This release describes a comparative study in a very small number of patients with MS who either used a video game program or not. The research study reports that the control group received no comparative treatment during the 8-week study period. The study reports changes in brain imaging and test scores that suggest benefit at the end of the study period. While encouraging, the release alludes to the need for considerable additional studies. We found that the release ignored some criteria we consider important, including cost, harms, alternative therapies and acknowledgement of the study funders or any potential conflict of interest. It would have been helpful for the release to emphasize more clearly what this study doesn’t do and next steps needed before this is something that patients with MS, who may be desperate for new therapies, should embrace.
MS is a degenerative brain disease that often affects individuals in the prime of life. For some, the course may be mild and managed with current therapy. However, for others it is a terrifying disease with rapid declines in function that can come without warning and only partially be reversed with treatment. In this context, therapies that help “train” the brain to function better within the limits of the disease make sense. And there are a range of rehabilitative programs that are available to MS patients and it is in this context that any new treatments, such as video game training should be considered. If proven effective, this approach of using a home-based, readily available video game/training program might improve the quality of life for MS patients whose prospects for improvement are often slim.
However, the size of the study population is far too small to extrapolate findings to MS patients overall, and neither the release nor the study itself demonstrate an actual clinical improvement in these patients, although the lead paragraph of the release suggests that such is the case.
The release makes no mention of the cost of this video game/training program although that would be a key immediate question in the minds of both MS patients and their families. Moreover, this cost may not be covered by health insurance whereas other forms of cognitive training, for example performed by occupational therapist, may be. The release also fails to mention the cost of other equipment required to play the video game. Together, the game and player can cost hundreds of dollars, depending on the model purchased, and while that cost may not be overly prohibitive, readers deserve to know it when considering the value of this study’s information.
The release says that the research showed “significant increases in thalamic functional connectivity” but fails to quantify the extent of those increases. Nor does it show that increased connectivity improves the patients’ quality of life, although it certainly suggests that outcome. More important for patients, the release states, “The modifications in functional connectivity shown in the video game group after training corresponded to significant improvements in test scores assessing sustained attention and executive function…” This improvement is not quantified, nor is it put into a perspective where the patient can know what this may or may not mean in terms of life functioning (see quality of evidence section).
While there are no obvious harms that would come from playing the video game/training program used in the study we think addressing harms is applicable for this news release, and there was no mention. It is possible that focusing on training in one part of brain function may lead to lack of attention in other parts, and this imbalance may result in relative gains and losses in brain activity that may have negative impacts in certain cognitive or functional areas. It may also be worth noting that harm may come from overuse. In a controlled setting like this study, overuse may be preventable. But what if this was available at home and the person could use it 24/7?
The news release adequately frames the trial and its findings and describes how outcomes were measured through cognitive and imaging tests. But the release could have gone further in providing the specific outcome data, which we addressed in the benefits section above. This was a very small study using only two dozen patients, half of which were controls. While the release states that brain scans showed increased connectivity in game-playing patients, it fails to offer evidence of improvements in the patients’ disease or in their ability to cope with it.
The combination in the release of information about the incurable disease of MS, plus the appeal of video games potentially playing a therapeutic role, makes this a release that should trigger broad interest, but that does not seem to reach the level of disease-mongering.
The release doesn’t share any information on how the research was funded, while in fairness, neither does the original research paper. Neither does it discuss any potential conflict of interest, although the research paper suggests there is none. Given the mention of the use of a commercial game, information about funding and conflict of interest is relevant.
The release fails to mention any alternatives to the use of the video game/training program which might produce equivalent improvement in connectivity within this region of the brain. As previously mentioned, there are other forms of therapy for patients with MS and it isn’t clear how this new therapy compares. At least a mention of this would have been appropriate. The last line of the release says this new treatment could be combined with existing rehabilitation therapy, but we think this is too little, too late.
The release does identify the specific video game used in the study and its manufacturer, Nintendo, allowing readers to do a quick web search showing both it and accompanying equipment are readily available on the market.
A study showing that a video game used regularly in a home environment might improve the condition of MS patients, if confirmed, is certainly novel enough to warrant a news release, although the lack of substantive findings from the research weaken its value to readers.
The release does not appear to use unjustifiable language.
Systematic, Criteria-Driven
The tale of two “negative” studies. Or, how spin is applied to make research findings look more impressive. A must read. https://johnmandrola.substack.com/p/the-tale-of-two-negative-studies
The @nytimes chose to interview one of the editors of the @AnnalsofIM (publisher of this paper) who "gushed with extraordinary glee: It’s huge! There are very few things that reduce your mortality by 30%."
Turns out coffee is not one of those few things despite all that glee. https://twitter.com/garyschwitzer/status/1533202075928215558
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