Background: Chronic obstructive pulmonary disease (COPD) requires consistent sustained management, including regular physical activity, pulmonary rehabilitation, and self-care adherence. Despite strong clinical guidelines, patient engagement remains a major challenge, leading to suboptimal disease control and increased health care use. Gamified interventions have emerged as potential tools to improve adherence, motivation, and outcomes in chronic disease management. However, their effectiveness and implementation in COPD remain underexplored.
Objective: This review synthesizes current evidence on gamified interventions for COPD management to evaluate their effectiveness, focusing on patient engagement, physical outcomes, and quality of life.
Methods: We conducted a systematic search in PubMed, Scopus, Web of Science, Embase, IEEE Xplore, Cochrane Library, and China National Knowledge Infrastructure for studies published from January 2014 to October 2024. Only original studies involving trials (both randomized controlled trials [RCTs] and non-RCTs), intervention studies, feasibility studies, cross-sectional surveys, or qualitative studies were included.
Results: A total of 29 studies met the inclusion criteria: 11 (38%) RCTs; 7 (24%) pilot studies; 5 (17%) observational studies (including qualitative studies); and 6 (21%) other studies using gamified technologies such as virtual reality, exergames, and mobile apps. Compared to nongamified methods, gamified interventions provided an engaging, home-based alternative for COPD management, supporting long-term rehabilitation. Gamification features such as real-time feedback, adaptive challenges, and personalized goals increased patient adherence and motivation, with high engagement seen in virtual reality and exergame-based interventions, and showed notable improvements in COPD management, enhancing exercise tolerance, self-management, and symptom control. However, most of the studies (22/29, 76%) were of short duration, with small sample sizes.
Conclusions: Gamified COPD management tools offer flexibility and empower patients to self-manage their condition, potentially reducing the need for clinic visits. Gamified interventions show promise in COPD management, although current studies have methodological limitations. Future research should focus on conducting larger trials to assess the sustained impact of gamified interventions on COPD outcomes; developing culturally relevant adaptations to enhance the global applicability of these interventions; and collaborating with patients, clinicians, and game developers to make the interventions more engaging and effective.
Background: Haptic feedback technology is widely used, including in serious games. It is an additional sensory method that supplements audio and vision, provides a novel user experience through a physical control layer, and enhances the immersion of virtual reality, thereby improving the user's cognitive state while alleviating dependence on visual information. However, there is limited research on haptic feedback preferences for mobile serious card games designed for older adults.
Objective: The study aims to investigate older adults' preferences for haptic feedback in mobile serious card games.
Methods: This study recruited a total of 250 participants from Dangtu County, Anhui Province, China, with an average age of 64.78 (SD 4.23) years. A descriptive survey was conducted among older adults, structured questionnaires were distributed, and data were collected via the Wenjuanxing (Changsha Ranxing Information Technology Co Ltd) mobile app. Reliability and validity analyses were performed using SPSS (IBM Corp) software. The questionnaire investigated older adults' basic understanding of card games and serious games, the integration of card games with mobile devices, the potential impact of combining card games with haptic feedback technology, as well as suggestions and opinions.
Results: The results showed that 63.2% (158/250) of the older adults liked the slight haptic feedback mode, and 78.4% (196/250) of the participants believed that combining haptic feedback technology with mobile card games would help improve cognitive abilities. The study found that 73.6% (184/250) of the older adults believed that this technology could reduce their reliance on visual information. This confirms that the combination of serious card games and haptic feedback can alleviate sensory impairments in older adults. Qualitative analysis revealed the potential of haptic feedback to reduce visual fatigue and provide an engaging cognitive training experience.
Conclusions: Older adults have shown great interest in incorporating haptic feedback into mobile serious card games, believing that this could enhance their cognitive abilities while reducing their reliance on visual information. However, limitations include sample size and geographic restrictions, differences in digital literacy, self-reported data, and lack of longitudinal assessment. Longitudinal studies are recommended to evaluate the long-term effects of mobile serious card games with haptic feedback on cognitive abilities. Such investigations could provide valuable insights for game developers, rehabilitation institutions, and the development of cognitive training tools for older adults.
Background: Given the appeal of active video games (AVG), many tools are now being used for combined training in older adults. However, there is a lack of comparative data to determine which type of AVG is better suited to older adults.
Objective: The purpose of this study was to compare user experience (UX), workload, pleasure, and intensity of three different experiences: (1) an Immersive and Interactive Wall Exergame (I2WE), (2) a consumer device (SWITCH), and (3) a combination of video games and physical stimulation (biking and videogaming, BIKE-VG) for older adults. I2WE and SWITCH are categorized as Moving While Thinking training, meaning that the cognitive task is integrated into the motor or physical task. In contrast, BIKE-VG is categorized as Thinking While Moving training, where the cognitive and motor or physical tasks are not interconnected. The nature of the cognitive, physical, and motor combinations also differentiates them. I2WE is multi-domain training, while BIKE-VG is physical-cognitive training, and SWITCH is motor-cognitive training.
Methods: A total of 90 older adults (mean [SD] 69.49 [5.78]) were divided into 3 groups (I2WE, SWITCH, and BIKE-VG). Each participant completed a 45-minute group session and then filled out questionnaires to evaluate UX, workload, pleasure, and intensity.
Results: The UX was positive for I2WE and SWITCH, and neutral for BIKE-VG. It was higher for I2WE than for BIKE-VG (t87=2.83; P=.02; d=0.70; 95% CI 0.15-1.69). The workload was moderate across all 3 groups. The intensity was moderate for all groups, ranging between 50% and 70% of the maximum heart rate, and approached high intensity for the I2WE and SWITCH groups. It was significantly higher for I2WE than for BIKE-VG (t66= 2.86; P=.01; d=0.70; 95% CI 1.04-11.43). The perceived pleasure was significantly higher for I2WE (t87=3.63; P=.001; d=0.9;95% CI 2.74-13.23) and SWITCH (t87=3.11; P=.01; d=0.87; 95% CI 1.82-13.69) compared with BIKE-VG.
Conclusions: The UX and perceived enjoyment are higher for the Moving While Thinking training compared with the Thinking While Moving training. This indicates that the I2WE and SWITCH training approaches are promising and motivating options for combined training for older adults.
Background: Virtual reality (VR) is increasingly used as a distraction tool for painful procedures in children. Studies have shown variable benefit but have not identified factors to maximize utility.
Objective: This study aimed to undertake a feasibility study to investigate factors influencing virtual reality headset (VRH) utility for venipuncture and cannulation.
Methods: Children admitted as inpatients were recruited and given a VRH during anticipated venipuncture or cannulation. Feedback from participants, parents, and operators was obtained through questionnaires and the Wong-Baker Faces Scale (WBFS).
Results: Thirteen children of a target 32 (41%), aged a median of 7 (range 5-12) years, were recruited to the study; 9 (69%) parents and 7 (54%) participants reported a positive VR experience, found VRH comfortable, and wanted repeat application for future venisection or cannulation. However, patient recruitment was suboptimal at 41% (binomial 95% CI 24%-59%) of the target, as busy operators undertaking venisection or cannulation on eligible patients were unable to spare time for VRH use during the COVID-19 pandemic. The preprocedure time spent with VRH was associated with participants' positive experience of VR distraction (median 15, IQR 2.5-50 vs 180, IQR 120-450) seconds (P=.02). Five (38.4%) participants removed the VRH prior to procedure; these were relatively young compared to those who continued VRH (median 6, IQR 5.00-7.00 vs 10, IQR 6.75-12.00 years), suggesting better acceptance of VR in older children. There was no significant difference in WBFS pain ratings before (median 0, IQR 0-10) or after the procedure (median 0, IQR 0-6), with many children choosing 0 ("no hurt") at initial assessment. By contrast, parent and doctor or phlebotomist responses indicated that VR reduced pain and anxiety (n=9, 69%), in agreement with participant perception (n=7, 54%; Cohen κ=0.68).
Conclusions: VR as a distraction tool in children is influenced by age and preprocedure familiarity, suggesting that the optimal use is in older children with greater cognitive and emotional maturity. Multidimensional feedback from participants, parents, and investigators should be obtained to test the true efficacy of VR in future studies.
Background: Exergame-based training enhances physical and cognitive performance in older adults, including those with mild neurocognitive disorder (mNCD). In-game metrics generated from user interactions with exergames enable individualized adjustments. However, there is a need to systematically investigate how well such game metrics capture true cognitive and motor-cognitive performance to provide a more robust basis for personalized training.
Objective: The primary objective was to identify valid game metrics as indicators for in-game domain-specific cognitive performance during exergaming in individuals with mNCD. We also aimed to explore game metric performance changes over time during exergame-based training.
Methods: Data were analyzed from individuals with mNCD who completed a 12-week home-based, exergame-based intervention following the Brain-IT training concept. A cross-sectional analysis was conducted by correlating game metrics with standardized neurocognitive reference assessments. To confirm the alternative hypothesis, we predetermined the following criteria: (1) statistically significant correlation (P≤.05; uncorrected; 1-sided) with (2) a correlation coefficient (Pearson r or Spearman ρ) of ≥0.4. Visual and curve-fitting longitudinal analyses were conducted to explore game performance changes over time.
Results: Data were available from 31 participants (mean age 76.4, SD 7.5 y; n=9, 29% female). In total, 33% (6/18) of the game metrics were identified as valid indicators for in-game cognitive performance during exergaming. In the neurocognitive domain of learning and memory, these metrics included the mean reaction time (ρ=-0.747), the number of collected items (ρ=0.691), and the precision score (r=-0.607) for the game Shopping Tour (P<.001 in all cases), as well as the point rate (P=.008; r=0.471) for the game Simon. In addition, point rate was a valid indicator for executive function (P=.006; r=0.455) and visuospatial skills (P=.02; r=0.474) for the games Targets and Gears, respectively. The exploratory longitudinal analysis revealed high interindividual variability, with a general trend of the expected typical curvilinear curves of rapid initial improvements followed by a plateau in performance.
Conclusions: This study demonstrated that metrics reflecting the precision of responses generally performed better than metrics reflecting the speed of responses. These observations highlight the importance of selecting valid game metrics for implementation in exergame designs. Further research is needed to explore the potential of game metrics and identify factors contributing to individual variability in in-game performance and performance progression, as well as identifying and adopting strategies that facilitate individual learning success and thus promote effectiveness in improving health outcomes.
Background: Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental condition characterized by inattention, hyperactivity, and impulsivity, significantly impacting the psychological, social, and academic well-being of affected children and adolescents. Traditional ADHD diagnostic methods often rely on subjective reports, which can be biased. Recent advancements in serious games offer the potential for objective assessment tools.
Objective: This study aimed to evaluate the discriminative power and concurrent validity of the serious game Attention Slackline in distinguishing children and adolescents with ADHD from those without the condition and in correlating game performance with standardized ADHD assessment scales.
Methods: A sample of 32 children and adolescents diagnosed with ADHD and 39 healthy controls participated in the study. Participants were divided into 2 age groups: children (aged 6-11 years) and adolescents (aged 12-17 years). The serious game Attention Slackline was administered alongside established ADHD assessment scales, including the Child and Adolescent Assessment System and the ADHD Rating Scale IV. Group differences were analyzed using multivariate analysis of covariance, and effect sizes were reported using Cohen d. Correlations between game performance and ADHD symptoms were calculated using Pearson r.
Results: Children with ADHD demonstrated significantly worse performance in Attention Slackline than the controls (t65=-2.26; P=.03; |d|=0.901), whereas no significant differences were observed in adolescents (t65=0.75; P=.73; |d|=0.191). Task performance was negatively correlated with family-reported hyperactivity/impulsivity symptoms in children across both tests (r=-0.43 and r=-0.51), but no significant correlations were observed in adolescents.
Conclusions: The findings support the validity of Attention Slackline for assessing hyperactivity/impulsivity symptoms in children with ADHD. However, its efficacy decreases in adolescents, potentially due to developmental factors, such as compensatory strategies and ceiling effects in task performance. The gamified nature of the tool enhances engagement, which is crucial for young populations, while maintaining its diagnostic utility in measuring impulsivity. The age-dependent validity aligns with previous research indicating that continuous performance test paradigms are less effective in older populations due to developmental maturation. Attention Slackline shows potential as a complementary tool for ADHD diagnosis in children, offering an engaging and objective assessment of hyperactivity/impulsivity. Future research should aim to establish clinical cutoff points and refine the task's complexity to align with individual characteristics.
Background: Virtual reality (VR) technology has emerged as a promising tool for cognitive rehabilitation in patients with neuropsychiatric disorders. These patients often endure significant cognitive impairments, which are associated with decreased quality of life and increased disease burden. Traditional treatments are limited in improving cognitive functions, making VR-based interventions an area of growing interest.
Objective: This meta-analysis aims to evaluate the efficacy of VR-based interventions on cognitive function in patients with neuropsychiatric disorders by synthesizing data from randomized controlled trials (RCTs).
Methods: Following PRISMA guidelines, we conducted a comprehensive search across PubMed, Web of Science, MEDLINE, EMBASE, and Cochrane Library for RCTs from January 2010 to December 2024. Studies were included if they evaluated the impact of VR-based interventions on cognitive outcomes in patients with neuropsychiatric disorders. Data extraction and risk of bias assessment were performed independently by 2 researchers. Meta-analyses were conducted using random-effects models, and standardized mean differences (SMDs) as effect size.
Results: A total of 21 RCTs involving 1051 participants were included. Overall, VR-based interventions significantly improved cognitive functions of patients with neuropsychiatric disorders (SMD 0.67, 95% CI 0.33-1.01, z=3.85; P<.001). Subgroup analyses revealed significant benefits for cognitive rehabilitation training (SMD 0.75, 95% CI 0.33-1.17, z=3.53; P<.001), exergame-based training (SMD 1.09, 95% CI 0.26-1.91, z=2.57; P=.01), and telerehabilitation and social functioning training (SMD 2.21, 95% CI 1.11-3.32, z=3.92; P<.001). Conversely, immersive cognitive training, music attention training, and vocational and problem-solving skills training did not yield significant improvements (z=1.86, P=.06; z=0.35, P=.72; z=0.88, P=.38; respectively). Disease-type subgroup analyses indicated significant improvements in schizophrenia (SMD 0.92, 95% CI 0.22-1.62, z=2.58; P=.01), and mild cognitive impairment (SMD 0.75, 95% CI 0.16-1.35, z=2.47; P=.01), but not in brain injuries, Parkinson disease, or stroke (z=0.34, P=.73; z=1.26, P=.21; z=1.16, P=.24; respectively).
Conclusions: This meta-analysis revealed that VR-based interventions can improve cognitive functions among individuals with neuropsychiatric disorders, with notable improvements observed in cognitive rehabilitation training, exergame-based training, and tele-rehabilitation and social functioning training. These results offer valuable evidence supporting the use of VR technology in rehabilitation for neuropsychiatric conditions and inform the optimization of future intervention approaches.
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