Getting into a "Flow" state: a systematic review of flow experience in neurological diseases.
Beatrice Ottiger, Erwin Van Wegen, Katja Keller and 4 others
PMID 33879182WHAT IT FOUND
Flow questionnaires are used in neurorehabilitation, often during serious games, but none has been validated in neurological patients.
Patients sometimes reported higher flow during game-based sessions, but the review did not show better function.
Key findings
01Seven of the ten included studies used serious games as the therapeutic intervention.
02None of the flow questionnaires had been tested for psychometric properties in neurologically impaired people.
03Some trials reported higher flow scores in game-based conditions than in comparison conditions.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The review included case studies, cohort studies and randomized trials, and did not assess study quality, so the studies cannot be weighted equally. Included patients had different neurological conditions, so results may not apply equally to stroke, traumatic brain injury, multiple sclerosis or Parkinson's disease. Flow questionnaires were validated mainly in athletes and healthy people, not in neurological patients, and cognitive or language problems may affect answers. No test-retest reliability, measurement error, criterion validity or responsiveness was found for these questionnaires. Many included studies were small usability or pilot studies, so high flow scores may reflect early game development rather than established therapy. The search was limited to English publications, so relevant studies may be missing.
Declared interests
Funding came from the Jacques und Gloria Gossweiler-Stiftung. The supplied text does not report author conflicts of interest.
The easy way to misread this
Do not conclude that serious games or challenge-skill occupational therapy improve function because patients report flow. The review found no validated flow questionnaire for neurological patients, and higher flow scores were not shown to produce better outcomes.