ABSTRACT
OBJECTIVE: To evaluate whether a mobile health application that employs elements of social game design could compliment medical care for unresolved concussion symptoms. DESIGN: Phase I and Phase II (open-label, non-randomized, ecological momentary assessment methodology). SETTING: Outpatient concussion clinic. PARTICIPANTS: Youth, aged 13-18 years, with concussion symptoms 3+ weeks after injury; Phase I: n = 20; Phase II: n = 19. INTERVENTIONS: Participants received standard of care for concussion. The experimental group also used a mobile health application as a gamified symptoms journal. OUTCOME MEASURES: Phase I: feasibility and satisfaction with intervention (7-point Likert scale, 1 high). Phase II: change in SCAT-3 concussion symptoms (primary), depression and optimism. RESULTS: Phase 1: A plurality of participants completed the intervention (14 of 20) with high use (110 +/- 18% play) and satisfaction (median +/- interquartile range (IQR) = 2.0+/- 0.0). Phase II: Groups were equivalent on baseline symptoms, intervention duration, gender distribution, days since injury and medication prescription. Symptoms and optimism improved more for the experimental than for the active control cohort (U = 18.5, p = 0.028, effect size r = 0.50 and U = 18.5, p = 0.028, effect size r = 0.51, respectively). CONCLUSIONS: Mobile apps incorporating social game mechanics and a heroic narrative may promote health management among teenagers with unresolved concussion symptoms.
Subject(s)
Brain Concussion/diagnosis , Adolescent , Brain Concussion/therapy , Ecological Momentary Assessment , Feasibility Studies , Female , Humans , Male , Mobile Applications , Symptom Assessment , TelemedicineABSTRACT
OBJECTIVE: Technological advances have sparked the development of computer- and smartphone-based self-help programs for depressed people, but these programs' efficacy is uncertain. This randomized controlled trial evaluated an intervention called SuperBetter (SB), which is accessed via smartphone and/or the SB Web site. MATERIALS AND METHODS: Online, we recruited 283 adult iPhone(®) (Apple, Cupertino, CA) users with significant depression symptoms according to the Center for Epidemiological Studies Depression questionnaire (CES-D). They were randomly assigned to one of three conditions: (a) a version of SB using cognitive-behavioral therapy and positive psychotherapy strategies to target depression (CBT-PPT SB); (b) a general SB version focused on self-esteem and acceptance (General SB); or (c) a waiting list control group (WL). The two SB groups were instructed to use SB for 10 minutes daily for 1 month. All participants completed psychological distress and well-being measures online every 2 weeks through follow-up. An intent-to-treat analysis was conducted using hierarchical linear modeling. RESULTS: As hypothesized, SB participants achieved greater reductions in CES-D scores than WL participants by posttest (Cohen's d=0.67) and by follow-up (d=1.05). Contrary to prediction, CBT-PPT SB did not perform better than General SB; both versions of SB were more effective than the WL control. Differences between SB versions favored General SB but were not statistically significant. CONCLUSIONS: These large effect sizes should be interpreted cautiously in light of high attrition rates and the motivated, self-selected sample. Nonetheless, smartphone-based/Internet-based self-help may play an important role in treating depression.
