<p><strong>Background: </strong>Exergaming, which combines physical activity with interactive gaming, has been shown to improve motor skills and fitness. However, exergaming's potential in complex, open-skill sports such as tennis, which require real-time coordination, decision-making, and technical precision, remains underexplored. Furthermore, only a few studies have evaluated the impact of exergaming on both technical skill development and psychological outcomes such as motivation and confidence, especially among novice players. This study addresses these gaps by comparing the combination of exergame-based tennis training and on-court tennis training (EBTT+OCTT) with on-court tennis training alone (OCTT×2) in improving technical skills, grip strength, confidence, and motivation.</p><p><strong>Objective: </strong>This study aims to assess the effect of exergaming tennis in developing tennis technical skills, grip strength, confidence level, and motivation level.</p><p><strong>Methods: </strong>In a 12-week quasi-experimental trial, 66 novices were randomized to either the EBTT+OCTT or the OCTT×2 group. Participants consisted of 22 males and 44 females, with the mean BMI and age of approximately 22 (SD 2.9) kg/m<sup>2</sup> and 26 (SD 7) years, respectively. The EBTT+OCTT group had 1 weekly session of OCTT and 1 session of exergaming training using Virtual Tennis (PlayStation 3 Move), while the OCTT×2 group completed 2 weekly on-court sessions. Outcomes included tennis technical skills such as groundstroke technique, service speed, and service accuracy (assessed using the Hewitt tennis test), grip strength (using a handheld dynamometer), confidence (using the Sports Confidence Inventory), and motivation (using the Sport Motivation Scale). Mean differences (MDs) between pre- and postintervention were collected and analyzed using repeated-measures ANOVA (α=.05) and Pearson correlation analysis. Effect sizes were calculated using partial eta squared (ηp²), where values ≥0.14 indicated large effects.</p><p><strong>Results: </strong>After 12 weeks of training, both EBTT+OCTT and OCTT×2 groups showed significant improvements (P<.001) in tennis technical skills (MD=17.06-22.62), grip strength (MD=9.59-11.04 kg), and confidence levels (MD=23.29-26.28). These outcome measures have large effect sizes (ηp²=0.84-0.92); however, they did not significantly differ (P>.05) across the groups when compared, with P<sub>grip strength</sub>=.24, P<sub>hit</sub>=.97, P<sub>accuracy</sub>=.86, P<sub>speed=</sub>.72, and P<sub>confidence</sub>=.31. In terms of motivation, EBTT+OCTT retained intrinsic motivation (IM) better than OCTT×2, with significant reductions in IM, mainly IM-to-know (MD=7, SD 2.95) and IM-to-accomplish (MD=5, SD 3.77) observed in the OCTT×2 group (P<.001). Grip strength, confidence, and motivation levels (except amotivation) showed positive correlations with tennis technical skills (r=0.39-0.80).</p><p><strong>Conclusions: </strong>EBTT+OCTT and O
{"title":"Effects of Exergaming Tennis on Players' Tennis Skills and Mental State Compared to Regular Tennis in Adult Players: Quasi-Experimental Study.","authors":"Jia Sheng Ngo, See Ziau Hoe, Maziah Mat Rosly","doi":"10.2196/73732","DOIUrl":"https://doi.org/10.2196/73732","url":null,"abstract":"<p><strong>Background: </strong>Exergaming, which combines physical activity with interactive gaming, has been shown to improve motor skills and fitness. However, exergaming's potential in complex, open-skill sports such as tennis, which require real-time coordination, decision-making, and technical precision, remains underexplored. Furthermore, only a few studies have evaluated the impact of exergaming on both technical skill development and psychological outcomes such as motivation and confidence, especially among novice players. This study addresses these gaps by comparing the combination of exergame-based tennis training and on-court tennis training (EBTT+OCTT) with on-court tennis training alone (OCTT×2) in improving technical skills, grip strength, confidence, and motivation.</p><p><strong>Objective: </strong>This study aims to assess the effect of exergaming tennis in developing tennis technical skills, grip strength, confidence level, and motivation level.</p><p><strong>Methods: </strong>In a 12-week quasi-experimental trial, 66 novices were randomized to either the EBTT+OCTT or the OCTT×2 group. Participants consisted of 22 males and 44 females, with the mean BMI and age of approximately 22 (SD 2.9) kg/m<sup>2</sup> and 26 (SD 7) years, respectively. The EBTT+OCTT group had 1 weekly session of OCTT and 1 session of exergaming training using Virtual Tennis (PlayStation 3 Move), while the OCTT×2 group completed 2 weekly on-court sessions. Outcomes included tennis technical skills such as groundstroke technique, service speed, and service accuracy (assessed using the Hewitt tennis test), grip strength (using a handheld dynamometer), confidence (using the Sports Confidence Inventory), and motivation (using the Sport Motivation Scale). Mean differences (MDs) between pre- and postintervention were collected and analyzed using repeated-measures ANOVA (α=.05) and Pearson correlation analysis. Effect sizes were calculated using partial eta squared (ηp²), where values ≥0.14 indicated large effects.</p><p><strong>Results: </strong>After 12 weeks of training, both EBTT+OCTT and OCTT×2 groups showed significant improvements (P<.001) in tennis technical skills (MD=17.06-22.62), grip strength (MD=9.59-11.04 kg), and confidence levels (MD=23.29-26.28). These outcome measures have large effect sizes (ηp²=0.84-0.92); however, they did not significantly differ (P>.05) across the groups when compared, with P<sub>grip strength</sub>=.24, P<sub>hit</sub>=.97, P<sub>accuracy</sub>=.86, P<sub>speed=</sub>.72, and P<sub>confidence</sub>=.31. In terms of motivation, EBTT+OCTT retained intrinsic motivation (IM) better than OCTT×2, with significant reductions in IM, mainly IM-to-know (MD=7, SD 2.95) and IM-to-accomplish (MD=5, SD 3.77) observed in the OCTT×2 group (P<.001). Grip strength, confidence, and motivation levels (except amotivation) showed positive correlations with tennis technical skills (r=0.39-0.80).</p><p><strong>Conclusions: </strong>EBTT+OCTT and O","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"14 ","pages":"e73732"},"PeriodicalIF":4.1,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146105530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p><strong>Background: </strong>Educators are exploring new methods to educate beyond the classroom as global concerns about students' cognitive, emotional, and social well-being grow. Physical education (PE) has been demonstrated to boost cognitive and psychological outcomes in several studies. Most research has neglected the benefits of gamification and artificial intelligence (AI)-based feedback in PE, focusing instead on conventional PE formats. The impacts of technologically enhanced PE settings on students' cognitive performance through feedback and reward mechanisms remain understudied.</p><p><strong>Objective: </strong>This study aimed to investigate how intrinsic motivation and AI-based feedback moderated the effects of gamified PE on students' cognitive performance.</p><p><strong>Methods: </strong>The study used a cross-sectional design. In Beijing, Shanghai, Chengdu, and Guangzhou, a total of 1029 public high school students completed a standardized questionnaire. Students in secondary school (male: n=490, 47.6% and female: n=539, 52.4%) aged 10-18 years, were recruited from urban, suburban, and rural locales. Participants were sourced from public, private, and semigovernment schools, reflecting a range of academic achievement levels and access to technology. Students participating in standard PE sessions were included, whereas those with medical conditions that restricted physical exercise were excluded. Data were gathered via standardized questionnaires during designated PE sessions. Gamified PE, cognitive performance, intrinsic motivation, teacher support, collaboration, and AI feedback were examined using standardized instruments. Trained facilitators helped younger participants understand and follow ethical norms. The study used maximum likelihood estimation for structural equation modeling. Bootstrapping was used to analyze mediation and moderation effects at a 5% significance level (α=.05).</p><p><strong>Results: </strong>According to structural equation modeling, gamified PE highly predicts cognitive performance (β=.34; P<.001). Other significant factors were teacher support (β=.31; P<.001), physical exercise enjoyment (β=.28; P<.001), and teamwork (β=.26; P<.001). AI-based feedback strengthened the link between gamified PE and cognitive performance under moderation analysis (β=.18; P<.001). Mediation analysis indicated that intrinsic motivation partially mediated the relationship, resulting in a significant indirect effect (β=.21, 95% CI 0.12-0.31; SE=0.05).</p><p><strong>Conclusions: </strong>This research integrates gamified PE with AI-based feedback mechanisms to evaluate students' cognitive outcomes, a domain that has been rarely investigated experimentally. This study highlights the combined effect of intrinsic motivation and AI-generated feedback in a technology-enhanced PE context, in contrast to previous research that primarily focuses on traditional PE methods or isolated gamification elements. The findings enhance th
{"title":"Gamified Physical Education and Cognitive Performance Among Chinese Secondary School Students: Cross-Sectional Moderation Mediation Study.","authors":"Jingtong Zhang, Sae-Sook Oh, Yaru Xu","doi":"10.2196/81086","DOIUrl":"https://doi.org/10.2196/81086","url":null,"abstract":"<p><strong>Background: </strong>Educators are exploring new methods to educate beyond the classroom as global concerns about students' cognitive, emotional, and social well-being grow. Physical education (PE) has been demonstrated to boost cognitive and psychological outcomes in several studies. Most research has neglected the benefits of gamification and artificial intelligence (AI)-based feedback in PE, focusing instead on conventional PE formats. The impacts of technologically enhanced PE settings on students' cognitive performance through feedback and reward mechanisms remain understudied.</p><p><strong>Objective: </strong>This study aimed to investigate how intrinsic motivation and AI-based feedback moderated the effects of gamified PE on students' cognitive performance.</p><p><strong>Methods: </strong>The study used a cross-sectional design. In Beijing, Shanghai, Chengdu, and Guangzhou, a total of 1029 public high school students completed a standardized questionnaire. Students in secondary school (male: n=490, 47.6% and female: n=539, 52.4%) aged 10-18 years, were recruited from urban, suburban, and rural locales. Participants were sourced from public, private, and semigovernment schools, reflecting a range of academic achievement levels and access to technology. Students participating in standard PE sessions were included, whereas those with medical conditions that restricted physical exercise were excluded. Data were gathered via standardized questionnaires during designated PE sessions. Gamified PE, cognitive performance, intrinsic motivation, teacher support, collaboration, and AI feedback were examined using standardized instruments. Trained facilitators helped younger participants understand and follow ethical norms. The study used maximum likelihood estimation for structural equation modeling. Bootstrapping was used to analyze mediation and moderation effects at a 5% significance level (α=.05).</p><p><strong>Results: </strong>According to structural equation modeling, gamified PE highly predicts cognitive performance (β=.34; P<.001). Other significant factors were teacher support (β=.31; P<.001), physical exercise enjoyment (β=.28; P<.001), and teamwork (β=.26; P<.001). AI-based feedback strengthened the link between gamified PE and cognitive performance under moderation analysis (β=.18; P<.001). Mediation analysis indicated that intrinsic motivation partially mediated the relationship, resulting in a significant indirect effect (β=.21, 95% CI 0.12-0.31; SE=0.05).</p><p><strong>Conclusions: </strong>This research integrates gamified PE with AI-based feedback mechanisms to evaluate students' cognitive outcomes, a domain that has been rarely investigated experimentally. This study highlights the combined effect of intrinsic motivation and AI-generated feedback in a technology-enhanced PE context, in contrast to previous research that primarily focuses on traditional PE methods or isolated gamification elements. The findings enhance th","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"14 ","pages":"e81086"},"PeriodicalIF":4.1,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146105486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p><strong>Background: </strong>In the context of global aging, cognitive decline among older adults has become a prevalent issue, significantly impacting their daily lives. Serious games have demonstrated potential in enhancing cognitive abilities in this population. However, most existing serious games designed for older adults rely heavily on visual interfaces, which are often potentially detrimental for those with pre-existing visual impairments.</p><p><strong>Objective: </strong>This study had two primary objectives: (1) to design a theoretical prototype for a haptic-driven serious game for older adults based on the Design-Play-Experience (DPE) framework, aiming to enhance cognitive abilities, including attention, logical reasoning, and decision-making while simultaneously mitigating challenges associated with visual impairment, and (2) to conduct a pilot study evaluating the prototype's usability, accessibility, and user experience within the target population.</p><p><strong>Methods: </strong>We used a cross-sectional, mixed methods pilot study with a single-group observational design, comprising a theoretical design and a pilot user study. First, the DPE framework was systematically applied to develop a game prototype by integrating haptic feedback technology (using built-in smartphone vibration motors) across its 3 core dimensions: design (haptic symbol system, accessible interface), play (dynamic difficulty adjustment), and experience (emotional engagement). Subsequently, a pilot study was conducted with 10 older adults recruited via convenience sampling (mean age 62.9, SD 3.35 years; 5 male, 5 female; all with self-reported mild visual impairments, such as presbyopia). Following interaction with the prototype, data were collected remotely using the System Usability Scale (SUS) and semistructured interviews administered via videoconferencing. Quantitative data from the SUS were analyzed using descriptive statistics, while qualitative data from the interviews were processed using thematic analysis.</p><p><strong>Results: </strong>Pilot user studies showed that the game prototype had good usability, with an average SUS score of 89.5 (SD 2.72; 95% CI 87.6-91.4), which is considered "excellent." Thematic analysis of the interviews revealed three significant themes. The first theme was intuitive haptic feedback, which reflected that participants were able to quickly grasp and value the vibrational cues used to identify cards. The second theme was based on reduced eye strain, in which the combination of large fonts, high-contrast interfaces, and haptic feedback was praised for its effectiveness in relieving eye strain. The third theme was simplicity, where the simplified card game mechanics were considered both fun and challenging.</p><p><strong>Conclusions: </strong>This study developed and validated a haptic, serious game for older adults. Its innovation lies in the systematic application of the DPE framework to achieve "haptic substitution
背景：在全球老龄化的背景下，老年人的认知能力下降已经成为一个普遍问题，严重影响了他们的日常生活。严肃游戏在提高这一人群的认知能力方面具有潜力。然而，大多数为老年人设计的严肃游戏都严重依赖视觉界面，这对那些已有视觉障碍的人来说往往是有害的。目的：本研究有两个主要目的：(1)基于设计-游戏-体验（design - play - experience， DPE）框架为老年人设计触觉驱动的严肃游戏理论原型，旨在提高老年人的认知能力，包括注意力、逻辑推理和决策能力，同时减轻与视觉障碍相关的挑战；(2)在目标人群中开展试点研究，评估原型的可用性、可访问性和用户体验。方法：我们采用一项横断面、混合方法的先导研究，采用单组观察设计，包括理论设计和先导用户研究。首先，通过将触觉反馈技术（使用内置智能手机振动马达）整合到3个核心维度上，系统地应用DPE框架开发游戏原型：设计（触觉符号系统、可访问界面）、游戏（动态难度调整）和体验（情感参与）。随后，通过方便抽样招募了10名老年人（平均年龄62.9岁，SD 3.35岁，男5名，女5名，均自述有轻度视力障碍，如老花眼），进行了一项试点研究。在与原型交互之后，使用系统可用性量表（SUS）和通过视频会议管理的半结构化访谈远程收集数据。来自SUS的定量数据使用描述性统计进行分析，而来自访谈的定性数据则使用专题分析进行处理。结果：试点用户研究表明，游戏原型具有良好的可用性，平均SUS得分为89.5 (SD 2.72; 95% CI 87.6-91.4)，被认为是“优秀”。对访谈的专题分析揭示了三个重要主题。第一个主题是直观的触觉反馈，这反映了参与者能够快速掌握和重视用于识别卡片的振动线索。第二个主题是基于减少眼睛疲劳，其中大字体、高对比度界面和触觉反馈的组合在缓解眼睛疲劳方面的有效性得到了赞扬。第三个主题是简单性，即简化的卡牌游戏机制既有趣又具有挑战性。结论：该研究开发并验证了一款针对老年人的触觉严肃游戏。它的创新之处在于系统地应用DPE框架，实现“触觉替代视觉”，这与以往专注于一般沉浸式体验的研究不同。本研究的主要贡献是为创建易于使用的认知训练工具提供了一个可重用的设计蓝图。这些发现在现实世界中具有实际意义，为在社区和护理机构中部署低视觉负荷干预提供了可行的方法。
{"title":"A Haptic-Driven Serious Game for Cognitive Stimulation and Visual Impairment Mitigation in Older Adults Based on the Design-Play-Experience Framework: Cross-Sectional Mixed Methods Pilot Study.","authors":"Xin Huang, Nazlena Mohamad Ali, Shafrida Sahrani, Yue Zhang","doi":"10.2196/86290","DOIUrl":"https://doi.org/10.2196/86290","url":null,"abstract":"<p><strong>Background: </strong>In the context of global aging, cognitive decline among older adults has become a prevalent issue, significantly impacting their daily lives. Serious games have demonstrated potential in enhancing cognitive abilities in this population. However, most existing serious games designed for older adults rely heavily on visual interfaces, which are often potentially detrimental for those with pre-existing visual impairments.</p><p><strong>Objective: </strong>This study had two primary objectives: (1) to design a theoretical prototype for a haptic-driven serious game for older adults based on the Design-Play-Experience (DPE) framework, aiming to enhance cognitive abilities, including attention, logical reasoning, and decision-making while simultaneously mitigating challenges associated with visual impairment, and (2) to conduct a pilot study evaluating the prototype's usability, accessibility, and user experience within the target population.</p><p><strong>Methods: </strong>We used a cross-sectional, mixed methods pilot study with a single-group observational design, comprising a theoretical design and a pilot user study. First, the DPE framework was systematically applied to develop a game prototype by integrating haptic feedback technology (using built-in smartphone vibration motors) across its 3 core dimensions: design (haptic symbol system, accessible interface), play (dynamic difficulty adjustment), and experience (emotional engagement). Subsequently, a pilot study was conducted with 10 older adults recruited via convenience sampling (mean age 62.9, SD 3.35 years; 5 male, 5 female; all with self-reported mild visual impairments, such as presbyopia). Following interaction with the prototype, data were collected remotely using the System Usability Scale (SUS) and semistructured interviews administered via videoconferencing. Quantitative data from the SUS were analyzed using descriptive statistics, while qualitative data from the interviews were processed using thematic analysis.</p><p><strong>Results: </strong>Pilot user studies showed that the game prototype had good usability, with an average SUS score of 89.5 (SD 2.72; 95% CI 87.6-91.4), which is considered \"excellent.\" Thematic analysis of the interviews revealed three significant themes. The first theme was intuitive haptic feedback, which reflected that participants were able to quickly grasp and value the vibrational cues used to identify cards. The second theme was based on reduced eye strain, in which the combination of large fonts, high-contrast interfaces, and haptic feedback was praised for its effectiveness in relieving eye strain. The third theme was simplicity, where the simplified card game mechanics were considered both fun and challenging.</p><p><strong>Conclusions: </strong>This study developed and validated a haptic, serious game for older adults. Its innovation lies in the systematic application of the DPE framework to achieve \"haptic substitution ","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"14 ","pages":"e86290"},"PeriodicalIF":4.1,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146093317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bárbara Ramalho, Samuel Gomes, Marta Silva Vicente, Filipa Magalhães, Rodolfo Gonçalves Costa, Sandra Gama, Vasileios Charisis, Leontios Hadjileontiadis, Sofia B Dias
<p><strong>Background: </strong>Serious games offer promising avenues for clinical care by enhancing patient engagement and delivering therapeutic benefits. In psoriatic arthritis (PsA), chronic pain contributes to emotional distress, functional limitations, and reduced well-being. While symptom-tracking apps exist, few digital interventions directly address chronic pain through engaging, therapeutic experiences tailored to patients' cognitive and physical needs.</p><p><strong>Objective: </strong>This study aimed to co-design mobile serious games-NoPain Games-to support patients with PsA in managing chronic pain. Conducted within the iPROLEPSIS Horizon Europe project, the study involved a multidisciplinary cocreation session with rheumatologists, researchers, and technical experts, followed by a usability feedback session with patients with PsA. The goal was to identify therapeutic priorities, refine game mechanics, and assess usability to inform the development of personalized, accessible digital interventions.</p><p><strong>Methods: </strong>A sequential mixed methods design was used. First, a 90-minute remote cocreation session was held with 14 experts (6 rheumatologists, 4 technical experts, and 4 researchers) from 3 European countries. Participants reviewed game storyboards and discussed therapeutic and design priorities. Thematic analysis of transcribed discussions identified key insights. Next, a 60-minute remote usability feedback session was conducted with 5 patients with PsA (aged 25-64 y), who interacted with 2 high-fidelity game prototypes (Space Oddity and Four Seasons). Usability was assessed using the System Usability Scale (SUS), and qualitative feedback was collected through moderated discussion. Item-level analysis using item characteristic curves provided deeper insight into usability perceptions and item sensitivity. All ethics requirements were met for both study phases.</p><p><strong>Results: </strong>Thematic analysis of the transcribed dialogs of the cocreation session revealed three core themes: (1) therapeutic benefits (pain distraction, memory enhancement, cognitive stimulation, stress reduction, and creative engagement); (2) game difficulty (balancing duration and complexity to sustain engagement without fatigue); and (3) accessibility and interaction (addressing physical limitations, optimizing touchscreen usability, and ensuring inclusive design). These insights informed the development of 2 NoPain Game prototypes, which received a SUS score of 79 (SD 10.4; 95% CI 69.89-88.11), indicating good usability. Item characteristic curve analysis showed strong discrimination for learnability, while ease of use and confidence exhibited ceiling effects. Items like support needs and inconsistency showed minimal variability, and the learning curve demonstrated delayed but meaningful responsiveness at higher usability levels. Qualitative feedback reinforced the relevance of difficulty adjustment, technical refinements, and game m
{"title":"Co-Designing Mobile Serious Games to Support Patients With Psoriatic Arthritis and Chronic Pain: Mixed Methods Study.","authors":"Bárbara Ramalho, Samuel Gomes, Marta Silva Vicente, Filipa Magalhães, Rodolfo Gonçalves Costa, Sandra Gama, Vasileios Charisis, Leontios Hadjileontiadis, Sofia B Dias","doi":"10.2196/75072","DOIUrl":"10.2196/75072","url":null,"abstract":"<p><strong>Background: </strong>Serious games offer promising avenues for clinical care by enhancing patient engagement and delivering therapeutic benefits. In psoriatic arthritis (PsA), chronic pain contributes to emotional distress, functional limitations, and reduced well-being. While symptom-tracking apps exist, few digital interventions directly address chronic pain through engaging, therapeutic experiences tailored to patients' cognitive and physical needs.</p><p><strong>Objective: </strong>This study aimed to co-design mobile serious games-NoPain Games-to support patients with PsA in managing chronic pain. Conducted within the iPROLEPSIS Horizon Europe project, the study involved a multidisciplinary cocreation session with rheumatologists, researchers, and technical experts, followed by a usability feedback session with patients with PsA. The goal was to identify therapeutic priorities, refine game mechanics, and assess usability to inform the development of personalized, accessible digital interventions.</p><p><strong>Methods: </strong>A sequential mixed methods design was used. First, a 90-minute remote cocreation session was held with 14 experts (6 rheumatologists, 4 technical experts, and 4 researchers) from 3 European countries. Participants reviewed game storyboards and discussed therapeutic and design priorities. Thematic analysis of transcribed discussions identified key insights. Next, a 60-minute remote usability feedback session was conducted with 5 patients with PsA (aged 25-64 y), who interacted with 2 high-fidelity game prototypes (Space Oddity and Four Seasons). Usability was assessed using the System Usability Scale (SUS), and qualitative feedback was collected through moderated discussion. Item-level analysis using item characteristic curves provided deeper insight into usability perceptions and item sensitivity. All ethics requirements were met for both study phases.</p><p><strong>Results: </strong>Thematic analysis of the transcribed dialogs of the cocreation session revealed three core themes: (1) therapeutic benefits (pain distraction, memory enhancement, cognitive stimulation, stress reduction, and creative engagement); (2) game difficulty (balancing duration and complexity to sustain engagement without fatigue); and (3) accessibility and interaction (addressing physical limitations, optimizing touchscreen usability, and ensuring inclusive design). These insights informed the development of 2 NoPain Game prototypes, which received a SUS score of 79 (SD 10.4; 95% CI 69.89-88.11), indicating good usability. Item characteristic curve analysis showed strong discrimination for learnability, while ease of use and confidence exhibited ceiling effects. Items like support needs and inconsistency showed minimal variability, and the learning curve demonstrated delayed but meaningful responsiveness at higher usability levels. Qualitative feedback reinforced the relevance of difficulty adjustment, technical refinements, and game m","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"14 ","pages":"e75072"},"PeriodicalIF":4.1,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12858048/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146093258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p><strong>Background: </strong>Longer life expectancy makes physical exercise crucial for active aging. However, adherence to traditional exercise among community-dwelling older adults is generally low. Virtual reality (VR) and mixed reality (MR) Tai Chi exergames, as novel health promotion tools, show significant potential, particularly for older adults exercising in a home setting.</p><p><strong>Objective: </strong>This study aimed to evaluate the usability and feasibility of a VR and MR Tai Chi exergame for community-dwelling older adults, focusing on subjective experience, physiological comfort, and objective interaction performance. The study also explored the relationships between key usability factors and sought to quantify links between objective accuracy and subjective experience (the Game Experience Questionnaire or Virtual Reality Sickness Questionnaire [VRSQ]) to inform choices of display mode, feedback strength, and session length.</p><p><strong>Methods: </strong>Of the 86 community-dwelling older adults recruited for this study, data from 70 participants were considered valid after an initial screening, during which 16 (18.6%) were excluded due to issues with VR adaptation. Participants were sequentially assigned in a rotating order to 1 of 4 variants (VR/MR×soothing/intense) to balance exposure; however, primary analyses were preplanned to be collapsed across variants, focusing on whole-sample usability and feasibility rather than confirmatory between-group hypotheses. The primary outcome measures included the Game Experience Questionnaire, VRSQ, and objective gameplay logs.</p><p><strong>Results: </strong>The VR/MR Tai Chi game demonstrated good overall usability and acceptability among the screened participants. Subjective experience was highly positive, with median scores for "positive affect" (median 4.0) and "competence" (median 3.8) being significantly high, whereas the median for "Challenge" (median 1.4) was significantly low (P<.001 for all). Physiological comfort in the postscreening sample was acceptable, with the most common mild symptoms being dizziness with eyes closed (20.0%) and vertigo (18.6%), both of low severity; however, the initial exclusion of 18.6% of participants due to VR discomfort is noteworthy. Therefore, generalizability is limited because the analyzed sample overrepresents older adults who tolerate immersive displays. Accuracy showed significant positive correlations with flow (ρ=0.342) and competence (ρ=0.322), whereas the VRSQ total score was significantly negatively correlated with positive affect (ρ=-0.334, P=.005).</p><p><strong>Conclusions: </strong>Tai Chi exergames based on immersive technologies offer a feasible and attractive pathway for promoting physical exercise among community-dwelling older adults, particularly within the home environment, supporting the goal of aging in place. As a single, laboratory-based session, the reported satisfaction may partly reflect a novelty effect; therefor
{"title":"Immersive Tai Chi for Home-Based Exercise in Older Adults: Usability and Feasibility Study.","authors":"XiaCheng Song, Nazlena Mohamad Ali, Mohamad Hidir Mhd Salim, Muhammad Yudhi Rezaldi","doi":"10.2196/79453","DOIUrl":"https://doi.org/10.2196/79453","url":null,"abstract":"<p><strong>Background: </strong>Longer life expectancy makes physical exercise crucial for active aging. However, adherence to traditional exercise among community-dwelling older adults is generally low. Virtual reality (VR) and mixed reality (MR) Tai Chi exergames, as novel health promotion tools, show significant potential, particularly for older adults exercising in a home setting.</p><p><strong>Objective: </strong>This study aimed to evaluate the usability and feasibility of a VR and MR Tai Chi exergame for community-dwelling older adults, focusing on subjective experience, physiological comfort, and objective interaction performance. The study also explored the relationships between key usability factors and sought to quantify links between objective accuracy and subjective experience (the Game Experience Questionnaire or Virtual Reality Sickness Questionnaire [VRSQ]) to inform choices of display mode, feedback strength, and session length.</p><p><strong>Methods: </strong>Of the 86 community-dwelling older adults recruited for this study, data from 70 participants were considered valid after an initial screening, during which 16 (18.6%) were excluded due to issues with VR adaptation. Participants were sequentially assigned in a rotating order to 1 of 4 variants (VR/MR×soothing/intense) to balance exposure; however, primary analyses were preplanned to be collapsed across variants, focusing on whole-sample usability and feasibility rather than confirmatory between-group hypotheses. The primary outcome measures included the Game Experience Questionnaire, VRSQ, and objective gameplay logs.</p><p><strong>Results: </strong>The VR/MR Tai Chi game demonstrated good overall usability and acceptability among the screened participants. Subjective experience was highly positive, with median scores for \"positive affect\" (median 4.0) and \"competence\" (median 3.8) being significantly high, whereas the median for \"Challenge\" (median 1.4) was significantly low (P<.001 for all). Physiological comfort in the postscreening sample was acceptable, with the most common mild symptoms being dizziness with eyes closed (20.0%) and vertigo (18.6%), both of low severity; however, the initial exclusion of 18.6% of participants due to VR discomfort is noteworthy. Therefore, generalizability is limited because the analyzed sample overrepresents older adults who tolerate immersive displays. Accuracy showed significant positive correlations with flow (ρ=0.342) and competence (ρ=0.322), whereas the VRSQ total score was significantly negatively correlated with positive affect (ρ=-0.334, P=.005).</p><p><strong>Conclusions: </strong>Tai Chi exergames based on immersive technologies offer a feasible and attractive pathway for promoting physical exercise among community-dwelling older adults, particularly within the home environment, supporting the goal of aging in place. As a single, laboratory-based session, the reported satisfaction may partly reflect a novelty effect; therefor","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"14 ","pages":"e79453"},"PeriodicalIF":4.1,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12851409/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146093268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p><strong>Background: </strong>Music education is central to holistic child development; yet, traditional piano instruction in China often emphasizes rote memorization at the expense of meaningful understanding. Elementary school pupils, particularly novices, frequently struggle with rhythm, melody, and music theory. Game-based learning (GBL), which applies game elements to teaching, may address these challenges by enhancing engagement, providing immediate feedback, and fostering long-term learning.</p><p><strong>Objective: </strong>This study aimed to examine the effects of a GBL module for piano education on elementary school pupils' music knowledge in Anhui Province, China, compared to traditional instruction.</p><p><strong>Methods: </strong>A quasi-experimental, nonequivalent control group pretest-posttest design was used. Participants were allocated nonrandomly to experimental and control groups based on scheduling feasibility and teacher availability. A total of 60 novice piano learners (mean age 8.8 years, SD 1.16 years; 16 boys and 44 girls) from 3 elementary schools were assigned to either the GBL group (n=30) or the control group (n=30). Music knowledge was measured using the standardized Level 1 Basic Music Written Test before and after an 8-week intervention. Nonparametric analyses were applied, including Mann-Whitney U, Wilcoxon signed-rank, and McNemar item-level analyses. Rank-based effect sizes (r) and 95% CIs were reported where applicable.</p><p><strong>Results: </strong>Baseline differences were present, with the control group scoring higher at pretest (median 52, IQR 24-76) than the GBL group (median 28, IQR 16-64; Mann-Whitney U=265.50; r=-0.35; 95% CI -0.39 to -0.32; P=.006). After the intervention, the GBL group significantly outperformed controls (median 100, IQR 88-100 vs median 60, IQR 40-92; Mann-Whitney U=4.0; r=-0.87; 95% CI -0.90 to -0.83; P<.001). Within-group analyses confirmed significant pre-post improvements for both groups (control Z=-3.24; r=-0.59; P=.001; and GBL Z=-4.81; r=-0.88; P<.001). Item-level McNemar tests showed significant improvements (P<.05) in 5 of 25 items for the GBL group. Missing data were negligible (<2%) and handled via listwise deletion after Little's missing completely at random (MCAR) confirmation (P=.08).</p><p><strong>Conclusions: </strong>The GBL module significantly improved pupils' music knowledge, overcoming baseline disparities and producing posttest score gains with consistent mastery. The innovation of the study lies in the systematic integration of gamification with Orff and Dalcroze pedagogy through the Sidek Module Development Model, which distinguishes it from previous music education studies that examine gamification in isolation. By providing a validated, cost-effective, and scalable instructional module, the study contributes empirical evidence to the field of game-based music education and other practical implications for improving piano instruction in resource-constrai
{"title":"Effects of Game-Based Learning on Piano Music Knowledge Among Elementary School Pupils: Pretest-Posttest Quasi-Experimental Study.","authors":"Yun Wang, Wee Hoe Tan, Qiaoling Ye, Tingting Gu","doi":"10.2196/80766","DOIUrl":"10.2196/80766","url":null,"abstract":"<p><strong>Background: </strong>Music education is central to holistic child development; yet, traditional piano instruction in China often emphasizes rote memorization at the expense of meaningful understanding. Elementary school pupils, particularly novices, frequently struggle with rhythm, melody, and music theory. Game-based learning (GBL), which applies game elements to teaching, may address these challenges by enhancing engagement, providing immediate feedback, and fostering long-term learning.</p><p><strong>Objective: </strong>This study aimed to examine the effects of a GBL module for piano education on elementary school pupils' music knowledge in Anhui Province, China, compared to traditional instruction.</p><p><strong>Methods: </strong>A quasi-experimental, nonequivalent control group pretest-posttest design was used. Participants were allocated nonrandomly to experimental and control groups based on scheduling feasibility and teacher availability. A total of 60 novice piano learners (mean age 8.8 years, SD 1.16 years; 16 boys and 44 girls) from 3 elementary schools were assigned to either the GBL group (n=30) or the control group (n=30). Music knowledge was measured using the standardized Level 1 Basic Music Written Test before and after an 8-week intervention. Nonparametric analyses were applied, including Mann-Whitney U, Wilcoxon signed-rank, and McNemar item-level analyses. Rank-based effect sizes (r) and 95% CIs were reported where applicable.</p><p><strong>Results: </strong>Baseline differences were present, with the control group scoring higher at pretest (median 52, IQR 24-76) than the GBL group (median 28, IQR 16-64; Mann-Whitney U=265.50; r=-0.35; 95% CI -0.39 to -0.32; P=.006). After the intervention, the GBL group significantly outperformed controls (median 100, IQR 88-100 vs median 60, IQR 40-92; Mann-Whitney U=4.0; r=-0.87; 95% CI -0.90 to -0.83; P<.001). Within-group analyses confirmed significant pre-post improvements for both groups (control Z=-3.24; r=-0.59; P=.001; and GBL Z=-4.81; r=-0.88; P<.001). Item-level McNemar tests showed significant improvements (P<.05) in 5 of 25 items for the GBL group. Missing data were negligible (<2%) and handled via listwise deletion after Little's missing completely at random (MCAR) confirmation (P=.08).</p><p><strong>Conclusions: </strong>The GBL module significantly improved pupils' music knowledge, overcoming baseline disparities and producing posttest score gains with consistent mastery. The innovation of the study lies in the systematic integration of gamification with Orff and Dalcroze pedagogy through the Sidek Module Development Model, which distinguishes it from previous music education studies that examine gamification in isolation. By providing a validated, cost-effective, and scalable instructional module, the study contributes empirical evidence to the field of game-based music education and other practical implications for improving piano instruction in resource-constrai","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"14 ","pages":"e80766"},"PeriodicalIF":4.1,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12865349/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145998028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kuan-Chu Su, Ko-Chiu Wu, Kuei-Ru Chou, Chia-Hsu Huang
{"title":"Correction: Tongue Muscle Training App for Middle-Aged and Older Adults Incorporating Flow-Based Gameplay: Design and Feasibility Pilot Study.","authors":"Kuan-Chu Su, Ko-Chiu Wu, Kuei-Ru Chou, Chia-Hsu Huang","doi":"10.2196/90410","DOIUrl":"10.2196/90410","url":null,"abstract":"","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"14 ","pages":"e90410"},"PeriodicalIF":4.1,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12810744/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145989219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jason Carter Stanton, Nicole L Peel, Caroline J Mills, Paul P Breen
Unlabelled: This letter presents the conceptualization, design, and technical evaluation of the RedMan-GreenMan game co-designed with carers, aimed to help children with autism spectrum disorder (hereafter autism) acquire pedestrian safety skills. While the system has been implemented and is in active use, no empirical evaluation of learning outcomes or behavioral impact has been conducted to date, and the focus of this work is on system development, functionality, and technical evaluation.
{"title":"RedMan-GreenMan: Co-Designed Pedestrian Safety Game Prototype for Children With Autism.","authors":"Jason Carter Stanton, Nicole L Peel, Caroline J Mills, Paul P Breen","doi":"10.2196/69260","DOIUrl":"10.2196/69260","url":null,"abstract":"<p><strong>Unlabelled: </strong>This letter presents the conceptualization, design, and technical evaluation of the RedMan-GreenMan game co-designed with carers, aimed to help children with autism spectrum disorder (hereafter autism) acquire pedestrian safety skills. While the system has been implemented and is in active use, no empirical evaluation of learning outcomes or behavioral impact has been conducted to date, and the focus of this work is on system development, functionality, and technical evaluation.</p>","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"14 ","pages":"e69260"},"PeriodicalIF":4.1,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12806593/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145984757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yao Li, Gijs Luijten, Christina Gsaxner, Kim Grunert, Alexis Bader, Frank Hölzle, Rainer Röhrig, Matías de la Fuente, Jan Egger, Kunpeng Xie, Behrus Hinrichs-Puladi
Background: Augmented reality head-mounted displays could overcome the spatial dissociation between medical imaging and the surgical field, which may be particularly important in anatomically dense regions, such as the head and neck. Although many head-mounted displays offer markerless inside-out tracking at a fraction of the cost of navigation systems, their overlay accuracy with superimposition (SI) modality onto the surgical field remains limited. The virtual twin (VT), displaying holography adjacent to the surgical field, may offer a viable alternative. However, its performance is still unclear.
Objective: This study aimed to compare the accuracy and efficiency of the two visualization modalities, SI and VT, for anatomical localization in the head and neck region.
Methods: In a randomized crossover trial to compare two augmented reality visualization modalities (SI and VT), 38 participants used a HoloLens 2 to localize point, line-based, and volume-based anatomical structures on head phantoms. Their performance was evaluated with respect to accuracy, workload, time, and user experience.
Results: SI achieved significantly better point localization accuracy than VT both in absolute (mean 14.4, SD 4.2 mm vs mean 15.8, SD 5.5 mm; P=.003) and relative accuracy (mean 3.4, SD 2.2 mm vs mean 6.0, SD 5.0 mm; P<.001). In line-based structures, accuracy was comparable between SI (average surface distance [ASD], mean 23.4, SD 4.1 mm; Hausdorff distance [HD], mean 31.5, SD 7.8 mm) and VT (ASD=mean 23.0, SD 4.5 mm; P=.51; HD=mean 31.0, SD 7.5 mm; P=.57). However, SI showed significantly higher deviation than VT in volume-based structure (ASD=mean 37.1, SD 13.8 mm vs mean 34.1, SD 14.2 mm; P=.01; HD=mean 52.0, SD 16.8 mm vs mean 49.1, SD 15.8 mm; P=.03). Participants were faster with SI (P=.02), while workload NASA-TLX (National Aeronautics and Space Administration Task Load Index) scores did not demonstrate a significant difference (P=.79).
Conclusions: Given that SI did not clearly outperform VT under overlaid soft tissue and viewing challenges, VT remains a viable alternative in certain surgical scenarios where high accuracy is not required. Future research should focus on optimizing viewing angle guidance and the linkage between the anatomical target and the skin surface.
背景：增强现实头戴式显示器可以克服医学成像和手术领域之间的空间分离，这在解剖学上密集的区域，如头部和颈部，可能特别重要。虽然许多头戴式显示器以导航系统的一小部分成本提供无标记的由内到外跟踪，但它们在手术领域的叠加精度仍然有限。虚拟双胞胎（VT），在手术野附近显示全息图，可能提供一个可行的替代方案。然而，其表现仍不明朗。目的：本研究旨在比较SI和VT两种可视化方式在头颈部区域解剖定位中的准确性和效率。方法：在一项比较两种增强现实可视化模式（SI和VT）的随机交叉试验中，38名参与者使用HoloLens 2来定位头部幻影上的点、线和体解剖结构。它们的性能是根据准确性、工作量、时间和用户体验来评估的。结果：在绝对精度（平均14.4,SD 4.2 mm vs平均15.8,SD 5.5 mm； P= 0.003）和相对精度（平均3.4,SD 2.2 mm vs平均6.0,SD 5.0 mm）上，SI的点定位精度明显优于VT。结论：在软组织覆盖和视觉挑战下，SI并没有明显优于VT，在某些不需要高精度的手术场景中，VT仍然是一种可行的选择。未来的研究重点应放在优化视角引导和解剖目标与皮肤表面的联系上。
{"title":"Usability Study of Augmented Reality Visualization Modalities on Localization Accuracy in the Head and Neck: Randomized Crossover Trial.","authors":"Yao Li, Gijs Luijten, Christina Gsaxner, Kim Grunert, Alexis Bader, Frank Hölzle, Rainer Röhrig, Matías de la Fuente, Jan Egger, Kunpeng Xie, Behrus Hinrichs-Puladi","doi":"10.2196/75962","DOIUrl":"10.2196/75962","url":null,"abstract":"<p><strong>Background: </strong>Augmented reality head-mounted displays could overcome the spatial dissociation between medical imaging and the surgical field, which may be particularly important in anatomically dense regions, such as the head and neck. Although many head-mounted displays offer markerless inside-out tracking at a fraction of the cost of navigation systems, their overlay accuracy with superimposition (SI) modality onto the surgical field remains limited. The virtual twin (VT), displaying holography adjacent to the surgical field, may offer a viable alternative. However, its performance is still unclear.</p><p><strong>Objective: </strong>This study aimed to compare the accuracy and efficiency of the two visualization modalities, SI and VT, for anatomical localization in the head and neck region.</p><p><strong>Methods: </strong>In a randomized crossover trial to compare two augmented reality visualization modalities (SI and VT), 38 participants used a HoloLens 2 to localize point, line-based, and volume-based anatomical structures on head phantoms. Their performance was evaluated with respect to accuracy, workload, time, and user experience.</p><p><strong>Results: </strong>SI achieved significantly better point localization accuracy than VT both in absolute (mean 14.4, SD 4.2 mm vs mean 15.8, SD 5.5 mm; P=.003) and relative accuracy (mean 3.4, SD 2.2 mm vs mean 6.0, SD 5.0 mm; P<.001). In line-based structures, accuracy was comparable between SI (average surface distance [ASD], mean 23.4, SD 4.1 mm; Hausdorff distance [HD], mean 31.5, SD 7.8 mm) and VT (ASD=mean 23.0, SD 4.5 mm; P=.51; HD=mean 31.0, SD 7.5 mm; P=.57). However, SI showed significantly higher deviation than VT in volume-based structure (ASD=mean 37.1, SD 13.8 mm vs mean 34.1, SD 14.2 mm; P=.01; HD=mean 52.0, SD 16.8 mm vs mean 49.1, SD 15.8 mm; P=.03). Participants were faster with SI (P=.02), while workload NASA-TLX (National Aeronautics and Space Administration Task Load Index) scores did not demonstrate a significant difference (P=.79).</p><p><strong>Conclusions: </strong>Given that SI did not clearly outperform VT under overlaid soft tissue and viewing challenges, VT remains a viable alternative in certain surgical scenarios where high accuracy is not required. Future research should focus on optimizing viewing angle guidance and the linkage between the anatomical target and the skin surface.</p>","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"14 ","pages":"e75962"},"PeriodicalIF":4.1,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12798918/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145966241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rui Li, Sabzali Musa Kahn, Bingyu Duan, Seng Yue Wong
<p><strong>Background: </strong>The metaverse provides an immersive, interactive medium for health education, but most studies evaluate immersion and gamification together. Randomized evidence disentangling their separate effects on immediate learning and short-term retention in breast health education is lacking.</p><p><strong>Objective: </strong>To isolate the effects of gamification, over and above an identical immersive metaverse environment, on immediate gains and 4-week retention of women's breast health knowledge.</p><p><strong>Methods: </strong>This two-arm parallel individually randomized controlled trial was conducted in Hangzhou, China. Eligible participants were women aged ≥18 years who were interested in breast health and able to use a personal computer with internet access. A total of 80 women were recruited via the Xiaohongshu social media platform; 8 withdrew before randomization or did not complete the baseline assessment, and the remaining 72 women were randomized to a Gamified Metaverse (GM) or a Non-Gamified Metaverse (NGM) group using a computer-generated 1:1 sequence. Both groups used the Mammoverse platform with identical educational content and exposure time. Breast health knowledge was assessed at baseline (T1), immediately post-intervention (T2), and 4-week follow-up (T3) using the same questionnaire, the primary outcome was change in knowledge score. Using linear mixed-effects models, with age, education, family history of breast cancer, prior training, and baseline knowledge as covariates. Participants and investigators were not blinded.</p><p><strong>Results: </strong>All randomized participants completed follow-up and were included in the analysis (GM group n=36; NGM group n=36), with no loss to follow-up. Knowledge scores improved in both groups, but gains from T1 to T2 were larger in GM than NGM (Hedges g=0.65, 95% CI 0.18-1.12, p=.007). From T2 to T3, there was no between-group difference in change scores (p=.91). However, at 4 weeks GM retained higher absolute knowledge than NGM (estimated marginal means 15.7 vs 13.0). No intervention-related adverse events were reported.</p><p><strong>Conclusions: </strong>This study marks the first application of gamification in BSE education for ordinary Chinese women within a 3D desktop metaverse. By comparing gamified and non-gamified versions under identical metaverse platform conditions, it expands the application boundaries of gamified metaverses in breast health education. Gamification significantly enhanced immediate acquisition of breast health knowledge but did not provide additional advantages for short-term retention. However, the gamified group maintained higher absolute knowledge levels at the 4-week follow-up. Overall, in the 3D desktop metaverse, immersive experiences provide foundational effects, while gamification delivers immediate gains. To further optimize long-term retention, memory consolidation strategies must be integrated into the gamified framework.</
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