JMIR Serious Games最新文献

{"title":"The Impact of Gamified Teaching on Undergraduate Nursing Students' Disaster Nursing Competence, Self-Efficacy, and Self-Directed Learning Ability: Quasi-Experimental Study.","authors":"Shiyi Bai, HuiJuan Zeng, Qianmei Zhong, Cheng Yang, Shenglu Liu, Lulu Cao, Mei He","doi":"10.2196/85947","DOIUrl":"10.2196/85947","url":null,"abstract":"<p><strong>Background: </strong>Gamified teaching is considered an effective strategy for enhancing learning motivation. However, there is insufficient research on systematically designing theory-based gamified approaches for disaster nursing, particularly in resource-limited conventional classroom settings.</p><p><strong>Objective: </strong>This study aimed to compare the impact of gamified teaching versus conventional teaching on disaster nursing competence, self-efficacy, and self-directed learning ability among undergraduate nursing students.</p><p><strong>Methods: </strong>A quasi-experimental, nonequivalent control group pretest-posttest design was used. Participants were third-year nursing students who had completed foundational and medical-surgical nursing courses with no prior gamified learning (GL) experience. They were nonrandomly allocated to experimental (GL group, n=66) and conventional learning (CL group, n=66) groups based on scheduling feasibility. The GL group received 180 minutes (4 class hours) of gamification, incorporating points, group competitions, and collaboration. The CL group received traditional instruction. Outcomes were measured at 3 time points (preintervention, immediate posttest, and 1-week follow-up) using the Disaster Nursing Competence Scale, General Self-Efficacy Scale, and Self-Directed Learning Ability Scale of Nursing Undergraduates. Data were analyzed using linear mixed models with group, time, group × time interaction, and baseline differences (disaster experience) as covariates.</p><p><strong>Results: </strong>The GL group scored significantly higher than the CL group on the total posttest score for disaster nursing competence (mean difference [MD]=0.205, 95% CI 0.032-0.378; P=.02), although the difference was not statistically significant at follow-up. The knowledge dimension (MD=0.274; P=.01) and practical skills dimension (MD=0.201; P=.03) showed the same pattern of immediate improvement, whereas the physical and mental qualities dimension demonstrated a delayed effect at follow-up (MD=0.537; P=.003). The total score for self-directed learning ability was higher in the gamified teaching group than in the control group at follow-up (MD=0.116, 95% CI 0.012-0.220; P=.03), with significant improvements in collaborative learning ability (group × time interaction effect F2,390=5.17, P=.01; follow-up between-group difference=0.243, P=.001) and information competence (follow-up between-group difference=0.140; P=.04), but no significant change in self-management ability. There were no significant differences between the 2 groups in general self-efficacy at any time point (interaction effect P=.33).</p><p><strong>Conclusions: </strong>Unlike most studies focusing on digital gaming platforms, this study shows that a low-technology, highly interactive classroom gamification approach is feasible under conventional teaching conditions. The uniqueness of this gamified teaching lies in its ability to simultaneously ","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"14 ","pages":"e85947"},"PeriodicalIF":4.7,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13252707/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148217914","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":"Multimodal Psychophysiological Assessment of Craving in Patients With Alcohol Dependence During Virtual Reality Cue Exposure: Exploratory Single-Arm Clinical Study.","authors":"Alva Lütt, Nadja Ruckser, Alessandro Turno, Nikolaos Tsamitros, Julia Thormann, Daniel Schulze, Ivan Nenchev, Thomas Wolbers, Sofia Marie Lange Mussons, Robert Schöneck, Jil Zoé Fuhrmann, Felix Bermpohl, Andreas Heinz, Miriam Sebold, Anne Beck, Stefan Gutwinski","doi":"10.2196/84156","DOIUrl":"10.2196/84156","url":null,"abstract":"<p><strong>Background: </strong>Craving is a diagnostic criterion and predictor of relapse in patients with alcohol dependence (AD) and is induced in cue exposure therapy (CET) to prepare patients for real-life risk situations. The benefits of virtual reality (VR) as an innovative tool within treatment for this highly prevalent disorder include increased practicability, standardization, and personalization of CET. Accurate measurement of craving is essential to develop effective virtual reality cue exposure (VR-CE) scenarios. Despite being relevant for diagnostics and therapy, the psychophysiological reaction to alcohol cues and its relationship to subjective craving has not been sufficiently examined.</p><p><strong>Objective: </strong>This study aimed to investigate the induction of subjective craving, its physiological correlates, and their relationship in patients with AD during an innovative VR-CE paradigm, including 2 alcohol-associated risk scenarios (bar and living room) and a neutral baseline scenario.</p><p><strong>Methods: </strong>Craving was analyzed by measuring physiological reactions (electrodermal activity, including nonspecific skin conductance responses [NS-SCR] and skin conductance level [SCL]; heart rate [variability] [HR(V)]; brightness-corrected pupil diameter [BCPD]; and respiration rate [RR]) and subjective craving (visual analog scale) in 61 patients with AD. Linear mixed-effects models were conducted to estimate the effects of VR-CE. Correlations between subjective and physiological craving parameters were analyzed using Spearman correlations.</p><p><strong>Results: </strong>Results showed that alcohol-associated VR scenarios had significant effects on subjective craving (β values between 9.48, 95% CI 6.02-12.95 and 15.93, 95% CI 12.47-19.40, with moderate effect sizes between d=0.56 and d=0.72) and on NS-SCR frequency (β values between 0.97, 95% CI 0.14-1.80 and 3.06, 95% CI 2.23-3.89, with small-to-large effect sizes between d=0.31 and d=0.91), BCPD (β values between 0.03, 95% CI 0.01-0.06 and 0.05, 95% CI 0.02-0.07, with small effect sizes between d=0.21 and d=0.29), and RR (β values between 0.67, 95% CI 0.06-1.28 and 1.66, 95% CI 1.05-2.26, with small effect sizes between d=0.22 and d=0.45), but not on SCL and HR(V). Correlation analyses showed significant but weak correlations between subjective craving and electrodermal activity (SCL: r=0.20, P=.04; NS-SCR frequency: r=0.21, P=.03).</p><p><strong>Conclusions: </strong>This study showed that subjective and physiological craving (NS-SCR, BCPD, and RR but not SCL and HR[V]) can be successfully induced by VR-CE in patients with AD. These outcomes add to research on the induction of craving using a wide range of psychophysiological and subjective parameters. Furthermore, this study expands the still-limited research on the relationship between subjective and psychophysiological craving in patients with AD. In the long term, this study informs the development of effectiv","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"14 ","pages":"e84156"},"PeriodicalIF":4.7,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13252710/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148217897","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":"Serious Game Aimed at Assessing Executive Planning Skills in Children With Autism: Cross-Sectional Design and Formative Evaluation of ShopAutiPlan.","authors":"Athmar N M Shamhan, Mohamad Hassan Fadi Hijab, Marwa Qaraqe, Dena Al-Thani","doi":"10.2196/90444","DOIUrl":"10.2196/90444","url":null,"abstract":"<p><strong>Background: </strong>Planning deficits are a common and functionally significant executive function difficulty in children with autism, affecting everyday activities such as organizing tasks, prioritizing goals, and monitoring progress. Traditional neuropsychological assessments often lack ecological validity and may not capture these skills in real-world contexts. Serious games offer promising alternatives by simulating everyday scenarios and enabling observation of planning behaviors during interactive tasks. However, most existing systems focus on training rather than theory-driven assessment, and are rarely evaluated for usability before deployment with children with autism.</p><p><strong>Objective: </strong>This study aimed to design and evaluate ShopAutiPlan, a supermarket-based serious game intended to assess executive planning skills in children with ASD by conducting a formative expert evaluation before its use in clinical or research settings. The evaluation sought to identify usability strengths and limitations, ensuring that the system aligns with planning theory and accommodates the unique needs of autistic users.</p><p><strong>Methods: </strong>A theory-driven design approach grounded in the Hayes-Roth cognitive model of planning was used to map planning subcomponents-including goal formulation, strategy generation, sequencing, execution, and monitoring-to in-game tasks and logged behavioral metrics. A cross-sectional, formative expert-based usability evaluation was conducted using inspection and think-aloud protocols. Six domain experts (2 psychologists, 2 human-computer interaction researchers, and 2 game developers) participated in individual evaluation sessions. Usability assessment was guided by ASD-specific usability heuristics, and experts completed the System Usability Scale (SUS). SUS scores were summarized using descriptive statistics, and qualitative feedback was analyzed through deductive coding mapped to heuristic categories.</p><p><strong>Results: </strong>Across experts, 45 usability issues were identified, spanning cognitive accessibility, feedback clarity, realism, and technical performance. Severity ratings varied according to disciplinary perspectives: psychologists highlighted cognitive load, sensory accessibility, and task clarity, whereas developers focused on system responsiveness, interaction consistency, and technical reliability. The overall SUS score (mean 70.4, 95% CI 45.2-95.7) exceeded the standard benchmark of 68, supporting the acceptability of the system and complementing the qualitative findings from the heuristic evaluation. Recommendations from the evaluation informed iterative refinements to interface design, interaction flow, and task representation to enhance alignment between planning constructs and user experience.</p><p><strong>Conclusions: </strong>To the best of our knowledge, this study introduces the first shopping-based serious game specifically designed to assess executive p","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"14 ","pages":"e90444"},"PeriodicalIF":4.7,"publicationDate":"2026-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13245710/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148204799","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":"Nintendo Switch-Based Exergaming for Subthreshold Depression: Mixed Methods Randomized Controlled Trial.","authors":"Kexin Huang, Lei Song, Ariadna Albajara Sáenz, Rendong He, Yongliang Jiao, Yong Jia, Li Chen","doi":"10.2196/80937","DOIUrl":"10.2196/80937","url":null,"abstract":"<p><strong>Background: </strong>Subthreshold depression (StD) increases the risk of progression to major depressive disorder. Although exercise can reduce depressive symptoms, adherence remains challenging. Exergames on platforms such as Nintendo Switch may improve motivation and participation in physical activity; however, evidence for efficacy in StD is limited.</p><p><strong>Objective: </strong>This study aims to evaluate the effects of a Nintendo Switch-based exergaming intervention on depressive symptoms, anxiety, and sleep quality, and to explore participant experiences among adults with StD.</p><p><strong>Methods: </strong>This sequential explanatory mixed methods study comprised a randomized controlled trial followed by semistructured interviews. Eighty-four adults with StD were randomized using computer-generated permuted blocks with concealed allocation to an intervention group (IG; n=42), which received an 8-week Nintendo Switch-based exergame program (2-3 sessions/week, 50-60 minutes/session), or a control group (CG; n=42), which continued usual activities. Outcome assessors and data analysts were blinded. Depressive symptoms, anxiety, and sleep quality were assessed at baseline (T0), postintervention (T1, Week 8), one-month follow-up (T2, Week 12), and 2-month follow-up (T3, Week 16). Generalized estimating equations (GEE) were used to analyze longitudinal changes and time×group interactions under the intention-to-treat principle. Semistructured interviews were conducted with a purposive subsample of IG participants (n=17) at T1 and analyzed using thematic analysis.</p><p><strong>Results: </strong>Eighty-four participants were randomized; 81 completed the postintervention assessment, with 3 out of 42 (7.1%) CG participants lost to follow-up at T1. Baseline characteristics were similar across groups (mean age 23.07, SD 1.45 years; 70/84, 83.3% female). Compared with CG, the IG showed significantly greater reductions in depressive symptoms at all time points (T1: β=-4.07, 95% CI -5.84 to -2.30; P<.001; T2: β=-4.29, 95% CI -6.14 to -2.43; P<.001; T3: β=-3.81, 95% CI -5.54 to -2.08; P<.001), along with significant improvements in sleep quality (T1: β=-2.98, 95% CI -4.55 to -1.40; P<.001; T2: β=-2.19, 95% CI -3.58 to -0.80; P=.002; T3: β=-2.45, 95% CI -3.81 to -1.09; P<.001). Anxiety also improved significantly at T1 (β=-2.60, 95% CI -4.70 to -0.50; P=.02) and T3 (β=-2.38, 95% CI -4.62 to -0.14; P=.04). Group×time interactions were significant for depressive symptoms (Wald χ23=28.18; P=.001) and sleep quality (Wald χ23=23.21; P<.001), confirming sustained intervention effects. Qualitative findings supported these results, highlighting immersive engagement, perceived psychophysiological benefits, and adherence facilitators. No adverse events were reported.</p><p><strong>Conclusions: </strong>A Nintendo Switch-based exergaming intervention was associated with improvements in depressive symptoms, anxiety, and sleep quality in adults with StD","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"14 ","pages":"e80937"},"PeriodicalIF":4.7,"publicationDate":"2026-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13240639/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148175730","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 Assessment of Cognitive Impulsivity in Eating Disorders and Mental Ill-Health: Mixed Methods Study Incorporating Lived Experience Co-Design and Evaluation.","authors":"Emily Colton, Courtney McLean, Alexandra Anderson, Lauren Hanegraaf, Antonio Verdejo-Garcia","doi":"10.2196/79784","DOIUrl":"10.2196/79784","url":null,"abstract":"<p><strong>Background: </strong>Cognitive impulsivity is a multifaceted construct associated with symptom severity, functional impairment, and poor quality of life in eating disorders (EDs) and mental ill-health. However, objective assessment of cognitive impulsivity is piecemeal and complex, with many assessment tools lacking psychometric evaluation and ecological validity. Furthermore, validated assessment tools are rarely perceived to be engaging or meaningful by individuals who complete them, limiting their utility in research and forming a barrier to clinical translation. Thus, although cognitive impulsivity predicts treatment engagement and outcomes, it is rarely assessed or addressed in a clinical context.</p><p><strong>Objective: </strong>We aimed to redesign and evaluate the Cognitive Impulsivity Suite (CIS), a validated gamified assessment battery of cognitive impulsivity, through user-centered co-design, agile game development, and user-centered evaluation. This collaborative study partnered researchers with individuals with lived experiences (LEs) of EDs and commonly co-occurring mental ill-health, and game development experts.</p><p><strong>Methods: </strong>In a sequential mixed methods design, we first defined user requirements through inductive thematic analysis of data from 2 focus groups incorporating 7 individuals with LE of EDs and commonly co-occurring mental health conditions (mean age 27.6, SD 7.03 y; 4 women, 2 men, 1 nonbinary), researchers, clinicians, and technology professionals. Agile game development was achieved through 6-week-long sprints, involving game developers and a play-testing team of researchers. During LE evaluation, we collected and analyzed data from an expanded sample (n=18; mean age 30.5, SD 6.56 y; 12 women, 3 men, 2 nonbinary), using a pragmatic blending of qualitative and quantitative research methods. This included inductive and deductive thematic analysis of \"thinking aloud\" data, descriptive statistics, and ANOVA tests of the Game User Experience Satisfaction Scale, short version (GUESS-18) surveys.</p><p><strong>Results: </strong>We co-designed guiding principles and ideas for aesthetics, story concepts, and gameplay features, which closely aligned with leading theories of psychological well-being, clinical evidence concerning ED recovery, and gamification frameworks. Qualitative evaluations of the new tool, CIS Papillon Park, showed user engagement and motivation were driven by opportunities for autonomy, personal accomplishment, and simulated interpersonal relationships, aligning with approaches to gamification based on self-determination theory. In quantitative evaluation, a mean GUESS-18 composite score of 45.9 (SD 9.85) showed CIS Papillon Park achieved sound overall user satisfaction, with subscale scores revealing strengths in usability, narrative, visual and audio aesthetics, and personal gratification.</p><p><strong>Conclusions: </strong>The contributions of this study are grounded in i","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"14 ","pages":"e79784"},"PeriodicalIF":4.7,"publicationDate":"2026-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13232921/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148156677","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":"Cognitive Load Across Interaction Formats in Digital Attention Assessment for Children: Within-Subject Neuroimaging and Behavioral Comparison Study.","authors":"Harim Jeong, Yong Jeon Cheong, Jihyeong Ro, Jihyun Cha, Jongkwan Choi, Minyoung Jung","doi":"10.2196/93468","DOIUrl":"10.2196/93468","url":null,"abstract":"<p><strong>Background: </strong>Digital health technologies increasingly use tablet-based cognitive assessments for children, yet interaction design choices can substantially influence cognitive load and measurement validity. Although cognitive load has been extensively studied in educational settings, its impact on patient-facing digital assessment tools for pediatric populations remains underexplored.</p><p><strong>Objective: </strong>This study examined how the interaction format influences cognitive load and measurement validity in a tablet-based Stroop task for children, comparing text-based with color-based response selection to determine which format better supports valid attention assessment.</p><p><strong>Methods: </strong>Using a within-subject design, 127 typically developing children (n=55, 43.3%, girls; n=72, 56.7%, boys) aged 6-12 (mean 9.15, SD 1.56) years were recruited via convenience sampling from local communities in the Republic of Korea. Participants completed both a text-based and a color-based Stroop task on a tablet. Cognitive load was indexed using prefrontal functional near-infrared spectroscopy (fNIRS), measuring functional connectivity (FC) and global network efficiency. Behavioral outcome measures included accuracy, reaction time, and the composite efficiency score. Clinical validity was assessed by correlating task performance with parent-reported attention problems using a standardized behavioral rating scale. General cognitive ability was controlled using a standardized intelligence measure. Condition differences were analyzed using paired-sample t tests (α=.05), clinical associations using Pearson correlations with Fisher r-to-z transformation, and predictor contributions using random forest regression.</p><p><strong>Results: </strong>In the paired-sample t tests, the color-based format yielded significantly higher accuracy (0.91 vs 0.86; mean difference 0.05, 95% CI 0.03-0.08; t<sub>126</sub>=3.81, Cohen d=0.34, P<.001), faster reaction times (1183 vs 1269 ms; mean difference -85.4 ms, 95% CI -107.2 to -63.5; t<sub>126</sub>=-7.72, Cohen d=-0.69, P<.001), and superior composite performance (t<sub>126</sub>=6.81, Cohen d=0.62, P<.001). Pearson correlations revealed that color-based performance was significantly associated with parent-reported attention problems (r=-0.20, 95% CI -0.37 to -0.03; P=.03), whereas text-based performance was not (r=-0.05, 95% CI -0.23 to 0.12;' P=.56); the Fisher r-to-z test indicated this difference was not statistically significant (z=1.54, P=.12). fNIRS-derived neural indices (ΔFC, global efficiency) did not differ significantly between conditions (P>.05). Random forest analyses indicated that after controlling for age and general cognitive ability, individual variations in prefrontal efficiency accounted for 40% to 44% of residual performance variance.</p><p><strong>Conclusions: </strong>This study provides some of the first empirical evidence that the interaction format substantial","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"14 ","pages":"e93468"},"PeriodicalIF":4.7,"publicationDate":"2026-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13250493/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148030590","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":"Exploring the Effects of Serious Games (Immersive Virtual Reality Versus Web-Based Platforms) on Interprofessional Education Among Undergraduate Health Care Students: Randomized Controlled Trial and Multimethod Study.","authors":"Justina Yat Wa Liu, Rina Wing Yan Wong, Sabina Margaret Pinto, Curtis Ka Ho Wong, Patrick Pui Kin Kor, Shanshan Wang, Kitty Chan","doi":"10.2196/80033","DOIUrl":"10.2196/80033","url":null,"abstract":"<p><strong>Background: </strong>Interprofessional education (IPE) is essential for developing teamwork and communication skills in health care training. Building interprofessional competency involves acquiring knowledge, cultivating readiness to engage in teamwork, and fostering effective collaboration. However, challenges include geographical barriers and faculty resistance that can hinder progress. Innovative solutions to enhance engagement and collaboration include serious games played using immersive virtual reality (IVR) and web-based platforms. Despite their potential, research comparing the effectiveness of these approaches for IPE remains limited.</p><p><strong>Objective: </strong>This study aimed to identify effective implementation methods by evaluating the impact of IVR and web-based serious games on health care students' interprofessional competencies and learning experiences.</p><p><strong>Methods: </strong>A multimethod approach was used to evaluate students' pre- and postlearning outcomes and experiences. Nursing and physiotherapy students were randomly assigned to either the IVR group or web-based group. The Readiness for Interprofessional Learning Scale (RIPLS), Brief Sense of Community Scale (BSCS), and Intrinsic Motivation Inventory (IMI) were used to measure learning experiences. Learning outcomes were examined through multiple-choice questions (MCQs). After the outcome assessments, groups switched modalities to allow all students to experience both learning approaches. Four focus groups (n=34) provided qualitative insights into learning experiences.</p><p><strong>Results: </strong>The study included 271 students (IVR group: 125; web-based group: 146). Both groups showed significant improvements in community building (BSCS; IVR: r=-0.29, 95% CI 0.06-0.31; P=.001; web-based: r=-0.27, 95% CI 0.07-0.31; P=.001). The IVR group showed improvements in only the pressure/tension subscale of the IMI (r=-0.45, 95% CI -0.05 to -0.25; P<.001), while the web-based group showed improvements across all IMI subscales, including interest/enjoyment (r=-0.17, 95% CI 0.00-0.30; P=.043), perceived competence (r=-0.19, 95% CI 0.00-0.50; P=.02), and pressure/tension (r=-0.46, 95% CI -0.75 to -0.50; P<.001). Both groups showed significant improvements in knowledge-checking MCQ scores (IVR: r=-0.64, 95% CI 2.00-3.00; P<.001; web-based: r=-0.80, 95% CI 4.50-6.00; P<.001), with the web-based group outperforming the IVR group (r=-0.34, 95% CI -3.00 to -2.00; P<.001). RIPLS scores showed no significant difference in both groups, suggesting that greater exposure is required to enhance IPE readiness. A qualitative analysis revealed 6 themes: valuing collaboration opportunities, fostering trust and shared learning, promoting engagement and authenticity, enhancing knowledge retention, balancing innovation with practicality, and improving realism and inclusivity. No adverse events were noted.</p><p><strong>Conclusions: </strong>To our knowledge, this is the fi","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"14 ","pages":"e80033"},"PeriodicalIF":4.7,"publicationDate":"2026-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13200777/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148015675","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":"Using Eye Tracking to Measure Video Game-Assisted Therapy for Improved Visual Outcomes in Pediatric Strabismus: Randomized Control Trial.","authors":"Ahmad F Klaib","doi":"10.2196/66538","DOIUrl":"10.2196/66538","url":null,"abstract":"<p><strong>Background: </strong>Strabismus, commonly known as crossed eyes, is a condition characterized by the misalignment of the eyes, leading to impaired binocular vision and depth perception. Traditional management often involves occlusion therapy, which can be hindered by poor compliance. Video game therapy has emerged as a promising adjunct to traditional treatments, potentially improving compliance and directly stimulating visual and cognitive functions.</p><p><strong>Objective: </strong>This study compares the effectiveness of traditional occlusion therapy with and without the addition of video game therapy in improving visual outcomes among children with strabismus.</p><p><strong>Methods: </strong>This randomized, controlled clinical trial included 30 children aged 5 to 10 years diagnosed with various types of strabismus. Participants were randomly assigned to 2 groups: the control group (eye patching alone) and the treatment group (eye patching combined with video game therapy). The intervention lasted 3 months, with data collected at baseline and after the treatment. Primary outcomes included visual acuity, angle of deviation, and stereoacuity, while fixation stability was measured using the Tobii eye tracker. Data were analyzed using paired 2-tailed t tests, independent 2-tailed t tests, Mann-Whitney U tests, and multivariate analysis of variance, with a significance level set at P<.05.</p><p><strong>Results: </strong>The treatment group showed significant improvements across all measured outcomes. Visual acuity improved significantly in both the amblyopic (P<.001) and fellow or nonamblyopic eyes (P<.001). The angle of deviation decreased (P<.001), and stereoacuity improved (P<.001). Fixation stability, as measured by the eye tracker, also showed significant improvement and was higher in the treatment group (mean 2.87, SD 0.56 seconds) compared with the control group (mean 1.88, SD 0.42 seconds; P<.001). The control group, which received only eye patching, also exhibited significant improvements, though to a lesser extent. Posttreatment visual acuity in the amblyopic eye was significantly better in the treatment group compared to the control group (P<.001), with similar results for the fellow or nonamblyopic eye (P<.001). Stereoacuity also showed superior improvement in the treatment group (P=.01). Fixation stability was significantly better in the treatment group (P<.001), and multivariate analysis of variance indicated a highly significant overall difference between the 2 groups across multiple outcomes (P<.001).</p><p><strong>Conclusions: </strong>The combination of traditional eye patching with video game therapy significantly enhances treatment outcomes in children with strabismus, particularly in improving visual acuity, stereoacuity, and fixation stability. While both interventions effectively reduce the angle of deviation, video game therapy offers additional benefits by engaging in and improving the functional aspects of vis","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"14 ","pages":"e66538"},"PeriodicalIF":4.7,"publicationDate":"2026-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13200800/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148015601","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":"Effectiveness of Virtual Reality Interventions on Perioperative Anxiety, Depression, Blood Pressure, and Heart Rate: Systematic Review and Meta-Analysis of Randomized Controlled Trials.","authors":"Shijin Wang, Hong Yan, Zhehui Yang, Yan Liu, Tingting Zhang, Yuanyuan Tang, Yuling Luo","doi":"10.2196/81799","DOIUrl":"10.2196/81799","url":null,"abstract":"<p><strong>Background: </strong>Perioperative stress hinders patient recovery and poses significant challenges for clinical nursing. It triggers a vicious cycle of negative psychological emotions and adverse physiological stress responses. Immersive virtual reality (VR), an innovative nonpharmacological intervention, has been gradually incorporated into perioperative care, showing promise in alleviating patient stress. However, comprehensive evaluations of its multidimensional efficacy remain lacking.</p><p><strong>Objective: </strong>This study aims to systematically evaluate the dual regulatory effects of VR interventions on both psychological emotions and objective physiological stress in adult patients undergoing perioperative care.</p><p><strong>Methods: </strong>Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines, we comprehensively searched 9 electronic databases for randomized controlled trials (RCTs) published from January 2000 to March 2026. Eligible RCTs evaluated VR combined with routine care vs routine care alone in adult patients (≥18 years). The risk of bias was assessed using the Cochrane Risk of Bias 2 tool (Cochrane Collaboration). Meta-analyses were performed using a random-effects model based on the Hartung-Knapp-Sidik-Jonkman method. We reported 95% CIs and 95% prediction intervals (PIs) to interpret clinical heterogeneity and evaluated evidence certainty using the Grading of Recommendations, Assessment, Development, and Evaluation approach.</p><p><strong>Results: </strong>We included 42 RCTs involving 4648 participants. Compared to routine care, VR significantly reduced anxiety (standardized mean difference -1.17, 95% CI -1.50 to -0.85; 95% PI -3.16 to 0.81) and depression (standardized mean difference -1.26, 95% CI -1.71 to -0.81; 95% PI -2.39 to -0.13). Physiologically, VR effectively decreased systolic blood pressure (mean difference [MD] -5.12, 95% CI -7.21 to -3.03; 95% PI -11.73 to 1.49), diastolic blood pressure (MD -3.45, 95% CI -5.18 to -1.73; 95% PI -8.63 to 1.72), and heart rate (MD -4.45, 95% CI -5.94 to -2.97; 95% PI -10.15 to 1.24). Subgroup analyses revealed that the anxiolytic effect was more pronounced in Asian populations.</p><p><strong>Conclusions: </strong>VR serves as a safe and effective adjunctive intervention that exhibits a dual regulatory mechanism, simultaneously mitigating psychological distress and stabilizing hemodynamic parameters in perioperative adults. Unlike existing systematic reviews that are predominantly limited to a single psychological metric (eg, anxiety) or focused on pediatric populations, this review integrates both psychological (anxiety and depression) and objective physiological (blood pressure and heart rate) dimensions into a unified evaluation framework. While average benefits are robust, the wide PIs suggest that true effects may vary across individuals due to clinical heterogeneity. Future standardized, large-scale RCTs","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"14 ","pages":"e81799"},"PeriodicalIF":4.7,"publicationDate":"2026-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13188064/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147972597","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":"Cognitive Function Assessment Using a Virtual Reality Serious Game System in Patients With Stable Schizophrenia: Prospective Cohort Study.","authors":"Xingxing Li, Yu Zhuo, Xiandong Meng, Wenting Zhao, Chenxin Wu, Kai Yan, Leiyu Yue, Yu Sun, Qian Xiong, Xi Cao, Xiaomin Kou, Jianying Yu","doi":"10.2196/83001","DOIUrl":"10.2196/83001","url":null,"abstract":"<p><strong>Background: </strong>Cognitive impairment is a core and enduring deficit in schizophrenia, severely affecting social functioning and quality of life. Traditional assessments such as the MATRICS Consensus Cognitive Battery face limitations in validity and engagement. Virtual reality (VR) serious games may offer an immersive alternative, and machine learning (ML) can uncover complex behavioral patterns. However, integrating VR-based assessment with ML for discriminating stable-phase schizophrenia remains unexplored.</p><p><strong>Objective: </strong>This prospective cohort study aimed to examine whether a VR serious game (\"Fruit Pioneer\") can effectively assess cognitive function in stable schizophrenia, verify its correlation with the standard Brief Cognitive Assessment Tool for Schizophrenia (B-CATS), and test the discriminative capacity using ML models. We hypothesize that (1) patients with schizophrenia will show poorer VR game performance than healthy controls (HCs), (2) VR metrics will correlate with B-CATS scores, and (3) ML models will help classify patients with schizophrenia and HCs using VR data.</p><p><strong>Methods: </strong>A total of 42 patients with stable schizophrenia and 65 HCs (aged 18-40 years) were enrolled. Exclusion criteria included color blindness, visual impairment, substance abuse, and comorbid chronic physical diseases. Finally, 39 patients with schizophrenia and 64 HCs were included. Materials included the VR serious game \"Fruit Pioneer,\" B-CATS (Digital Symbol Substitution Test, Trail Making Test Part A, Trail Making Test Part B, and Animal Fluency), Simulator Sickness Questionnaire, and Game Experience Questionnaire. Data were collected via standardized VR gameplay and paper-based assessments. Logistic regression and a support vector machine (SVM) model were built using VR metrics.</p><p><strong>Results: </strong>Patients with schizophrenia performed worse on all B-CATS subtests (all P<.001). They also showed lower VR total scores (median 467, IQR 376-544 vs median 683, IQR 616-753; P<.001), longer reaction times (median 1.11, IQR 0.995-1.23 vs median 1.03, IQR 0.96-1.1; P=.006), lower gaze hit rates (median 0.515, IQR 0.442-0.554 vs median 0.552, IQR 0.497-0.592; P=.01), and higher bomb penalty scores (median 150, IQR 95-170 vs median 108, IQR 85-131; P=.002). In the schizophrenia group, VR metrics correlated with B-CATS results, whereas this relationship was minimal in HCs. Classification performance of the SVM (average area under the curve [AUC]=0.874, 95% CI 0.860-0.888) was comparable to logistic regression (average AUC=0.854, 95% CI 0.838-0.870).</p><p><strong>Conclusions: </strong>This study demonstrates the innovative integration of a VR serious game with ML to assess cognitive function in stable schizophrenia. Unlike prior VR studies focused mainly on validation, our approach combines behavioral metrics with an SVM model, achieving effective classification. The findings support the potential of a","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"14 ","pages":"e83001"},"PeriodicalIF":4.7,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13197741/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147855705","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}