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Immersive Virtual Reality-Assisted Therapy for Distressing Voices in Psychosis: Qualitative Study of Participants' and Therapists' Experiences in the Challenge Trial. 沉浸式虚拟现实辅助治疗精神病的痛苦声音:挑战试验中参与者和治疗师经验的定性研究。
IF 4.1 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-12-01 DOI: 10.2196/77920
Mads Juul Christensen, Matilde Poulsen Rydborg, Rikke Jørgensen, Cecilie Dueholm Nielsen, Jan Mainz, Imogen H Bell, Neil Thomas, Lisa Charlotte Smith, Lise Sandvig Mariegaard, Thomas Ward, Merete Nordentoft, Louise Birkedal Glenthøj, Ditte Lammers Vernal
<p><strong>Background: </strong>Immersive virtual reality-assisted therapy (VRT) is a relational therapy for distressing voices in psychosis. Like AVATAR therapy (AT), VRT centers on therapist-facilitated dialogues with a digital avatar representing a voice. Unlike AT, VRT uses immersive virtual reality (VR). While participant experiences of AT have been explored, therapist perspectives remain unexamined, and for VRT, neither participant nor therapist experiences have been studied. Understanding these perspectives is essential to inform optimization of therapy, future research, and implementation.</p><p><strong>Objective: </strong>The objective of this qualitative study was to explore both trial participants' and therapists' experience of VRT in the Challenge trial.</p><p><strong>Methods: </strong>Semistructured interviews were conducted with 10 trial participants and 8 therapists across the 3 Challenge trial sites. Trial participants were purposively sampled to ensure site representation and variation in voice-hearing duration. Individual interviews were conducted with trial participants, while therapists participated in site-based groups with 2-3 in each. Interviews were audio-recorded, transcribed, and subjected to reflexive thematic analysis from a critical realist position. Coding and theme development were inductive. People with lived experience were invited to an initial focus group for topic guide development and a later theme validation workshop. Reporting followed the Standards of Reporting Qualitative Research (SRQR).</p><p><strong>Results: </strong>A total of five overarching themes were generated: (1) using technology to meet the voice, (2) a different approach to voice-hearing and treatment, (3) on a tight schedule, (4) a toolbox for transformation, and (5) a price to pay. Trial participants and therapists generally found VRT acceptable, appropriate, and feasible. Highlights included the acknowledging approach to the voice(s), facilitation of engagement with the voice(s), and opportunity to share the otherwise private experience of voice-hearing. Externalizing and embodying the voice(s) in VR-supported avatar role-plays was seen as a key affordance. Positive outcomes included increased trial participant empowerment and self-worth, enabling or improving voice dialogue, new understanding of voice intentions, and changes in voice frequency or content. Challenges included instances of participant anxiety, exhaustion, or suboptimal sense of (voice) presence; adverse voice reactions; technological malfunctions and limitations to avatar design; measurement insensitivity; tensions between assertiveness and compassion; difficulties with reproducing negative voice content; and the demanding nature of the therapy and the nontraditional skills required of therapists.</p><p><strong>Conclusions: </strong>The study provided comprehensive insights into trial participants' and therapists' experiences of VRT in the Challenge trial. Findings share sev
背景:沉浸式虚拟现实辅助治疗(VRT)是一种治疗精神病患者痛苦声音的关系疗法。与AVATAR疗法(AT)一样,VRT的核心是治疗师与代表声音的数字化身进行对话。与AT不同,VRT使用沉浸式虚拟现实(VR)。虽然已经探索了AT的参与者经验,但治疗师的观点仍然没有得到检验,对于VRT,参与者和治疗师的经验都没有被研究过。了解这些观点对优化治疗、未来研究和实施至关重要。目的:本定性研究的目的是探讨试验参与者和治疗师在挑战试验中对VRT的体验。方法:采用半结构化访谈法,对3个Challenge试验地点的10名试验参与者和8名治疗师进行访谈。有目的地对试验参与者进行抽样,以确保现场代表性和语音听力持续时间的变化。与试验参与者进行了个人访谈,而治疗师则参加了以现场为基础的小组,每个小组2-3人。采访被录音、转录,并从批判现实主义的立场进行反身性的主题分析。编码和主题开发是归纳性的。有实际经验的人被邀请参加主题指南开发的最初焦点小组和后来的主题验证研讨会。报告遵循定性研究报告标准(SRQR)。结果:总共产生了五个总体主题:(1)使用技术来满足声音,(2)不同的声音听力和治疗方法,(3)紧凑的时间表,(4)转换工具箱,(5)支付的代价。试验参与者和治疗师普遍认为VRT是可接受的、适当的和可行的。重点包括承认声音的方法,促进与声音的接触,以及分享声音听力的私人经验的机会。在虚拟现实支持的角色扮演中,声音的外化和体现被视为一个关键的支持。积极的结果包括增加试验参与者的权力和自我价值,促进或改善语音对话,对语音意图的新理解,以及语音频率或内容的变化。挑战包括参与者焦虑、疲惫或不理想的(声音)存在感;不良声音反应;虚拟角色设计的技术故障和局限性;测量不敏感;自信和同情之间的紧张关系;再现负面声音内容的困难;治疗的要求和对治疗师非传统技能的要求。结论:本研究对Challenge试验中受试者和治疗师的VRT体验提供了全面的见解。研究结果与针对痛苦声音的其他关系疗法的定性研究有一些相似之处,并强调了VRT带来积极变化的潜力。未来研究和实施的关键考虑因素包括监测焦虑和语音反应,确保硬件和软件的操作可靠性,以及解决治疗师需要的额外努力,这在日常实践中可能是不可持续的。作为一项要求很高的干预措施,VRT的成功实施需要充分的培训、监督和结构支持。
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引用次数: 0
Effects of Progressive Aerobic Training on Executive-Reward Network Connectivity and Symptoms of Internet Gaming Disorder: Randomized Controlled Trial. 渐进式有氧训练对执行-奖励网络连通性和网络游戏障碍症状的影响:随机对照试验。
IF 4.1 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-11-28 DOI: 10.2196/83597
Shaoyu Cui, Xuefeng Xu, Xin Luo, Meiting Wei, Guang-Heng Dong
<p><strong>Background: </strong>Internet gaming disorder (IGD) causes neurocognitive deficits and brain dysfunction. Progressive aerobic training (PAT) seems more practical. However, its effect on IGD and the underlying neural mechanism remains unclear.</p><p><strong>Objective: </strong>This preregistered, randomized controlled, single-blind study examined the efficacy of a novel non-pharmacological intervention by elucidating the neurocognitive mechanisms in IGD.</p><p><strong>Methods: </strong>A total of 72 participants with IGD (meeting the DSM-5 criteria for IGD, Internet Addiction Test [IAT] score >50, and no comorbid conditions) were recruited and randomly assigned to a PAT group (received 12 weeks of PAT with the intensity dynamically adjusted based on real-time performance) or a free training (FT) group (completed sessions of equal duration but without a progressive structure, allowing free choice of exercise mode and intensity). No intervention-related adverse events were reported. Sixty-four participants completed the experiment (PAT: 33; FT: 31), including pretreatment and posttreatment functional magnetic resonance imaging scans and 20 PAT sessions in a month. Regional homogeneity and degree centrality are calculated; the overlapping brain regions were used as seed points for functional connectivity (FC) analysis. The correlation between FC and behavioral data and neurotransmitters was also evaluated.</p><p><strong>Results: </strong>The PAT group demonstrated a significantly greater reduction in IAT scores compared to the FT group (t32=4.333, Pbonf<0.001, Cohen d=0.754, 95% CI 0.362-1.137), accompanied by a specific reduction in game craving within the PAT group (t32=2.278, Pbonf=0.03, Cohen d=0.397, 95% CI 0.045-0.851]). FC analysis revealed that PAT significantly enhanced FC within the executive control network (ECN), increasing connectivity between the right medial superior frontal gyrus (R-mSFG) and key regions, including the left postcentral gyrus (F1, 62=7.95, P=.006), bilateral superior parietal gyrus (right: F1, 62=5.68, P=.02; left: F1, 62=8.85, P=.004), and left inferior frontal gyrus (F1, 62=11.37, P=.001). PAT also strengthened ECN-reward network (RN) integration, enhancing FC between the R-mSFG and bilateral insula (right: F1, 62=11.41, P=.001; left: F1, 62=7.94, P=.006) and left substantia nigra (F1, 62=10.60, P=.002). These neural changes were behaviorally relevant, as pretest game craving positively correlated with post-intervention FC strength between the R-mSFG and left postcentral gyrus (r=0.36, P=.04, 95% CI 0.02-0.63) and right precentral gyrus (r=0.40, P=.02, 95% CI 0.07-0.65). Furthermore, the FC changes were significantly associated with cannabinoid (CB1) (P=.003) and metabotropic glutamate (mGluR5) receptor distributions (P=.005).</p><p><strong>Conclusions: </strong>This study demonstrates the efficacy of a progressive and adaptive PAT intervention in reducing IGD severity, moving beyond static protocols by dy
背景:网络游戏障碍(IGD)导致神经认知缺陷和脑功能障碍。渐进式有氧训练(PAT)似乎更实用。然而,其对IGD的影响及其潜在的神经机制尚不清楚。目的:这项预注册、随机对照、单盲研究通过阐明IGD的神经认知机制来检验一种新型非药物干预的疗效。方法:共招募了72名IGD患者(符合DSM-5的IGD标准,网络成瘾测试[IAT]评分bbbb50,无合并症),并随机分配到PAT组(接受12周的PAT,强度根据实时表现动态调整)或自由训练组(完成等长时间的训练,但没有进行性结构,允许自由选择运动模式和强度)。无干预相关不良事件报告。64名参与者完成了实验(PAT: 33; FT: 31),包括治疗前和治疗后的功能磁共振成像扫描和一个月20次的PAT。计算区域均匀性和度中心性;将重叠的脑区作为种子点进行功能连接(FC)分析。同时评估了FC与行为数据和神经递质的相关性。结果:与FT组相比,PAT组在IAT评分上的下降幅度明显更大(t32=4.333)。结论:本研究证明了渐进式和适应性PAT干预在降低IGD严重程度方面的有效性,通过动态调整强度来适应个人表现,超越了静态方案。治疗效果可能是通过调节ECN和RN之间的功能连接来调节的,这可能会增强自上而下的控制。这些结果得到了FC,行为和神经递质系统之间相关性的支持,表明PAT代表了一种有希望的非药物干预方法,值得进一步研究。
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引用次数: 0
Efficacy of the Web-Based Gamified Infection Control Training System on Practices for Health Care Workers in Residential Care Homes: Clustered Randomized Controlled Trial. 基于网络的游戏化感染控制培训系统对养老院医护人员实践的效果:聚类随机对照试验
IF 4.1 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-11-27 DOI: 10.2196/71593
Angela Y M Leung, Doris Y P Leung, Terence K Lau, Justina Y W Liu, Teris Cheung, Daphne S K Cheung, Simon C Lam, Eliza M L Wong, Mimi M Y Tse, Alex Molassiotis
<p><strong>Background: </strong>Staff working in residential care homes (RCHs) have played a significant role in preventing the spread of infection among residents, visitors, and staff. Providing continuous professional training to the staff is essential. Current infection control training mostly rests on short educational talks or one-to-one reminders in the RCHs. A blended mode of online interactive games and face-to-face consultations was now proposed as a new way to conduct infection control training in the RCHs.</p><p><strong>Objective: </strong>This study aims to assess the efficacy of the Blended Gaming COVID-19 Training System (BGCTS) on infection control practices and self-reported knowledge, attitude, and practices of standard precautions among health care workers in RCHs.</p><p><strong>Methods: </strong>A 2-arm, single-blinded, parallel cluster randomized controlled trial was designed, and 30 RCHs were recruited and randomized into an intervention group to receive the BGCTS and a control group to receive usual care on infection control training. Due to the COVID-19 pandemic and infected cases in the homes, 17 RCHs refused or delayed the on-site observations. The BGCTS intervention, developed based on "The COVID-19 Risk Communication Package for Healthcare Facilities" of the World Health Organization, consists of two parts: (1) an eHealth mode of a 120-minute web-based training system covering 8 topics, delivered in short-clip videos and games, and (2) two 30-minute face-to-face interactive sessions for concept clarification. The 2 infection control practices, "use of gloves and personal protective equipment (PPE) and performing respiratory hygiene" and "hand rub," were assessed by on-site unobtrusive observations, and self-reported infection control practices and knowledge and attitude toward infection control were measured via online survey post intervention.</p><p><strong>Results: </strong>A total of 212 staff from 13 RCHs were involved in the analysis, with 7 RCHs from the intervention group (n=114) and 6 RCHs from the control group (n=98). A significantly greater increase in the proportions of proper use of gloves and PPE and respiratory hygiene performance (β=.195, 95% CI 0.046-0.344; P=.02) and properly performed hand rub (β=.068, 95% CI 0.005-0.132; P=.04) was observed in the intervention group. The changes in the self-reported outcomes were not statistically significant.</p><p><strong>Conclusions: </strong>BGCTS improved RCH staff's performance in 2 infection control practices by objective measurement, "gloves and PPE use and performance in respiratory hygiene" and "hand rub." BGCTS was shown to be an effective training, although it was a 2-week intervention. The BGCTS did not perform better than infection control briefing sessions in self-reported infection control knowledge, attitude, and practices. This electronic-based infection control training with 2 intensive interactive sessions has good potential to be adopted as regul
背景:在养老院(RCHs)工作的工作人员在防止感染在居民、访客和工作人员之间传播方面发挥了重要作用。为员工提供持续的专业培训是必不可少的。目前的感染控制培训主要是在安老院舍进行简短的教育讲座或一对一提醒。现建议将在线互动游戏和面对面咨询的混合模式作为在安老院舍开展感染控制培训的新方式。目的:本研究旨在评估混合游戏COVID-19培训系统(BGCTS)对养老院医护人员感染控制行为和自我报告的知识、态度和标准预防措施的效果。方法:设计2组、单盲、平行集群随机对照试验,招募30名RCHs,随机分为干预组接受BGCTS治疗,对照组接受感染控制常规护理训练。由于2019冠状病毒病大流行和家庭感染病例,17家安老院拒绝或延迟现场观察。BGCTS干预是根据世界卫生组织的“医疗机构COVID-19风险沟通包”开发的,由两部分组成:(1)一个120分钟的网络培训系统的eHealth模式,涵盖8个主题,以短视频和游戏的形式提供;(2)两个30分钟的面对面互动课程,用于概念澄清。通过现场低调观察评估“使用手套和个人防护装备(PPE)并进行呼吸卫生”和“搓手”两项感染控制措施,并通过干预后在线调查测量自我报告的感染控制措施以及对感染控制的知识和态度。结果:13家养老院共212名工作人员参与分析,其中干预组7名(n=114),对照组6名(n=98)。干预组正确使用手套、个人防护用品和呼吸卫生行为的比例(β= 0.195, 95% CI 0.046 ~ 0.344, P= 0.02)和正确洗手的比例(β= 0.068, 95% CI 0.005 ~ 0.132, P= 0.04)显著高于对照组。自我报告结果的变化没有统计学意义。结论:BGCTS通过客观测量“手套和个人防护用品的使用和呼吸卫生绩效”和“洗手”改善了RCH工作人员在2个感染控制实践中的绩效。BGCTS被证明是一种有效的训练,尽管它是一个为期两周的干预。在自我报告的感染控制知识、态度和实践方面,BGCTS的表现并不比感染控制说明会好。这种以电子为基础的2次强化互动感染控制培训具有良好的潜力,可作为安老院舍的常规培训。试验注册:Clinicaltrials.gov NCT04783025;http://clinicaltrials.gov/ct2/show/NCT04783025。
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引用次数: 0
Mobile Exergames to Reduce Sedentary Time in Patients With Heart Failure: What Do Health Care Professionals Expect? 手机游戏减少心力衰竭患者久坐时间:医疗保健专业人员的期望是什么?
IF 4.1 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-11-26 DOI: 10.2196/69126
Leonie Klompstra, Anna Strömberg, Antoni Bayes-Genis, Maria Boldo, Beatriz González, Nuria Santaularia, Tiny Jaarsma

Unlabelled: Health care professionals emphasized that while exergaming holds promise as a motivational approach to supporting physical activity among patients with heart failure, its success depends on thoughtful integration into existing care pathways, personalization to patient needs, and addressing technological barriers.

未标记:卫生保健专业人员强调,虽然运动作为一种激励方法有望支持心力衰竭患者的身体活动,但它的成功取决于对现有护理途径的深思熟虑的整合,对患者需求的个性化,以及解决技术障碍。
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引用次数: 0
Evaluating the Effectiveness of Immersive Virtual Reality Rehabilitation Games With Enhanced Visual Training for Hand Motor Function Improvement Using Electromyography: Randomized Controlled Trial. 利用肌电图评估沉浸式虚拟现实康复游戏增强视觉训练对手部运动功能改善的有效性:随机对照试验。
IF 4.1 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-11-25 DOI: 10.2196/74314
Faisal Amin, Asim Waris, Muhammad Jawad Khan, Muhammad Adeel Ijaz, Hammad Nazeer, Syed Omer Gilani, Fawwaz Hazzazi, Umer Hameed Shah
<p><strong>Background: </strong>Hand motor dysfunction greatly reduces the performance of stroke survivors. This affects their ability to perform hand motor tasks effectively. Patients receive slow interventions due to interventional limitations in stroke rehabilitation, which can pose challenges for sustaining enduring improvements. We developed immersive virtual reality (VR) games that used an innovative approach to cognitive engagement within visual training feedback for achieving long-lasting improvements.</p><p><strong>Objective: </strong>This study aimed to evaluate the effectiveness of fully immersive VR-based hand games compared with conventional physical therapy and to assess the correlations between electromyographic data and clinical outcome measures for improving hand motor function in patients with subacute stroke.</p><p><strong>Methods: </strong>A randomized controlled study was conducted among 52 patients with subacute stroke who met the inclusion criteria. These patients were equally allocated to an experimental group (n=26) and a control group (n=26). The experimental group received both fully immersive VR-based hand game therapy and conventional physical therapy, whereas the control group received only conventional physical therapy. Owing to the nature of the intervention, the study was unblinded, and both therapists and patients were aware of the intervention. Both groups participated in intervention sessions 4 days a week for 6 weeks (24 sessions in total). Moreover, both groups underwent 2 weeks of follow-up. Clinical outcome measures, including the Fugl-Meyer Assessment-upper extremity (FMA-UE), Action Research Arm Test (ARAT), and Box and Block Test (BBT), were used to assess motor recovery and functional performance. The minimal clinically meaningful difference (MCID) was used for comparing clinical outcome measures to examine clinically meaningful improvements. Furthermore, the correlation between electromyography data and clinical outcome measures, and the weekly progression in movement performance were evaluated to identify improvements in hand motor function.</p><p><strong>Results: </strong>After the intervention, there were significant differences in FMA-UE, ARAT, and BBT scores (all P<.001) between the experimental and control groups. The MCID findings illustrated that the experimental group had clinically meaningful improvements compared to the control group. There were significant correlations between electromyography signal features and clinical outcome measures (all P<.05) in both groups after rehabilitation. However, the experimental group exhibited strong positive correlations, while the control group exhibited moderate positive correlations. At follow-up, the mean movement accuracy was notably higher in the experimental group than in the control group (mean 83.59%, SD 1.1% vs mean 79.20%, SD 0.8%), indicating that hand motor function was effectively sustained through the use of the VR-based intervention in the
背景:手部运动功能障碍极大地降低了中风幸存者的表现。这会影响他们有效执行手部运动任务的能力。由于卒中康复的干预限制,患者接受缓慢的干预,这可能对维持持久的改善构成挑战。我们开发了沉浸式虚拟现实(VR)游戏,在视觉训练反馈中使用了一种创新的认知参与方法,以实现持久的改进。目的:本研究旨在评估完全沉浸式vr手部游戏与传统物理治疗的有效性,并评估肌电图数据与改善亚急性脑卒中患者手部运动功能的临床结果指标之间的相关性。方法:对52例符合纳入标准的亚急性脑卒中患者进行随机对照研究。将这些患者平均分为实验组(n=26)和对照组(n=26)。实验组接受全沉浸式vr手游治疗和常规物理治疗,对照组只接受常规物理治疗。由于干预的性质,该研究是非盲法的,治疗师和患者都知道干预。两组均参加干预,每周4天,共24次,为期6周。两组均随访2周。临床结果测量,包括Fugl-Meyer上肢评估(FMA-UE)、动作研究臂测试(ARAT)和盒块测试(BBT),用于评估运动恢复和功能表现。最小临床意义差异(MCID)用于比较临床结果措施,以检查临床意义改善。此外,评估肌电图数据与临床结果测量之间的相关性,以及运动表现的每周进展,以确定手部运动功能的改善。结果:干预后,FMA-UE、ARAT、BBT评分均有显著差异(均p)。结论:本研究结果显示,基于vr的手部游戏与增强的视觉训练反馈显著改善了亚急性卒中患者的手部运动功能。
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引用次数: 0
Efficacy of a Mobile Serious Game (SwaziYolo) for Increasing HIV Risk Perception: Randomized Controlled Trial. 手机严肃游戏(SwaziYolo)提高HIV风险认知的有效性:随机对照试验
IF 4.1 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-11-24 DOI: 10.2196/70333
Bhekumusa Wellington Lukhele, Mac Delay, Fortunate Shabalala, Mfundi Motsa, Alexander Kay, Christina El Saaidi, Masako Kihara, Masahiro Kihara, Katia J Bruxvoort

Background: Eswatini has one of the highest HIV prevalence rates worldwide (24.8% among people aged ≥15 years), with unprotected heterosexual transmission accounting for more than 90% of new HIV infections in the country. Low HIV risk perception is known to influence risk behavior. Mobile phone technology is growing rapidly, offering opportunities for technology-driven interventions to improve HIV risk perception and prevention.

Objective: We aimed to design and test a serious game to increase HIV risk perception and intention to engage in protective HIV behaviors among young people in Eswatini.

Methods: Our team developed SwaziYolo, a smartphone-based, interactive, educational story game that places the player in the role of a young adult looking for love in Eswatini's capital city. We conducted the Serious Games HIV Prevention Trial (SGPrev-Trial), a 4-week, 2-arm, unblinded, 1:1 randomized controlled trial of SwaziYolo among people aged between 18 and 29 years in Eswatini. The primary outcome was HIV risk perception using a 10-item and subset 8-item Perceived Risk of HIV Infection Scale (PRHS). We used modified intention-to-treat and per-protocol difference-in-difference (DID) estimation to compare the change between groups in the mean PHRS scores before and after intervention.

Results: Of the 380 participants in the study, 122 (64.2%) in the control group and 119 (62.6%) in the intervention group completed the follow-up, and 95 (79.8%) played the game. In the modified intention-to-treat analyses, no significant differences between groups were observed for the 8-item PRHS (DID: mean 1.1, SD 0.72; P=.13) and the 10-item PRHS (DID: mean 1.3, SD 0.80; P=.12) scores. In the per-protocol analyses, HIV risk perception increased significantly among participants who played the game (8-item DID: mean 1.6, SD 0.74; P=.04 and 10-item DID: mean 1.8, SD 0.83; P=.03). Nearly all (94/95, 98.9%) participants strongly agreed or agreed that they would recommend SwaziYolo to their peers.

Conclusions: SwaziYolo was acceptable and increased HIV risk perception among young people in Eswatini who self-selected to play the game. More research is needed to improve and evaluate the SwaziYolo intervention.

Trial registration: UMIN Clinical Trial Registry UMIN000021781; https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000025103.

背景:斯威士兰是世界上艾滋病毒感染率最高的国家之一(在15岁以上人群中为24.8%),无保护的异性传播占该国新发艾滋病毒感染的90%以上。众所周知,低艾滋病毒风险认知会影响风险行为。移动电话技术正在迅速发展,为技术驱动的干预措施提供了机会,以改善对艾滋病毒风险的认识和预防。目的:我们旨在设计和测试一个严肃的游戏,以提高斯瓦蒂尼年轻人对艾滋病毒的风险认知和参与保护性艾滋病毒行为的意愿。方法:我们的团队开发了《斯威士兰约洛》,这是一款基于智能手机的互动式教育故事游戏,玩家将扮演一个在斯威士兰首都寻找爱情的年轻人。我们进行了Serious Games HIV预防试验(SGPrev-Trial),这是一项为期4周,两组,非盲,1:1随机对照试验,在斯威士兰18至29岁的人群中进行。主要结果是使用10项和8项艾滋病毒感染感知风险量表(PRHS)进行艾滋病毒风险感知。我们使用改进的意向治疗和每个方案的差异(DID)估计来比较干预前后各组平均PHRS评分的变化。结果:380名参与者中,对照组122人(64.2%)、干预组119人(62.6%)完成了随访,95人(79.8%)参与了游戏。在修改后的意向治疗分析中,8项PRHS (DID:平均1.1,SD 0.72; P= 0.13)和10项PRHS (DID:平均1.3,SD 0.80; P= 0.12)评分在组间无显著差异。在每个方案分析中,参与游戏的参与者的艾滋病毒风险感知显著增加(8项DID:平均1.6,SD 0.74; P= 0.04; 10项DID:平均1.8,SD 0.83; P= 0.03)。几乎所有(94/95,98.9%)的参与者都强烈同意或同意他们会向同龄人推荐斯威士兰。结论:SwaziYolo是可接受的,并且增加了自愿参加游戏的斯威士兰年轻人对艾滋病毒风险的认识。需要更多的研究来改进和评估斯威士兰的干预措施。试验注册:UMIN临床试验注册中心UMIN000021781;https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000025103。
{"title":"Efficacy of a Mobile Serious Game (SwaziYolo) for Increasing HIV Risk Perception: Randomized Controlled Trial.","authors":"Bhekumusa Wellington Lukhele, Mac Delay, Fortunate Shabalala, Mfundi Motsa, Alexander Kay, Christina El Saaidi, Masako Kihara, Masahiro Kihara, Katia J Bruxvoort","doi":"10.2196/70333","DOIUrl":"10.2196/70333","url":null,"abstract":"<p><strong>Background: </strong>Eswatini has one of the highest HIV prevalence rates worldwide (24.8% among people aged ≥15 years), with unprotected heterosexual transmission accounting for more than 90% of new HIV infections in the country. Low HIV risk perception is known to influence risk behavior. Mobile phone technology is growing rapidly, offering opportunities for technology-driven interventions to improve HIV risk perception and prevention.</p><p><strong>Objective: </strong>We aimed to design and test a serious game to increase HIV risk perception and intention to engage in protective HIV behaviors among young people in Eswatini.</p><p><strong>Methods: </strong>Our team developed SwaziYolo, a smartphone-based, interactive, educational story game that places the player in the role of a young adult looking for love in Eswatini's capital city. We conducted the Serious Games HIV Prevention Trial (SGPrev-Trial), a 4-week, 2-arm, unblinded, 1:1 randomized controlled trial of SwaziYolo among people aged between 18 and 29 years in Eswatini. The primary outcome was HIV risk perception using a 10-item and subset 8-item Perceived Risk of HIV Infection Scale (PRHS). We used modified intention-to-treat and per-protocol difference-in-difference (DID) estimation to compare the change between groups in the mean PHRS scores before and after intervention.</p><p><strong>Results: </strong>Of the 380 participants in the study, 122 (64.2%) in the control group and 119 (62.6%) in the intervention group completed the follow-up, and 95 (79.8%) played the game. In the modified intention-to-treat analyses, no significant differences between groups were observed for the 8-item PRHS (DID: mean 1.1, SD 0.72; P=.13) and the 10-item PRHS (DID: mean 1.3, SD 0.80; P=.12) scores. In the per-protocol analyses, HIV risk perception increased significantly among participants who played the game (8-item DID: mean 1.6, SD 0.74; P=.04 and 10-item DID: mean 1.8, SD 0.83; P=.03). Nearly all (94/95, 98.9%) participants strongly agreed or agreed that they would recommend SwaziYolo to their peers.</p><p><strong>Conclusions: </strong>SwaziYolo was acceptable and increased HIV risk perception among young people in Eswatini who self-selected to play the game. More research is needed to improve and evaluate the SwaziYolo intervention.</p><p><strong>Trial registration: </strong>UMIN Clinical Trial Registry UMIN000021781; https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000025103.</p>","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"13 ","pages":"e70333"},"PeriodicalIF":4.1,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12686855/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145596591","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}
引用次数: 0
A Novel Eye Tracking-Based Gamified Assessment of Contrast Sensitivity Function in Children: Prospective Development and Reliability Study. 一种新的基于眼动追踪的儿童对比敏感度功能游戏化评估:前瞻性发展和可靠性研究。
IF 4.1 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-11-20 DOI: 10.2196/81082
Yunsi He, Yijing Zhuang, Lei Feng, Xuanyu Xu, Ying Deng, Moruomi Li, Yangfei Pang, Ying Yao, Wentong Yu, Zixuan Xu, Yusong Zhou, Yudan Zhong, Qiuying Li, Qingqing Ye, Junpeng Yuan, Yun Wen, Jinrong Li
<p><strong>Background: </strong>Reliable assessment of visual function in young children remains a challenge. Contrast sensitivity function (CSF) is a sensitive and fundamental index of visual performance, yet existing pediatric CSF assessments lack objectivity and adaptability. To bridge this methodological gap, we developed a novel eye tracking-based gamified contrast sensitivity function (ETGCSF) tool that integrates gaze-based detection with interactive gameplay to objectively quantify CSF in an engaging and child-centered manner.</p><p><strong>Objective: </strong>This study aimed to (1) establish the feasibility and test-retest reliability of the ETGCSF tool in preschool-aged children and (2) evaluate whether optimization using adaptive algorithms and enhanced gamification elements could improve test efficiency while maintaining reliability.</p><p><strong>Methods: </strong>This was a prospective study with 2 sequential cohorts. A total of 80 Chinese children aged 3 to 6 years were pragmatically recruited from Zhongshan Ophthalmic Center between May 2021 and July 2023. On the basis of timing of data collection, 35% (28/80) of the children were included in experiment 1 (mean age 5.24, SD 0.15 years), and 65% (52/80) were included in experiment 2 (mean age 4.76, SD 0.11 years). Children completed 2 runs of ETGCSF test. Experiment 1 used the baseline ETGCSF protocol, and experiment 2 used the optimized protocol. Primary outcomes were test-retest reliability of the area under the log contrast sensitivity function curve (AULCSF) and CSF acuity, reported as intraclass correlation coefficients (ICCs) with 95% CIs.</p><p><strong>Results: </strong>In experiment 1, the ETGCSF tool showed strong reliability, with ICCs of 0.890 (95% CI 0.741-0.951) for AULCSF and 0.890 (95% CI 0.763-0.949) for CSF acuity. The median test duration was 482 (IQR 451-569) seconds. In experiment 2, the optimized ETGCSF reduced median test duration to 241 (IQR 189-296) seconds (P<.001) while maintaining comparable reliability. AULCSF estimates varied by 0.03 log units across 2 runs (95% CI -0.51 to 0.57; t51=0.749; P=.46), with an ICC of 0.851 (95% CI 0.740-0.914; P<.001) that was not significantly different from that of experiment 1 (z=0.660; P=.51). Similarly, CSF acuity estimates varied by 0.004 log units (95% CI -0.33 to 0.32; t51=0.192; P=.85), with an ICC of 0.832 (95% CI 0.708-0.904; P<.001), also comparable to that of experiment 1 (z=-0.925; P=.36).</p><p><strong>Conclusions: </strong>This study introduces a paradigm shift in pediatric visual assessment by leveraging objective eye tracking and gamified engagement to transform contrast sensitivity testing into a scalable, child-friendly process. The ETGCSF tool demonstrated strong reliability and markedly improved efficiency in assessing CSF in preschool children aged 3 to 6 years. These findings support ETGCSF as a promising tool for real-world clinical practice, and its modular design holds potential for future adapta
背景:幼儿视觉功能的可靠评估仍然是一个挑战。对比敏感度函数(CSF)是一项敏感而基础的视觉表现指标,但现有的儿童CSF评估缺乏客观性和适应性。为了弥补这种方法上的差距,我们开发了一种新颖的基于眼动追踪的游戏化对比敏感度功能(ETGCSF)工具,该工具将基于凝视的检测与交互式游戏玩法相结合,以吸引人的、以儿童为中心的方式客观地量化CSF。目的:本研究旨在(1)建立ETGCSF工具在学龄前儿童中的可行性和重测信度;(2)评估使用自适应算法和增强游戏化元素进行优化是否可以在保持信度的同时提高测试效率。方法:这是一项前瞻性研究,有2个顺序队列。本研究于2021年5月至2023年7月从中山眼科中心实际招募了80名3 - 6岁的中国儿童。根据数据采集时间,35%(28/80)的患儿被纳入实验1,平均年龄5.24岁,SD 0.15岁;65%(52/80)的患儿被纳入实验2,平均年龄4.76岁,SD 0.11岁。儿童完成2次ETGCSF测试。实验1采用基线ETGCSF方案,实验2采用优化后的方案。主要结果是对数对比敏感度函数曲线下面积(AULCSF)和脑脊液敏锐度的重测信度,报告为类内相关系数(ICCs), ci为95%。结果:在实验1中,ETGCSF工具显示出较强的可靠性,AULCSF的ICCs为0.890 (95% CI 0.741-0.951), CSF敏锐度的ICCs为0.890 (95% CI 0.763-0.949)。中位测试持续时间为482秒(IQR 451-569)。在实验2中,优化后的ETGCSF将测试持续时间的中位数减少到241 (IQR 189-296)秒。结论:本研究通过利用客观眼动追踪和游戏化参与,将对比敏感度测试转变为一个可扩展的、儿童友好的过程,为儿童视觉评估带来了范式转变。ETGCSF工具在评估3 - 6岁学龄前儿童脑脊液方面表现出很强的可靠性和显著提高的效率。这些发现支持ETGCSF作为现实世界临床实践的一个有前途的工具,其模块化设计具有未来适应的潜力,从非常年幼的儿童的流线型快速筛查到研究的全CSF分析。
{"title":"A Novel Eye Tracking-Based Gamified Assessment of Contrast Sensitivity Function in Children: Prospective Development and Reliability Study.","authors":"Yunsi He, Yijing Zhuang, Lei Feng, Xuanyu Xu, Ying Deng, Moruomi Li, Yangfei Pang, Ying Yao, Wentong Yu, Zixuan Xu, Yusong Zhou, Yudan Zhong, Qiuying Li, Qingqing Ye, Junpeng Yuan, Yun Wen, Jinrong Li","doi":"10.2196/81082","DOIUrl":"10.2196/81082","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Reliable assessment of visual function in young children remains a challenge. Contrast sensitivity function (CSF) is a sensitive and fundamental index of visual performance, yet existing pediatric CSF assessments lack objectivity and adaptability. To bridge this methodological gap, we developed a novel eye tracking-based gamified contrast sensitivity function (ETGCSF) tool that integrates gaze-based detection with interactive gameplay to objectively quantify CSF in an engaging and child-centered manner.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed to (1) establish the feasibility and test-retest reliability of the ETGCSF tool in preschool-aged children and (2) evaluate whether optimization using adaptive algorithms and enhanced gamification elements could improve test efficiency while maintaining reliability.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This was a prospective study with 2 sequential cohorts. A total of 80 Chinese children aged 3 to 6 years were pragmatically recruited from Zhongshan Ophthalmic Center between May 2021 and July 2023. On the basis of timing of data collection, 35% (28/80) of the children were included in experiment 1 (mean age 5.24, SD 0.15 years), and 65% (52/80) were included in experiment 2 (mean age 4.76, SD 0.11 years). Children completed 2 runs of ETGCSF test. Experiment 1 used the baseline ETGCSF protocol, and experiment 2 used the optimized protocol. Primary outcomes were test-retest reliability of the area under the log contrast sensitivity function curve (AULCSF) and CSF acuity, reported as intraclass correlation coefficients (ICCs) with 95% CIs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In experiment 1, the ETGCSF tool showed strong reliability, with ICCs of 0.890 (95% CI 0.741-0.951) for AULCSF and 0.890 (95% CI 0.763-0.949) for CSF acuity. The median test duration was 482 (IQR 451-569) seconds. In experiment 2, the optimized ETGCSF reduced median test duration to 241 (IQR 189-296) seconds (P&lt;.001) while maintaining comparable reliability. AULCSF estimates varied by 0.03 log units across 2 runs (95% CI -0.51 to 0.57; t51=0.749; P=.46), with an ICC of 0.851 (95% CI 0.740-0.914; P&lt;.001) that was not significantly different from that of experiment 1 (z=0.660; P=.51). Similarly, CSF acuity estimates varied by 0.004 log units (95% CI -0.33 to 0.32; t51=0.192; P=.85), with an ICC of 0.832 (95% CI 0.708-0.904; P&lt;.001), also comparable to that of experiment 1 (z=-0.925; P=.36).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This study introduces a paradigm shift in pediatric visual assessment by leveraging objective eye tracking and gamified engagement to transform contrast sensitivity testing into a scalable, child-friendly process. The ETGCSF tool demonstrated strong reliability and markedly improved efficiency in assessing CSF in preschool children aged 3 to 6 years. These findings support ETGCSF as a promising tool for real-world clinical practice, and its modular design holds potential for future adapta","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"13 ","pages":"e81082"},"PeriodicalIF":4.1,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12634006/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145563963","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}
引用次数: 0
Performance and Perceptions of Health Care Professionals Using an Immersive Virtual Reality Tool for Home Care Training: Observational Feasibility and Acceptability Study. 医疗保健专业人员使用沉浸式虚拟现实工具进行家庭护理培训的表现和看法:观察性可行性和可接受性研究。
IF 4.1 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-11-20 DOI: 10.2196/75104
José Mira, Javier Rios, Eva Gil-Hernández, Nida Abed, Vanesa Ribeiro-Neves, Clara Pérez-Esteve, Mercedes Guilabert-Mora, Almudena Arroyo, Maria Purificacion Ballester

Background: Informal caregivers play a crucial role in home care and many lack formal training, potentially compromising patient safety. Immersive virtual reality (VR) offers an innovative approach to training by simulating real-life caregiving scenarios in a risk-free environment. Prior to implementation, the environments and the technique's feasibility and acceptability must be assessed by the professionals who will use it to train caregivers, establishing a performance benchmark based on experienced health care professionals.

Objective: This study aims to test feasibility and develop exploratory benchmarks and acceptability of immersive VR training for home caregiving tasks, using experienced professionals to establish a reference standard for execution quality.

Methods: This observational study was conducted in health care centers in Andalusia, the Valencian Community, and Madrid (Spain). A structured process was followed, including the identification of key home care tasks, the development of best practice guidelines, creation of immersive VR training materials, and the design of a performance evaluation rubric. Health care professionals (n=75) were recruited using a convenience sampling approach. They performed caregiving tasks in VR, and their performance was recorded and assessed using a standardized rubric, which included 205 predefined errors. Participants also completed a posttraining survey evaluating usability, comprehension, and perceived applicability to real-world caregiving.

Results: A total of 75 professionals participated, completing 257 caregiving simulations in a fully immersive VR environment. A total of 417 errors were identified (417/3142, 13.3% of the maximum number of predefined errors), with a mean average of 5.6 (SD 6.8) errors per participant. The most frequent errors occurred in medication management, insulin administration, diaper changing, broncho aspiration prevention, blood pressure monitoring, and hand hygiene. The perceived usefulness of VR training was rated 8.1 out of 10 points (SD 1.9), with 98.7% (74/75) of the participants stating that the time spent in the simulation was worthwhile and 85.3% (64/75) agreeing that the tasks were appropriately represented.

Conclusions: Immersive VR training for informal caregivers is a feasible and well-accepted approach, demonstrating high perceived usefulness among health care professionals. The study establishes a preliminary benchmark for home caregiving task execution, providing a basis for future research evaluating informal caregivers' performance and targeted training interventions to enhance patient safety. Further studies are needed to explore the long-term impact of VR training on caregiver competence and home care quality.

背景:非正式护理人员在家庭护理中发挥着至关重要的作用,许多人缺乏正式培训,可能危及患者安全。沉浸式虚拟现实(VR)通过在无风险环境中模拟现实生活中的护理场景,提供了一种创新的培训方法。在实施之前,必须由专业人员评估环境和技术的可行性和可接受性,这些专业人员将使用它来培训护理人员,并根据经验丰富的卫生保健专业人员建立绩效基准。目的:本研究旨在测试沉浸式VR培训用于家庭护理任务的可行性,并制定探索性基准和可接受性,利用经验丰富的专业人员建立执行质量的参考标准。方法:本观察性研究在安达卢西亚、瓦伦西亚社区和马德里(西班牙)的卫生保健中心进行。遵循一个结构化的过程,包括确定关键的家庭护理任务,制定最佳实践指南,创建沉浸式VR培训材料,以及设计绩效评估指标。采用方便抽样方法招募卫生保健专业人员(n=75)。他们在虚拟现实中完成护理任务,他们的表现被记录下来,并使用标准化的标准进行评估,其中包括205个预定义的错误。参与者还完成了一项培训后调查,评估可用性、理解力和对现实世界护理的感知适用性。结果:共有75名专业人员参与,在完全沉浸式VR环境中完成了257次护理模拟。共发现417个错误(417/3142,占最大预定义错误数的13.3%),平均每个参与者有5.6个错误(SD 6.8)。最常见的错误发生在药物管理、胰岛素给药、换尿布、支气管误吸预防、血压监测和手卫生方面。VR训练的感知有用性评分为8.1分(SD 1.9), 98.7%(74/75)的参与者表示在模拟中花费的时间是值得的,85.3%(64/75)的参与者同意任务得到了适当的表示。结论:对非正式护理人员进行沉浸式VR培训是一种可行且被广泛接受的方法,在卫生保健专业人员中表现出很高的感知有用性。本研究初步建立了家庭照护任务执行的基准,为后续研究评估非正式照护者的绩效和有针对性的培训干预以提高患者安全提供依据。VR培训对护理人员能力和家庭护理质量的长期影响有待进一步研究。
{"title":"Performance and Perceptions of Health Care Professionals Using an Immersive Virtual Reality Tool for Home Care Training: Observational Feasibility and Acceptability Study.","authors":"José Mira, Javier Rios, Eva Gil-Hernández, Nida Abed, Vanesa Ribeiro-Neves, Clara Pérez-Esteve, Mercedes Guilabert-Mora, Almudena Arroyo, Maria Purificacion Ballester","doi":"10.2196/75104","DOIUrl":"10.2196/75104","url":null,"abstract":"<p><strong>Background: </strong>Informal caregivers play a crucial role in home care and many lack formal training, potentially compromising patient safety. Immersive virtual reality (VR) offers an innovative approach to training by simulating real-life caregiving scenarios in a risk-free environment. Prior to implementation, the environments and the technique's feasibility and acceptability must be assessed by the professionals who will use it to train caregivers, establishing a performance benchmark based on experienced health care professionals.</p><p><strong>Objective: </strong>This study aims to test feasibility and develop exploratory benchmarks and acceptability of immersive VR training for home caregiving tasks, using experienced professionals to establish a reference standard for execution quality.</p><p><strong>Methods: </strong>This observational study was conducted in health care centers in Andalusia, the Valencian Community, and Madrid (Spain). A structured process was followed, including the identification of key home care tasks, the development of best practice guidelines, creation of immersive VR training materials, and the design of a performance evaluation rubric. Health care professionals (n=75) were recruited using a convenience sampling approach. They performed caregiving tasks in VR, and their performance was recorded and assessed using a standardized rubric, which included 205 predefined errors. Participants also completed a posttraining survey evaluating usability, comprehension, and perceived applicability to real-world caregiving.</p><p><strong>Results: </strong>A total of 75 professionals participated, completing 257 caregiving simulations in a fully immersive VR environment. A total of 417 errors were identified (417/3142, 13.3% of the maximum number of predefined errors), with a mean average of 5.6 (SD 6.8) errors per participant. The most frequent errors occurred in medication management, insulin administration, diaper changing, broncho aspiration prevention, blood pressure monitoring, and hand hygiene. The perceived usefulness of VR training was rated 8.1 out of 10 points (SD 1.9), with 98.7% (74/75) of the participants stating that the time spent in the simulation was worthwhile and 85.3% (64/75) agreeing that the tasks were appropriately represented.</p><p><strong>Conclusions: </strong>Immersive VR training for informal caregivers is a feasible and well-accepted approach, demonstrating high perceived usefulness among health care professionals. The study establishes a preliminary benchmark for home caregiving task execution, providing a basis for future research evaluating informal caregivers' performance and targeted training interventions to enhance patient safety. Further studies are needed to explore the long-term impact of VR training on caregiver competence and home care quality.</p>","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"13 ","pages":"e75104"},"PeriodicalIF":4.1,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12679075/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145563945","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}
引用次数: 0
Effects of Balance-Based Exergame Training With Variable Difficulty on Balance and Spatiotemporal Gait Outcomes in Adults With Mild Cognitive Impairment: Randomized Controlled Trial. 基于平衡的可变难度运动训练对轻度认知障碍成人平衡和时空步态结果的影响:随机对照试验。
IF 4.1 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-11-18 DOI: 10.2196/74092
Aruba Saeed, Imran Amjad, Imran Khan Niazi, Abdullah Alzahrani, Muhammad Shafiq, Heidi Haavik
<p><strong>Background: </strong>Exergame balance training integrates cognitive and motor challenges, potentially enhancing neuroplasticity, postural control, and gait stability in mild cognitive impairment (MCI). However, whether modulating the task difficulty of a balance-based exergame training may influence posture- and gait-related outcomes remains unknown.</p><p><strong>Objective: </strong>We compared balance and gait improvements across exergame training groups performing exercise with different difficulty levels and a Wii Fit group in adults with MCI.</p><p><strong>Methods: </strong>This 4-armed, parallel design, double-blinded, randomized clinical trial included 97 participants with MCI (Montreal Cognitive Assessment score=18-25). Participants were convenience-sampled from the Railway General Hospital, Rawalpindi, Pakistan, and randomized to one of 4 intervention groups: low-difficulty, moderate-difficulty, high-difficulty exergame training or a Wii Fit training group. Each participant completed 24 sessions (40 min, 3/week) supervised by physical therapists. Gait and balance were assessed using time up and go (TUG), cognitive time up and go (C-TUG), and the Gait & Balance mobile app at baseline and after 4 and 8 weeks. Although the calculated sample size was 80, 97 were recruited to offset attrition. Eighty-seven participants completed the study (94% adherence) (attrition: low-difficulty 1, moderate 3, high 2, Wii Fit 2; 10% total). Data were analyzed using mixed-model analysis of covariance with baseline values as covariates to assess time×group interactions. Bonferroni-adjusted post hoc comparisons revealed between-group differences.</p><p><strong>Results: </strong>High-difficulty training showed the greatest TUG gains (-0.71, SD 0.32; P=.03, anteroposterior (AP) steadiness with eyes open (EO) on firm surface (0.04, SD 0.02; P=.04), step time variability head forward (HF; 0.06, SD 0.09; P=.02), walking speed HF (0.08, SD 0.04; P=.05), step time head turn (HT; -0.04, SD 0.02; P=.04), step time variability HT (-0.35, SD 0.09; P<.001), step length variability (-0.27, SD 0.13; P=.04), and walking speed HT (0.09, SD 0.04; P=.01) versus Wii Fit. Moderate-difficulty training improved AP steadiness EO firm (0.05, SD 0.02; P=.03) and reduced step time variability HT (-0.26, SD 0.09; P=.01). Low-difficulty training improved C-TUG (-1.61, SD 0.63; P=.01), AP steadiness EO firm (0.05, SD 0.02; P=.03), step time variability HF (-0.20, SD 0.09; P=.03), step time variability HT (-0.25, SD 0.09; P=.01), step length variability (-0.31, SD 0.12; P=.014), and walking speed HT (0.11, SD 0.04; P=.03). No significant differences observed between exergame difficulty groups (P>.05).</p><p><strong>Conclusions: </strong>Balance-based exergame training improves balance and gait in adults with MCI, with no significant differences across difficulty levels, while the high- and low-difficulty training outperformed Wii Fit in several outcomes. High-difficulty training
背景:运动平衡训练整合了认知和运动挑战,可能增强轻度认知障碍(MCI)患者的神经可塑性、姿势控制和步态稳定性。然而,调节以平衡为基础的运动训练的任务难度是否会影响姿势和步态相关的结果仍然未知。目的:我们比较了不同难度的运动训练组和Wii Fit组对MCI成人的平衡和步态的改善。方法:该四臂、平行设计、双盲、随机临床试验纳入97例MCI患者(蒙特利尔认知评估评分=18-25)。参与者从巴基斯坦拉瓦尔品第的铁路总医院方便地抽样,并随机分为4个干预组:低难度、中难度、高难度运动训练组或Wii Fit训练组。在物理治疗师的监督下,每位参与者完成了24个疗程(40分钟,每周3次)。在基线和4周和8周后,使用起止时间(TUG)、认知起止时间(C-TUG)和步态与平衡移动应用程序评估步态和平衡。虽然计算的样本量为80人,但为了弥补人员流失,我们招募了97人。87名参与者完成了这项研究(94%的坚持)(消耗:低难度1,中等难度3,高难度2,Wii Fit 2;总数10%)。数据分析采用混合模型协方差分析,以基线值为协变量评估time×group相互作用。经bonferroni校正的事后比较显示了组间差异。结果:高难度训练表现出最大的TUG增益(-0.71,SD 0.32; P= 0.03),坚实表面上的正前方(AP)睁眼稳定性(EO) (0.04, SD 0.02; P= 0.04),步速变异性(HF; 0.06, SD 0.09; P= 0.02),步速变异性(HF; 0.08, SD 0.04; P= 0.05),步速转头(HT; -0.04, SD 0.02; P= 0.04),步速变异性(HT; -0.35, SD 0.09; P= 0.05)。结论:基于平衡的运动训练可以改善MCI成人的平衡和步态,在不同难度水平上没有显著差异,而高难度和低难度训练在几个结果上优于Wii Fit。高难度训练在TUG、姿势稳定性、步态变异性和步行速度方面产生了最一致的改善。这些结果支持分级认知运动锻炼作为增强MCI患者姿势控制和行走稳定性的有效策略,可能有助于老年人预防跌倒和保持活动能力。试验注册:ClinicalTrials.gov NCT04959383;https://clinicaltrials.gov/study/NCT04959383。
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引用次数: 0
Prevalence, Sex Differences, and Predictors of Internet Gaming Disorder Among Impoverished Rural Adolescents: Cross-Sectional and Prospective Cohort Study. 贫困农村青少年网络游戏障碍的患病率、性别差异和预测因素:横断面和前瞻性队列研究。
IF 4.1 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-11-17 DOI: 10.2196/83522
Chenhan Wang, Yifan Li, Shuhong Lin, Qiuping Huang, Yongyan Shi, Guangxian Yang, Erjia Huang, Xicheng Deng, Jinwen Luo

Background: Internet gaming disorder (IGD) is prevalent globally and linked to significant negative outcomes. Impoverished rural adolescents face unique risks due to limited supervision and unequal digital resources, with limited longitudinal research conducted in this population. Existing studies show sex differences in IGD prevalence, but their manifestations and mechanisms in rural populations remain unclear.

Objective: This is the first large-sample cross-sectional and prospective cohort study targeting impoverished adolescents in rural areas. It aimed to determine the prevalence of IGD among impoverished rural adolescents, identify sex-specific risk and protective factors, and evaluate the longitudinal predictors of IGD.

Methods: In this study, self-administered questionnaires were used to collect demographic characteristics, affective states, impulsivity, gaming time, and scores for IGD. First, the prevalence of IGD at baseline and follow-up, along with sex differences, was calculated. Correlation analysis was conducted to explore variables associated with IGD. Subsequently, multivariate logistic regression analysis was conducted to identify baseline and follow-up predictors of IGD.

Results: The cross-sectional analysis at baseline included 13,931 valid responses (IGD prevalence: n=725, 5.2%; males: 489/7304, 6.7%; females: 236/6627, 3.6%). A 1-year longitudinal follow-up showed IGD prevalence of 5% (692/13,931; males: 511/7304, 7.0%; females: 181/6627, 2.7%; after multiple imputations). Common baseline factors were gaming time (females: odds ratio [OR] 1.11, 95% CI 1.08-1.14, P<.001; males: OR 1.11, 95% CI 1.09-1.13, P<.001), self-esteem scores (females: OR 0.95, 95% CI 0.92-0.98, P=.002; males: OR 0.95, 95% CI 0.92-0.97, P<.001), depression scores (females: OR 1.14, 95% CI 1.11-1.16, P<.001; males: OR 1.11, 95% CI 1.09-1.13, P<.001), and impulsive behavior (females: OR 1.16, 95% CI 1.10-1.22, P<.001; males: OR 1.10, 95% CI 1.06-1.14, P<.001). Companionship (OR 0.71, 95% CI 0.52-0.97; P=.03) was a protective factor for females, while age (OR 1.08, 95% CI 1.02-1.15; P=.02) and poor self-regulation (OR 1.07, 95% CI 1.03-1.11; P=.001) posed extra risk for males at baseline. Longitudinal predictors were baseline gaming time (females: OR 1.06, 95% CI 1.03-1.09, P<.001; males: OR 1.02, 95% CI 1.00-1.05, P=.03) and impulsive behavior (females: OR 1.38, 95% CI 1.30-1.46, P<.001; males: OR 1.27, 95% CI 1.22-1.31, P<.001). Baseline companionship (OR 0.32, 95% CI 0.23-0.43; P<.001) was a protective factor for females, while baseline poor self-regulation (OR 1.32, 95% CI 1.27-1.37; P<.001) was a predictive factor for males after 1 year.

Conclusions: IGD prevalence was lower in rural than in urban populations and higher in males than in females. Impulsivity, gaming time, and guardian companionship showed sex differences: females relied more o

背景:网络游戏障碍(IGD)在全球范围内普遍存在,并与显著的负面结果有关。贫困农村青少年由于监管有限和数字资源不平等,面临着独特的风险,对这一人群的纵向研究有限。现有研究显示IGD患病率存在性别差异,但其在农村人群中的表现和机制尚不清楚。目的:这是第一个针对农村贫困青少年的大样本横断面和前瞻性队列研究。该研究旨在确定贫困农村青少年IGD的患病率,确定性别特异性的危险因素和保护因素,并评估IGD的纵向预测因素。方法:在本研究中,采用自填问卷收集人口统计学特征、情感状态、冲动性、游戏时间和IGD得分。首先,计算了基线和随访时IGD的患病率以及性别差异。进行相关分析,探讨与IGD相关的变量。随后,进行多变量logistic回归分析,以确定IGD的基线和随访预测因素。结果:基线横断面分析包括13931份有效应答(IGD患病率:n=725, 5.2%;男性:489/7304,6.7%;女性:236/6627,3.6%)。1年的纵向随访显示,IGD患病率为5%(692/ 13931;男性:511/7304,7.0%;女性:181/6627,2.7%,经多次计算)。常见的基线因素是游戏时间(女性:比值比[OR] 1.11, 95% CI 1.08-1.14, p)。结论:农村IGD患病率低于城市人口,男性高于女性。冲动、游戏时间和监护人陪伴表现出性别差异:女性更依赖伴侣,而男性更容易出现自我调节能力差的情况。干预措施应处理这些差异,加强家庭支持和心理调整。本研究为农村地区IGD的性别特异性途径提供了新的见解,并为制定有针对性的预防策略提供了经验证据,突出了其对公共卫生的现实意义。
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JMIR Serious Games
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