Gamified assessments of pediatric upper extremity function: A systematic review and appraisal.

Abstract

Background: Assessing upper extremity function accurately in the clinic hinges on valid, reliable outcome measures and patient engagement. Especially in pediatric care and research, video-game-based and play-based assessments may help motivate performance and support more effective clinical evaluation.

Purpose: This systematic review critically appraised the gamified assessments available for pediatric upper extremity function.

Study design: Systematic review (PROSPERO: CRD42023460034).

Methods: Databases included PubMed, Embase, CINAHL, and Scopus. Eligible studies evaluated psychometrics and included children under 18 years. Following preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, two reviewers independently screened studies, extracted data, assessed risk of bias, and rated psychometrics and evidence quality by the COnsensus-based Standards for selection of health Measurement INstruments (COSMIN) methodology.

Results: Reviewers screened 2513 studies; 27 reports describing nine outcome measures were included. The observer-rated Assisting Hand Assessment (AHA) family, which includes four age-based versions for children with unilateral hand dysfunction and the Both Hands Assessment for bilateral dysfunction, has extensive psychometric evidence. These are well-structured, reliable, and feasible assessments that engage patients with age-appropriate toys and board games while evaluating functions such as grasp, fine-motor adjustment, and bimanual coordination. Validation for additional upper extremity conditions is warranted. We also recommend two video-game-based kinematic measures, which quantify upper extremity function objectively. Abilities Captured Through Interactive Video Evaluation (ACTIVE) is appropriate for degenerative neuromuscular diseases; ACTIVE was the only kinematic assessment in this review with at least moderate-quality evidence of sufficient psychometrics. However, based on preliminary evidence, a recently developed dragon-themed video game is a strong candidate for quantifying joint range of motion, potentially serving a broader patient population than ACTIVE.

Conclusions: Overall, we endorse the AHA family as a set of well-structured, reliable, and feasible observer-rated assessments that engage patients through play sessions thoughtfully geared toward different developmental stages. Two kinematic measures are promising and warrant further study.