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Rheumatoid arthritis
Original research
Gaming for Adherence to Medication using Ehealth in Rheumatoid arthritis (GAMER) study: a randomised controlled trial
  1. Bart P H Pouls1,2,
  2. Charlotte L Bekker2,
  3. Fatma Gundogan3,
  4. Renske CF Hebing4,
  5. Hein AW van Onzenoort2,5,
  6. Liesbeth I van de Ven6,
  7. Harald E Vonkeman7,8,
  8. Rob Tieben9,
  9. Johanna E Vriezekolk1,
  10. Sandra van Dulmen10,11,12 and
  11. Bart Van den Bemt1,2
  1. 1 Research & Innovation, Sint Maartenskliniek, Ubbergen, Gelderland, The Netherlands
  2. 2 Department of Pharmacy Radboudumc, Radboud Institute for Health Sciences, Nijmegen, Gelderland, The Netherlands
  3. 3 Pharmacy, Gelre Ziekenhuizen Apeldoorn, Apeldoorn, Gelderland, The Netherlands
  4. 4 Pharmacy, Amsterdam Rheumatology and immunology Centre Reade, Amsterdam, Noord Holland, The Netherlands
  5. 5 Pharmacy, Amphia Hospital, Breda, North Brabant, The Netherlands
  6. 6 Pharmacy, Maastricht UMC+, Maastricht, Limburg, The Netherlands
  7. 7 Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente, Enschede, The Netherlands
  8. 8 Department of Psychology, Health & Technology, University of Twente, Enschede, The Netherlands
  9. 9 Research, Development and Innovation, Game Solutions Lab, Eindhoven, The Netherlands
  10. 10 Healthcare Communication, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
  11. 11 Department of Primary and Community Care Radboudumc, Radboud Institute for Health Sciences, Nijmegen, Gelderland, The Netherlands
  12. 12 Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
  1. Correspondence to Dr Bart P H Pouls; bart.pouls{at}radboudumc.nl

Abstract

Objective To examine the effect on adherence to disease modifying anti-rheumatic drugs (DMARDs) in participants with rheumatoid arthritis (RA) of a serious game that targeted implicit attitudes toward medication.

Methods A multicentre randomised controlled trial (RCT) was performed with adults with RA that used DMARDs and possessed a smartphone/tablet. Control and intervention groups received care as usual. The intervention group played the serious game at will during 3 months. Game play data and online questionnaires Compliance Questionnaire on Rheumatology (CQR), Beliefs about Medicine Questionnaire (BMQ), Health Assessment Questionnaire (HAQ) and Rheumatoid Arthritis Disease Activity Index (RADAI) were collected. Primary outcome was DMARD implementation adherence operationalised as the difference in proportion of non-adherent participants (<80% taking adherence) between intervention and control group after 3 months using a Chi-squared test. Two sample t-tests and Wilcoxon rank-sum test were performed to test for differences on secondary outcomes.

Results Of the 110 intervention participants that started the study, 87 participants (79%) installed the game and had a median playtime of 9.7 hours at 3 months. Overall, 186 participants completed the study. Adherence in intervention group (63%) and control group (54%) did not differ significantly (p=0.13) at 3 months. Neither were there differences oberved in CQR continuous score, beliefs about medication (BMQ) or clinical outcomes (HAQ and RADAI).

Conclusion A serious game aimed at reinterpreting attitudes toward medication failed to show an effect on adherence to DMARDs or clinical outcomes in patients with RA. The game was played frequently indicating that it can be an effective channel for reaching patients.

Trial registration number NL7217.

  • Rheumatoid Arthritis
  • Antirheumatic Agents
  • Health services research

Data availability statement

Data are available upon reasonable request. The data underlying this article will be shared on reasonable request to the corresponding author.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/rmdopen-2022-002616

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    Data availability statement

    Data are available upon reasonable request. The data underlying this article will be shared on reasonable request to the corresponding author.

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    Footnotes

    • Contributors Substantial contributions to study conception and design: BPHP, CLB, RT, SvD, BVdB; substantial contributions to data acquisition: BPHP, FG, RCFH, HEV, HAWvO, LIvdV; substantial contributions to analysis and interpretation of the data: BPHP, CLB, RT, SvD, BVdB; drafting the article or revising it critically for important intellectual content: BPHP, CLB, FG, RCFH, HEV, HAWvO, LIvdV, RT, SvD, BVdB; final approval of the version of the article to be published: BPHP, CLB, FG, RCFH, HEV, HAWvO, LIvdV, RT, SvD, BVdB. Guarantor: BPHP.

    • Funding This work was supported by AbbVie Inc. AbbVie Inc. did not have any influence on the conduct, results or interpretation of findings of this study.

    • Competing interests BPHP, CLB, FG, RCFH, HAWvO, LIvdV, RT and SvD have no conflicts of interest to report. HEV reports grants and/or personal fees from AbbVie, Amgen, AstraZeneca, BMS, Celgene, Celltrion, Galapagos, Gilead, GSK, Janssen-Cilag, Lilly, MSD, Novartis, Pfizer, Roche, Sanofi-Genzyme, UCB all outside the submitted work. JEV reports speakers’ fees from Eli Lilly and Galapagos all outside the submitted work. BVdB reports grants and/or personal fees from UCB, Pfizer, Sanofi-Aventis, Galapagos, Amgen en Eli Lilly all outside the submitted work.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.