surgery clinic of a hospital in eastern Turkey between January 2016 and January 2017. The sample of the study consisted of 88 patients (44 test, 44 control) selected by using the randomized sampling method. In the experimental group, funny videos from Turkish old comedy movies were watched for 10 min before surgery. Anxiety, measured by the State-Trait Anxiety Inventory, and vital signs were measured before and after the experimental protocol. In the analysis of the data, descriptive statistics, χ2 and t test were used. Results: The state-trait anxiety pre- and post-test mean score of the experimental group was found to be 39.59 ± 3.66 and 37.54 ± 3.52 before and after watching the video, respectively, indicating a statistically significant difference between these two values (p ≤ 0.05). No statistically significant difference was found between the pre- and post-test state-trait anxiety scores of the patients in the control group. The decrease from the pre- to post-test mean pain score was determined as 0.65 ± 1.05 in the experimental group and 0.11 ± 0.96 in the control group. A statistically significant difference was found between the groups’ post-test mean pain scores (p ≤ 0.05). Conclusion: The study results suggest that watching Turkish comedy movie videos has a positive effect on postoperative pain and anxiety in surgical oncology patients.