JMIR Serious Games最新文献

Background: Accumulating evidence and medical guidelines recommend high-dose neurorehabilitation for recovery after stroke. The reality, however, is that most patients receive a fraction of this dose, with therapist availability and costs of delivery being major implementational barriers.

Objective: This study aimed to explore a potential solution by conducting a retrospective analysis of a real-world enhanced clinical service that used gamified self-training technologies at home under remote therapist supervision.

Methods: Data from 17 patients who completed a 12-18 week full-body, high-dose neurorehabilitation program entirely at home were analyzed. Program delivery relied primarily on patients training independently (asynchronously) with the MindMotion GO (MindMaze) gamified-therapy solution. Accompanying telerehabilitation training sessions with a therapist occurred weekly while therapists used a web application to continuously monitor and manage the program remotely. Effectiveness of the program was assessed through measured active training time, a measure that more closely reflects delivered dosage as opposed to scheduled dose. Patient recovery was evaluated with standardized impairment and functional clinical measures and patient self-reported outcome measures. Finally, a cost model was computed to evaluate the resource efficiency of the program.

Results: Patients maintained high training adherence throughout the program and reached an average total active training time of 39.7 (SD 21.4) hours, with the majority delivered asynchronously (mean 82.2%, SD 10.8%). Patients improved in both upper-limb (Fugl-Meyer Upper Extremity, mean 6.4, SD 5.1; P<.001) and gait and balance measures (Functional Gait Assessment, mean 3.1, SD 2.6; P<.001; Berg Balance Scale, mean 6.1, SD 4.4; P<.001). Overall, the program was viewed very favorably among patients who completed a post-program survey, with 73.7% (14/19) of respondents being satisfied or very satisfied, while 63.2% (12/19) of respondents reported subjective improvements in physical abilities. Per-patient therapist costs approximated US $338, representing a resource-efficient alternative to delivering the same dose via one-on-one in-person training sessions (US $1903).

Conclusions: This work demonstrates effective high-dose neurorehabilitation delivery via gamified therapy technologies at home. The approach shows that training time can be successfully decoupled from therapist-presence without compromising adherence, outcomes, or patient satisfaction over an extended program period. Given growing concerns over therapist availability and increasing health care costs, this resource-efficient approach can help achieve medical guidelines and complement existing clinic-based approaches.

Background: Parkinson disease (PD) is a rapidly growing neurological condition worldwide. While physiotherapy and exercise are effective interventions, the addition of motivational aspects that improve adherence could be beneficial for people with PD. Incorporating technological devices into motor rehabilitation, coupled with gamification elements, could enhance the relevance of rehabilitation and alleviate motor symptoms.

Objective: The aim of this scoping review was to identify and classify the technological devices that integrate gamification elements used in motor rehabilitation in PD, and to describe the justification behind the use of these devices and elements in this context.

Methods: We conducted a scoping review following the framework proposed by Joanna Briggs Institute, along with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. Major health science databases (MEDLINE, EMBASE, Scopus, Cochrane, Web of Science, PsycINFO, and Epistemonikos) were systematically searched. Relevant studies were included if they used technological interventions with gamification elements for motor symptom rehabilitation in PD. Gamification elements were extracted and categorized based on established frameworks, and content analysis was used to review the justifications for the use of technologies integrating gamification.

Results: A total of 4451 studies were retrieved from the search. After the abstract and full-text screening, 81 studies were eligible for data extraction. The analysis identified 453 gamification elements across studies, with development and accomplishment being the most prominent core drive. Progress/feedback was the most frequently used element (79/81, 98% of studies), followed by points (70/81, 86%) and levels/progression (66/81, 81%). Other notable elements included badges, leaderboards, and customization, while several core drives, like ownership and possession, lacked reported elements. Most interventions were delivered through commercial video game consoles (33/81, 41%), followed by computer-based systems (32/81, 40%). Tablet-based applications and integrated rehabilitation platforms were used in 11% (9/81) and 10% (8/81) of the studies, respectively. The expected roles of technology were clear, but intentional use of gamification was scarce.

Conclusions: This scoping review highlights the widespread adoption of technologies integrating gamification elements for motor symptom rehabilitation in individuals with PD. However, it also underscores a critical gap in understanding and justifying gamification mechanics. The current landscape relies heavily on commercial video games and emphasizes performance-based experiences, lacking theoretical grounding.

Background: The COVID-19 pandemic has significantly affected health care professionals, especially nurses, who have experienced elevated levels of stress, burnout, and physical health challenges. In the postpandemic era, supporting their well-being is crucial. Gamification, which is the application of game design elements in nongame contexts, has emerged as a promising strategy to promote engagement in health behaviors. This study explores the use of a gamified mobile app to support self-health management among nurses recovering from the COVID-19 experience.

Objective: This study aimed to evaluate the preliminary efficacy of a gamified mobile app for promoting self-health management among nurses who experienced the COVID-19 pandemic. The study examined whether gamification could enhance engagement, improve physical health outcomes, and encourage sustainable behavior change.

Methods: A single-arm pre-post intervention study was conducted using a user-centered design. The app was developed based on the Octalysis framework and goal-setting theory, incorporating personalized exercise prescriptions and health monitoring features. Nurses from a regional hospital in Hsinchu, Taiwan, participated in the 8-week intervention. Data were collected through interviews, pre- and postintervention surveys, and app usage analytics. Key outcomes included changes in step counts, BMI, and user engagement.

Results: After the intervention, BMI classification improved significantly. The proportion of participants classified as obese decreased from 38.5% (90/234) to 13.7% (32/234), and the proportion of those classified as overweight increased from 24.8% (58/234) to 34.6% (81/234). Overall, the combined proportion of overweight or obese participants declined from 63.2% (148/234) to 48.3% (113/234), and that of participants with normal BMI increased from 18.4% (43/234) to 33.8% (79/234) (χ²₄=29.98; P<.001). Octalysis tool results showed strong motivational engagement, with the highest scores in development and accomplishment (mean 7.29), epic meaning and calling (mean 7.05), and empowerment of creativity and feedback (mean 6.55).

Conclusions: The gamified mobile app demonstrated promising efficacy in enhancing self-health management among nurses in the post-COVID era by increasing physical activity and improving BMI. Gamification elements, such as achievement, purpose, and feedback, were effective in sustaining engagement. Further studies are recommended to assess long-term outcomes and broader applicability.

Background: Rehabilitation interventions to improve standing balance are often tedious and complex, limiting user engagement and increasing the burden of the clinicians delivering them. Virtual reality (VR) has been incorporated into such practices as a solution and VR illusions have emerged as a method for perturbing balance within interventions. However, the influence of VR illusions on balance performance, such as center of pressure (CoP), and user experience metrics remain under explored.

Objective: This study aimed to evaluate the impact of the VR illusions on standing balance and immersive user experience in young adults.

Methods: Young healthy adults (N=15, aged 18-35 years) played a VR table tennis game while standing on a force plate and were provided with eight directional and magnitude-based VR illusions scaled according to participants' heights. VR illusions were generated by offsetting the position of the playing hand in VR and were provided through 8 trials for each participant. Each VR illusion was delivered throughout final 50 seconds of each 70-second trial. Absolute CoP displacements, directional tendency of CoP displacement, and game performance were analyzed to evaluate the impact of the VR illusions. Responses to the User Experience Questionnaire, Slater-Usoh-Steed Presence Questionnaire, NASA Task Load Index, and Virtual Reality Sickness Questionnaire were analyzed to assess the immersive user experience.

Results: Both the magnitude of VR illusion and changes in VR illusion direction led to significantly greater CoP displacements, with high illusion magnitudes, and anterior and posterior directional illusions associated with higher CoP displacements. Conversely, those illusion magnitudes and directions were associated with low game performance. The directional tendency of the CoP displacements varied across the illusion directions but showed a significant association with the illusion directions. Questionnaire responses showed that participants had moderate to high immersive user experience within the VR illusion paradigm.

Conclusions: This study provides a novel approach for the future development of more effective VR-based balance rehabilitation interventions. The results provide inspiration for the development of future VR-based exergames that can perturbate CoP direction and magnitude. By adjusting the difficulty level through directional and magnitude changes in VR illusions, exergames could provide a personalized rehabilitation experience.

Background: The opioid crisis has significantly impacted adolescents and their families. This is attributed in part to increased opioid prescriptions in pediatric emergency departments (EDs) due to acute pain conditions and injuries. Although EDs frequently prescribe opioids, no effective preventative interventions have been implemented to educate adolescents and their families on safe opioid use. This study evaluates the MedSMA℞T Families intervention, which consists of an engaging serious game, Adventures in PharmaCity, and a personalized Family Medication Safety Plan (FMSP) with the aim of reducing opioid misuse and promoting opioid medication safety. The MedSMA℞T Families intervention was developed to educate adolescents and adults prescribed opioids on safe practices such as opioid storage and disposal.

Objective: This study aimed to explore and characterize adolescents' and parents' experiences and perspectives on implementing the MedSMA℞T Families intervention in the ED to improve opioid education and safety among adolescents.

Methods: A total of 93 participants, including 16 children and 77 parents, were recruited from the pediatric ED at a tertiary academic hospital to play the MedSMA℞T game in the ED. A total of 16 participants, including 8 children and 8 parents, were followed up with interviews to gather qualitative feedback. Participants engaged with the MedSMA℞T game-Adventures in PharmaCity-and the FMSP. Data were collected through gameplay observation and 75-minute semistructured interviews via Zoom. Quantitative in-game data were analyzed using descriptive analysis and qualitative data were analyzed using thematic analysis with NVivo (version 14; Lumivero).

Results: Parents spent an average of 22.16 (SD 4.97) minutes playing the game, while children spent an average of 21.99 (SD 8.06) minutes. Families appreciated the game's design and noted usability challenges and suggested enhancements for clearer gameplay instructions. Participants reported increased knowledge of opioid safety, highlighted the importance of communication with health care providers, and a desire for a mobile app to assist with medication management. The FMSP was perceived as valuable for promoting awareness of safe practices and connected well to the knowledge gained from the game.

Conclusions: The MedSMA℞T Families intervention was well received as a beneficial educational tool to educate adolescents and their families on safe opioid use. Additionally, it highlights a clear need for more accessible digital tools to increase opioid education. This feedback indicates a strong interest in improving educational resources to ensure safe opioid management within families.

Background: As a novel intervention method that combines exercise and games, exergames have demonstrated a positive impact on enhancing the cognitive and physical functions of older adults with mild cognitive impairment (MCI). However, there remains a dearth of knowledge and evidence regarding the experiences and needs of the older adult population in China with MCI about exergames.

Objective: This qualitative study aimed to investigate the experience of and needs for exergames among older adults with MCI.

Methods: We adopted a phenomenological methodology for this study, and conducted it at a community and nursing home in Changsha, Hunan Province, from June to August 2023. We used the purpose sampling method to conduct semistructured interviews with 21 older people with MCI. Older people with MCI were allowed to experience exergames using our preselected exergame device, the Nintendo Switch, and they were interviewed to understand their experience and needs for exergames. The interviews were recorded and transcribed verbatim, and the data were uploaded to NVivo 12 software for encoding. The corresponding text was then reviewed for data analysis. Data analysis was guided by the methodology proposed by Giorgi and was carried out simultaneously with data collection. This study's trustworthiness was evaluated according to credibility, dependability, confirmability, and transferability criteria.

Results: Overall, 21 participants (mean age 70.2, SD 7.6 y; n=17, 81% women; mean Montreal Cognitive Assessment score 18.8, SD 3.6) were interviewed. Moreover, 21 interviews were conducted. By the 18th interview, the data were saturated, and to make sure no new topics came up, we conducted 3 more interviews. The experience of older people with MCI with exergames includes five parts: their attitudes toward exergames vary, they are both entertaining and interesting, they promote physical activity and exercise, they pass the time and relieve loneliness, and their conditions of use are not restricted. The needs of older people with MCI for exergames include the desire to design older people-friendly exergames, ensure scientific validity and safety in the process of sports, provide a good gaming experience, exercise physical and cognitive function, and provide support and training.

Conclusions: This study provides an interpretative understanding of the experiences and needs associated with exergames in older people with MCI, which could inform exergame development appropriate for this population and guide the implementation of exergame interventions in this population. Most older people with MCI expressed a positive attitude toward exergames, but not all were interested in them. Older people with MCI viewed exergames as both entertaining and fun, promoting physical activity and exercise, passing the time, relieving loneliness, and the conditions of use w

Background: Nature engagement, including affective and physical interactions with nature, is linked to a multitude of health and well-being benefits. Unfortunately, opportunities for engaging with nature are decreasing worldwide. University students, especially, are a demographic group that tends to engage little with nature. Immersive virtual nature (IVN; ie, digital nature content delivered through immersive devices, such as head-mounted displays) has been proposed as a medium to facilitate nature experiences and engagement. In recent years, 360° nature videos have emerged as an accessible way to create IVN content, although it is still unclear whether they can elicit presence and increase nature engagement to a greater extent than nature videos delivered through nonimmersive media.

Objective: We aimed to investigate the effectiveness of nature videos as a medium to promote nature engagement among university students, comparing devices with different levels of immersion. Specifically, 2 experimental conditions were tested: a 360° nature video delivered through a head-mounted display (IVN) and a matching video displayed on a tablet screen (nonimmersive virtual nature).

Methods: In total, 38 students were recruited at the library of a university campus and invited to participate in an organized hiking tour at the location displayed during the virtual nature experience. They were then randomized, using a random number generator, to either the IVN (n=20, 53%) or the nonimmersive virtual nature condition (n=18, 47%). Pre- and postexposure assessments of nature connectedness, intention to perform green exercise, intention to visit the hiking location, and intention to participate in the organized hiking tour were collected. Presence, cybersickness, and actual attendance on the tour were also assessed.

Results: A mixed ANOVA showed statistically significant pre- to postexposure assessment increases in nature connectedness (F_1,36=33.49; P<.001; η_p²=0.48); intention to perform green exercise (F_1,36=5.55; P=.02); intention to visit the hiking location (F_1,36=15.34; P<.001; η_p²=0.26); and intention to participate in the hiking tour (F_1,36=12.45; P=.001; η_p²=0.30). Both conditions were associated with medium to high ratings of "being there" and "sense of reality" but low ratings of "realism." The cybersickness levels were generally low. Of the 38 students, 6 (16%) participated in the organized tour. The mixed ANOVA found no statistical differences between the two conditions for any of the outcomes. The participants' changes in nature connectedness (ρ=0.35; P=.03) and attendance on the hiking tour (ρ=.37; P=.02) correlated with the presence item "being there."

Conclusions: This study provides novel evidence on the potential of virtual natu