Background: Exergames have emerged as effective interventions for promoting physical activity and preventing type 2 diabetes (T2D). Kinect-based exergames have demonstrated improvements in exercise adherence and health outcomes, but their high cost and reliance on specialized hardware hinder widespread home-based adoption. Recent advances in computer vision now enable monocular camera-based systems, offering a potentially cost-effective and scalable alternative for promoting physical activity at home.
Objective: This study aimed to evaluate the feasibility and user experience of monocular camera-based exergames as a home-based intervention for individuals at risk for T2D.
Methods: Forty-five community-dwelling individuals at high risk for T2D (mean age 47.12, SD 6.92 years) were recruited and randomized into three groups (n=15 each): (1) control group (traditional offline exercise), (2) Kinect group (Kinect-based exergame), and (3) monocular group (monocular camera-based exergame). Participants engaged in a 10-minute intervention once per week for 7 weeks. Data were collected at 3 time points: baseline (exercise performance: heart rate and perceived fatigue), postintervention (exercise performance and user experience, including game experience and intrinsic motivation), and follow-up (user engagement and qualitative feedback). One-way ANOVA was used for data analysis.
Results: Exercise performance was comparable across all groups, with no significant differences in heart rate (P=.76) or fatigue levels (P=.25). However, participants in the monocular group reported significantly lower fatigue than those in the control group (P=.04). Intrinsic motivation was significantly higher in both the Kinect (mean 35.13, SD 3.20) and monocular (mean 34.00, SD 4.41) groups than in the control group (mean 26.06, SD 1.87; P<.001), with no significant difference between the 2 exergame groups (P=.44). While most user experience measures showed no significant differences, the monocular group reported a higher perceived challenge (mean 3.45, SD 0.51) than the Kinect group (mean 2.96, SD 0.39; P=.09). Additionally, the monocular group exhibited higher engagement, as evidenced by more frequent use, fewer challenges, and a greater intention to continue using the system.
Conclusions: Monocular camera-based exergame is a feasible and effective solution for promoting physical activity in individuals at risk for T2D. It offers motivational and experiential benefits similar to Kinect-based systems but requires less costly and more accessible equipment. These findings suggest that monocular systems have strong potential as scalable tools for home-based chronic disease prevention.
{"title":"Development and Evaluation of a Monocular Camera-Based Mobile Exergame for at-Home Intervention in Individuals at High Risk of Type 2 Diabetes: Randomized Controlled Trial.","authors":"Jianan Zhao, Dian Zhu, Yanan Wang, Yaqin Xia, Zeshi Zhu, Jihong Yu","doi":"10.2196/75823","DOIUrl":"10.2196/75823","url":null,"abstract":"<p><strong>Background: </strong>Exergames have emerged as effective interventions for promoting physical activity and preventing type 2 diabetes (T2D). Kinect-based exergames have demonstrated improvements in exercise adherence and health outcomes, but their high cost and reliance on specialized hardware hinder widespread home-based adoption. Recent advances in computer vision now enable monocular camera-based systems, offering a potentially cost-effective and scalable alternative for promoting physical activity at home.</p><p><strong>Objective: </strong>This study aimed to evaluate the feasibility and user experience of monocular camera-based exergames as a home-based intervention for individuals at risk for T2D.</p><p><strong>Methods: </strong>Forty-five community-dwelling individuals at high risk for T2D (mean age 47.12, SD 6.92 years) were recruited and randomized into three groups (n=15 each): (1) control group (traditional offline exercise), (2) Kinect group (Kinect-based exergame), and (3) monocular group (monocular camera-based exergame). Participants engaged in a 10-minute intervention once per week for 7 weeks. Data were collected at 3 time points: baseline (exercise performance: heart rate and perceived fatigue), postintervention (exercise performance and user experience, including game experience and intrinsic motivation), and follow-up (user engagement and qualitative feedback). One-way ANOVA was used for data analysis.</p><p><strong>Results: </strong>Exercise performance was comparable across all groups, with no significant differences in heart rate (P=.76) or fatigue levels (P=.25). However, participants in the monocular group reported significantly lower fatigue than those in the control group (P=.04). Intrinsic motivation was significantly higher in both the Kinect (mean 35.13, SD 3.20) and monocular (mean 34.00, SD 4.41) groups than in the control group (mean 26.06, SD 1.87; P<.001), with no significant difference between the 2 exergame groups (P=.44). While most user experience measures showed no significant differences, the monocular group reported a higher perceived challenge (mean 3.45, SD 0.51) than the Kinect group (mean 2.96, SD 0.39; P=.09). Additionally, the monocular group exhibited higher engagement, as evidenced by more frequent use, fewer challenges, and a greater intention to continue using the system.</p><p><strong>Conclusions: </strong>Monocular camera-based exergame is a feasible and effective solution for promoting physical activity in individuals at risk for T2D. It offers motivational and experiential benefits similar to Kinect-based systems but requires less costly and more accessible equipment. These findings suggest that monocular systems have strong potential as scalable tools for home-based chronic disease prevention.</p>","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"13 ","pages":"e75823"},"PeriodicalIF":4.1,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12699957/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145742875","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}
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
{"title":"Immersive Virtual Reality-Assisted Therapy for Distressing Voices in Psychosis: Qualitative Study of Participants' and Therapists' Experiences in the Challenge Trial.","authors":"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","doi":"10.2196/77920","DOIUrl":"10.2196/77920","url":null,"abstract":"<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","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"13 ","pages":"e77920"},"PeriodicalIF":4.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12670062/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145654220","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>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
{"title":"Effects of Progressive Aerobic Training on Executive-Reward Network Connectivity and Symptoms of Internet Gaming Disorder: Randomized Controlled Trial.","authors":"Shaoyu Cui, Xuefeng Xu, Xin Luo, Meiting Wei, Guang-Heng Dong","doi":"10.2196/83597","DOIUrl":"10.2196/83597","url":null,"abstract":"<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","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"13 ","pages":"e83597"},"PeriodicalIF":4.1,"publicationDate":"2025-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12669919/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145654246","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}
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。
{"title":"Efficacy of the Web-Based Gamified Infection Control Training System on Practices for Health Care Workers in Residential Care Homes: Clustered Randomized Controlled Trial.","authors":"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","doi":"10.2196/71593","DOIUrl":"10.2196/71593","url":null,"abstract":"<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","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"13 ","pages":"e71593"},"PeriodicalIF":4.1,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12699250/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145633697","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}
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.
{"title":"Mobile Exergames to Reduce Sedentary Time in Patients With Heart Failure: What Do Health Care Professionals Expect?","authors":"Leonie Klompstra, Anna Strömberg, Antoni Bayes-Genis, Maria Boldo, Beatriz González, Nuria Santaularia, Tiny Jaarsma","doi":"10.2196/69126","DOIUrl":"10.2196/69126","url":null,"abstract":"<p><strong>Unlabelled: </strong>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.</p>","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"13 ","pages":"e69126"},"PeriodicalIF":4.1,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12661590/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145633847","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}
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
{"title":"Evaluating the Effectiveness of Immersive Virtual Reality Rehabilitation Games With Enhanced Visual Training for Hand Motor Function Improvement Using Electromyography: Randomized Controlled Trial.","authors":"Faisal Amin, Asim Waris, Muhammad Jawad Khan, Muhammad Adeel Ijaz, Hammad Nazeer, Syed Omer Gilani, Fawwaz Hazzazi, Umer Hameed Shah","doi":"10.2196/74314","DOIUrl":"10.2196/74314","url":null,"abstract":"<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","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"13 ","pages":"e74314"},"PeriodicalIF":4.1,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12646558/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145604094","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}
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.
{"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}
<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":"<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","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}
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.
{"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}
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
{"title":"Effects of Balance-Based Exergame Training With Variable Difficulty on Balance and Spatiotemporal Gait Outcomes in Adults With Mild Cognitive Impairment: Randomized Controlled Trial.","authors":"Aruba Saeed, Imran Amjad, Imran Khan Niazi, Abdullah Alzahrani, Muhammad Shafiq, Heidi Haavik","doi":"10.2196/74092","DOIUrl":"10.2196/74092","url":null,"abstract":"<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","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"13 ","pages":"e74092"},"PeriodicalIF":4.1,"publicationDate":"2025-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12673310/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145540728","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}
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