Background: Individuals with mild intellectual disabilities (ID) often face cognitive and functional challenges, which can lead to low physical activity (PA) and a higher risk of obesity. While virtual reality (VR) exergames show promise for promoting PA in typically developing children, a key barrier for individuals with ID is the lack of a structured teaching methodology. This study argues that a tailored approach is essential to help children with mild ID gain independence in gameplay. By learning specific patterns, they can achieve greater autonomy, which not only facilitates increased PA but also improves motor competence, physical fitness, functional abilities, and overall well-being.
Objective: This study aims to evaluate the effectiveness of the WISH (Warm-up, Imitation, Settings, Half-hour exergame session) and WON (Warm-up, Objective evaluation, No problem!) training protocols in improving participant independence, exergame performance, and overall gameplay experience in VR.
Methods: We used a multisession, single-group research design involving 16 training sessions in this pilot study. The 16 sessions were conducted during scheduled physical education classes at a special school in Poland from October 2023 to May 2024. The intervention comprised two main protocols: the WISH protocol (sessions 1-4), an introductory phase focused on familiarization with VR technology and gameplay mechanics, and the WON protocol (sessions 5-16), designed for gradual reduction of trainer assistance to promote gameplay independence.
Results: The statistical analysis confirmed the effectiveness of both the WISH and WON protocols. A Wilcoxon signed-rank test on the WISH protocol revealed a statistically significant improvement in understanding instructions for the warm-up (r=0.87; P=.009), the projector imitation (r=0.91; P=.007), and participant exergame performance (r=0.90; P=.03). Within the WON protocol, the Wilcoxon test also showed a significant increase in participant exergame performance (r=0.89; P=.008). Further analysis using Spearman rank-order correlation indicated a very strong association between increased independence and better exergame performance (ρ=0.91; P=.002) and overall gameplay experience (ρ=0.63; P<.05).
Conclusions: This pilot study suggests that the structured WISH and WON training protocols may have the potential to enhance functional autonomy, exergame performance, and overall gameplay experience in individuals with mild ID. The observed improvements indicate that such structured pedagogical approaches could be beneficial for this population. These preliminary findings warrant further investigation through larger-scale, controlled studies to confirm efficacy and explore the transferability of these benefits to broader contexts and other VR exergames.
{"title":"Achieving Gameplay Independence in Virtual Reality Exergames for Individuals With Mild Intellectual Disabilities: Pilot Study.","authors":"Julia Ciążyńska, Janusz Maciaszek","doi":"10.2196/71823","DOIUrl":"10.2196/71823","url":null,"abstract":"<p><strong>Background: </strong>Individuals with mild intellectual disabilities (ID) often face cognitive and functional challenges, which can lead to low physical activity (PA) and a higher risk of obesity. While virtual reality (VR) exergames show promise for promoting PA in typically developing children, a key barrier for individuals with ID is the lack of a structured teaching methodology. This study argues that a tailored approach is essential to help children with mild ID gain independence in gameplay. By learning specific patterns, they can achieve greater autonomy, which not only facilitates increased PA but also improves motor competence, physical fitness, functional abilities, and overall well-being.</p><p><strong>Objective: </strong>This study aims to evaluate the effectiveness of the WISH (Warm-up, Imitation, Settings, Half-hour exergame session) and WON (Warm-up, Objective evaluation, No problem!) training protocols in improving participant independence, exergame performance, and overall gameplay experience in VR.</p><p><strong>Methods: </strong>We used a multisession, single-group research design involving 16 training sessions in this pilot study. The 16 sessions were conducted during scheduled physical education classes at a special school in Poland from October 2023 to May 2024. The intervention comprised two main protocols: the WISH protocol (sessions 1-4), an introductory phase focused on familiarization with VR technology and gameplay mechanics, and the WON protocol (sessions 5-16), designed for gradual reduction of trainer assistance to promote gameplay independence.</p><p><strong>Results: </strong>The statistical analysis confirmed the effectiveness of both the WISH and WON protocols. A Wilcoxon signed-rank test on the WISH protocol revealed a statistically significant improvement in understanding instructions for the warm-up (r=0.87; P=.009), the projector imitation (r=0.91; P=.007), and participant exergame performance (r=0.90; P=.03). Within the WON protocol, the Wilcoxon test also showed a significant increase in participant exergame performance (r=0.89; P=.008). Further analysis using Spearman rank-order correlation indicated a very strong association between increased independence and better exergame performance (ρ=0.91; P=.002) and overall gameplay experience (ρ=0.63; P<.05).</p><p><strong>Conclusions: </strong>This pilot study suggests that the structured WISH and WON training protocols may have the potential to enhance functional autonomy, exergame performance, and overall gameplay experience in individuals with mild ID. The observed improvements indicate that such structured pedagogical approaches could be beneficial for this population. These preliminary findings warrant further investigation through larger-scale, controlled studies to confirm efficacy and explore the transferability of these benefits to broader contexts and other VR exergames.</p>","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"13 ","pages":"e71823"},"PeriodicalIF":4.1,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12663707/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145512782","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>Gaming is a prevalent activity during adolescence, a developmental stage characterized by vulnerability to gaming disorder (GD). According to the self-determination theory, gaming environments can satisfy and frustrate basic psychological needs-autonomy, competence, and relatedness-processes linked to GD. However, existing research has primarily focused on adult populations, and validated instruments assessing both in-game need satisfaction (NS) and in-game need frustration (NF) in adolescents are lacking.</p><p><strong>Objective: </strong>This study aimed to address this gap by validating the Spanish version of the Basic Psychological Need Satisfaction and Frustration Scale for Gaming (BPNSFS-G) in adolescents. We examined its psychometric properties, its relationship with GD and gaming behavior, and differences in NS and NF across subgroups defined by risk factors for GD (sex, the developmental stage, and the gaming modality).</p><p><strong>Methods: </strong>A total of 1174 adolescents (mean 12.07, SD 1.23; middle adolescents: 815/1174, 69.4%; male: 637/1037, 61.4%; online gamers: 388/511, 76.3%) participated in a school-based GD prevention program and completed a self-report battery, which included the adapted BPNSFS-G, a validated GD scale, and ad hoc items (daily gaming time and weekly frequency). The Spanish adaptation of the BPNSFS-G was developed using the back-translation method to ensure its content validity. A structural equation modeling approach was used to test its structural, construct, convergent, and discriminant validity, as well as measurement invariance. Reliability at both the item and factor levels, along with criterion validity, was also assessed.</p><p><strong>Results: </strong>Through exploratory and confirmatory factor analyses, the scale structure was confirmed, validating 2 separate measures: a 3-factor second-order model for NS and a unidimensional model for NF, both with adequate internal consistency (NS: Cronbach α=0.75; NF: Cronbach α=0.77). The results also supported its validity, with NF more strongly associated with GD (r=0.49), and NS more closely related to gaming time (r=0.25-0.36). The scales functioned similarly across sex and developmental stage groups, but not across gaming modalities. Notably, NS showed significant differences across all subgroups, especially between boys and girls (t<sub>759.31</sub>=8.28; P<.001; g=0.55) and between online and offline gaming modes (t<sub>178.47</sub>=5.13; P<.001; g=0.58), with no meaningful differences found for NF.</p><p><strong>Conclusions: </strong>This study provides initial evidence for the validity and reliability of the Spanish version of the BPNSFS-G for adolescents. The resulting Youth Gaming Experience Scales (Youth Satisfying Gaming Experience Scale and Youth Frustrating Gaming Experience Scale) are brief, theoretically grounded, and empirically supported instruments for assessing in-game psychological need satisfaction and f
{"title":"In-Game Need Satisfaction, Frustration, and Gaming Addiction Patterns Across Subgroups of Adolescents Through Structural Equation Modeling: Cross-Sectional and Instrument Validation Study of the Youth Gaming Experience Scales.","authors":"Amparo Luján-Barrera, Lydia Cervera-Ortiz, Mariano Chóliz","doi":"10.2196/63612","DOIUrl":"10.2196/63612","url":null,"abstract":"<p><strong>Background: </strong>Gaming is a prevalent activity during adolescence, a developmental stage characterized by vulnerability to gaming disorder (GD). According to the self-determination theory, gaming environments can satisfy and frustrate basic psychological needs-autonomy, competence, and relatedness-processes linked to GD. However, existing research has primarily focused on adult populations, and validated instruments assessing both in-game need satisfaction (NS) and in-game need frustration (NF) in adolescents are lacking.</p><p><strong>Objective: </strong>This study aimed to address this gap by validating the Spanish version of the Basic Psychological Need Satisfaction and Frustration Scale for Gaming (BPNSFS-G) in adolescents. We examined its psychometric properties, its relationship with GD and gaming behavior, and differences in NS and NF across subgroups defined by risk factors for GD (sex, the developmental stage, and the gaming modality).</p><p><strong>Methods: </strong>A total of 1174 adolescents (mean 12.07, SD 1.23; middle adolescents: 815/1174, 69.4%; male: 637/1037, 61.4%; online gamers: 388/511, 76.3%) participated in a school-based GD prevention program and completed a self-report battery, which included the adapted BPNSFS-G, a validated GD scale, and ad hoc items (daily gaming time and weekly frequency). The Spanish adaptation of the BPNSFS-G was developed using the back-translation method to ensure its content validity. A structural equation modeling approach was used to test its structural, construct, convergent, and discriminant validity, as well as measurement invariance. Reliability at both the item and factor levels, along with criterion validity, was also assessed.</p><p><strong>Results: </strong>Through exploratory and confirmatory factor analyses, the scale structure was confirmed, validating 2 separate measures: a 3-factor second-order model for NS and a unidimensional model for NF, both with adequate internal consistency (NS: Cronbach α=0.75; NF: Cronbach α=0.77). The results also supported its validity, with NF more strongly associated with GD (r=0.49), and NS more closely related to gaming time (r=0.25-0.36). The scales functioned similarly across sex and developmental stage groups, but not across gaming modalities. Notably, NS showed significant differences across all subgroups, especially between boys and girls (t<sub>759.31</sub>=8.28; P<.001; g=0.55) and between online and offline gaming modes (t<sub>178.47</sub>=5.13; P<.001; g=0.58), with no meaningful differences found for NF.</p><p><strong>Conclusions: </strong>This study provides initial evidence for the validity and reliability of the Spanish version of the BPNSFS-G for adolescents. The resulting Youth Gaming Experience Scales (Youth Satisfying Gaming Experience Scale and Youth Frustrating Gaming Experience Scale) are brief, theoretically grounded, and empirically supported instruments for assessing in-game psychological need satisfaction and f","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"13 ","pages":"e63612"},"PeriodicalIF":4.1,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12658397/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145504380","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}
Uri Adrian Prync Flato, Adriana Flato, Isabella Bispo Diaz T Martins, Giuliana Simoes Nakano, Julia Caroline Romao, Manuela Simões Nakano, Emilio José Beffa Dos Santos, Yuuki Daniel Tahara Villas Boas, Leonardo Escobar Medeiros, Vinicius Gazin Rossignoli, Gabriel Zanatta Cunha, Rafael Carreira Batista, Pedro Gazotto Rodrigues da Silva, Miguel Florentino, Amanda Rabelo, Thais Dias Midega, Rogerio Passos, Helio Guimaraes, Karl Kern
<p><strong>Background: </strong>Out-of-hospital cardiac arrests (OHCAs) predominantly occur in residential settings, often witnessed by children who could act as first responders. The World Health Organization (WHO) supports the Kids Save Lives (KSL) initiative, recommending basic life support (BLS) training for children aged ≥11 years. However, disparities in BLS education persist globally, particularly in low-resource regions where socioeconomic barriers, such as school type, malnutrition, and limited infrastructure, hinder implementation. Younger children (aged <11 years) face additional challenges due to physical limitations (eg, height, weight, and grip strength), which may compromise their ability to achieve adequate chest compression depth. While gamified learning has shown promise in improving BLS engagement and skill acquisition, its efficacy across diverse socioeconomic groups remains understudied.</p><p><strong>Objective: </strong>This study aimed to compare cardiopulmonary resuscitation (CPR) performance (compression depth, rate, and recoil) between public and private school students following a game-based BLS intervention and evaluate the feasibility of a serious game (Kids Save Hearts) in improving BLS knowledge and irrespective of socioeconomic background.</p><p><strong>Methods: </strong>We conducted an observational cohort study with 336 students aged 7-17 years from 10 public and 10 private schools in Brazil (April to November 2022). Participants received 40 minutes of video-based CPR training (American Heart Association CPR in Schools) followed by 10 minutes of gamified training using the Children Save Hearts serious game (SG). CPR quality was assessed via quality of cardiopulmonary resuscitation (QCPR) scores (Laerdal QCPR manikin), measuring compression depth (mm), compression rate (per minute), and chest recoil. Anthropometric data (height, weight, and grip strength) and socioeconomic indicators (school type) were collected. Nonparametric tests (Mann-Whitney U and chi-square tests) and multivariate regression (SPSS v27.0; IBM Corp) were used to analyze associations between demographics, physical characteristics, and CPR performance.</p><p><strong>Results: </strong>Older students (11-17 years) outperformed younger peers (7-10 years) in median compression depth (48 mm vs 37 mm; P<.001) and overall QCPR scores (84 vs 42, P<.001). Private school students had higher grip strength (24.92 vs 21.48 g/cm²; P=.001), but school type did not significantly affect CPR quality. Postintervention SG scores improved universally (P<.001), with no age or socioeconomic disparities. Multivariate analysis identified age (P<.001), height (P<.001), and grip strength (P<.001) as independent predictors of high QCPR scores (≥70).</p><p><strong>Conclusions: </strong>Age and physical development were stronger determinants of CPR quality than socioeconomic factors. The game-based intervention effectively improved BLS knowledge and skills across all partici
院外心脏骤停（ohca）主要发生在住宅环境中，通常由可以作为第一响应者的儿童目睹。世界卫生组织（世卫组织）支持儿童拯救生命（KSL）倡议，建议对≥11岁的儿童进行基本生命支持（BLS）培训。然而，在全球范围内，劳工统计局教育的差异仍然存在，特别是在低资源地区，那里的社会经济障碍（如学校类型、营养不良和有限的基础设施）阻碍了实施。目的：本研究旨在比较公立和私立学校学生在基于游戏的BLS干预后的心肺复苏（CPR）表现（按压深度、速率和后坐力），并评估严肃游戏（Kids Save Hearts）在提高BLS知识方面的可行性，而不考虑社会经济背景。方法：我们对来自巴西10所公立和10所私立学校的336名7-17岁的学生进行了一项观察性队列研究（2022年4月至11月）。参与者接受了40分钟基于视频的心肺复苏术培训（美国心脏协会学校心肺复苏术），然后使用儿童拯救心脏严肃游戏（SG）进行10分钟的游戏化培训。通过心肺复苏（QCPR）质量评分（Laerdal QCPR假人）、测量按压深度（mm）、按压率（每分钟）和胸部后坐力来评估心肺复苏质量。收集了人体测量数据（身高、体重和握力）和社会经济指标（学校类型）。采用非参数检验（Mann-Whitney U检验和卡方检验）和多元回归（SPSS v27.0; IBM Corp）分析人口统计学、身体特征和心肺复苏术表现之间的关系。结果：年龄较大的学生（11-17岁）在中位按压深度（48 mm vs 37 mm）上优于年龄较小的学生（7-10岁）；结论：年龄和身体发育比社会经济因素更能决定心肺复苏术的质量。基于游戏的干预有效地提高了所有参与者的劳工统计局知识和技能，显示了其作为公平培训工具的潜力。这些发现支持了游戏化劳工统计局项目在资源有限环境下的可扩展性。
{"title":"Enhancing Equity in Schoolchildren's Basic Life Support Education in Brazil Through Serious Games: Cohort Study.","authors":"Uri Adrian Prync Flato, Adriana Flato, Isabella Bispo Diaz T Martins, Giuliana Simoes Nakano, Julia Caroline Romao, Manuela Simões Nakano, Emilio José Beffa Dos Santos, Yuuki Daniel Tahara Villas Boas, Leonardo Escobar Medeiros, Vinicius Gazin Rossignoli, Gabriel Zanatta Cunha, Rafael Carreira Batista, Pedro Gazotto Rodrigues da Silva, Miguel Florentino, Amanda Rabelo, Thais Dias Midega, Rogerio Passos, Helio Guimaraes, Karl Kern","doi":"10.2196/69252","DOIUrl":"10.2196/69252","url":null,"abstract":"<p><strong>Background: </strong>Out-of-hospital cardiac arrests (OHCAs) predominantly occur in residential settings, often witnessed by children who could act as first responders. The World Health Organization (WHO) supports the Kids Save Lives (KSL) initiative, recommending basic life support (BLS) training for children aged ≥11 years. However, disparities in BLS education persist globally, particularly in low-resource regions where socioeconomic barriers, such as school type, malnutrition, and limited infrastructure, hinder implementation. Younger children (aged <11 years) face additional challenges due to physical limitations (eg, height, weight, and grip strength), which may compromise their ability to achieve adequate chest compression depth. While gamified learning has shown promise in improving BLS engagement and skill acquisition, its efficacy across diverse socioeconomic groups remains understudied.</p><p><strong>Objective: </strong>This study aimed to compare cardiopulmonary resuscitation (CPR) performance (compression depth, rate, and recoil) between public and private school students following a game-based BLS intervention and evaluate the feasibility of a serious game (Kids Save Hearts) in improving BLS knowledge and irrespective of socioeconomic background.</p><p><strong>Methods: </strong>We conducted an observational cohort study with 336 students aged 7-17 years from 10 public and 10 private schools in Brazil (April to November 2022). Participants received 40 minutes of video-based CPR training (American Heart Association CPR in Schools) followed by 10 minutes of gamified training using the Children Save Hearts serious game (SG). CPR quality was assessed via quality of cardiopulmonary resuscitation (QCPR) scores (Laerdal QCPR manikin), measuring compression depth (mm), compression rate (per minute), and chest recoil. Anthropometric data (height, weight, and grip strength) and socioeconomic indicators (school type) were collected. Nonparametric tests (Mann-Whitney U and chi-square tests) and multivariate regression (SPSS v27.0; IBM Corp) were used to analyze associations between demographics, physical characteristics, and CPR performance.</p><p><strong>Results: </strong>Older students (11-17 years) outperformed younger peers (7-10 years) in median compression depth (48 mm vs 37 mm; P<.001) and overall QCPR scores (84 vs 42, P<.001). Private school students had higher grip strength (24.92 vs 21.48 g/cm²; P=.001), but school type did not significantly affect CPR quality. Postintervention SG scores improved universally (P<.001), with no age or socioeconomic disparities. Multivariate analysis identified age (P<.001), height (P<.001), and grip strength (P<.001) as independent predictors of high QCPR scores (≥70).</p><p><strong>Conclusions: </strong>Age and physical development were stronger determinants of CPR quality than socioeconomic factors. The game-based intervention effectively improved BLS knowledge and skills across all partici","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"13 ","pages":"e69252"},"PeriodicalIF":4.1,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12599981/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145488810","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}
Federica Pallavicini, Eleonora Orena, Lisa Arnoldi, Federica Achille, Stefano Stefanini, Maddalena Cassa, Alessandro Pepe, Guido Veronese, Luca Bernardelli, Francesca Sforza, Sara Fascendini, Carlo Alberto Defanti, Marco Gemma, Massimo Clerici, Giuseppe Riva, Fabrizia Mantovani
[This corrects the article DOI: 10.2196/50326.].
[这更正了文章DOI: 10.2196/50326]。
{"title":"Correction: Effects and Acceptability of a 1-Week Home-Based Virtual Reality Training for Supporting the Management of Stress and Anxiety: Randomized Pilot Trial.","authors":"Federica Pallavicini, Eleonora Orena, Lisa Arnoldi, Federica Achille, Stefano Stefanini, Maddalena Cassa, Alessandro Pepe, Guido Veronese, Luca Bernardelli, Francesca Sforza, Sara Fascendini, Carlo Alberto Defanti, Marco Gemma, Massimo Clerici, Giuseppe Riva, Fabrizia Mantovani","doi":"10.2196/77791","DOIUrl":"10.2196/77791","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.2196/50326.].</p>","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"13 ","pages":"e77791"},"PeriodicalIF":4.1,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12645161/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145482022","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}
Yuri Gustavo de Sousa Barbalho, Calliandra Maria de Souza Silva, Carla Sílvia Neves da Nora Fernandes, Raíza Rana de Souza Lima Trombini, Patrícia Littig Melo, Aline Farias de Oliveira, Alayne Larissa Martins Pereira, Alessandro de Oliveira Silva, Luciano Ramos de Lima, Marina Morato Stival, Diana Lúcia Moura Pinho, Silvana Schwerz Funghetto
Background: Population aging underlines the critical need to improve health professional training to adequately care for adults aged >60 years. Developing educational resources to support academics and professionals presents a valuable opportunity to enhance understanding of health conditions and improve clinical management. Serious games are designed to develop teaching, training, and learning skills. Their use in the educational setting is warranted, as they integrate digital aspects and gamification to create a playful experience for content acquisition. Deepening this theme in nursing education will improve assistance to the older adult population, leading to more qualified care based on gerontological practices and comprehensive health care for older adults.
Objective: This study aims to develop and validate a serious game on older adult health for undergraduate nursing students.
Methods: This quantitative and descriptive methodological study, conducted between February 2023 and December 2023 at a public university in the Federal District of Brazil, involved the active participation of 27 undergraduate nursing students in their eighth to tenth semesters. The game, Health Unit in Focus (HUF), was developed and validated with their input. It features 75 clinical cases distributed across 3 themes: pharmacology, metabolic syndrome, and semiology. Of the 40 students initially enrolled, 27 completed the study. The app was validated using the System Usability Scale and student feedback, and the results were reported following the Game-Based Intervention Reporting Guidelines (GAMING).
Results: The participants had a mean age of 22.67 (SD 1.44) years, were mostly female (20/27, 74%), and were in their eighth semester (26/27, 96%). The game received an average System Usability Scale score of 85.75 (median 86.57), classified as excellent, as all evaluated items scored >75. Participants considered the game easy to use; accessible; practical; and rich in well-founded, useful content. This high usability score, coupled with the overwhelmingly positive feedback from the students, instills confidence in the game's effectiveness. Furthermore, 100% (27/27) of students agreed that learning through games is effective and expressed interest in incorporating more interactive games into their training. The serious game HUF showed good usability, as its overall score was "excellent," with its highest score in the odd-numbered items that addressed the positive aspects identified in the analysis.
Conclusions: The serious game HUF is not just a valid and reliable tool for training nursing students but also an engaging and interactive approach to learning. Its ability to captivate and involve students in the learning process is a testament to its potential to revolutionize nursing education. It is essential that the development of new methodological resources
背景：人口老龄化突出了改善卫生专业培训的迫切需要，以充分照顾50至60岁的成年人。发展教育资源以支持学者和专业人员，为增进对健康状况的了解和改善临床管理提供了宝贵的机会。严肃游戏是为了培养教学、培训和学习技能而设计的。它们在教育环境中的使用是合理的，因为它们整合了数字方面和游戏化，为内容获取创造了有趣的体验。在护理教育中深化这一主题将改善对老年人口的援助，从而在老年学实践和老年人综合保健的基础上提供更合格的护理。目的：本研究旨在为护理本科学生开发并验证一种老年人健康严肃游戏。方法：这项定量和描述性方法学研究于2023年2月至2023年12月在巴西联邦区的一所公立大学进行，涉及27名8至10学期的本科护理专业学生的积极参与。这款名为《Health Unit in Focus》（HUF）的游戏便是基于玩家的输入而开发并验证的。它包括75个临床病例，分布在3个主题：药理学、代谢综合征和符号学。在最初登记的40名学生中，有27人完成了这项研究。该应用程序使用系统可用性量表和学生反馈进行验证，并根据基于游戏的干预报告指南（游戏）报告结果。结果：参与者平均年龄为22.67岁（SD 1.44），以女性居多（20/ 27,74%），为第八学期（26/ 27,96%）。游戏的系统可用性量表得分平均为85.75分（中位数为86.57分），被评为优秀，因为所有评估项目得分均为bbb75分。参与者认为该游戏易于使用；访问;实用的;并且有丰富的有根据的、有用的内容。如此高的可用性分数，再加上来自学生的积极反馈，让他们对游戏的有效性充满信心。此外，100%（27/27）的学生同意通过游戏学习是有效的，并表示有兴趣在他们的培训中加入更多互动游戏。严肃游戏《HUF》表现出了良好的可用性，因为它的总体得分是“优秀”，其中得分最高的是奇数项，这些项反映了分析中确定的积极方面。结论：严肃游戏HUF不仅是一种有效可靠的护理学生培训工具，而且是一种引人入胜的互动学习方法。它的能力，吸引和参与学生在学习过程中是一个证明，其潜在的革命性护理教育。开发新的方法资源，例如严肃游戏，必须以科学证据为基础，以保证更可靠和成功地实现其既定目标。
{"title":"A Serious Game (Health Unit in Focus) for Enhancing Undergraduate Education on Older Adults' Health: Design and Validation Study.","authors":"Yuri Gustavo de Sousa Barbalho, Calliandra Maria de Souza Silva, Carla Sílvia Neves da Nora Fernandes, Raíza Rana de Souza Lima Trombini, Patrícia Littig Melo, Aline Farias de Oliveira, Alayne Larissa Martins Pereira, Alessandro de Oliveira Silva, Luciano Ramos de Lima, Marina Morato Stival, Diana Lúcia Moura Pinho, Silvana Schwerz Funghetto","doi":"10.2196/66289","DOIUrl":"10.2196/66289","url":null,"abstract":"<p><strong>Background: </strong>Population aging underlines the critical need to improve health professional training to adequately care for adults aged >60 years. Developing educational resources to support academics and professionals presents a valuable opportunity to enhance understanding of health conditions and improve clinical management. Serious games are designed to develop teaching, training, and learning skills. Their use in the educational setting is warranted, as they integrate digital aspects and gamification to create a playful experience for content acquisition. Deepening this theme in nursing education will improve assistance to the older adult population, leading to more qualified care based on gerontological practices and comprehensive health care for older adults.</p><p><strong>Objective: </strong>This study aims to develop and validate a serious game on older adult health for undergraduate nursing students.</p><p><strong>Methods: </strong>This quantitative and descriptive methodological study, conducted between February 2023 and December 2023 at a public university in the Federal District of Brazil, involved the active participation of 27 undergraduate nursing students in their eighth to tenth semesters. The game, Health Unit in Focus (HUF), was developed and validated with their input. It features 75 clinical cases distributed across 3 themes: pharmacology, metabolic syndrome, and semiology. Of the 40 students initially enrolled, 27 completed the study. The app was validated using the System Usability Scale and student feedback, and the results were reported following the Game-Based Intervention Reporting Guidelines (GAMING).</p><p><strong>Results: </strong>The participants had a mean age of 22.67 (SD 1.44) years, were mostly female (20/27, 74%), and were in their eighth semester (26/27, 96%). The game received an average System Usability Scale score of 85.75 (median 86.57), classified as excellent, as all evaluated items scored >75. Participants considered the game easy to use; accessible; practical; and rich in well-founded, useful content. This high usability score, coupled with the overwhelmingly positive feedback from the students, instills confidence in the game's effectiveness. Furthermore, 100% (27/27) of students agreed that learning through games is effective and expressed interest in incorporating more interactive games into their training. The serious game HUF showed good usability, as its overall score was \"excellent,\" with its highest score in the odd-numbered items that addressed the positive aspects identified in the analysis.</p><p><strong>Conclusions: </strong>The serious game HUF is not just a valid and reliable tool for training nursing students but also an engaging and interactive approach to learning. Its ability to captivate and involve students in the learning process is a testament to its potential to revolutionize nursing education. It is essential that the development of new methodological resources","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"13 ","pages":"e66289"},"PeriodicalIF":4.1,"publicationDate":"2025-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12584992/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145444864","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>With the growing prevalence of aging populations, improving the health and quality of life of older adults has become a critical concern globally. In this context, sports technology presents promising applications. The exergame-based training mat-an electronic exercise technology-integrates gamification with diverse training designs, offering a safe and engaging approach to promoting health and well-being in older adults.</p><p><strong>Objective: </strong>This study aims to examine the impact of a novel exergame-based mat training program on community-dwelling older adults, particularly evaluating its effectiveness in enhancing physical activity levels, quality of life, and functional fitness. The primary end point was exploratory, focusing on the feasibility and effectiveness of the exergame-based training program on physical fitness, physical activity, and quality of life.</p><p><strong>Methods: </strong>This randomized parallel-designed study enrolled 32 older adults aged 60-80 years from Taipei City. Participants were randomly assigned to either the experimental or control group. The experimental group underwent a 10-week exergame-based mat training program, consisting of 2 sessions per week (70 minutes per session), using gamified group-based exercise training. The control group maintained their usual daily activities. Pre- and postintervention assessments were conducted using the International Physical Activity Questionnaire (IPAQ), the World Health Organization Quality of Life Brief Version (WHOQOL-BREF), the Senior Fitness Test, and the AFAscan fitness assessment.</p><p><strong>Results: </strong>The experimental group demonstrated significantly increased overall and high-intensity physical activity levels (P=.04; mean difference [MD] 439, 95% CI 28-914; d=0.72). Quality of life significantly enhanced across the physical (P=.01; r=0.53), psychological (P=.02; r=0.52), and social (P=.02; r=0.50) domains of the WHOQOL-BREF. Furthermore, functional fitness parameters, including upper limb muscular strength (P=.007; MD 5.33, 95% CI 1.59-9.07; d=1.06), lower limb muscular strength (P=.01; MD 4.73, 95% CI 1.15-8.32; d=0.98), core strength (P<.001; MD 13.1, 95% CI 7.90-18.2; d=1.89), lower limb flexibility (P=.008; MD 6.47, 95% CI 1.82-11.1; d=1.04), dynamic balance (P=.03; MD -0.72, 95% CI -1.36 to -0.07; d=0.84), static balance (P=.005; MD 15.1, 95% CI 5.01-25.3; d=1.12), agility (P=.001; MD 32.6, 95% CI 15.6-49.6; d=1.44), and cardiorespiratory endurance (P=.04; MD 9.73, 95% CI 0.37-19.1; d=0.78), showed significant enhancements with the exergame-based mat training program. There were no adverse events observed during the study.</p><p><strong>Conclusions: </strong>In this exploratory trial, the exergame-based mat training program produced medium-to-large improvements (Cohen d ranging from 0.72 to 1.89) across physical activity, quality of life, and functional fitness domains. Although the precision of the CIs va
背景：随着人口老龄化的日益普遍，改善老年人的健康和生活质量已成为全球关注的一个关键问题。在这种情况下，体育技术呈现出有前景的应用。基于游戏的训练垫是一种电子运动技术，将游戏化与多种训练设计相结合，提供了一种安全和吸引人的方法来促进老年人的健康和福祉。目的：本研究旨在研究一种新的基于运动的垫子训练计划对社区居住的老年人的影响，特别是评估其在提高身体活动水平、生活质量和功能健康方面的有效性。主要终点是探索性的，关注基于运动的训练计划在身体健康、身体活动和生活质量方面的可行性和有效性。方法：本研究随机平行设计，选取台北市60 ~ 80岁老年人32名。参与者被随机分为实验组和对照组。实验组进行了为期10周的基于游戏的垫子训练计划，包括每周2次（每次70分钟），使用游戏化的基于小组的运动训练。对照组维持他们的日常活动。采用国际身体活动问卷（IPAQ）、世界卫生组织生活质量简要版（WHOQOL-BREF）、老年人健康测试和AFAscan健康评估进行干预前和干预后评估。结果：实验组整体和高强度体力活动水平显著提高（P= 0.04；平均差异[MD] 439, 95% CI 28-914; d=0.72）。WHOQOL-BREF的生理（P= 0.01; r=0.53）、心理（P= 0.02; r=0.52）和社会（P= 0.02; r=0.50）领域的生活质量均显著提高。此外，功能健身参数，包括上肢肌肉力量（P= 0.007; MD 5.33, 95% CI 1.59-9.07; d=1.06），下肢肌肉力量（P= 0.01; MD 4.73, 95% CI 1.15-8.32; d=0.98），核心力量(P结论：在这项探索性试验中，基于运动的垫训练计划在身体活动、生活质量和功能健身领域产生了中等到较大的改善（Cohen d范围从0.72到1.89）。尽管ci的精度各不相同，但效果的一致方向支持干预的有意义的影响。这些发现表明，以运动为基础的垫训练项目可能作为一种实用的社区健康促进策略，有可能预防与年龄相关的虚弱，提高老年人的独立性和幸福感。
{"title":"A Novel Gamified Exercise Program Incorporating Stampede Training for Enhancing Functional Fitness, Physical Activity Levels, and Quality of Life in Community-Dwelling Older Adults: Randomized Parallel Exploratory Trial.","authors":"Siao-Fen Huang, Ching-Wen Fan, Diana Khasna Nisrina, Tsai-Wei Lin, Wen Ching Huang","doi":"10.2196/73474","DOIUrl":"10.2196/73474","url":null,"abstract":"<p><strong>Background: </strong>With the growing prevalence of aging populations, improving the health and quality of life of older adults has become a critical concern globally. In this context, sports technology presents promising applications. The exergame-based training mat-an electronic exercise technology-integrates gamification with diverse training designs, offering a safe and engaging approach to promoting health and well-being in older adults.</p><p><strong>Objective: </strong>This study aims to examine the impact of a novel exergame-based mat training program on community-dwelling older adults, particularly evaluating its effectiveness in enhancing physical activity levels, quality of life, and functional fitness. The primary end point was exploratory, focusing on the feasibility and effectiveness of the exergame-based training program on physical fitness, physical activity, and quality of life.</p><p><strong>Methods: </strong>This randomized parallel-designed study enrolled 32 older adults aged 60-80 years from Taipei City. Participants were randomly assigned to either the experimental or control group. The experimental group underwent a 10-week exergame-based mat training program, consisting of 2 sessions per week (70 minutes per session), using gamified group-based exercise training. The control group maintained their usual daily activities. Pre- and postintervention assessments were conducted using the International Physical Activity Questionnaire (IPAQ), the World Health Organization Quality of Life Brief Version (WHOQOL-BREF), the Senior Fitness Test, and the AFAscan fitness assessment.</p><p><strong>Results: </strong>The experimental group demonstrated significantly increased overall and high-intensity physical activity levels (P=.04; mean difference [MD] 439, 95% CI 28-914; d=0.72). Quality of life significantly enhanced across the physical (P=.01; r=0.53), psychological (P=.02; r=0.52), and social (P=.02; r=0.50) domains of the WHOQOL-BREF. Furthermore, functional fitness parameters, including upper limb muscular strength (P=.007; MD 5.33, 95% CI 1.59-9.07; d=1.06), lower limb muscular strength (P=.01; MD 4.73, 95% CI 1.15-8.32; d=0.98), core strength (P<.001; MD 13.1, 95% CI 7.90-18.2; d=1.89), lower limb flexibility (P=.008; MD 6.47, 95% CI 1.82-11.1; d=1.04), dynamic balance (P=.03; MD -0.72, 95% CI -1.36 to -0.07; d=0.84), static balance (P=.005; MD 15.1, 95% CI 5.01-25.3; d=1.12), agility (P=.001; MD 32.6, 95% CI 15.6-49.6; d=1.44), and cardiorespiratory endurance (P=.04; MD 9.73, 95% CI 0.37-19.1; d=0.78), showed significant enhancements with the exergame-based mat training program. There were no adverse events observed during the study.</p><p><strong>Conclusions: </strong>In this exploratory trial, the exergame-based mat training program produced medium-to-large improvements (Cohen d ranging from 0.72 to 1.89) across physical activity, quality of life, and functional fitness domains. Although the precision of the CIs va","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"13 ","pages":"e73474"},"PeriodicalIF":4.1,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12582559/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145437971","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}
Michelle C Haas, Larissa Wild, Leander Schneeberger, Eveline S Graf, Anna Lisa Martin-Niedecken
<p><strong>Background: </strong>Exergaming, involving physically active play, provides a means for motivating and functional training. It may also offer an innovative solution for rehabilitation after sports injuries such as anterior cruciate ligament (ACL) injury. Rehabilitation is lengthy and only partially prepares athletes for the demands of sports. As a result, only 65% of athletes return to the same performance level as before the injury. Exergames specific to ACL rehabilitation are missing. Their unique combination of physical and cognitive challenge may contribute to preparing patients for their return to sports. Collaboration of sport scientists, game designers, and physiotherapists enables comprehensive and user-centered development of an innovative training concept incorporating the needs of both patients and therapists along with scientific evidence.</p><p><strong>Objective: </strong>This project aimed to develop a specific exergame scenario for sports rehabilitation after ACL injuries. A research-driven, user-centered, iterative approach was followed. The project was structured into four phases: (1) assessment of motor performance during a fitness exergame, (2) investigation and establishment of user requirements, (3) development of a new exergame, and (4) validation of the new exergame.</p><p><strong>Methods: </strong>For assessment of motor performance, lower extremity kinematics during a fitness exergame scenario in the ExerCube were assessed in 24 athletes (6 after ACL injury) using marker-based motion capture. Regarding user requirements, focus groups with physiotherapists and patients were conducted. Development of a new exergame was from the kinematic analysis results and user requirements guided the iterative, interdisciplinary design of a new exergame scenario and movement concept for the ExerCube. For validation, developed exergame scenarios were recurrently evaluated with patient and therapist focus groups and transformed into a final exergame scenario.</p><p><strong>Results: </strong>For assessment of motor performance, there was a main effect of exercise in maximal knee valgus, knee internal rotation, and hip flexion with P<.001. Squats showed the lowest knee valgus (4.23°, 95% CI 4.12-4.51) and knee internal rotation angle (3.68°, 95% CI 3.33-4.03). Focus groups revealed that patients want to return to sports as quickly as possible but have concerns about sensory overload during training. Physiotherapists desire a device that allows additional independent training with new therapeutic stimuli. Concerning the development of a new exergame, the movement concept for the new exergame included strength and balance exercises, and a mini-exergame for endurance, reaction, and skill training. Three difficulty levels allow for varying complexity and speed. For validation, focus groups on the newly developed exergame scenarios highlighted their motivational potential, suitability for autonomous use, and the need for therapist-cont
{"title":"Exploring Mixed-Reality Exergames for Sports Rehabilitation: Design Insights and Evaluation Findings.","authors":"Michelle C Haas, Larissa Wild, Leander Schneeberger, Eveline S Graf, Anna Lisa Martin-Niedecken","doi":"10.2196/68431","DOIUrl":"10.2196/68431","url":null,"abstract":"<p><strong>Background: </strong>Exergaming, involving physically active play, provides a means for motivating and functional training. It may also offer an innovative solution for rehabilitation after sports injuries such as anterior cruciate ligament (ACL) injury. Rehabilitation is lengthy and only partially prepares athletes for the demands of sports. As a result, only 65% of athletes return to the same performance level as before the injury. Exergames specific to ACL rehabilitation are missing. Their unique combination of physical and cognitive challenge may contribute to preparing patients for their return to sports. Collaboration of sport scientists, game designers, and physiotherapists enables comprehensive and user-centered development of an innovative training concept incorporating the needs of both patients and therapists along with scientific evidence.</p><p><strong>Objective: </strong>This project aimed to develop a specific exergame scenario for sports rehabilitation after ACL injuries. A research-driven, user-centered, iterative approach was followed. The project was structured into four phases: (1) assessment of motor performance during a fitness exergame, (2) investigation and establishment of user requirements, (3) development of a new exergame, and (4) validation of the new exergame.</p><p><strong>Methods: </strong>For assessment of motor performance, lower extremity kinematics during a fitness exergame scenario in the ExerCube were assessed in 24 athletes (6 after ACL injury) using marker-based motion capture. Regarding user requirements, focus groups with physiotherapists and patients were conducted. Development of a new exergame was from the kinematic analysis results and user requirements guided the iterative, interdisciplinary design of a new exergame scenario and movement concept for the ExerCube. For validation, developed exergame scenarios were recurrently evaluated with patient and therapist focus groups and transformed into a final exergame scenario.</p><p><strong>Results: </strong>For assessment of motor performance, there was a main effect of exercise in maximal knee valgus, knee internal rotation, and hip flexion with P<.001. Squats showed the lowest knee valgus (4.23°, 95% CI 4.12-4.51) and knee internal rotation angle (3.68°, 95% CI 3.33-4.03). Focus groups revealed that patients want to return to sports as quickly as possible but have concerns about sensory overload during training. Physiotherapists desire a device that allows additional independent training with new therapeutic stimuli. Concerning the development of a new exergame, the movement concept for the new exergame included strength and balance exercises, and a mini-exergame for endurance, reaction, and skill training. Three difficulty levels allow for varying complexity and speed. For validation, focus groups on the newly developed exergame scenarios highlighted their motivational potential, suitability for autonomous use, and the need for therapist-cont","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"13 ","pages":"e68431"},"PeriodicalIF":4.1,"publicationDate":"2025-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12619019/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145421793","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}
Shiyi Tong, Lixuan Li, Yuankun Zhang, Weiyan Ren, Fang Pu
Background: Body movement-controlled video games (BMCVGs) are increasingly adopted in rehabilitation because they combine physical training with interactive engagement. Flow experience, a critical factor for enhancing user engagement and training efficacy, exhibits age-related differences that are essential for designing age-appropriate rehabilitation tasks. However, current BMCVG rehabilitation tasks often overlook these age-related differences in subjective experience, leading to insufficient engagement among older adults.
Objective: This study aimed to explore differences in flow experience between younger and older adults when performing the same BMCVG rehabilitation task and to provide empirical evidence for designing personalized and age-appropriate programs.
Methods: A total of 40 participants were recruited, including 21 older adults (mean age 63.00, SD 6.64 y; n=10, 48% male participants) and 19 younger adults (mean age 24.68, SD 1.16 y; n=9, 47% male participants). Participants performed the "Space Pop" task in Kinect Adventures, simulating limb coordination training. Flow experience was assessed using the Chinese version of the Flow State Scale-2, which measures 9 dimensions of flow. Group differences were analyzed using the nonparametric Wilcoxon rank-sum tests, and effect sizes (Cohen d) were calculated via bootstrap estimation.
Results: Older adults exhibited significantly lower overall flow experience than younger adults (W=339.5; P<.001; Cohen d=1.45; η2=0.37). Significant differences were also found in the dimensions of "challenge-skill balance" (W=339; P<.001); "clear goals" (W=271; P=.04); "sense of control" (W=389.5; P<.001); and "loss of self-consciousness" (W=268; P=.048). The largest effect was observed in the "sense of control" dimension (Cohen d=3.22; η2=0.74), indicating it was the most significantly impacted by age. Other dimensions (eg, concentration and time transformation) showed no significant differences.
Conclusions: Age plays a significant role in shaping flow experiences during BMCVG rehabilitation tasks. Older adults' reduced flow may be attributed to declines in cognitive processing speed, motor control, and self-efficacy, which particularly impair their sense of control and goal clarity. Tailoring designs through strategies such as dynamic difficulty adjustment, clearer goal cues, and reduced motor demands is crucial. These adaptations can enhance older adults' sense of control and immersion, promoting active participation and ultimately improving rehabilitation outcomes.
{"title":"Age Differences in Flow Experience During Body Movement-Controlled Video Game Rehabilitation Tasks: Cross-Sectional Study.","authors":"Shiyi Tong, Lixuan Li, Yuankun Zhang, Weiyan Ren, Fang Pu","doi":"10.2196/76278","DOIUrl":"10.2196/76278","url":null,"abstract":"<p><strong>Background: </strong>Body movement-controlled video games (BMCVGs) are increasingly adopted in rehabilitation because they combine physical training with interactive engagement. Flow experience, a critical factor for enhancing user engagement and training efficacy, exhibits age-related differences that are essential for designing age-appropriate rehabilitation tasks. However, current BMCVG rehabilitation tasks often overlook these age-related differences in subjective experience, leading to insufficient engagement among older adults.</p><p><strong>Objective: </strong>This study aimed to explore differences in flow experience between younger and older adults when performing the same BMCVG rehabilitation task and to provide empirical evidence for designing personalized and age-appropriate programs.</p><p><strong>Methods: </strong>A total of 40 participants were recruited, including 21 older adults (mean age 63.00, SD 6.64 y; n=10, 48% male participants) and 19 younger adults (mean age 24.68, SD 1.16 y; n=9, 47% male participants). Participants performed the \"Space Pop\" task in Kinect Adventures, simulating limb coordination training. Flow experience was assessed using the Chinese version of the Flow State Scale-2, which measures 9 dimensions of flow. Group differences were analyzed using the nonparametric Wilcoxon rank-sum tests, and effect sizes (Cohen d) were calculated via bootstrap estimation.</p><p><strong>Results: </strong>Older adults exhibited significantly lower overall flow experience than younger adults (W=339.5; P<.001; Cohen d=1.45; η2=0.37). Significant differences were also found in the dimensions of \"challenge-skill balance\" (W=339; P<.001); \"clear goals\" (W=271; P=.04); \"sense of control\" (W=389.5; P<.001); and \"loss of self-consciousness\" (W=268; P=.048). The largest effect was observed in the \"sense of control\" dimension (Cohen d=3.22; η2=0.74), indicating it was the most significantly impacted by age. Other dimensions (eg, concentration and time transformation) showed no significant differences.</p><p><strong>Conclusions: </strong>Age plays a significant role in shaping flow experiences during BMCVG rehabilitation tasks. Older adults' reduced flow may be attributed to declines in cognitive processing speed, motor control, and self-efficacy, which particularly impair their sense of control and goal clarity. Tailoring designs through strategies such as dynamic difficulty adjustment, clearer goal cues, and reduced motor demands is crucial. These adaptations can enhance older adults' sense of control and immersion, promoting active participation and ultimately improving rehabilitation outcomes.</p>","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"13 ","pages":"e76278"},"PeriodicalIF":4.1,"publicationDate":"2025-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12571201/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145400920","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}
Bo Liu, Yisheng Fan, Meng Xu, Fangyuan Chang, Yue Shi, Zhao Liu
Background: Amblyopia is the leading cause of visual impairment in children worldwide. The predominant clinical treatment, occlusion therapy, is marred by poor adherence, often attributed to the physical discomfort and social stigma associated with eye patching. Adjunct digital visual trainings have not consistently sustained patient engagement due to their repetitive nature, thereby compromising their efficacy.
Objective: This study aimed to evaluate the effectiveness of a gamified mobile app designed to increase treatment adherence among children with amblyopia by making the therapeutic process more engaging and accessible within home settings.
Methods: An exploratory study was conducted, commencing with qualitative interviews and questionnaires to explore the barriers to traditional treatment adherence. This formative research informed the development of a gamified mobile app, which was shaped by cognitive appraisal theory to address identified emotional and psychological needs, potentially impacting adherence. The subsequent quantitative phase utilized a randomized controlled trial involving 34 children with amblyopia who were aged 7-10 years and recruited from a local primary school. These participants were randomly assigned to either the intervention group, which used a novel gamified mobile app developed by our team, or the control group, which utilized another commercially available mobile app. Both groups engaged with their respective apps in a home environment. The 8-item Morisky Medication Adherence Scale was adapted to measure treatment adherence.
Results: Over the 4-week trial, 34 children aged 7-10 years with amblyopia were enrolled and randomized into 2 groups: intervention (n=18) and control (n=16). Children in both the intervention and control groups engaged daily for 20 minutes at home, using mobile apps designed for visual rehabilitation. The intervention group (n=18) achieved a significantly higher mean adherence rate (mean 6.56, SD 1.06) on the Morisky Medication Adherence Scale compared to the control group (n=16; mean 5.01, SD 1.22; P<.001). Thematic analysis of the design process revealed that integrating cognitive appraisal theory effectively enhanced emotional engagement and adherence.
Conclusions: The integration of cognitive appraisal theory into the design of a gamified mobile app for amblyopia treatment has shown to significantly improve adherence among children.
{"title":"Effectiveness of a Gamified Mobile App in Enhancing Treatment Adherence for Children With Amblyopia: Explorative Study.","authors":"Bo Liu, Yisheng Fan, Meng Xu, Fangyuan Chang, Yue Shi, Zhao Liu","doi":"10.2196/60309","DOIUrl":"10.2196/60309","url":null,"abstract":"<p><strong>Background: </strong>Amblyopia is the leading cause of visual impairment in children worldwide. The predominant clinical treatment, occlusion therapy, is marred by poor adherence, often attributed to the physical discomfort and social stigma associated with eye patching. Adjunct digital visual trainings have not consistently sustained patient engagement due to their repetitive nature, thereby compromising their efficacy.</p><p><strong>Objective: </strong>This study aimed to evaluate the effectiveness of a gamified mobile app designed to increase treatment adherence among children with amblyopia by making the therapeutic process more engaging and accessible within home settings.</p><p><strong>Methods: </strong>An exploratory study was conducted, commencing with qualitative interviews and questionnaires to explore the barriers to traditional treatment adherence. This formative research informed the development of a gamified mobile app, which was shaped by cognitive appraisal theory to address identified emotional and psychological needs, potentially impacting adherence. The subsequent quantitative phase utilized a randomized controlled trial involving 34 children with amblyopia who were aged 7-10 years and recruited from a local primary school. These participants were randomly assigned to either the intervention group, which used a novel gamified mobile app developed by our team, or the control group, which utilized another commercially available mobile app. Both groups engaged with their respective apps in a home environment. The 8-item Morisky Medication Adherence Scale was adapted to measure treatment adherence.</p><p><strong>Results: </strong>Over the 4-week trial, 34 children aged 7-10 years with amblyopia were enrolled and randomized into 2 groups: intervention (n=18) and control (n=16). Children in both the intervention and control groups engaged daily for 20 minutes at home, using mobile apps designed for visual rehabilitation. The intervention group (n=18) achieved a significantly higher mean adherence rate (mean 6.56, SD 1.06) on the Morisky Medication Adherence Scale compared to the control group (n=16; mean 5.01, SD 1.22; P<.001). Thematic analysis of the design process revealed that integrating cognitive appraisal theory effectively enhanced emotional engagement and adherence.</p><p><strong>Conclusions: </strong>The integration of cognitive appraisal theory into the design of a gamified mobile app for amblyopia treatment has shown to significantly improve adherence among children.</p>","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"13 ","pages":"e60309"},"PeriodicalIF":4.1,"publicationDate":"2025-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12569704/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145389837","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}
Sören Freerik Brähmer, Benjamin Iffland, Stefan Kreisel, Martin Driessen, Eva M Trompetter, Meret Schomburg, Max Toepper, Carolin Steuwe
<p><strong>Background: </strong>In the face of an increasing treatment need among people with dementia, effective and efficient interventions with a focus on quality of life need to be established. In this context, serious games have received increasing attention. However, there is a lack of apps specifically designed for people with dementia.</p><p><strong>Objective: </strong>In this prospective pilot study, we examined the usability of a newly developed serious game app ("Digimenz").</p><p><strong>Methods: </strong>A total of 43 people with cognitive impairment and mild to severe dementia completed the repeated-measures study procedure. Participants were recruited from an inpatient geriatric psychiatric ward and a long-term care facility. Participants were asked to complete 4 conditions in randomized order, including playing 3 different serious games (experimental conditions) and reading a newspaper (control condition). Each condition was completed once, and the total duration was 60 to 90 minutes per participant. Data on app usability were collected through self-ratings and observation after each condition. We tested for differences in usability among the conditions and the recruitment sites, and analyzed the relation of usability to cognitive capacity.</p><p><strong>Results: </strong>The serious games were accepted in both settings (long-term care: 30/30, 100% interested; psychiatric ward: 31/41, 76% interested), although study completion was lower in the psychiatric subsample (15/41, 37%) than in the long-term care subsample (28/30, 93%). Global usability was rated good (System Usability Scale global mean score: 79). More severely impaired patients had more pronounced difficulties in learning how to play the games (ρMMSE, Learnability=-0.61, 95% CI -0.78 to -0.36; P<.001) and playing them alone (ρMMSE, Support=-0.49, 95% CI -0.69 to -0.19; P<.001). Nevertheless, playing the games was associated with a more positive mood (likelihood ratio χ23=25.09; P<.001), independent of the level of cognitive functioning (likelihood ratio χ21=0.64; P=.42). All games were played with a moderate error rate (0.19-0.49).</p><p><strong>Conclusions: </strong>Our results indicated a positive association between serious game usage and well-being in patients with dementia, given adequate support. This is a valuable addition to the understanding of serious game usage in dementia care. Although challenging, user-centered development of serious games with people who are severely impaired by dementia is an important research target. Limitations like low data quality and a simplified design are inherent in this study population. Nevertheless, we demonstrated how usability testing in this target group is possible through careful definition and operationalization. The inclusion of different data sources, different recruitment sites, and different levels of cognitive impairment increased the generalizability of the findings. To accommodate severely impaired patients, futur
背景：面对痴呆症患者日益增长的治疗需求，需要建立以生活质量为重点的有效和高效干预措施。在这种背景下，严肃游戏受到了越来越多的关注。然而，目前还缺乏专门为痴呆症患者设计的应用程序。目的：在这项前瞻性先导研究中，我们检查了一款新开发的严肃游戏应用程序（“Digimenz”）的可用性。方法：共有43名认知障碍和轻度至重度痴呆患者完成了重复测量研究程序。参与者是从住院老年精神科病房和长期护理机构招募的。参与者被要求按随机顺序完成4个条件，包括玩3种不同的严肃游戏（实验条件）和阅读报纸（控制条件）。每个条件完成一次，每个参与者的总持续时间为60到90分钟。应用程序可用性的数据收集通过自评和观察每个条件后。我们测试了不同条件和招聘地点的可用性差异，并分析了可用性与认知能力的关系。结果：严肃游戏在两种环境中都被接受（长期护理：30/30,100%感兴趣；精神科病房：31/41,76%感兴趣），尽管精神科亚样本的研究完成率（15/41,37%）低于长期护理亚样本（28/30,93%）。全球可用性被评为良好（系统可用性量表全球平均得分：79）。更严重的受损患者在学习如何玩游戏方面有更明显的困难（ρMMSE, Learnability=-0.61, 95% CI = -0.78至-0.36）。结论：我们的研究结果表明，在给予充分支持的情况下，痴呆患者的严重游戏使用与幸福感之间存在正相关。这是对痴呆症护理中严肃游戏使用的理解的一个有价值的补充。尽管具有挑战性，但以用户为中心开发严重受痴呆症影响的严肃游戏是一个重要的研究目标。数据质量低和设计简化等局限性是本研究人群固有的。尽管如此，我们还是演示了如何通过仔细的定义和操作化在这个目标群体中进行可用性测试。纳入不同的数据来源、不同的招募地点和不同程度的认知障碍增加了研究结果的普遍性。为了适应严重受损的患者，未来的发展应该包括更广泛的困难和适应群体环境。
{"title":"Development of a Serious Game App (Digimenz) for Patients With Dementia: Prospective Pilot Study for Usability Testing in Inpatient Treatment and Long-Term Care.","authors":"Sören Freerik Brähmer, Benjamin Iffland, Stefan Kreisel, Martin Driessen, Eva M Trompetter, Meret Schomburg, Max Toepper, Carolin Steuwe","doi":"10.2196/69812","DOIUrl":"10.2196/69812","url":null,"abstract":"<p><strong>Background: </strong>In the face of an increasing treatment need among people with dementia, effective and efficient interventions with a focus on quality of life need to be established. In this context, serious games have received increasing attention. However, there is a lack of apps specifically designed for people with dementia.</p><p><strong>Objective: </strong>In this prospective pilot study, we examined the usability of a newly developed serious game app (\"Digimenz\").</p><p><strong>Methods: </strong>A total of 43 people with cognitive impairment and mild to severe dementia completed the repeated-measures study procedure. Participants were recruited from an inpatient geriatric psychiatric ward and a long-term care facility. Participants were asked to complete 4 conditions in randomized order, including playing 3 different serious games (experimental conditions) and reading a newspaper (control condition). Each condition was completed once, and the total duration was 60 to 90 minutes per participant. Data on app usability were collected through self-ratings and observation after each condition. We tested for differences in usability among the conditions and the recruitment sites, and analyzed the relation of usability to cognitive capacity.</p><p><strong>Results: </strong>The serious games were accepted in both settings (long-term care: 30/30, 100% interested; psychiatric ward: 31/41, 76% interested), although study completion was lower in the psychiatric subsample (15/41, 37%) than in the long-term care subsample (28/30, 93%). Global usability was rated good (System Usability Scale global mean score: 79). More severely impaired patients had more pronounced difficulties in learning how to play the games (ρMMSE, Learnability=-0.61, 95% CI -0.78 to -0.36; P<.001) and playing them alone (ρMMSE, Support=-0.49, 95% CI -0.69 to -0.19; P<.001). Nevertheless, playing the games was associated with a more positive mood (likelihood ratio χ23=25.09; P<.001), independent of the level of cognitive functioning (likelihood ratio χ21=0.64; P=.42). All games were played with a moderate error rate (0.19-0.49).</p><p><strong>Conclusions: </strong>Our results indicated a positive association between serious game usage and well-being in patients with dementia, given adequate support. This is a valuable addition to the understanding of serious game usage in dementia care. Although challenging, user-centered development of serious games with people who are severely impaired by dementia is an important research target. Limitations like low data quality and a simplified design are inherent in this study population. Nevertheless, we demonstrated how usability testing in this target group is possible through careful definition and operationalization. The inclusion of different data sources, different recruitment sites, and different levels of cognitive impairment increased the generalizability of the findings. To accommodate severely impaired patients, futur","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"13 ","pages":"e69812"},"PeriodicalIF":4.1,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12558423/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145377845","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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