Journal of Medical Internet Research最新文献

Background: Cognitive decline across the mild cognitive impairment (MCI)-dementia continuum is a major driver of loss of independence and growing health- and social-care burden. Immersive technologies, such as virtual reality (VR), augmented reality (AR), and Cave Automatic Virtual Environment (CAVE) systems, are increasingly explored as tools to enhance engagement, personalization, and ecological validity in cognitive rehabilitation.

Objective: This systematic review synthesizes current evidence on the usability, therapeutic effects, and implementation challenges of immersive technologies for cognitive rehabilitation in MCI and dementia.

Methods: A systematic search of Scopus and Web of Science was conducted for peer-reviewed journal articles published between 2021 and 2026. Eligible studies investigated VR, AR, or CAVE interventions targeting cognitive rehabilitation outcomes in MCI and/or dementia and reported measures related to usability or acceptability, or cognitive, functional, or behavioral outcomes. Due to heterogeneity in technologies, intervention content, and outcome measures, findings were synthesized narratively with comparisons across modalities and study designs.

Results: In total, 119 studies met the inclusion criteria. Across immersive VR interventions, signals of benefit were most consistently reported for memory, attention, and executive functioning, with several studies also targeting outcomes with higher ecological relevance (eg, everyday task performance and functional skills). AR approaches primarily support context-aware cueing and task guidance in real-world settings, aiming to strengthen daily functioning and independence. CAVE-based systems were frequently used for spatial navigation and embodied interaction, offering advantages for supervised clinical deployment. Key barriers included cybersickness and comfort issues, interface complexity, and onboarding demands in cognitively impaired users, limited accessibility and standardization of outcome measures, small samples and short follow-up periods, and practical constraints related to cost, space, staffing, and caregiver involvement.

Conclusions: Immersive VR, AR, and CAVE systems are feasible and often engaging for cognitive rehabilitation in MCI and dementia, with promising therapeutic signals but substantial uncertainty driven by methodological and implementation heterogeneity. Future work should prioritize standardized reporting (intervention components, dose, and adverse events), clinically meaningful outcomes (including functional end points), adequately powered comparative trials, and explicit evaluation of scalability and real-world deployment pathways.

Background: Unplanned emergency department (ED) visits and hospital readmissions following discharge contribute to patient distress, increased health care costs, and system inefficiencies. Early postdischarge follow-up can improve care transitions, yet evidence on the effectiveness of telephone-based interventions remains mixed. Telephone calls, a low-barrier form of digital health, may enhance equity and accessibility by reaching patients who face challenges with in-person or higher-technology follow-up.

Objective: This study evaluated the impact of a nurse-led postdischarge telephone intervention delivered by Fraser Health Virtual Care on short-term ED visits and hospital readmissions among recently discharged high-risk patients. Secondary objectives included examining patient experiences with the service and identifying care gaps addressed during follow-up calls.

Methods: A pragmatic quasi-randomized trial was conducted (May 2022-September 2022). Participants were eligible if they were aged 18 years or older and classified as high-risk for readmission using the LACE (Length of stay, Acuity of admission, Comorbidities, and Emergency department use) index (≥10 or <9 and ≥45 y). Participants were allocated to either a postdischarge telephone intervention group or a standard care control group based on daily nurse availability. Intervention participants received a structured nurse-led call 48 hours after discharge assessing understanding of discharge instructions, medication management, follow-up appointments, and home supports. Primary outcomes were ED visits within 7 and 30 days post call; secondary outcomes were hospital readmissions and patient experience. Negative binomial regression models were used to calculate adjusted incident rate ratios (IRRs).

Results: A total of 7091 participants were included (intervention: n=3911, of whom 1752 completed the call; control: n=3180). Postdischarge calls significantly reduced ED visits at both 7 days (adjusted IRR 0.719, 95% CI 0.617-0.837; P<.001) and 30 days (IRR 0.878, 95% CI 0.783-0.983; P=.02). No statistically significant reductions were observed in hospital readmissions at either 7 days (IRR 0.809; P=.13) or 30 days (IRR 0.942; P=.54). Forty percent of completed calls (n=701) identified at least 1 gap in discharge understanding or follow-up care. Most participants found the calls helpful and reported increased confidence in managing their care.

Conclusions: Structured nurse-led postdischarge telephone calls significantly reduced short-term ED utilization but did not impact readmission rates. These findings support the role of telephone-based virtual care as a scalable, low-barrier strategy to improve care transitions and reduce avoidable ED visits. Additional or ongoing interventions may be required to influence hospital readmission outcomes among high-risk patients.