JMIR Serious Games最新文献

{"title":"Analysis of Machine Learning-Based Investigation Into Multivariate Factors of Team Performance in Serious Games: Cross-Sectional Retrospective Study.","authors":"Gruyff Germain Abdul-Rahman, Freark de Lange, Andrej Zwitter, Noman Haleem","doi":"10.2196/83478","DOIUrl":"10.2196/83478","url":null,"abstract":"<p><strong>Background: </strong>Serious games (SGs) are increasingly used to study and enhance team performance in organizational and educational settings. While prior research has explored leadership and communication as isolated factors, the multivariate interactions between behavioral indicators remain poorly understood. A deeper understanding of these relationships can reveal which behavioral and demographic factors most strongly predict successful outcomes, offering insights relevant to both scientific research and practical training design.</p><p><strong>Objective: </strong>This study aimed to develop machine learning (ML) models to predict team success in SGs. Specifically, it sought to identify the behavioral and demographic predictors that most strongly influence team performance outcomes.</p><p><strong>Methods: </strong>This study used a cross-sectional retrospective design. Behavioral and demographic data were analyzed from 233 teams participating in escape room-based SGs delivered by JGM Serious eXperiences in The Netherlands. Teams of 2-8 players (mean age 25.8 y; 53 all-male, 55 all-female, and 125 mixed-gender) were scored by trained observers across collaboration, communication, and leadership constructs using Likert-scale indicators. Exploratory data analysis compared winning (n=141) and losing teams (n=92) using descriptive statistics, Pearson correlations, and significance testing (independent-samples t tests and Mann-Whitney U tests). Mean differences were interpreted with 95% CIs. A total of 4 ML models: logistic regression, random forest, multilayer perceptron, and support vector classifier, were trained using 5-fold cross-validation (F1-score). The best model was interpreted using SHAP (Shapley Additive Explanations).</p><p><strong>Results: </strong>Winning teams scored higher on several behavioral constructs, but only 4: knowledge sharing, leadership, guidance, and extraversion, showed statistically significant differences between winners and losing teams. These effects were supported by 95% CIs, Shapiro-Wilk tests for normality, and Mann-Whitney U tests where assumptions were violated, indicating that only a subset of behavioral indicators meaningfully distinguishes successful teams. Among the ML models, logistic regression achieved the highest accuracy (88%), followed by multilayer perceptron (87%), random forest (87%), and support vector classifier (85%). SHAP analysis showed that gender composition and prior escape-room experience were the strongest demographic predictors of success, while \"celebrating progress\" (extern5) and \"taking initiative when the team is stuck\" (sturing5) were the most influential behavioral indicators.</p><p><strong>Conclusions: </strong>This work demonstrates the usefulness of multivariate analysis in studying and understanding complex human behavior in SG environments as opposed to studying isolated behavioral indicators, often described in previous studies. The ML models developed using beha","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"14 ","pages":"e83478"},"PeriodicalIF":4.7,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13075534/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147673541","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":"Research Design Processes in Serious Games for Adolescent Mental Health: Systematic Review.","authors":"S T Rooij de, D A Kuipers, J T Prins, J P E N Pierie","doi":"10.2196/77173","DOIUrl":"10.2196/77173","url":null,"abstract":"<p><strong>Background: </strong>Serious games are increasingly recognized as effective tools in adolescent mental health interventions, providing engaging platforms for emotional regulation, skill development, and behavioral change. However, the ways in which core theoretical concepts such as transfer, boundary crossing, and models of reality are incorporated into serious game designs are not consistently described in the literature. Clarifying how these concepts are addressed is important for understanding how game-based learning may connect to real-world health care practice.</p><p><strong>Objective: </strong>This systematic review aims to examine how serious games for adolescent health care are designed to support learning and facilitate outcomes. Specifically, it examines how the design incorporates constructs of transfer, boundary crossing, and models of reality, and how these elements are represented across published studies.</p><p><strong>Methods: </strong>We conducted a systematic search across 5 databases (PubMed, Scopus, ERIC, PsycINFO, and EMBASE) covering publications up to 2023. Studies were included if they involved serious games targeting adolescents with behavioral or developmental health concerns. Titles and abstracts were screened independently by 2 reviewers, with disagreements resolved by a third party. A qualitative analytical framework was applied to identify elements of design, with a particular focus on transfer, boundary crossing, and models of reality.</p><p><strong>Results: </strong>Thirty-three studies met the inclusion criteria. Figural transfer was identified in 24 studies, while literal transfer was identified in 10 studies. Among boundary-crossing mechanisms, reflection occurred most frequently (22 studies), whereas transformation was observed in 3 studies. Causal and procedural models of reality were most commonly identified as primary model types, whereas relational and structural models were more often reported as secondary. Explicit design rationales were infrequently reported across studies.</p><p><strong>Conclusions: </strong>This review demonstrates that serious games for adolescent mental health most frequently emphasize reflective and representational forms of learning. Across the reviewed studies, theoretical constructs related to transfer, boundary crossing, and models of reality were often implicitly embedded rather than explicitly articulated. The proposed analytical framework offers a structured approach for analyzing these design characteristics and may support designers, researchers, and health care professionals in more explicitly aligning design choices with intended learning mechanisms and real-world applications.</p>","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"14 ","pages":"e77173"},"PeriodicalIF":4.7,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13068190/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147654165","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":"Navigating Virtual Reality in Stroke Rehabilitation: Scoping Review of Diverse Intervention Effects.","authors":"Ruixue Liu, Beibei Lin, Yanhuan Zhai, Wei Wang","doi":"10.2196/72498","DOIUrl":"10.2196/72498","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Virtual reality (VR) technology has been increasingly explored in stroke rehabilitation due to its immersive and interactive features. However, considerable heterogeneity exists in intervention designs, study populations, and outcome measures, limiting the feasibility of conducting a systematic review.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This scoping review aims to comprehensively map randomized controlled trials (RCTs) investigating the use of VR interventions in stroke rehabilitation, with particular focus on upper limb function, gait and balance, cognitive function, and quality of life.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Following the Arksey and O'Malley framework and PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, we conducted a scoping review of RCTs published in databases from their inception to January 4, 2025. Seven databases were searched, including PubMed, Embase, Web of Science, CNKI, Wanfang, VIP, and CBM. Studies were included if they met predefined eligibility criteria, including adult patients with stroke receiving VR-based rehabilitation and a randomized controlled trial design. Exclusion criteria included non-Chinese or non-English literature, literature with unavailable full text, studies with duplicate publication or data, and studies that were irrelevant to the research topic or did not incorporate VR technology in their intervention measures. Data extracted included intervention type, sample size, training frequency and duration, outcomes, and study setting. Due to significant heterogeneity across studies, a narrative synthesis approach was used. No formal risk of bias or quality appraisal was conducted.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Fifteen RCTs involving 804 patients with stroke were included. Intervention modalities varied significantly in terms of type, content, frequency, and duration. Nonimmersive VR (NIVR) interventions were more frequently applied in studies targeting upper limb function and gait training, while fully immersive VR (FIVR) was assessed in 2 head-mounted display (HMD)-based trials, whereas most studies used NIVR for upper-limb and gait-related outcomes. Many studies reported positive trends in motor function, cognitive performance, gait balance, and quality of life. However, findings were inconsistent, and not all outcomes reached statistical significance. Mild adverse events, such as fatigue or dizziness, were occasionally reported; however, no serious events occurred.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This scoping review outlines the research status of VR in stroke rehabilitation. VR may offer potential benefits; however, existing studies have limitations, including substantial heterogeneity in intervention protocols, limited long-term follow-up, and baseline imbalances in some trials. In addition, because this review did not include a formal quality or risk-of-bias assessment, the observed effects ","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"14 ","pages":"e72498"},"PeriodicalIF":4.7,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13061288/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147638919","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":"Analysis of Spatiotemporal Features in a Virtual Navigation Game Across Different Age Groups: Quantitative Research.","authors":"Xiaofeng Qiao, Shan Tian, Min Tang, Shipei He, Jinghui Wang, Linyuan Fan, Yuanjie Zhu, Zhiyang Zhang, Songjun Du, Chaojie Dong, Yepu Chen, Xiaoyu Liu","doi":"10.2196/83128","DOIUrl":"10.2196/83128","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;With rapid urbanization, the proliferation of densely arranged buildings and increasingly homogeneous architectural designs has made disorientation and navigation difficulties more common, especially for older adults. Meanwhile, advances in virtual reality technology now allow researchers to create highly immersive navigation games, offering opportunities for assessing cognitive abilities and examining how environmental factors shape navigation behavior.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed to design a virtual reality-based navigation game capable of assessing cognitive abilities through navigation behavior and quantitatively examining how environmental configurations influence navigation patterns in different age groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We designed a virtual goal-directed navigation game and recruited 2 groups, younger adults (n=18) and older adults (n=21), to complete identical wayfinding tasks. Before the formal experiment, participants completed cognitive assessments and received training. To characterize navigational behavior, k-means clustering was applied to classify navigation states and extract behaviorally meaningful navigation measurements, which were then examined for correlations with cognitive test scores. To quantify the effects of environmental structure, space syntax analysis was conducted to calculate line-based and grid-based experienced metrics for each participant, and their associations with navigation performance were examined. Additionally, between-group differences in navigation performance and experienced metrics were evaluated across age groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Our results revealed that navigation behavior performance, particularly navigation efficiency, was significantly influenced by cognitive abilities and was strongly associated with several cognitive tests: the Montreal Cognitive Assessment (r=0.495, P=.04), Trail Making Test Part A (r=-0.761, P=.001), and the Mental Rotation Test (r=0.848, P&lt;.001). In terms of environmental influences, experienced axial integration (EAI) and experienced visual integration (EVI) demonstrated significant age-related differences: EAI (z=-2.43, P=.01) and EVI (t=2.48, P=.02). Moreover, navigation efficiency exhibited distinct age-specific correlations with experienced metrics: among older adults, navigation efficiency was negatively associated with EVI (r=-0.48, P=.04), and young adults showed negative correlation between navigation efficiency and EAI (r=-0.64, P=.005).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Our findings demonstrate that k-means clustering provides an effective approach for classifying navigation states and extracting quantitative behavioral indicators for assessing cognitive abilities. In addition, the environment-based experienced metrics derived from space syntax analysis revealed distinct age-related navigation patterns, highlighting how spatial configuration shapes wayfinding behavior acro","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"14 ","pages":"e83128"},"PeriodicalIF":4.7,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13046224/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147609012","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 and Usability of the \"FORTEe Get Strong\" App to Promote Physical Activity and Health Awareness in Children and Adolescents With Cancer During Intensive Treatment Using an App-Based Approach: Mixed Methods Study.","authors":"Mareike Kuehn, Lena Wypyrsczyk, Francesca Lanfranconi, Adriana Cristina Balduzzi, Hayley Marriott, Alba Solera-Sanchez, Joachim Wiskemann, Nikolai Bauer, Nina Karguth, Barbara Heißerer, Norbert W Paul, Rodolf Mongondry, Wilhelm Bloch, Katie Rizvi, Martin Kaj Fridh, Eva S C Ramos, Carmen Fiuza-Luces, Miriam Götte, Gabriele Gauß, Filippo Spreafico, Barbara Konda, Milica Stefanović, Elias Dreismickenbecker, Marie A Neu, Joerg Faber","doi":"10.2196/75653","DOIUrl":"10.2196/75653","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;As survival rates for children, adolescents, and young adults with cancer improve, managing treatment-related side effects is increasingly important. Enhancing physical activity levels has been shown to be effective in reducing some of these effects. Digital interventions, such as mobile apps, offer engaging tools to promote physical activity in young populations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This article introduces the \"FORTEe Get Strong\" app (Nurogames GmbH) and presents a formative evaluation of its acceptability among children, adolescents, and young adults with cancer.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The \"FORTEe Get Strong\" app was developed within the multicenter FORTEe trial. Grounded in behavior change theories, the app uses gamification to deliver a child-friendly platform promoting physical activity and health-related knowledge. An embedded mixed methods design, with qualitative insights contextualizing quantitative findings, was applied. User experience was assessed using a self-developed questionnaire combining Likert scale items (1-5: \"not at all satisfied\" to \"very satisfied,\" 1-3 for participants aged &lt;8 y) and open-ended questions. Quantitative data were analyzed descriptively and inferentially, including chi-square tests for differences in app usage by age, sex, and diagnosis, and Kruskal-Wallis tests to compare app feature ratings between age groups. Free text responses underwent qualitative content analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The app was published in May 2023; it integrates gamified features to teach health knowledge. Exercise videos address endurance, strength, flexibility, coordination, and gait. Feedback on user experience was provided by 53 patients aged 5-19 years (mean 11.4, SD 3.8 years, 95% CI 10.4-12.5; 27/53, 51% male). App use did not differ significantly by age groups (χ²3=5.1; P=.16; Cramer V=0.135), sex (χ²1=3.4; P=.06; φ=0.110), or diagnosis (P=.54; Cramer V=0.168). The app was generally well-received, with a mean Likert scale score of 4.14 (SD 1.04, 95% CI 3.84-4.43). For individual components, mean scores ranged from 3.52 (SD 1.44, 95% CI 3.09-3.95) for exercise content to 4.37 (SD 0.82, 95% CI 4.14-4.60) for design. Kruskal-Wallis tests revealed no significant differences among age groups. Qualitative analysis identified key categories regarding overall app evaluation, specific features, target group perception, usability, and suggestions for improvement. While participants highlighted the app's design and gamification, concerns arose regarding age-appropriateness, lack of supervision, and adaptability of exercises.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This study provides novel insights into user experience of children, adolescents, and young adults with cancer with a gamified exercise and health education app. Unlike previous studies focusing on survivorship, this evaluation offers a comprehensive understanding of how digital tools can support patients in main","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"14 ","pages":"e75653"},"PeriodicalIF":4.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13043004/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147592283","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":"Conceptualization and Measurement of Withdrawal Symptoms in Gaming Disorder and Development and Psychometric Validation of the Gaming Withdrawal Symptoms Questionnaire: Cross-Sectional Study.","authors":"Sylwia Starzec, Sławomir Śpiewak, Jolanta Starosta, Paweł Strojny","doi":"10.2196/81407","DOIUrl":"10.2196/81407","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Gaming disorder (GD) is an emerging issue that leads to significant impairment, yet existing tools for measuring withdrawal symptoms in GD are limited and often fail to capture its multidimensional nature. Most current measures rely on single-item assessments or adapted tools from substance use disorders, overlooking cognitive, behavioral, and physiological components. A comprehensive, multidimensional questionnaire is needed to more accurately assess withdrawal in GD, aiding in early detection and intervention.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The objective of this study was to develop and psychometrically validate a comprehensive measurement tool, the Gaming Withdrawal Symptoms Questionnaire (GWSQ), capturing the multidimensional nature of withdrawal symptoms in GD, including affective, cognitive, behavioral, and physiological components.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A multistage psychometric approach was used, starting with item generation from a scoping literature review. Exploratory factor analysis and confirmatory factor analysis were conducted to refine the questionnaire. Reliability and validity were assessed using 2 cross-sectional studies. Data were collected anonymously via an online survey platform. Participants were recruited from gaming-related platforms and social media (eg, Discord, Reddit, and Facebook) and restricted to actively engaged adult gamers who passed attention check questions to ensure data quality.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Study 1 involved 480 adults (mean age 23, SD 4.96 years; n=327, 68.1% male). Study 2 included 565 adults (mean age 25, SD 5.55 years; n=245, 43% male). Exploratory factor analysis revealed a 3-factor model of withdrawal symptoms: (1) motivational and cognitive symptoms, (2) affective symptoms, and (3) physical symptoms, explaining 54% of the variance. Confirmatory factor analysis confirmed adequate model fit (χ&lt;sup&gt;2&lt;/sup&gt;&lt;sub&gt;227&lt;/sub&gt;=887.8; P&lt;.001; comparative fit index=0.91; Tucker-Lewis index=0.90; root-mean-square error of approximation=0.072). The GWSQ demonstrated high internal consistency, with Cronbach α ranging from 0.89 (motivational and cognitive symptoms) to 0.90 (affective symptoms and physical symptoms). Correlations with related constructs (Internet Gaming Disorder Scale-Short Form [IGDS9-SF], Patient Health Questionnaire-9 items, and Generalized Anxiety Disorder-7 items) confirmed convergent validity with moderate associations (eg, IGDS9-SF: r=0.48, 95% CI 0.32-0.61) and discriminant validity, and normative data (sten scores) were established for the general population.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The GWSQ is the first validated multidimensional tool specifically designed to assess withdrawal symptoms in GD, representing a conceptual and methodological innovation. It addresses critical gaps in GD diagnosis and research by capturing a broader spectrum of symptoms beyond affective distress. The questionnaire's tripartite structure pr","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"14 ","pages":"e81407"},"PeriodicalIF":4.7,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13080298/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147592211","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":"Virtual Reality-Based Pain Modulation in Subacute Musculoskeletal Injury: Functional Near-Infrared Spectroscopy Study of Neural and Behavioral Correlates.","authors":"Ryan Andrew Mace, Ziyan Wu, Christine B Sieberg, Keerthana Deepti Karunakaran, Ke Peng, David Borsook","doi":"10.2196/77713","DOIUrl":"10.2196/77713","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Acute traumatic musculoskeletal injuries often result in persistent pain and disability despite physical recovery. Virtual reality (VR) provides an innovative approach for overcoming treatment barriers and may help address psychological risk factors for persistent pain and disability. However, the neural mechanisms underlying VR, particularly in subacute orthopedic pain, are insufficiently understood.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This pilot study examined the feasibility, acceptability, and neural correlates of an 8-week home-based therapeutic VR intervention (RelieVRx) for subacute (&lt;2 mo postinjury) musculoskeletal pain, using functional near-infrared spectroscopy (fNIRS) to assess changes in prefrontal cortex (PFC) activation and coactivation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Ten orthopedic patients (mean age 46.8, SD 11.86 years; 7/10, 70% female) completed the RelieVRx intervention and underwent fNIRS and behavioral assessments before and post treatment. Behavioral measures included pain intensity, pain interference, pain catastrophizing, pain anxiety, mindfulness, coping, and pain self-efficacy. fNIRS recorded PFC hemodynamic responses during movement-evoked pain and VR-based relaxation/distraction tasks. Feasibility and acceptability were assessed qualitatively and quantitatively (valid fNIRS recordings, participant feedback). Analyses evaluated pre-post changes in PFC activation, functional coactivation, and correlations with behavioral measures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;fNIRS procedures demonstrated high feasibility (74/80, 93% valid recordings), acceptability, and there were no safety concerns. Significant improvements were observed across all behavioral measures, including reduced pain intensity at rest (mean difference [MD]=-2.50, P&lt;.001, d=2.24), and with activity (MD=-3.40, P&lt;.001, d=1.98), decreased pain interference (MD range -3.90 to -4.90, P&lt;.001, d range 1.32 to 2.30), reduced pain anxiety (MD=-32.70, P=.001, d=2.14) and pain catastrophizing (MD=-16.40, P=.003, d=2.13), and improved mindfulness (MD=+3.29, P=.01, d=0.94), coping (MD=+0.59, P=.01, d=1.01), and self-efficacy (MD=15.40, P=.008, d=1.51). fNIRS showed significant posttreatment increases in medial PFC activation (right medial channel: distraction task t=-4.473, P=.004; relaxation task t=-3.036, P=0.02) and enhanced coactivation between medial and lateral PFC regions (distraction task t=-2.784, P=.03). Increased functional coactivation between the right medial and left lateral PFC was negatively correlated with improved mindfulness (r=-0.716, P=.046) and coping scores (r=-0.709, P=.049).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This study provides initial evidence of the feasibility and acceptability of integrating fNIRS neuroimaging into clinical VR interventions. Results indicate that engagement with VR therapy was associated with alterations in neural activity in key PFC regions implicated in pain regulation, correlating with si","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"14 ","pages":"e77713"},"PeriodicalIF":4.7,"publicationDate":"2026-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13035087/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147581335","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":"A Novel Virtual Reality Intervention Combining Movement Exercises and Body Illusions for the Treatment of Chronic Back Pain: Prospective Feasibility Study.","authors":"Isabel Neumann, Stefan Lindner, Yevgeniya Nedilko, Ralitsa Zhivova, Michael Gödde, Tobias Tischer-Zeitz, Heike L Rittner, Ivo Käthner","doi":"10.2196/81051","DOIUrl":"10.2196/81051","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Virtual reality (VR) has proven effective in delivering nonpharmacological interventions to reduce acute and chronic pain. For the treatment of nonspecific chronic low back pain (CLBP), it offers benefits over traditional treatment options, such as the possibility of gamified movement exercises with real-time performance feedback and virtual embodiment. We implemented a novel immersive VR intervention (a serious game) that combined these elements.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study evaluated the feasibility, tolerability, and initial clinical efficacy of the gamified VR intervention.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Patients with CLBP (n=20; mean age 47, SD 14 years; symptom duration &gt;3 months to ≤5 years; convenience sample) took part in a prospective, single-arm, and preregistered trial over 9 weeks. The VR therapy phase lasted 3 weeks, and there were 2 VR sessions per week conducted at the University Hospital Wuerzburg (Germany). Before the therapy phase, there was a 2-week baseline phase, and the posttherapy phase lasted 4 weeks. During the sessions, patients wore a head-mounted display. In VR, they embodied a virtual avatar and performed gamified movement exercises. Participants were immersed in a virtual toy factory, and they had the task of teaching 5 different toys how to move. They received real-time feedback on performance through a hologram overlaying their avatar. Based on performance, movements to be performed became gradually more difficult (graded exposure). Primary outcome measures were adherence and side effects for assessing feasibility and tolerability (Simulator Sickness Questionnaire), and pain intensity ratings (numerical rating scale 0-10) were used for assessing initial clinical efficacy. Secondary outcomes included back- and task-specific functioning and questionnaires to further test initial clinical efficacy and assess fear-avoidance beliefs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Adherence was high (18/20, 90%). Participants indicated lower pain in the posttherapy phase compared with baseline levels (mean difference 0.73, CI 0.27-1.19; t16=3.38; P=.004; d=0.82). There were only few and minor side effects. Task- and back-specific functioning improved (ie, performing daily life activities; Back Performance Scale: F2,34=4.53; P=.02; η2g=0.04; Roland-Morris Disability Questionnaire: F2,26=4.73; P=.02; η2g=0.08), and movement restrictions decreased (F2,32=10.82; P&lt;.001; η2g=0.06). There were no changes in the psychological outcome measures (eg, fear avoidance beliefs). Across all VR sessions, study participants reported high levels of fun (mean 8.07, SD 1.99).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;We implemented a gamified immersive VR intervention for the treatment of CLBP. The combination of gamified movement exercises and virtual body illusions is unique, and for the first time, it included real-time feedback via a hologram overlaying the virtual avatar of the user. The study demonstrated ","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"14 ","pages":"e81051"},"PeriodicalIF":4.7,"publicationDate":"2026-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13035036/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147581397","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":"User Experiences of Behavioral and Psychological Change Techniques in a Walking-Based Mobile Exergame: Cross-Sectional Qualitative Study.","authors":"Marianna Antoniadou, Helena Orädd, Aseel Berglund, Erik Berglund, Anna Strömberg, Tiny Jaarsma, Leonie Klompstra","doi":"10.2196/78776","DOIUrl":"10.2196/78776","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Physical activity plays a central role in the course and progression of chronic conditions in older adults. However, individuals within this population tend to have an inactive lifestyle. Exergaming, which is defined as the integration of physical activity with game-based elements, offers a promising approach to promote physical activity in individuals with chronic conditions. Despite its potential, limited evidence exists on how specific game elements influence behavioral and psychological outcomes in this population.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The aim of this study is to explore the behavioral and psychological change techniques experienced by individuals with chronic conditions using a walking-based mobile exergame, called Heart Farming.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A cross-sectional qualitative design was used based on a gamification framework, using data from semistructured interviews with 14 participants aged 67 to 92 years who used the Heart Farming exergame for 3 months. Participants with chronic conditions, including heart failure, Parkinson disease, type 2 diabetes, stroke, or rheumatic disease, were recruited from 2 ongoing studies. Data were analyzed using deductive content analysis and presented based on the gamification framework.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The data analysis revealed increased motivation to walk, which was facilitated by game elements such as goals, rewards, feedback, and planning. Participants valued not only the sense of progression and achievement within the game but also the real-world benefits, such as spending time in nature or feeling a sense of community with others. Exergaming was integrated into daily routines by supporting the planning and structuring of daily activities. It was also perceived as enjoyable, especially due to its farming theme and visual design. Behavioral change techniques such as goal setting, feedback, and social support were commonly experienced, whereas focus on past success (as described in the gamification framework) was not used as a technique by the exergame. Psychological techniques, including self-monitoring and stress management, were mentioned. A feeling of discomfort due to playing in public was reported, and participants varied in terms of the levels of digital literacy. Social interaction features were not adequately used, even though some participants created informal support groups to exergame.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This study contributes to the exergaming literature by examining behavioral and psychological change techniques from the perspective of individuals with chronic conditions. Exergaming incorporates a variety of behavioral and psychological change techniques, which were experienced by the participants in various ways. Individuals' previous knowledge of exergaming, interests, and illness progression were mentioned as factors that can influence their experiences of exergaming. By increasing the understan","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"14 ","pages":"e78776"},"PeriodicalIF":4.7,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13027676/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147529211","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 Gamified Swallowing Exercises in Adults With Dysphagia: Systematic Review and Meta-Analysis of Randomized Controlled Trials.","authors":"Jijia Liu, Meijun Ou, Mengyao Yan, Xianghua Xu, Li Qin","doi":"10.2196/82017","DOIUrl":"10.2196/82017","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Dysphagia is a prevalent health issue affecting quality of life. Gamified swallowing exercises have the potential to enhance swallowing function and adherence in adults with dysphagia. Nevertheless, such evidence has not yet been systematically synthesized.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed to systematically evaluate the effects of gamified swallowing exercises and promote their clinical application in swallowing rehabilitation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Eleven electronic databases were searched from inception to June 25, 2025. Randomized controlled trials (RCTs) that explored gamified swallowing exercises in adults with dysphagia, regardless of etiology, and reported on swallowing function, adherence, nutritional status, or quality of life were included. The Cochrane Risk of Bias tool 2.0 was applied to assess the methodological quality. We employed the Hartung-Knapp-Sidik-Jonkman method for random-effects model analysis to calculate effect sizes and 95% CIs. Subgroup analysis was conducted to explore potential causes of heterogeneity, and the overall quality of evidence was evaluated through GRADEpro GDT software.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 2400 initially identified records, 6 RCTs met the inclusion criteria, with 2 rated as low risk, 3 as some concerns, and 1 as high risk. These studies, conducted in China, South Korea, and Turkey between 2019 and 2025, enrolled a total of 330 poststroke patients with dysphagia. Interventions involved 1 to 3 games targeting the lips, tongue, and pharynx, with additional equipment. This meta-analysis indicated that gamified swallowing exercises improved swallowing function, as evidenced by enhanced swallowing performance (mean difference [MD]=1.1; 95% CI 0.9 to 1.3; I2=0; prediction interval [PI] 0.3 to 1.6), reduced dysphagia severity (standardized mean difference [SMD]=0.4; 95% CI 0.3 to 0.5; I2=0; PI 0.3 to 0.5), and increased adherence (MD=2.4; 95 % CI 1.8 to 2.9; I2=0; PI 1.2 to 2.7). However, no significant effects were observed on dysphagia screening (SMD=-1.8, 95% CI -5.4 to 1.8; I2=96.5%; PI -8.6 to 4.9) or quality of life (SMD=-2.30, 95% CI -9.6 to 5; I2=97.5%; PI -16.1 to 14.1). Overall, the quality of the included studies ranged from moderate to very low, which limits confidence in the pooled estimates.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This study provides the first quantitative synthesis of the effects of gamified swallowing exercises. The results demonstrate that gamified swallowing exercises improve swallowing function and enhance adherence, suggesting that gamified swallowing exercises are a promising method for swallowing rehabilitation. However, the overall risk of bias across included studies and the suboptimal evidence quality reduce the certainty of the current evidence. Therefore, the findings should be interpreted with caution. The small number of high-quality RCTs, reliance on additional equipment, and limited standardizati","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"14 ","pages":"e82017"},"PeriodicalIF":4.7,"publicationDate":"2026-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13021111/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147521055","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}