title: Pilot trial of spirometer games for airway clearance practice in cystic fibrosis.
abstract: BACKGROUND
  Many children with cystic fibrosis (CF) adhere poorly to airway clearance techniques (ACTs), and would rather play video games that challenge their dexterity and visual tracking skills. We developed gaming technology that encourages forced expiratory maneuvers.
  
  
  OBJECTIVE
  Following interviews regarding recreational activities and subjects' practice of ACTs, we conducted a pilot trial of spirometer games in 13 adolescents with CF, to test the hypothesis that games could increase subjects' engagement with forced expiratory breathing maneuvers and improve pulmonary function tests (PFTs).
  
  
  METHODS
  After baseline PFTs, subjects were provided with digital spirometers and computers set up as "game only" or "control" devices. After the first of 2 periods (each > 2 weeks), the computer was set-up for the alternate condition for period 2. The t test and non-parametric correlation analyses examined use, number of expiratory high flow events (HFEs), and change in PFTs, identifying trends at P ≤ .1, significance at P < .05.
  
  
  RESULTS
  Interviews disclosed minimal awareness of ACTs among our pediatric CF patients. Subjects used games and control software a similar percentage of days during the game (26%) and control periods (32%). There was a trend toward more minutes with the game versus control setup (P = .07), though HFE count did not differ between the 2 conditions (P = .71). Game play showed no overall effect on FEV(1), though correlation analysis showed a modest relation between minutes of play and change in FEV(1) from baseline (r = 0.50, P = .09). The game period showed a trend to increased vital capacity (P = .05).
  
  
  CONCLUSIONS
  Spirometer games elicit forced expiratory breath maneuvers in pediatric CF patients. Improvement in PFTs may be due to improved test performance technique, though improved obstructive/restrictive lung function due to game play cannot be excluded. A formal clinical trial of this approach is planned.
authors.affiliation: Department of Neurology, University of Vermont, Burlington, Vermont, USA. peter.bingham@uvm.edu
authors.forename: Peter M
authors.initials: PM
authors.lastname: Bingham
authors.forename: Thomas
authors.initials: T
authors.lastname: Lahiri
authors.forename: Taka
authors.initials: T
authors.lastname: Ashikaga
mesh_terms: D001676:Biofeedback, Psychology; D002648:Child; D003550:Cystic Fibrosis / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D010865:Pilot Projects; D012129:Respiratory Function Tests; D012138:Respiratory Therapy / Q000379:methods*; D013147:Spirometry / Q000379:methods*; D016896:Treatment Outcome; D018910:Video Games