JMIR Serious Games最新文献

{"title":"Two-Stage Gamified Digital Assessment for Autism Spectrum Disorder Screening and the Limits of Differentiating Social Communication Disorder in Children and Adolescents: Cross-Sectional Diagnostic Accuracy Study Using Explainable Machine Learning.","authors":"Minyoung Jung, Ju Ran, Ennyoung Lee, Youngkyung Sunwoo, SooYeon Kim, Ji-Hoon Kim, Sungja Cho","doi":"10.2196/102714","DOIUrl":"10.2196/102714","url":null,"abstract":"<p><strong>Background: </strong>Distinguishing autism spectrum disorder (ASD) from social communication disorder (SCD) is clinically challenging because both conditions present with overlapping social communication deficits. Standard caregiver-reported instruments capture surface-level behavioral similarities rather than underlying cognitive differences, motivating the development of digital gamified assessments that measure social cognitive processes directly.</p><p><strong>Objective: </strong>This study developed and evaluated a 2-stage gamified digital pipeline: stage 1 (Buddy Plan, a self-report module) for high-sensitivity ASD screening, and stage 2 (Buddy Drill, story-based social-judgment scenarios), which was examined with a leakage-controlled analysis, for assessing whether ASD can be differentiated from SCD.</p><p><strong>Methods: </strong>In this cross-sectional diagnostic accuracy study, 275 children and adolescents aged 6-18 years (mean 11.07, SD 3.13 years; 175/275, 63.6% male) were recruited by convenience sampling from 5 clinical and community sites in the Republic of Korea (May 2024 to February 2025) across 5 Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) groups: ASD (n=51), SCD (n=54), attention-deficit/hyperactivity disorder (n=23), high risk (n=52), and neurotypically developing (ND; n=95). Diagnoses were established by board-certified child psychiatrists. Participants completed 2 tablet-based modules: Buddy Plan (52 self-report items; stage 1) and Buddy Drill (153 story-based scenarios; stage 2). The primary outcome was diagnostic accuracy (area under the receiver operating characteristic curve [AUC], sensitivity, and specificity). Four machine learning algorithms were trained with nested cross-validation (5×5 folds). For stage 2, item selection and imputation were performed within each training fold. Explainability used Shapley Additive Explanations (SHAP). Significance was set at α=.05 (2-sided) with bootstrap 95% CIs.</p><p><strong>Results: </strong>Group differences were tested by 1-way ANOVA. For stage 1 (ASD vs ND; n=146), random forest achieved a nested AUC of 0.912 (95% CI 0.856-0.953). At a threshold of 0.200, sensitivity was 96.1% (49/51; 95% CI 86.8%-99.5%) and specificity was 58.9% (56/95; 95% CI 48.4%-68.9%), with 2 false negatives. For stage 2 (ASD vs SCD; n=100), the fully nested pipeline yielded only chance-level discrimination: regularized logistic regression achieved a nested AUC of 0.62 (95% CI 0.51-0.74), and no feature configuration (self-report: 0.55, objective: 0.62, combined: 0.63) exceeded chance. SHAP identified 5 cross-algorithm stage 1 biomarkers with significant ASD-versus-ND differences (all <i>P</i><.01) and no evidence of sex bias.</p><p><strong>Conclusions: </strong>The gamified Buddy Plan module shows promise for high-sensitivity ASD screening. In contrast, once feature-selection leakage was removed with a fully nested pipeline, the Buddy Drill module did not rob","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"14 ","pages":"e102714"},"PeriodicalIF":4.7,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13600596/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149030562","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}

{"title":"The Reciprocal Relationships Among Impulsivity, Self-Control, Gaming Time, and Internet Gaming Disorder Among Adolescents: Prospective Longitudinal Cohort Study.","authors":"Yanqiu Yu, Lijing Liu, Jianxin Zhang, Ji-Bin Li, Joseph Tf Lau","doi":"10.2196/86982","DOIUrl":"10.2196/86982","url":null,"abstract":"<p><strong>Background: </strong>Gaming time, impulsivity, and self-control are known determinants of internet gaming disorder (IGD). However, their reciprocity has not been empirically tested.</p><p><strong>Objective: </strong>This study investigated the reciprocal relationships among gaming time, impulsivity, self-control, and IGD simultaneously within a single cross-lagged panel model among Chinese adolescents, hypothesizing that all 4 variables would be prospectively associated with each other.</p><p><strong>Methods: </strong>This 1-year, 2-wave prospective longitudinal cohort (observational) study recruited grade 7 and grade 8 students from a convenience sample of 6 junior high schools in Chengdu and Guangzhou, China. Students completed an identical self-administered questionnaire in classrooms (using paper and pencil, without teachers present) in December 2018 (wave 1 [W1]) and December 2019 (wave 2 [W2]). Impulsivity, self-control, gaming time, and IGD were assessed using validated scales. The 2238 students (mean age 12.60, SD 0.63 years, 95% CI 12.58-12.63; male: n=1102, 49.24%, 95% CI 47.27%-51.21%) who completed the W1 survey were included in the final data analysis, with multiple imputations addressing missing data from dropouts and unmatched assessments across the 2 study waves.</p><p><strong>Results: </strong>Adjusting for background characteristics, autoregressive correlations, and concurrent correlations, the cross-lagged panel model showed that (1) the prospective association between gaming time at W1 and IGD at W2 was statistically nonsignificant (β=0.02, 95% CI -0.04 to 0.08), but IGD at W1 was prospectively and positively associated with gaming time at W2 (β=0.08, 95% CI 0.01-0.16; <i>P</i>=.02); (2) self-control at W1 was prospectively and negatively associated with both gaming time at W2 (β=-0.13, 95% CI -0.19 to -0.07; <i>P</i><.001) and IGD at W2 (β=-0.11, 95% CI -0.17 to -0.05; <i>P</i><.001), and IGD at W1 was prospectively and negatively associated with self-control at W2 (β=-0.09, 95% CI -0.15 to -0.03; <i>P</i><.001), but gaming time at W1 was not associated with self-control at W2 (β=0.04, 95% CI -0.01 to 0.09); and (3) the prospective associations between impulsivity at W1 and IGD at W2 (β=0.03, 95% CI -0.03 to 0.09) and between impulsivity at W1 and gaming time at W2 (β=-0.04, 95% CI -0.10 to 0.03) were statistically nonsignificant; reciprocally, neither IGD at W1 (β=0.05, 95% CI -0.01 to 0.11) nor gaming time at W1 (β=-0.01, 95% CI -0.07 to 0.05) was prospectively associated with impulsivity at W2.</p><p><strong>Conclusions: </strong>This prospective longitudinal cohort study is the first to disentangle the reciprocal prospective associations among gaming time, impulsivity, self-control, and IGD simultaneously within a single cross-lagged panel model. Unlike prior studies, which examined these variables separately and largely cross-sectionally, this design clarified their bidirectionality and relative longitudinal i","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"14 ","pages":"e86982"},"PeriodicalIF":4.7,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13600582/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149030568","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}

{"title":"Gameful Experience and Perceived Educational Value in a Student-Designed Medical Escape Room for Preclinical Medical Education: Cross-Sectional Study.","authors":"Eleni Dafli, Ioannis Kountouratzis, Ioanna Doufexi, Alexandros Nikolaidis, Aggelos Kourpanidis, Odysseas Koniaris, Nikolaos Kyriakidis, Maria Nikolaidou, Sotiria Gilou, Panagiotis Antoniou, Panagiotis D Bamidis","doi":"10.2196/96011","DOIUrl":"10.2196/96011","url":null,"abstract":"<p><strong>Background: </strong>Educational escape rooms are increasingly used in medical education to promote engagement, collaboration, and active problem-solving. However, existing literature varies considerably in theoretical grounding and evaluation methodology, and limited evidence exists regarding how specific dimensions of gameful experience may relate to learners' perceived educational value.</p><p><strong>Objective: </strong>This study aimed to evaluate preclinical medical students' perceptions of a student-designed medical escape room and to examine associations between dimensions of gameful experience and perceived educational value.</p><p><strong>Methods: </strong>A cross-sectional study was conducted during the 2023-2024 and 2024-2025 academic years among 144 preclinical medical students participating in a student-designed educational escape room. The intervention integrated foundational medical sciences, collaborative problem-solving, and simulation-based procedural tasks. Participants completed anonymous questionnaires after the activity. Perceived educational value was assessed using the Diabetes Escape Room Perception Scale (DERPS), while gameful experience was measured using the Gameful Experience Scale (GAMEX). Descriptive statistics, reliability analyses, principal component analysis with Varimax rotation, Spearman correlation analyses, one-sample Wilcoxon signed-rank tests, and multiple linear regression models were performed using IBM SPSS Statistics version 29. Statistical significance was set at an α level of .05.</p><p><strong>Results: </strong>Of the 144 participants, 140 (97.2%) completed all questionnaires. The sample was 52.1% (73/140) female, with a mean age of 20.8 (SD 1.5) years. Participants reported favorable perceptions of the escape room, with DERPS scores exceeding the neutral midpoint (mean 4.00, SD 0.50; <i>t</i><sub>139</sub>=35.50; <i>P</i><.001). The GAMEX showed high internal consistency (Cronbach α=0.89), and factor analysis supported the original 6-factor structure. Enjoyment (mean 4.75, SD 0.41), Creative Thinking (mean 4.33, SD 0.56), Activation (mean 3.99, SD 0.63), Absorption (mean 3.70, SD 0.76), and Dominance (mean 3.48, SD 0.81) were above the scale midpoint (all <i>P</i><.001). Scores on the Absence of Negative Affect dimension (mean 2.11, SD 1.12; <i>P</i><.001) were below the midpoint, indicating that participants reported some degree of challenge-related negative emotions during the activity. Spearman correlation analyses demonstrated positive associations between DERPS scores and Enjoyment (ρ=0.534; <i>P</i><.001), Creative Thinking (ρ=0.467; <i>P</i><.001), and Absorption (ρ=0.319; <i>P</i><.001). In multivariable regression analyses, Enjoyment was associated with both overall perception scores (β=0.385; <i>P</i><.001; <i>R</i>²=.442) and educational efficacy scores (β=0.279; <i>P</i>=.004; <i>R</i>²=.350). Dominance was related to educational efficacy scores (β=0.194; <i>P</i>=.04).</p><","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"14 ","pages":"e96011"},"PeriodicalIF":4.7,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13592745/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149017009","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}

{"title":"Scenario-Based Serious Game for Screening Mild Cognitive Impairment in Older Adults: Cross-Sectional Preliminary Validation Study.","authors":"Bomyi Jeon, Chi Hyeon Noh, Soo Rim Noh, Yerin Shim, Seung Bin Cho, Sungkun Cho","doi":"10.2196/92334","DOIUrl":"10.2196/92334","url":null,"abstract":"<p><strong>Background: </strong>Many existing digital cognitive assessments rely on isolated or abstract tasks, and primarily use accuracy-based outcome measures, despite recent advances in the field. Few have been culturally adapted to reflect the familiar daily-life experiences of Korean older adults. Integrating culturally meaningful scenarios with task-specific accuracy and reaction time (RT) measures may provide a more ecologically grounded approach to mild cognitive impairment (MCI) screening.</p><p><strong>Objective: </strong>This study aimed to develop and preliminarily evaluate a tablet-based, scenario-based serious game for community-based MCI screening among Korean older adults.</p><p><strong>Methods: </strong>In this cross-sectional diagnostic accuracy study, community-dwelling adults aged 60-84 years were recruited through convenience sampling from a senior welfare center in Daejeon, South Korea, between July 2024 and June 2025. Of 87 participants who underwent eligibility assessment, 67 participants were included in the analysis: 47 cognitively normal participants, and 20 participants with MCI. Clinical classification was determined according to Petersen criteria based on the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease battery, second edition, structured clinical interviews, and clinician judgment blinded to the serious game results. The serious game initially comprised 5 culturally familiar and ecologically grounded daily-life tasks, from which task-specific accuracy and RT features were extracted. A reduced 4-task model informed by exploratory misclassification analysis served as the primary classification model and was evaluated using random forest classification with out-of-bag validation. A full 5-task model and a demographic-adjusted model were also evaluated. Convergent validity and perceived workload were assessed.</p><p><strong>Results: </strong>The group with MCI was older (77.3 vs 74.5 y; <i>P</i>=.002) and had fewer years of education (9.4 vs 11.2 y; <i>P</i>=.04). The primary 4-task model achieved an overall accuracy of 82.1% (55/67), balanced accuracy of 80.1%, sensitivity of 75% (15/20), specificity of 85.1% (40/47), and an area under the receiver operating characteristic curve of 0.787 (95% CI 0.643-0.932). The demographic-adjusted model showed broadly comparable discrimination (area under the receiver operating characteristic curve 0.794, 95% CI 0.654-0.934). Accuracy and RT measures from the sale items task ranked among the most important predictors. Digital composite scores were significantly correlated with the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease battery, second edition total score (<i>r</i>=.655 and <i>r</i>=.447; both <i>P</i><.001). Perceived workload did not significantly differ between groups (<i>P</i>=.97).</p><p><strong>Conclusions: </strong>This study provides preliminary evidence for the diagnostic utility and feasibility o","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"14 ","pages":"e92334"},"PeriodicalIF":4.7,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13581261/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148982611","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}

{"title":"Dynamic Adoption of Immersive Tai Chi Training Among Older Adults: Exploratory Qualitative-Dominant Longitudinal Mixed Methods Follow-Up Study of Virtual and Mixed Reality Delivery.","authors":"Xiacheng Song, Huafeng Qu, Jing Jin, Lu Sun, Xiqiong Yi, Junfeng Zhu, Huirong Huang","doi":"10.2196/96262","DOIUrl":"10.2196/96262","url":null,"abstract":"<p><strong>Background: </strong>Immersive exercise systems may support guided movement practice and physical activity among older adults, but adoption of head-mounted systems cannot be inferred from single-session usability or intention ratings. Older adults must negotiate unfamiliar equipment, movement safety, comfort, perceived control, trust, and perceived benefit. Virtual reality (VR) and mixed reality (MR) are often grouped as extended reality despite different sensory and safety affordances.</p><p><strong>Objective: </strong>This study examined how older adults' barriers and facilitators evolved during repeated immersive Tai Chi training and how VR and MR delivery appeared to shape immersion, control, trust, safety appraisal, and conditional willingness to continue use.</p><p><strong>Methods: </strong>We conducted an exploratory, qualitative-dominant longitudinal mixed methods follow-up study in Hunan, China. Community-dwelling adults aged 60 years or older completed guided Tai Chi training in VR or MR while retaining parent-study allocation; comparisons were descriptive and hypothesis-generating. The completed-protocol quantitative sample and the main qualitative denominator each included 34 participants (VR: n=16; MR: n=18). Data sources comprised semistructured interviews, Game Experience Questionnaire dimensions, Virtual Reality Sickness Questionnaire (VRSQ) scores, safety observations, and task performance logs from days 1, 3, and 6. Qualitative data were coded using a Dynamic Barrier Framework-informed codebook and integrated with descriptive quantitative summaries.</p><p><strong>Results: </strong>Adoption unfolded as a staged process. During entry, unfamiliarity, competence concerns, and mild physical discomfort shaped responses. Initial uncertainty was endorsed by 7 of 16 (43.8%, 95% CI 23.1-66.8) VR participants and 6 of 18 (33.3%, 95% CI 16.3-56.3) MR participants. During adaptation, participants described practice, feedback, social reinforcement, and environmental experience; accuracy improved from day 1 to day 6 by 0.083 (95% CI 0.024-0.142) in VR and 0.103 (95% CI 0.037-0.169) in MR. Late-stage willingness remained conditional on comfort, safety, content variety, and usefulness. VR accounts more often emphasized environmental immersion and affective value, whereas MR accounts more often emphasized reality grounding, perceived control, and trust. Standardized VRSQ scores were low overall (VR 8.65 and MR 5.65, on a 0-100 scale), with no falls, serious adverse events, or session terminations.</p><p><strong>Conclusions: </strong>This study combines repeated qualitative accounts with symptom, safety, and performance evidence while holding the Tai Chi content constant across VR and MR delivery. Unlike single-session acceptance studies, broad extended reality comparisons, or endpoint-only evaluations, it shows adoption as a phase-sensitive and conditional process rather than a one-time decision. The Dynamic Barrier Framework explains ","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"14 ","pages":"e96262"},"PeriodicalIF":4.7,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13576671/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148976920","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}

{"title":"Effects and Moderators of Exergaming on Glucose and Lipid Metabolism in Children and Adolescents: Systematic Review and Meta-Analysis.","authors":"Shuo Zhou, Yang Yang, Xiaoquan Weng, Huakun Zheng, Lingyan Yuan","doi":"10.2196/93610","DOIUrl":"10.2196/93610","url":null,"abstract":"<p><strong>Background: </strong>Exergaming, or active video gaming, may make physical activity more engaging for children and adolescents. Earlier reviews have focused on activity, adiposity, fitness, or psychosocial outcomes, leaving effects on glycemic and lipid biomarkers uncertain. Their cardiometabolic relevance warrants synthesis.</p><p><strong>Objective: </strong>This systematic review and meta-analysis evaluated the effects of exergaming on glucose and lipid metabolism in children and adolescents, and explored potential moderators.</p><p><strong>Methods: </strong>Following PRISMA 2020 (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), we searched PubMed, Embase, Scopus, Web of Science, the Psychology and Behavioral Sciences Collection, and CENTRAL from inception to April 27, 2026, with backward and forward citation searching. Eligible controlled interventions enrolled participants aged ≤18 years and compared exergaming with nonexergaming controls. Outcomes were glucose, insulin, total cholesterol (TC), triglycerides, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C). Standardized mean differences (Hedges <i>g</i>) were pooled with inverse-variance random-effects models and the Hartung-Knapp-Sidik-Jonkman adjustment. We reported 95% CIs, heterogeneity, 95% prediction intervals (PIs), risk of bias, and GRADE (Grading of Recommendations Assessment, Development and Evaluation) certainty; subgroup analysis, meta-regression, and leave-one-out sensitivity analyses explored moderators and estimate stability.</p><p><strong>Results: </strong>Ten controlled intervention studies involving 732 participants were included. Pooled effects were nonsignificant for glucose (9 studies, 528 participants; Hedges <i>g</i>=-0.16, 95% CI -0.57 to 0.24; PI -1.12 to 0.79), insulin (5 studies, 308 participants; Hedges <i>g</i>=-0.06, 95% CI -0.35 to 0.23; PI -0.39 to 0.27), TC (9 studies, 510 participants; Hedges <i>g</i>=-0.39, 95% CI -1.11 to 0.33; PI -1.70 to 0.93), triglycerides (9 studies, 510 participants; Hedges <i>g</i>=-0.17, 95% CI -0.50 to 0.17; PI -0.88 to 0.55), and HDL-C (9 studies, 510 participants; Hedges <i>g</i>=-0.14, 95% CI -0.34 to 0.06; PI -0.35 to 0.07; effect sizes were reverse-oriented so that negative values favored exergaming). LDL-C showed a small favorable pooled average reduction (9 studies, 510 participants; Hedges <i>g</i>=-0.29, 95% CI -0.55 to -0.04; PI -0.73 to 0.14), but its PI crossed the null. All PIs crossed the null; heterogeneity was substantial for glucose, considerable for TC, moderate for triglycerides, and low for insulin, HDL-C, and LDL-C. Subgroup signals were exploratory, no significant meta-regression moderators were identified, and leave-one-out analyses did not materially alter the glucose, TC, or triglycerides estimates. Most randomized trials had risk-of-bias concerns; the nonrandomized study had serious risk of bias. These limitations reduce confidenc","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"14 ","pages":"e93610"},"PeriodicalIF":4.7,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13579656/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148976846","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}

{"title":"Development of a Mixed-Reality Application for Volitional Step Training in People With Multiple Sclerosis: Cross-Sectional Qualitative User-Centered Co-Design Study.","authors":"Gabriele Perachiotti, Isolde Martina Busch, Ersilia Vallefuoco, Giovanni D'Errico, Nicola Moccaldi, Sofia Straudi, Pasquale Arpaia","doi":"10.2196/94312","DOIUrl":"10.2196/94312","url":null,"abstract":"<p><strong>Background: </strong>People with multiple sclerosis (MS) are at high risk of falls, with approximately half experiencing at least 1 fall within 6 months. Multidirectional step training has shown potential for fall prevention, but evidence in people with MS remains inconsistent. Mixed reality (MR) offers adaptive and home-based rehabilitation opportunities. However, successful implementation of MR-based serious games requires structured co-design processes integrating patient, clinician, and technical perspectives.</p><p><strong>Objective: </strong>This qualitative study describes the co-design and prototyping of a home-based MR serious game called Head Your Limits for volitional step training in people with MS, aiming to identify patient-, clinician-, and technology-driven design requirements and translate them into an MR rehabilitation application.</p><p><strong>Methods: </strong>We implemented a cross-sectional qualitative user-centered co-design process. Phase 1 involved 2 online focus groups with people with MS to identify experiential and design preferences related to MR-based training. Phase 2 included a focus group with 4 clinicians and 1 engineer to define clinical and technical requirements. Phase 3 consisted of in-person hands-on testing of 2 MR prototypes (\"clock\" and \"grapes\"), developed in Unity and deployed on Meta Quest 3. Twenty people with MS were purposively screened from among individuals referred for motor rehabilitation; 14 participated in the online focus groups and 9 in in-person prototype testing (mean age 56.2, SD 7.0 years; mean Expanded Disability Status Scale score 5.1, SD 1.3; 6/9, 66.7% female). Iterative refinement followed each phase, translating stakeholder-derived requirements into architectural modifications of the MR application. Focus group recordings and moderator notes were reviewed to identify themes and design requirements guiding iterative prototype refinement.</p><p><strong>Results: </strong>Five primary patient-derived requirements emerged: multisensory feedback, gamification, progress tracking, visual accessibility, and ergonomic comfort. Clinicians emphasized adaptive difficulty, cognitive-motor integration, biomechanical validity, and caregiver compatibility. Prototype comparison showed that floor-level targets induced cervical discomfort and postural compensation, whereas auditory guidance reduced head flexion. The final application repositioned targets at eye level and implemented head-mounted display tracking to ensure appropriate center-of-mass displacement, preserve proprioceptive engagement, enable caregiver proximity, and integrate gamified feedback and performance reporting.</p><p><strong>Conclusions: </strong>Iterative stakeholder engagement resolved key design tensions related to ergonomics, sensory reliance, biomechanical validity, and motivation. The transition to eye-level, head-mediated interaction emerged as a core solution integrating therapeutic and user-experience goals. ","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"14 ","pages":"e94312"},"PeriodicalIF":4.7,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13620433/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148968715","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}

{"title":"Retraction: Implementations of Virtual Reality for Anxiety-Related Disorders: Systematic Review.","authors":"","doi":"10.2196/110891","DOIUrl":"10.2196/110891","url":null,"abstract":"","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"14 ","pages":"e110891"},"PeriodicalIF":4.7,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13615375/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148945000","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}

{"title":"Collaborative Gameplay for Children's Self-Efficacy in Computational Thinking: Qualitative Cross-Sectional Design Science Research Case Study.","authors":"Valéria Moreira Pinto, Mariana Seiça, Licinio Roque","doi":"10.2196/94416","DOIUrl":"10.2196/94416","url":null,"abstract":"<p><strong>Background: </strong>Despite science, technology, engineering, and mathematics (STEM) fields driving socioeconomic development and career prospects, they continue to struggle with low enrollment and high dropout rates. An important predictor of academic performance and career persistence is self-efficacy, which is the belief in one's ability to succeed. Research indicates that collaboration improves learning outcomes and is associated with improved STEM motivation. Computational thinking (CT) is also increasingly valued in STEM education due to its reliance on computational tools and problem-solving processes. Early exposure to STEM content in a child's educational journey may thus be a key opportunity for shaping their STEM self-efficacy and future career path.</p><p><strong>Objective: </strong>This study aimed to explore how a collaborative, playful learning experience influences self-efficacy in CT skills among children. This study followed an iterative Design Science Research (DSR) approach. In this study, we present the first iteration of the DSR process, focused on analyzing and retrieving design principles for exploring how collaborative gameplay may support self-efficacy in CT as a leverage for STEM education.</p><p><strong>Methods: </strong>For this study, a low-resolution study tabletop game, MeerPlay, was conceived as our main instrument to perform 5 gameplay rehearsal sessions with 14 children, aged between 6 and 11 years. Data were collected following a qualitative content analysis methodology, using video recordings of the sessions and individual semistructured interviews. The content analysis followed an axial coding approach, focused on retrieving evidence of collaborative behaviors that might have supported self-efficacy in CT during gameplay.</p><p><strong>Results: </strong>Results suggest that collaboration enables verbal persuasion, vicarious experience, and mutual problem-solving, which are important factors in self-efficacy development. The players engaged in a collaborative dialogue and strategic cooperative gameplay by sharing strategies and ideas, creating an environment of mutual support and encouragement. Participants gradually developed skills to overcome the game's challenges, perform new gameplay actions, and work together toward accomplishing the game's goal, thus supporting self-efficacy in CT challenges.</p><p><strong>Conclusions: </strong>We propose a set of game design principles for collaborative gameplay: (1) a shared player panel to jointly define the characters' actions, (2) conjoined game actions to achieve the overall objective, (3) shared in-game elements and actions, (4) shared dice-roll values to incite collaborative movements, and (5) community evolution and fate across time, promoting a sense of joint victory, loss, and reward. We introduce an innovative methodological approach to study how the design elements influence collaborative interactions supporting self-efficacy. Framing STEM promo","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"14 ","pages":"e94416"},"PeriodicalIF":4.7,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13557326/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148919754","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}

{"title":"Gamified Adult Basic Life Support Training for Schoolchildren Using Minecraft Education Edition: Cross-Sectional Program Evaluation.","authors":"Manuel Pardo Rios, Vanessa Fois González, Ana Belén Ocampo Cervantes, Carmen Amalia López López, José Tortosa Alcázar, Miriam Mendoza López, Petronila Mireia Alcázar Artero, Daniel Guillén Martínez, Robert Greif, Nino Fijačko, Aida Carballo-Fazanes, Cristian Abelairas-Gómez","doi":"10.2196/93141","DOIUrl":"10.2196/93141","url":null,"abstract":"<p><strong>Background: </strong>Early bystander cardiopulmonary resuscitation (CPR) and prompt defibrillation are key determinants of survival after out-of-hospital cardiac arrest, and school-based adult basic life support (BLS) education is a high-impact public health strategy. However, scalability and standardized assessment remain challenging. Gamified digital environments may sustain engagement while enabling comparable, rubric-based evaluation of learning artifacts. Few evaluations have examined whether a fully online gamified platform can support large-scale school-based adult BLS participation while generating standardized class-level artifacts for structured assessment.</p><p><strong>Objective: </strong>This study aims to assess the implementation of a fully online, school-oriented, gamified adult BLS initiative delivered through Minecraft Education Edition by quantifying program reach, rubric-based class-level project performance, and provider-side costs.</p><p><strong>Methods: </strong>We conducted a cross-sectional program evaluation of the 2025 Build & Save: CPR Museum Challenge during a 21-day window. Participation followed open, voluntary, convenience-based, self-selected sampling in schools. Teachers facilitated a self-directed online adult BLS course and a structured in-game building task with rooms representing key adult BLS actions (checking responsiveness, calling 112, compressing, defibrillating). Each class submitted one project (diary and world file), the unit of analysis; teacher and student counts were recorded only as reach indicators. Eligible submissions included the required PDF diary and an accessible world file; incomplete or nonassessable submissions were excluded before scoring. A 4-member jury assessed projects using a predefined 5-domain rubric (score of 1-4 per domain; base score 0-20; total 0-21, capped at 20). Descriptive statistics, Mann-Whitney <i>U</i> tests, Kruskal-Wallis tests, Spearman correlations, item-total reliability, and Cronbach α were computed using a 2-sided α of .05. Inferential tests were interpreted as exploratory. A cost-consequence analysis reported provider-side costs.</p><p><strong>Results: </strong>Thirty class-level projects were submitted; 27 were evaluated after excluding incomplete or nonassessable submissions. The initiative reached 23 teachers and 850 students across 11 regions (Spain, United States, Colombia, Malaysia). The median base and total scores were 7 (IQR 2-10; range 0-20). Rubric internal consistency was high (Cronbach α=0.95, 95% CI 0.89-0.97), with corrected item-total correlations of 0.81-0.89. Projects including an explanatory video scored higher than those without a video (Mann-Whitney <i>U</i>=134.5; <i>P</i>=.006; Cliff delta=0.66, 95% CI 0.37-0.92), and secondary-level projects outperformed primary-level submissions (Kruskal-Wallis <i>H</i>=7.46; <i>P</i>=.006). Domain correlations were strong (all <i>P</i><.001; highest ρ=0.94). Direct implementation costs were","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"14 ","pages":"e93141"},"PeriodicalIF":4.7,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13556288/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148912184","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}