Review and special article
Role of Video Games in Improving Health-Related Outcomes: A Systematic Review

https://doi.org/10.1016/j.amepre.2012.02.023Get rights and content

Context

Video games represent a multibillion-dollar industry in the U.S. Although video gaming has been associated with many negative health consequences, it also may be useful for therapeutic purposes. The goal of this study was to determine whether video games may be useful in improving health outcomes.

Evidence acquisition

Literature searches were performed in February 2010 in six databases: the Center on Media and Child Health Database of Research, MEDLINE, CINAHL, PsycINFO, EMBASE, and the Cochrane Central Register of Controlled Trials. Reference lists were hand-searched to identify additional studies. Only RCTs that tested the effect of video games on a positive, clinically relevant health consequence were included. Study selection criteria were strictly defined and applied by two researchers working independently. Study background information (e.g., location, funding source); sample data (e.g., number of study participants, demographics); intervention and control details; outcomes data; and quality measures were abstracted independently by two researchers.

Evidence synthesis

Of 1452 articles retrieved using the current search strategy, 38 met all criteria for inclusion. Eligible studies used video games to provide physical therapy, psychological therapy, improved disease self-management, health education, distraction from discomfort, increased physical activity, and skills training for clinicians. Among the 38 studies, a total of 195 health outcomes were examined. Video games improved 69% of psychological therapy outcomes, 59% of physical therapy outcomes, 50% of physical activity outcomes, 46% of clinician skills outcomes, 42% of health education outcomes, 42% of pain distraction outcomes, and 37% of disease self-management outcomes. Study quality was generally poor; for example, two thirds (66%) of studies had follow-up periods of <12 weeks, and only 11% of studies blinded researchers.

Conclusions

There is potential promise for video games to improve health outcomes, particularly in the areas of psychological therapy and physical therapy. RCTs with appropriate rigor will help build evidence in this emerging area.

Section snippets

Context

In 2009, U.S. retail sales of video games—including portable and console hardware, software and accessories—totaled more than $19.5 billion,1 which is greater than the gross national product for each of more than 90 world nations.2 In the U.S. and UK, the best-selling video game title of 2010,“Call of Duty: Black Ops,” amassed more revenue in its first day of sales than the biggest-ever first-day sales of any book, record album, or movie, including all Harry Potter and Star Wars titles.3

Today's

Research Question

The research question was defined as: Do results from RCTs indicate that video games can be effective interventions in promoting health and/or improving health outcomes associated with established ICD-9 codes? The scope of the question was not limited based on patient characteristics such as age.

Selection Criteria

A comprehensive research protocol was created (Appendix A, available online at www.ajpmonline.org). For inclusion in this systematic review, studies had to (1) be an RCT; (2) use a video game as the

Study Identification and Selection

The search strategy yielded 1452 unique articles. Of the 1452 articles, 38 (2.6%) met inclusion criteria (Figure 1). The two researchers who reviewed articles for inclusion had substantial agreement after their first independent assessments (% agreement=98.4%; κ=0.70, p<0.0001) according to the Landis and Koch framework.51 After adjudication, consensus was achieved easily in 100% of cases. Each article was assigned a single primary reason for exclusion. The most common reason for study

Discussion

The present study synthesizes the results of 38 RCTs, each of which tested the ability of a video game intervention to promote health and/or ameliorate disease. It finds that video games have been evaluated for a wide variety of health-related purposes among participants of all ages, most commonly for their ability to train patients and clinicians physically or psychologically. However, they also have been studied with respect to health education, disease self-management, distraction from pain,

Conclusion

Despite these limitations, this comprehensive systematic review demonstrates that video games may have potential for improving health in a wide variety of areas, for a variety of sociodemographic groups. This is a valuable finding, particularly given the growing popularity and ubiquity of video games worldwide. To most effectively assess the potential benefits of video games for health, it will be important for further research to utilize (1) RCT methodology when appropriate; (2) longer

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