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- Exergames to improve Rehabilitation after Anterior Cruciate Ligament Injury: Systematic review and GRADE evidence synthesisPublication . Fernandes, Carla Sílvia; Magalhães, Bruno; Gomes, José Augusto; Santos, CéliaIntroduction Exergames are a fun, engaging, and interactive form of exercise that has been used in rehabilitation. This systematic review aimed to evaluate the effectiveness of exergames compared to usual rehabilitation after anterior cruciate ligament reconstruction. Method We performed a Systematic Review and GRADE evidence synthesis. The PRISMA guidelines for systematic reviews were followed. MEDLINE® (Medical Literature Analysis and Retrieval System Online), CINAHL® (Cumulative Index to Nursing and Allied Health Literature), SPORTDiscus, SCOPUS, SciELO (Scientific Electronic Library Online), Cochrane Central Register of Controlled Trials, and PEDro (Physiotherapy Evidence Database) were searched from their first record to May 2021. Randomised controlled trials using exergames as an intervention were included. Results Initial literature searches yielded 794 non-duplicated records. After exclusion based on title, abstract, and full text review, five articles were included for analysis. Compared with the control group, the participants in the exergames group showed differences in proprioception and flexion angle difference. Conclusion Although there is no conclusive evidence that favours exergames over traditional rehabilitation, they did not aggravate the effects of rehabilitation. Nonetheless, exergames can be safe and motivating.
- Game2FamilyNursing: Study of a digital game to promote knowledge about family nursingPublication . Fernandes, Carla Sílvia; Campos, Maria Joana; Angelo, Margareth; Martins, MMBackground & Aim: The practice of family-centered nursing care brings positive benefits to health care. This article aims to describe the perception and usability of a game to promote knowledge about family assessment and intervention. Methods & Materials: A descriptive, cross-sectional study was conducted involving 102 nurses and nursing degree students in the second half of 2021. The evaluation was performed using the game usability instrument (System Usability Scale, SUS), the Intrinsic Motivation Inventory, and open questions about the game's advantages and disadvantages. Results: The average score obtained by applying the SUS was high, with a mean of 81.37. In addition, high mean values were observed in all dimensions of the Intrinsic Motivation Inventory. Concerning the game’s advantages and disadvantages, 198 codes were grouped into seven categories and 30 subcategories, highlighting more advantages than disadvantages. Conclusion: Overall, participants evaluated the game positively. Our findings suggest that using "Game2FamilyNursing" could be helpful and contribute as an educational tool in family nursing training.
- Exergames to improve rehabilitation after knee arthroplasty: a systematic review and grade evidence synthesisPublication . Fernandes, Carla Sílvia; Magalhães, Bruno; Gomes, José Augusto; Lima, Andreia; Santos, CéliaObjective: We aimed to systematically review and synthesise the impact of rehabilitation with games in people after knee arthroplasty. Methods: We conducted a systematic review following the Preferred Reporting Items for the declaration of Systematic Reviews (PRISMA – Preferred Reporting Items for Systematic Reviews and Meta- Analysis). The summary of evidence was developed using the Grading of Recommendations, Assessment, Development, and Assessment (GRADE). The review included randomised controlled trials that used characteristics of games in rehabilitation. Results: Eight articles from a total of 1289 identified articles were included after duplicates were removed. In total, 239 participants participated. There were no statistically significant changes between the groups using the exergames and control groups. The level of evidence was rated using GRADE and was very low or moderate. The difference in grouped means was not significant for Knee Flexion, Knee extension, Range of Motion, WOMAC (Western Ontario and McMaster Universities Arthritis Index), AKSS (American Knee Society Score), Self-Efficacy, Five Times Sit-to-Stand Test time, Pain, or Proprioception. Conclusions: The results of the different studies did not find significant changes in the intervention groups with exergames in the physical domains, especially in studies with shorter interventions. Therefore, further investment in future studies on developing and evaluating games is suggested to enhance training during the recovery process.
- “The Ark of Rights”: Development of a Board Game to Empower Older Adults Regarding Their RightsPublication . Fernandes, Carla Sílvia; Neto, Camila; Silva, Catarina; Dionísio, Sara; Oliveira, Susana; Amorim, Isabel; Matos, Alice Delerue; Martins, MMThere is an urgent need to ensure the rights of older adults. In particular, there is a lack of awareness of human rights by older adults themselves, for which intervention strategies should be developed. Due to the need for intervention at this level, a board game was created to empower older adults regarding their rights using a dynamic and interactive method. This article aims to describe the development stages of the board game “The Ark of Rights”® up to its pilot study. Its development followed three stages: A first phase to review the scientific literature and benchmarks on the rights of older persons, a second phase to define the game design and collect statements from older people for the game, and a third phase to test the game. The European Portuguese Validation of the System Usability Scale (SUS) was used to assess the latter phase. Approximately 200 older people contributed to the game’s contents (second phase), and 74 participated and positively evaluated the game’s usability and their satisfaction with its use (third phase). In summary, the game “The Ark of Rights” revealed itself to be a resource for empowering older adults regarding their rights. It also enables the identification of possible human rights violations among older adults and subsequent intervention.
- Developing a Card Game for Assessment and Intervention in the Person and the Family in Palliative Care: “Pallium Game”Publication . Fernandes, Carla Sílvia; Vale, M. Belém; Magalhães, Bruno; Castro, João P.; Azevedo, Marta D.; Lourenço, MarisaAbstract: Communication between the multidisciplinary team, the person, and the family in palliative and end-of-life situations implies, in most situations, a high negative emotional burden. Therefore, innovative strategies are needed to reduce it. The goal of this study is to describe the various stages of development and validation of a collaborative card game for people in palliative care and their families. Phase one is an exploratory study, Phase two is a Delphi study, and Phase three is a multiple case study. Participants for phases 2 and 3 were recruited using a convenience sampling method. The results demonstrate in an organized and structured way the different phases required to build a collaborative card game. The use of the game was found to be useful and effective. Four categories emerged from the content analysis of the open-ended responses: usability, evaluation tool, communication and therapeutic relationship, and meaning when using the game. A collaborative game in palliative care helps to create a space for individuals and families to express feelings and experiences, meeting the myriad of physical, psychosocial, and spiritual needs. The “Pallium game” is a useful and impactful approach to discussing sensitive topics in palliative care.
- Exploring the use of games in palliative care: A scoping reviewPublication . Lourenço, Marisa; Fernandes, Carla Sílvia; Vale, Maria Belém Rego CamposObjective There has been increasing recognition of the potential of games in health; however, knowledge of their application in palliative care is lacking. Therefore, this study aimed to identify and map the available evidence on the use of games in palliative care, analyzing how research has been conducted on this topic and identifying gaps in knowledge. Method A scoping review was carried out. The literature search was conducted using the respective descriptors and search syntax appropriate to each of the databases searched. The review included all study types with no time limits. Results Of the 685 articles initially identified, 53 were included for final analysis. Several different game types were identified, with the majority of studies using role-play (n = 29) and card games (n = 17). The games analyzed were essentially aimed at empowering patients (n = 14), and in some cases, extended to families or caregivers, as well as to medical and nursing students. The analysis of the articles in this review resulted in two major themes: Role-playing for training in palliative care and card games to discuss end-of-life care. Significance of results Games allow space for the expression of emotions and promote creativity. They can be applied both in a training context, to enable health professionals to develop essential skills in palliative care, and for patients, families, and caregivers, allowing them to talk about serious things while playing.
- Impact of Exergames on the Mental Health of Older Adults: A Systematic Review and GRADE Evidence SynthesisPublication . Fernandes, Carla Sílvia; Magalhães, Bruno; Lima, Andreia; Nóbrega, Perpétua; Silva, Mafalda; Santos, CéliaExergames, which combine digital games and physical exercise, have become a popular alternative to traditional exercise programs and are increasingly used in the health domains. This study aimed to provide a systematic review to synthesize existing studies on the use of exergames for the mental wellbeing of healthy older adults, aggregating the collected data to identify effect size. We performed a Systematic Review and Grading of Recommendations, Assessment, Development, and Assessment (GRADE) evidence synthesis. We performed the search in the following databases: MEDLINE®, CINAHL®, SPORTDiscus, SCOPUS, SciELO, Psychology and Behavioral Sciences Collection, and Cochrane® Central Register of Controlled Trials from the first record until October 2021. Randomized controlled trials using exergames as an intervention were included. A total of 10 articles published between 2009 and 2021 were selected. Most studies used the Nintendo Wii® as the exergame in the intervention program. Interventions ranged from 6 to 12 weeks, with 8-week programs being most frequent. It was possible to observe a positive effect on mood, the reduction of apathy, anxiety and depression, self-esteem, and affection.
- Impact of Exergames in Women with Breast Cancer After Surgery: a Systematic ReviewPublication . Fernandes, Carla Sílvia; Baldaia, Claudia; Ferreira, Luis MiguelIn recent years, exergames have been used in healthcare, and particularly in rehabilitation, with positive results. Exergames in healthcare have a signifcant potential; however, gaps in some areas remain, including the domain of exergames post-surgery for breast cancer. This study aimed to synthesise the existing studies on exergames following surgery for breast cancer and evaluate their impact through a systematic review. A total of 8 articles published between 2015 and 2022 were selected. The search took place in January 2022 with no time limits. Altogether 209 women participated in these studies. Interventions ranged from 4 to 8 weeks. Most of the interventions took place in the late postoperative period. It was possible to observe their impact on some indicators (range of motion, pain, functionality, depression). Importantly, no negative impact was reported in any of the diferent studies. The present review concluded that exergames can be a promising intervention for rehabilitation in oncology. However, more robust studies are needed that evaluate the efectiveness of using exergames as a complement to conventional rehabilitation and to assess the degree of satisfaction, motivation, and adherence of participants.