A Mixed-Methods Feasibility Study of a Gamified Therapy Prescription App for Children with Neurodisability

Abstract

Aim

Determine the feasibility of a gamified therapy (occupational therapy, physiotherapy, speech pathology) prescription app developed for children with neurodisability for delivering school and home therapy programs (the Zingo app).

Method

A mixed-methods feasibility study was conducted with children (and their parents, therapists, and teachers) with neurodisability (n = 8, female= 5) who were prescribed a 4-week individualized therapy program by their usual treating therapist using Zingo. Primary outcome measures were program adherence, engagement, app quality, and user experience, collected with quantitative and qualitative methods.

Results

Mean adherence to the program was 58.0% (SD 27.2). Our combined Engagement Index (EI) score was 74.4% (SD 11.7). App quality measured using Mobile Application Rating Scale- User version was 4.6/5 (SD 0.7, n = 6) for parents, 4.6/5 (SD 0.5, n = 5) for teachers, and 4.4/5 (SD 0.6, n = 6) for therapists. Thematic analysis of semi-structured interviews yielded a primary theme of “app as motivator” for therapy.

Conclusions

Adherence findings were affected by COVID-19 outbreak however remain comparable with other studies in this cohort. EI findings compared favorably with other studies. The findings are supportive of the feasibility of Zingo for delivering home and school therapy programs for children with neurodisability and was found to motivate therapy program completion.

Keywords:

• Mobile health technology
• occupational therapy
• pediatrics
• physical therapy
• physiotherapy
• speech pathology

Acknowledgements

We would like to acknowledge the therapists, teachers, education assistants, parents and children with disabilities who contributed to this project.

Authors’ Contributions

RJ conceived the idea for the trial, reviewed literature, sought ethical approval, coordinated recruitment, implemented outcome measures, conducted quantitative analyses, reviewed interview scripts and co-conducted thematic analysis, and drafted the paper. BW provided guidance on the development of the algorithm for the Engagement Index, guidance on app quality and user experience testing, reviewed the interview scripts and co-conducted thematic analysis, and edited the paper. NG assisted development of the trial concept, reviewing literature, ethical approval, and edited the paper. DG provided supervision of project, consulted on behavioral science elements, guided the literature review, ethical approval, and editing the paper. SW provided supervision around the concept of the trial, literature review, ethics application, and edited the paper.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Disclosure Statement

BW is a co-founder of Reach Health Promotion Innovations, which developed the Zingo App in partnership with Ability WA. There are no other competing interests to declare.

Additional information

Funding

This work is supported by a research grant from the study Non-Government Center Support (NGCS), Department of Education, Government of Western Australia (NGCS did not issue a grant number); Australian Government Research Training Program (RTP) Scholarship; and in-kind support from Ability WA, Western Australia. NGCS and RTP do not hold influence over study design; collection, management, analysis, and interpretation of data; writing of the report; and the decision to submit the report for publication

Notes on contributors

Rowan W. Johnson

Rowan W. Johnson, BSc, is a PhD candidate at Curtin University and a physiotherapist with extensive experience in therapy provision for children with disability. His current role at Perth Children’s Hospital is to establish a new community rehabilitation service. Rowan’s research investigates the potential for mobile health technology to improve children’s engagement with home therapy programs.

Becky K. White

Becky K. White, PhD, is an adjunct research fellow in the School of Population Health, Curtin University and director at Reach Health Promotion Innovations. With a health promotion background, Becky’s primary research focus is on digital health, social listening, gamification, user engagement, and digital inclusion.

Noula Gibson

Noula Gibson, PhD, is a Research Coordinator Physiotherapist at Perth Children’s Hospital where she is both a clinician and supports physiotherapists in research and evidence-based practice. She has over 25 years’ clinical experience in pediatric rehabilitation for children with neurological diagnoses and other complex pediatric medical illnesses. Noula’s publications and research interests are focussed on rehabilitation for children with neurological injury and preventing respiratory illness in cerebral palsy. She holds adjunct positions with Curtin University and the Telethon Kids Institute in Perth, Western Australia.

Daniel F. Gucciardi

Daniel F. Gucciardi, PhD, is a Professor in the Curtin School of Allied Health, Curtin University. Daniel’s research portfolio sits at the interface of the psychological and behavioral sciences, and utilizes basic and applied research paradigms to advance knowledge and practice on the complexities of human performance and health.

Sîan A. Williams

Sîan A. Williams, PhD, is a Senior Lecturer in the Curtin School of Allied Health, Curtin University, and Senior Research Fellow at the Liggins Institute, University of Auckland. With a background as a Clinical Exercise Physiologist and biomechanist, the primary focus of her research is related to pediatric disability (predominantly cerebral palsy), rehabilitation and physical activity, and muscle morphology and function.