Video games for people with schizophrenia

Background Commercial video games are a vastly popular form of recreational activity. Whilst concerns persist regarding possible negative effects of video games, they have been suggested to provide cognitive benefits to users. They are also frequently employed as control interventions in comparisons of more complex cognitive or psychological interventions. If independently effective, video games ‐ being both engaging and relatively inexpensive ‐ could provide a much more cost‐effective add‐on intervention to standard treatment when compared to costly, cognitive interventions. Objectives To review the effects of video games (alone or as an additional intervention) compared to standard care alone or other interventions including, but not limited to, cognitive remediation or cognitive behavioural therapy for people with schizophrenia or schizophrenia‐like illnesses. Search methods We searched the Cochrane Schizophrenia Group's Study‐Based Register of Trials (March 2017, August 2018, August 2019). Selection criteria Randomised controlled trials focusing on video games for people with schizophrenia or schizophrenia‐like illnesses. Data collection and analysis Review authors extracted data independently. For binary outcomes we calculated risk ratio (RR) with its 95% confidence interval (CI) on an intention‐to‐treat basis. For continuous data we calculated the mean difference (MD) between groups and its CI. We employed a fixed‐effect model for analyses. We assessed risk of bias for the included studies and created a 'Summary of findings' table using GRADE. Main results This review includes seven trials conducted between 2009 and 2018 (total = 468 participants, range 32 to 121). Study duration varied from six weeks to twelve weeks. All interventions in the included trials were given in addition to standard care, including prescribed medication. In trials video games tend to be the control for testing efficacy of complex, cognitive therapies; only two small trials evaluated commercial video games as the intervention. We categorised video game interventions into 'non‐exergame' (played statically) and 'exergame' (the players use bodily movements to control the game). Our main outcomes of interest were clinically important changes in: general functioning, cognitive functioning, social functioning, mental state, quality of life, and physical fitness as well as clinically important adverse effects. We found no clear difference between non‐exergames and cognitive remedi