Validation of a Portable Game Controller to Assess Peak Expiratory Flow Against Conventional Spirometry in Children: Cross-sectional Study

Abstract

Background International asthma guidelines recommend the monitoring of peak expiratory flow (PEF) as part of asthma self-management in children and adolescents who poorly perceive airflow obstruction, those with a history of severe exacerbations, or those who have difficulty controlling asthma. Measured with a peak flow meter, PEF represents a person’s maximum speed of expiration and helps individuals to follow their disease evolution and, ultimately, to prevent asthma exacerbations. However, patient adherence to regular peak flow meter use is poor, particularly in pediatric populations. To address this, we developed an interactive tablet-based game with a portable game controller that can transduce a signal from the user’s breath to generate a PEF value. Objective The purpose of this study was to evaluate the concordance between PEF values obtained with the game controller and various measures derived from conventional pulmonary function tests (ie, spirometry) and to synthesize the participants’ feedback. Methods In this cross-sectional multicenter study, 158 children (aged 8-15 years old) with a diagnosis or suspicion of asthma performed spirometry and played the game in one of two hospital university centers. We evaluated the correlation between PEF measured by both the game controller and spirometry, forced expiratory volume at 1 second (FEV1), and forced expiratory flow at 25%-75% of pulmonary volume (FEF25-75), using Spearman correlation. A Bland-Altman plot was generated for comparison of PEF measured by the game controller against PEF measured by spirometry. A post-game user feedback questionnaire was administered and analyzed. Results The participants had a mean age of 10.9 (SD 2.5) years, 44% (71/158) were female, and 88% (139/158) were White. On average, the pulmonary function of the participants was normal, including FEV1, PEF, and FEV1/forced vital capacity (FVC). The PEF measured by the game controller was reproducible in 96.2% (152/158) of participants according to standardized criteria. The PEF measured by the game controller presented a good correlation with PEF measured by spirometry (r=0.83, P<.001), with FEV1 (r=0.74, P<.001), and with FEF25-75 (r=0.65, P<.001). The PEF measured by the game controller presented an expected mean bias of –36.4 L/min as compared to PEF measured by spirometry. The participants’ feedback was strongly positive, with 78.3% (123/157) reporting they would use the game if they had it at home. Conclusions The game controller we developed is an interactive tool appreciated by children with asthma, and the PEF values measured by the game controller are reproducible, with a good correlation to values measured by conventional spirometry. Future studies are necessary to evaluate the clinical impact this novel tool might have on asthma management and its potential use in an out-of-hospital setting.

Development and Testing of a Data Capture Device for Use With Clinical Incentive Spirometers: Testing and Usability Study

“…Gamification of medical interventions is an exciting concept for improving medical care adherence. Breathing games for the incentive spirometer is a familiar idea, with one group brainstorming a suite of games for asthmatics focusing on breathing metaphors as incentives for spirometer use [ 26 ], while others developed video games to incentivize breathing exercises and peak expiratory flow using digital flowmeters [ 18 , 27 ]. There exists an abandoned patent around the use of the incentive spirometer as a game controller [ 28 ] and an active patent around use of the flowmeter in video games [ 29 ], further supporting the popularity of the idea.…”

Acceptability of Serious Games in Pediatric Asthma Education and Self-management: Pilot Study

“…Both games were translated and are now accessible in French, English, Spanish, Chinese, Russian, Arabic, Portuguese, Japanese, Vietnamese, Korean, Farsi, Turkish, German, and Italian. In addition, our team conducted a second study, where 158 children tested a game played using a breath-activated controller, which enables the assessment of one's breathing capacity [34].…”