Gameplay as a source of intrinsic motivation in a randomized controlled trial of auditory training for tinnitus

Abstract

Background: Previous studies of frequency discrimination training (FDT) for tinnitus used repetitive task-based training programmes relying on extrinsic factors to motivate participation. Studies reported limited improvement in tinnitus symptoms.

Purpose: To evaluate FDT exploiting intrinsic motivations by integrating training with computer-gameplay.

Methods: Sixty participants were randomly assigned to train on either a conventional task-based training, or one of two interactive game-based training platforms over six weeks. Outcomes included assessment of motivation, tinnitus handicap, and performance on tests of attention.

Results: Participants reported greater intrinsic motivation to train on the interactive game-based platforms, yet compliance of all three groups was similar (∼ 70%) and changes in self-reported tinnitus severity were not significant. There was no difference between groups in terms of change in tinnitus severity or performance on measures of attention.

Conclusion: FDT can be integrated within an intrinsically motivating game. Whilst this may improve participant experience, in this instance it did not translate to additional compliance or therapeutic benefit.

Trial registration: ClinicalTrials.gov NCT02095262.

Figure 1. Trial flow chart.

Figure 2. Screenshots of the three training platforms.

STAR2 background image rotates through a series of nature scenes unrelated to the task. Treasure Hunter is shown with an example of feedback after a level. Submarine is shown as successive snapshots to reflect movement across the screen, with an example of reward in the form of accrued points for each completed level.

Figure 3. Frequency of codes related to intrinsic motivation.

Data were extracted from 55 interviews in total (n = 18 for STAR2, 18 for Treasure Hunter, and 19 for Submarine).

Figure 4. Global Tinnitus Handicap Questionnaire scores.

Mean tinnitus handicap score (±95% CI) at the primary assessment points (T0 and T1 – black bars) and at follow up visits T2 and T3 (grey bars). n = 20 per group. Global score range in 0–2700.

Figure 5. Sustained and divided attention task scores before and after training.

There was no significant change in the measure of sustained attention after training. There was a significant between groups difference on the divided attention task for Group A compared to Group B but there was no effect of time or interaction (*p<0.05). n = 20 per group.