JMIR Formative Research最新文献

{"title":"Clustering-Based Accelerometer Measures of Physical Activity Patterns in Children With Overweight or Obesity: Baseline Cross-Sectional Methodological Analysis.","authors":"Hyatt Moore Iv, Thomas N Robinson, Alexandria Jensen, Fatma Gunturkun, K Farish Haydel, Kristopher I Kapphahn, Manisha Desai","doi":"10.2196/87532","DOIUrl":"10.2196/87532","url":null,"abstract":"<p><strong>Background: </strong>Accelerometers produce high-resolution physical activity data, but commonly used summary measures often reduce these data to total volume, intensity, or variability and may not retain interpretable temporal structure across the day. Cluster-based summaries may provide a way to characterize daily physical activity profiles while preserving information about when activity occurs.</p><p><strong>Objective: </strong>This study evaluated whether cluster-derived accelerometer summary measures could represent daily physical activity patterns and explain variation in pediatric cardiometabolic outcomes comparably to traditional accelerometer summary metrics.</p><p><strong>Methods: </strong>This baseline cross-sectional methodological analysis used data from 268 Latino children with overweight or obesity from low-income families participating in the Stanford GOALS trial. Participants were aged 7 to 11 years old and wore accelerometers for a minimum of 1 week according to study protocol. Valid daily activity profiles were summarized within a 7:00 AM-11:00 PM analytic window using consecutive, nonoverlapping 10-minute intervals. Daily profiles were clustered using unsupervised learning, and participant-level cluster-derived measures were created from the distribution of valid days assigned to each cluster. We compared these measures with traditional accelerometer summaries, including time spent in activity intensity states, Time Active Mean, Time Active Variability, Activity Intensity Mean, and Activity Intensity Variability. Linear regression models were used to evaluate associations with waist circumference, fasting insulin, and fasting triglycerides, adjusting for age and sex. Model performance was compared using <i>R</i>² and the Akaike information criterion.</p><p><strong>Results: </strong>Cluster-derived measures explained a comparable proportion of variation in the 3 cardiometabolic outcomes to traditional accelerometer summary metrics. For example, the highest <i>R</i>² values among the cluster-derived measures were 25%, 11%, and 6% for waist circumference, fasting insulin, and fasting triglycerides, respectively, compared with 25%, 10%, and 6% for Time Active Mean. No single summary-measure approach consistently yielded the highest <i>R</i>² across all 3 outcomes.</p><p><strong>Conclusions: </strong>Cluster-derived accelerometer measures provide a regression-ready approach for summarizing daily physical activity patterns while preserving interpretable clock-time structure. In this baseline analysis, these measures performed comparably to traditional accelerometer summaries while capturing temporal features not represented by conventional volume- or intensity-based metrics. Future work should evaluate external validation across diverse populations and settings and assess the use of these measures in longitudinal and intervention analyses.</p>","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"10 ","pages":"e87532"},"PeriodicalIF":2.4,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13649174/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149136816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Technical Feasibility of a Multimodal Electro-Optical and Infrared Imaging Pipeline for Postoperative Wound Assessment After Total Knee Arthroplasty: Formative Evaluation Study.","authors":"Tej S Ranade, Emily Hu, Kadambari Beelwar, Sandeep Boddeda, Praharsha Mulpur, Adarsh Annapareddy, A V Gurava Reddy","doi":"10.2196/99244","DOIUrl":"https://doi.org/10.2196/99244","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Early detection and monitoring of wound-related complications after total knee arthroplasty (TKA) are critical to optimize outcomes and preserve implants. Conventional postoperative monitoring relies on in-person assessment and patient-reported symptoms, which may delay recognition. Noncontact imaging acquired in the clinic or at home offers a potential route to earlier and more consistent assessment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed to evaluate the technical feasibility and performance of a multimodal AI system integrating electro-optical (EO) and infrared imaging for postoperative wound assessment following TKA and to explore clinical factors associated with early complications.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a single-center prospective cohort study of 749 patients undergoing primary TKA. Patients underwent standardized multimodal data collection at scheduled postoperative visits. EO-based models localized surgical landmarks and segmented complication-oriented tissue states; a fine-tuned vision-language model provided protocol verification and contextual visual reasoning. EO landmarks mapped to thermal space via deterministic alignment, followed by infrared region-of-interest segmentation and thermal classification. Each module was evaluated on a defined held-out set. The thermal classifier was assessed out-of-fold under 5-fold cross-validation with folds grouped by patient, in knees imaged on postoperative day 14 or later. Discrimination for clinician-adjudicated infection-related complications served as the primary outcome. Comorbidities and baseline laboratory values were explored for associations with complications.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 749 patients, 26 (3.5%) had a clinician-adjudicated infection-related complication. On held-out evaluation, the EO landmark detector reached a sensitivity of 0.967 (95% CI 0.954-0.979) and positive predictive value of 0.955 (95% CI 0.940-0.970), and the wound-tissue segmentation model reached a sensitivity of 0.845 (95% CI 0.833-0.857) and positive predictive value of 0.759 (95% CI 0.744-0.772). Infrared region-of-interest extraction isolated the surgical field with a mean intersection-over-union of 0.985 (SD 0.008; 95% CI 0.984-0.986) across 178 held-out patients. The trained thermal classifier discriminated infected scans with an area under the receiver operating characteristic curve (AUROC) of 0.978 (95% CI 0.959-0.992) in out-of-fold, patient-grouped cross-validation. At a representative operating point, sensitivity was 0.808 (95% CI 0.65-0.92), specificity 0.974 (95% CI 0.96-0.99), positive predictive value 0.618 (95% CI 0.49-0.78), and negative predictive value 0.990 (95% CI 0.98-1.00). Exploratory analyses showed nominal associations of chronic kidney disease and diabetes mellitus with postoperative complications that did not remain significant after multiplicity correction.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In this for","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"10 ","pages":"e99244"},"PeriodicalIF":2.4,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149136886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Evaluation of ChatGPT, DeepSeek, and Physician-Generated Acupuncture Treatment Protocols Across Chinese and English Language Settings: Cross-Sectional Evaluation Study.","authors":"Xin Liu, Zining Guo","doi":"10.2196/95851","DOIUrl":"https://doi.org/10.2196/95851","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Traditional Chinese medicine (TCM) has received increasing attention in evidence-based medicine. However, its largely experience-based and practice-oriented nature has slowed modernization and standardization. Advances in AI provide new opportunities for integrating AI with TCM.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study evaluates the application of large language models (LLMs), including ChatGPT (OpenAI) and DeepSeek, in generating acupuncture treatment protocols. We compare the validity and clinical effectiveness of physician-generated protocols with those produced by LLMs, examine differences in outputs across language corpora (Chinese and English), and establish a standardized assessment framework for systematically assessing the effectiveness of acupuncture point selection. Ultimately, this research aims to support the standardization of acupoint selection and promote greater consistency, reliability, and evidence-based development in acupuncture practice.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Qualified acupuncture treatment cases published in Acupuncture in Medicine were identified and translated from English into Chinese to create a bilingual case dataset. Standardized case prompts were independently input into DeepSeek and ChatGPT to generate acupuncture treatment protocols. Ten senior TCM physicians evaluated the AI-generated and physician-generated protocols using 7 criteria: local point selection, distal point selection, syndrome-based point selection, meridian-tracing point selection, neuroanatomical point selection, core acupoint selection, and synergistic effects. Repeated-measures ANOVA with sphericity assessment was used to examine differences across LLMs, language corpora, and protocol groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Blinded expert evaluations revealed significant differences among the 5 acupuncture groups for local point selection (P=.006), syndrome-based point selection (P=.005), neuroanatomical point selection (P&lt;.001), and core acupoints coverage principle (P=.03). For local point selection, DeepSeek Chinese output received higher scores than the other evaluated outputs, while ChatGPT English output scored higher than ChatGPT Chinese output. For syndrome-based point selection, the journal physician-generated protocols received lower scores than the DeepSeek Chinese, DeepSeek English, and ChatGPT Chinese outputs. For neuroanatomical point selection, DeepSeek English output achieved the highest scores among the 5 groups. For core acupoints coverage, the journal physician-generated protocols received lower scores than the DeepSeek Chinese, DeepSeek English, and ChatGPT English outputs. No significant differences were observed among the 5 groups for distal point selection, meridian-tracing point selection, or therapeutic synergy. Overall, DeepSeek performed better in the Chinese-language setting, whereas ChatGPT performed better in the English-language setting.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/stro","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"10 ","pages":"e95851"},"PeriodicalIF":2.4,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149136859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The correlates and rate of readmission six months post-discharge from inpatient psychiatric units in Alberta.","authors":"Ernest Owusu, Wanying Mao, Reham Shalaby, Hossam Eldin Elgendy, Belinda Agyapong, Ejemai Eboreime, Lawal A Mobolaji, Nnamdi Nkire, Peter H Silverstone, Pierre Chue, Wesley Vuong, Arto Ohinmaa, Valerie Taylor, Carla T Hilario, Andrew J Greenshaw, Vincent Agyapong","doi":"10.2196/96221","DOIUrl":"https://doi.org/10.2196/96221","url":null,"abstract":"<p><strong>Background: </strong>Hospital readmission rates have been proposed as an indicator of quality of care within inpatient psychiatric services. Numerous factors may predict readmissions into acute psychiatric care. Minimizing the risk factors linked to psychiatric readmissions can help develop preventive intervention strategies that enhance patient safety, improve quality of care and well-being, and help control healthcare costs.</p><p><strong>Objective: </strong>The objective of this paper is to assess the rate and correlates of readmission six months post-discharge from inpatient psychiatric units.</p><p><strong>Methods: </strong>This study employed a prospective observational cohort design. The study covered all acute mental health units in Edmonton, Calgary, and Grande Prairie.Admissions to inpatient care six months prior to and six months post the index admission were assessed using medical records from adult inpatient psychiatric units to identify factors associated with patients' readmission within 6 months of discharge. A stepped-wedge recruitment approach was employed. REDCap was used as the data collection tool and the data were exported to SPSS for Mac, version 25 for analysis. Descriptive statistics as well as univariate analysis using a chi-square test was conducted to assess the association between demographic and clinical factors and 6-month post-discharge readmission. Multiple binary logistic regression models were fitted to examine associations between predictors and readmission within six months post-discharge.</p><p><strong>Results: </strong>Of the 1,070 participants, 823 (76.9%) were not admitted within 6 months prior to the index admission. Most participants were Caucasian, 661 (61.8%). The six-month post-discharge readmission rate was 247 (23.1%) among participants. Participants who were admitted within six months prior to the index admission were almost two times more likely to be readmitted (OR = 1.76; 95% C.I. = 1.27-2.44; p= <.001) than participants with no prior admission to the index admission. Additionally, unemployed participants were almost twice as likely (OR = 1.69; 95% C.I. = 1.15-2.47; p = .007) to be readmitted compared with employed participants.</p><p><strong>Conclusions: </strong>These findings suggest that policies and intervention programs should focus on improving employment opportunities and strengthening post-discharge support systems, which could be instrumental in reducing readmission rates.</p><p><strong>Clinicaltrial: </strong>clinicaltrials.gov, NCT05133726. Registered on November 24, 2021.</p>","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a Validated Survey to Assess Virtual Interprofessional Education: Cross-Sectional Survey Study With Psychometric Validation.","authors":"Erica Breyman, Dale Coffin, Bini John, Nancy Krisch, Kathleen Monahan, Xiaoyue Zhang, Erin Hulfish","doi":"10.2196/92933","DOIUrl":"10.2196/92933","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The COVID-19 pandemic led to the rapid integration of telemedicine into health care delivery. As a result, the ability to effectively collaborate in interprofessional virtual teams became a necessity, as did the development of educational opportunities designed to equip health care students with these skills. Currently, there is a lack of dedicated tools to assess learners' ability and readiness to function as a well-coordinated virtual medical team.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The primary objective of this study was to conduct a psychometric assessment and validation of measures evaluating graduate-level health professions learners' experience and familiarity within virtual interprofessional settings. The secondary objective was to integrate these 2 validated subscales into a comprehensive survey tool for use in interprofessional education course evaluation, spanning domains including demographics, telehealth knowledge and skills, understanding interprofessional roles, communication, and teamwork.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;An interprofessional expert panel reviewed an initial item pool of 126 questions compiled from adaptations of previously validated instruments and newly developed items. Five experts with experience in interprofessional education and telehealth competencies independently rated each item, and the highest-ranked items were selected for distribution to graduate health professions students at Stony Brook University. The survey was administered during mandatory in-class instruction across the School of Medicine, School of Nursing, School of Health Professions, and School of Social Welfare between November 2023 and June 2024. Participation was voluntary, and responses were anonymous. Item reduction focused on the 33 experience items and 8 familiarity items using interitem correlations, the Cronbach α, item-to-total correlations, and exploratory factor analysis (EFA); confirmatory factor analysis was not conducted.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 520 responses were obtained. After excluding records without any response to questions 9 or 10 and duplicate submissions, 393 records were included in the analysis. The final survey was reduced from 51 to 32 items, including 5 demographic items, 3 telehealth knowledge items, 17 retained experience items, and 5 retained familiarity items. For the experience domain, EFA identified 17 items loading onto 3 factors, accounting for 69.81%, 13.00%, and 9.58% of the variance. Internal consistency remained high, with the Cronbach α decreasing from 0.94 to 0.90. For the familiarity domain, EFA supported a refined 5-item structure, with the Cronbach α decreasing from 0.94 to 0.91.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This EFA-based validation study provides preliminary psychometric support for 2 subscales assessing graduate health professions learners' experience and familiarity within virtual interprofessional settings. Additional validation work i","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"10 ","pages":"e92933"},"PeriodicalIF":2.4,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13645316/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multimodal Online Recruitment and Engagement of Black Breast Cancer Survivors for Mixed Methods Social Determinants of Health Research: Feasibility Study.","authors":"Kassandra I Alcaraz, Lensa S Keno, Brittany D Jenkins, Avonne E Connor","doi":"10.2196/96341","DOIUrl":"10.2196/96341","url":null,"abstract":"<p><strong>Unlabelled: </strong>This pilot study provides evidence that multimodal online recruitment and engagement are feasible for mixed methods social determinants of health research with sociodemographically diverse Black breast cancer survivors.</p>","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"10 ","pages":"e96341"},"PeriodicalIF":2.4,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13645196/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reliability of Childhood Autism Rating Scale, Second Edition, Assessments Using Telepsychiatry for Children With Neurodevelopmental Disorders and Their Caregivers: Randomized Feasibility Study.","authors":"Shunya Kurokawa, Kensuke Nomura, Nana Hosogane, Takashi Nagasawa, Yuko Kawade, Yu Matsumoto, Shuichi Morinaga, Yuriko Kaise, Ayana Higuchi, Akiko Goto, Naoko Inada, Masaki Kodaira, Taishiro Kishimoto","doi":"10.2196/82784","DOIUrl":"10.2196/82784","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic has increased the demand for telepsychiatry in neurodevelopmental assessment; however, few studies have examined the interrater reliability of clinician-rated autism scales, such as the Childhood Autism Rating Scale, Second Edition (CARS2), when used remotely. Although the feasibility and validity of telehealth assessments have been explored previously, the consistency between remote and in person CARS2 ratings by different clinicians remains underinvestigated.</p><p><strong>Objective: </strong>The objective of this study was to evaluate agreement between CARS2 total scores obtained by different evaluators using telepsychiatry and face-to-face assessments in children with autism spectrum disorder (ASD) and/or attention-deficit/hyperactivity disorder (ADHD).</p><p><strong>Methods: </strong>In this randomized feasibility study, 75 children aged 6 to 17 years with <i>DSM-5 (Diagnostic and Statistical Manual of Mental Disorders [Fifth Edition])</i> diagnoses of ASD, ADHD, or both were enrolled at 5 medical institutions in Japan; 73 of 75 were included in the final analysis. Each participant underwent 2 independent CARS2 evaluations, one face-to-face and the other via telepsychiatry, conducted by different evaluators who were blinded to each other's ratings. Remote assessments were conducted using a secure video platform with caregiver facilitation. Agreement was assessed using intraclass correlation coefficients (ICCs) for the overall sample and subgroups defined by primary diagnosis, sex, and age.</p><p><strong>Results: </strong>The overall ICC for CARS2 total scores between face-to-face and telepsychiatry assessments was 0.582 (95% CI 0.407-0.717), indicating moderate agreement. The ICC was 0.546 among participants with ASD as the primary diagnosis and 0.495 among those with ADHD as the primary diagnosis. Point estimates were higher among girls than boys (0.666 vs 0.495) and among children aged 11 years or older than among those aged 10 years or younger (0.676 vs 0.419). In a sensitivity analysis including all participants with an ASD diagnosis, the ICC was 0.580.</p><p><strong>Conclusions: </strong>CARS2 total scores obtained through telepsychiatry showed moderate agreement with scores obtained through face-to-face assessment when the assessments were conducted by different evaluators in different settings. Higher point estimates were observed among older children and girls, although these subgroup findings should be interpreted cautiously. Telepsychiatry-based CARS2 assessment may be considered a complementary approach rather than a replacement for comprehensive face-to-face evaluation. Larger studies using more standardized assessment protocols are needed.</p>","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"10 ","pages":"e82784"},"PeriodicalIF":2.4,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13641316/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Australian Digital Mental Health Services for Anxiety and Depression: Meta-Analysis and Comparison Study.","authors":"Bridget Bassilios, Katrina J Scurrah, Amy J Morgan, Leo Roberts, Maria Ftanou, Matthew J Spittal","doi":"10.2196/90121","DOIUrl":"10.2196/90121","url":null,"abstract":"<p><strong>Background: </strong>Mental Health Online, MindSpot, and THIS WAY UP are 3 Australian Government-funded digital mental health services (DMHSs). These services are free for consumers and deliver a range of (depression and anxiety disorder) psychological assessments and interventions using the internet, with or without clinician support.</p><p><strong>Objective: </strong>This study examines the uptake and effectiveness of these services.</p><p><strong>Methods: </strong>We used 3 data sources to examine the performance of the three DMHSs: (1) aggregated routinely collected service data to describe uptake of the services from January 2013 to December 2021, (2) peer-reviewed and gray literature reporting treatment outcomes, and (3) treatment outcome data from one evaluation conducted by Mental Health Online. The second and third data sources were used to analyze the effectiveness of the DMHSs compared to other mental health treatment programs (Australian primary, public, and low-intensity mental health care; UK stepped psychological care). We generated pooled mental health symptom (Cohen <i>d</i>) effect sizes for each service's clinician-supported and self-directed treatments and compared those with effect sizes we calculated for the alternative treatment programs.</p><p><strong>Results: </strong>The 3 DMHSs offered care to more than 282,000 consumers and therefore contributed to improving overall access to mental health care in Australia. Clinician-supported online treatment significantly improved the mental health of consumers who use these services (Mental Health Online, Cohen <i>d</i>=0.95; MindSpot, Cohen <i>d</i>=1.42; and THIS WAY UP, Cohen <i>d</i>=1.04), and self-directed treatment by Mental Health Online produced a moderate reduction (Cohen <i>d</i>=0.59) in anxiety disorder severity ratings. Clinician-supported treatments produced improvements in mental health symptoms that are close or equivalent to most (face-to-face, phone, and stepped or symptom severity-matched mental health care) comparison treatments examined.</p><p><strong>Conclusions: </strong>Mental Health Online, MindSpot, and THIS WAY UP are producing clinically significant improvement for consumers experiencing psychological distress and anxiety and depression symptoms. The magnitude of improvement produced by clinician-supported treatment is comparable with more resource-intensive face-to-face treatment options. Heterogeneity in the magnitude of improvements produced by the 3 DMHSs (and comparator interventions across levels of clinical need) indicates that findings should be interpreted with caution, particularly in relation to the populations for whom DMHSs may be most appropriate.</p>","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"10 ","pages":"e90121"},"PeriodicalIF":2.4,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13641322/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of a Virtual Reality Immersion Process as a Nonpharmacological Intervention for Behavioral and Psychological Symptoms of Dementia and Immediate Well-Being in People Living in Nursing Homes: Randomized Controlled Trial.","authors":"Marion Giroux, Floriane Delphin-Combe, Marianne Rion, Mohamed Nour Temedda, Virginie Dauphinot, Stéphanie Tripoz-Dit-Masson, Clémence Grangé, Antoine Garnier-Crussard, Sophie Dautricourt","doi":"10.2196/95542","DOIUrl":"10.2196/95542","url":null,"abstract":"<p><strong>Background: </strong>Behavioral and psychological symptoms of dementia (BPSD) are common among nursing home residents, notably those with Alzheimer disease and related diseases, impacting both themselves and health care professionals. Nonpharmacological interventions, including virtual reality (VR), have shown promise, but evidence from multicenter ecological studies remains limited.</p><p><strong>Objective: </strong>This study aimed to evaluate the effectiveness, in terms of BPSD evolution, immediate well-being, and social interactions, of a VR-based immersion intervention (Lumeen) as a nonpharmacological approach to managing BPSD among nursing home residents. It also aimed to confirm the feasibility of implementing and evaluating group-based immersive VR interventions in nursing homes.</p><p><strong>Methods: </strong>Fifty-six nursing home residents with BPSD took part in this multicenter randomized controlled trial (ClinicalTrials.gov NCT04769024), receiving either VR-based sessions or an active control condition consisting of nondigital cognitive stimulation. Both interventions consisted of two 45-minute group sessions per week for 6 weeks, resulting in a total of 12 sessions in each intervention group. BPSD severity was assessed preintervention and postintervention using the Neuropsychiatric Inventory (NPI) and the Apathy Interview. Immediate well-being and social interaction were assessed at each session using the Immediate Well-Being Evaluation and the Social Observation Behaviors Residents Index, respectively.</p><p><strong>Results: </strong>No significant between-group differences were found in BPSD reduction or in overall well-being outcomes. However, immediate well-being increased from presession to postsession in both groups when averaged across the 12 sessions, and social interactions were more frequent in the active control group. Only 2 mild adverse events were reported.</p><p><strong>Conclusions: </strong>VR interventions in nursing home residents with neurocognitive disorders did not demonstrate superiority over an active cognitive stimulation control in reducing BPSD. Both interventions were associated with improvements in immediate well-being, suggesting that nonpharmacological group-based activities may be beneficial in nursing home settings. Additionally, VR interventions were safe and feasible in this population. Immersive VR warrants further investigation in adequately powered pragmatic trials to clarify its specific added value and optimal implementation conditions for BPSD.</p>","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"10 ","pages":"e95542"},"PeriodicalIF":2.4,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13641323/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Movement and Frontal Theta Activity During Step-Based Exergaming in Healthy Younger and Older Adults: Laboratory-Based Cross-Sectional Study.","authors":"Nina Skjæret-Maroni, Helen Müller, Phillip Anders, Karoline Blix Grønvik, Jochen Baumeister, Beatrix Vereijken, Ellen Marie Bardal","doi":"10.2196/100270","DOIUrl":"https://doi.org/10.2196/100270","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Exergames are increasingly used in rehabilitation to simultaneously target physical and cognitive functions. Game scores are commonly used as indicators of performance, yet it remains unclear to what extent they reflect underlying movement and cognitive-control demands. Understanding this relationship is essential for interpreting what exergame performance scores reflect during gameplay.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;We aimed to investigate how movements and frontal theta activity, used as a proxy for cognitive-control demands, relate to game performance across game levels and age groups in a step-based exergame.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This cross-sectional laboratory study included 32 participants (16 older adults: mean age 76.5, SD 4.5, range 71-86 years; 16 younger adults: mean age 25, SD 2.1, range 22-28 years) recruited using convenience sampling from a university and recreational exercise groups in Trondheim, Norway. Participants completed a step-based exergame (\"The Mole\") at 3 difficulty levels (easy, medium, and hard). Movements were measured using accelerometers (vector magnitude and step count), and frontal theta activity was derived from mobile EEG (electroencephalogram) as mean power spectral density in the 4-7 Hz range as a proxy for cognitive-control demands. Game scores were recorded as performance indicators. Repeated-measures general linear models were used to test effects of difficulty and age group, and Pearson correlation analyses examined associations between variables.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Younger adults achieved higher game scores than older adults across all difficulty levels, and performance declined at higher task difficulty (all P&lt;.001). The amount of movement (vector magnitude) showed strong and generally consistent positive correlations with game score across all levels and both age groups (r=0.67-0.80). All correlations except the hard level in older adults were statistically significant after correction for multiple comparisons. Step count showed weaker and less consistent associations across groups. No statistically significant differences in frontal theta activity were observed between age groups or across task difficulty levels (all P&gt;.15). Associations between frontal theta and game score were near 0 in younger adults (r=-0.096 to 0.001), whereas older adults showed small-to-moderate correlations at easy and medium difficulty levels (r=0.345-0.416) and a stronger correlation at the greatest difficulty level (r=0.76). However, none of the correlations between frontal theta and game score were statistically significant after correction for multiple comparisons (all P&gt;.003).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In this controlled exergaming setting, game performance was strongly associated with the amount of movement performed, whereas associations with frontal theta activity, used as a proxy for cognitive-control demands, were limited and context-dependent. Th","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"10 ","pages":"e100270"},"PeriodicalIF":2.4,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}