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Gamified assessments of pediatric upper extremity function: A systematic review and appraisal
Holly Cordray1, Miguel Fiandeiro1, Manisha Banala1
1Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
Insights
The Assisting Hand Assessment (AHA) family is a reliable, play-based tool for pediatric upper extremity function. Two video-game kinematic measures show promise for objective assessment in children.
Area of Science:
- Pediatric Rehabilitation
- Biomedical Engineering
- Clinical Measurement
Background:
- Accurate assessment of pediatric upper extremity function requires valid, reliable measures and patient engagement.
- Gamified and play-based assessments can enhance motivation and clinical evaluation in children.
Purpose of the Study:
- To systematically review and critically appraise gamified assessments for pediatric upper extremity function.
Main Methods:
- Systematic review following PRISMA guidelines.
- Searched PubMed, Embase, CINAHL, and Scopus for studies on psychometrics in children under 18.
- Assessed risk of bias and evidence quality using COSMIN methodology.
Main Results:
- Included 27 reports on nine outcome measures from 2513 screened studies.
- The Assisting Hand Assessment (AHA) family demonstrates extensive psychometric evidence for assessing grasp, fine-motor adjustment, and bimanual coordination.
- Two video-game-based kinematic measures, including Abilities Captured Through Interactive Video Evaluation (ACTIVE), show promise for objective quantification, with a new dragon-themed game showing potential for broader application.
Conclusions:
- The AHA family is endorsed as a well-structured, reliable, and feasible observer-rated assessment for pediatric upper extremity function.
- Two promising kinematic measures require further investigation for broader clinical use.
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.
