Influence of non-immersive avatar-based gamification on the Hawthorne Effect in pediatric gait.

Abstract

The Hawthorne Effect occurs when participants alter their behavior when they are aware that they are being examined. The effect has been reported in many experiments, including gait analysis, and is considered an important source of bias that might impact both clinical and research results. Cognitive distraction is one potential solution to reducing the Hawthorne effect during gait analysis, but it is challenging in children, and can, in itself, alter gait. This study investigated the carryover effect of an alternative low-immersion avatar-based intervention on gait and subjective feelings in typically developing children. Will a low-immersion avatar-based intervention change feelings and indicators of temporospatial and kinematic outcomes in children in a laboratory setting, potentially reducing the Hawthorne Effect? Typically developing children aged 5-13 participated in a standard laboratory gait analysis before experiencing a game in which they viewed their motion on monitors around the lab as that of a cartoon avatar in a 3D virtual environment. Following this intervention, standard walking trials were repeated. In addition, participants completed a survey of their feelings about the study both before onset and after completion. Thirty-one children participated in the study, 16 females and 15 males, mean aged 9.1 years. Arm swing, proposed as a measure of how relaxed and natural gait was, increased significantly following the intervention, while temporospatial parameters did not. The effect was more pronounced in females and younger children. Participants felt significantly happier, more excited, less scared, and less sad after the intervention. Changes in feelings were not closely associated with changes in gait. This study suggests that gamification may reduce the Hawthorne effect and potentially produce more natural gait in children. The game intervention had a carryover effect, producing changes in gait even after the intervention was removed.