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

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. Mea...

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Autores principales: Chelabi, Khadidja, Balli, Fabio, Bransi, Myriam, Gervais, Yannick, Marthe, Clement, Tse, Sze Man
Formato: Online Artículo Texto
Lenguaje:English
Publicado: JMIR Publications 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7880812/
https://www.ncbi.nlm.nih.gov/pubmed/33512326
http://dx.doi.org/10.2196/25052
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author Chelabi, Khadidja
Balli, Fabio
Bransi, Myriam
Gervais, Yannick
Marthe, Clement
Tse, Sze Man
author_facet Chelabi, Khadidja
Balli, Fabio
Bransi, Myriam
Gervais, Yannick
Marthe, Clement
Tse, Sze Man
author_sort Chelabi, Khadidja
collection PubMed
description 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 (FEV(1)), and forced expiratory flow at 25%-75% of pulmonary volume (FEF(25-75)), 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 FEV(1), PEF, and FEV(1)/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 FEV(1) (r=0.74, P<.001), and with FEF(25-75) (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.
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spelling pubmed-78808122021-02-23 Validation of a Portable Game Controller to Assess Peak Expiratory Flow Against Conventional Spirometry in Children: Cross-sectional Study Chelabi, Khadidja Balli, Fabio Bransi, Myriam Gervais, Yannick Marthe, Clement Tse, Sze Man JMIR Serious Games Original Paper 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 (FEV(1)), and forced expiratory flow at 25%-75% of pulmonary volume (FEF(25-75)), 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 FEV(1), PEF, and FEV(1)/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 FEV(1) (r=0.74, P<.001), and with FEF(25-75) (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. JMIR Publications 2021-01-29 /pmc/articles/PMC7880812/ /pubmed/33512326 http://dx.doi.org/10.2196/25052 Text en ©Khadidja Chelabi, Fabio Balli, Myriam Bransi, Yannick Gervais, Clement Marthe, Sze Man Tse. Originally published in JMIR Serious Games (http://games.jmir.org), 29.01.2021. https://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Serious Games, is properly cited. The complete bibliographic information, a link to the original publication on http://games.jmir.org, as well as this copyright and license information must be included.
spellingShingle Original Paper
Chelabi, Khadidja
Balli, Fabio
Bransi, Myriam
Gervais, Yannick
Marthe, Clement
Tse, Sze Man
Validation of a Portable Game Controller to Assess Peak Expiratory Flow Against Conventional Spirometry in Children: Cross-sectional Study
title Validation of a Portable Game Controller to Assess Peak Expiratory Flow Against Conventional Spirometry in Children: Cross-sectional Study
title_full Validation of a Portable Game Controller to Assess Peak Expiratory Flow Against Conventional Spirometry in Children: Cross-sectional Study
title_fullStr Validation of a Portable Game Controller to Assess Peak Expiratory Flow Against Conventional Spirometry in Children: Cross-sectional Study
title_full_unstemmed Validation of a Portable Game Controller to Assess Peak Expiratory Flow Against Conventional Spirometry in Children: Cross-sectional Study
title_short Validation of a Portable Game Controller to Assess Peak Expiratory Flow Against Conventional Spirometry in Children: Cross-sectional Study
title_sort validation of a portable game controller to assess peak expiratory flow against conventional spirometry in children: cross-sectional study
topic Original Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7880812/
https://www.ncbi.nlm.nih.gov/pubmed/33512326
http://dx.doi.org/10.2196/25052
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