TY - JOUR AU - Liszio, Stefan AU - Bäuerlein, Franziska AU - Hildebrand, Jens AU - van Nahl, Carolin AU - Masuch, Maic AU - Basu, Oliver PY - 2025/3/31 TI - Cooperative Virtual Reality Gaming for Anxiety and Pain Reduction in Pediatric Patients and Their Caregivers During Painful Medical Procedures: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e63098 VL - 14 KW - virtual reality KW - extended reality KW - mixed reality KW - serious game KW - video game KW - pain KW - anxiety KW - stress KW - child KW - caregiver KW - patient experience KW - well-being KW - medical procedures KW - punctures KW - distraction KW - intervention N2 - Background: The hospital experience is often marked by fear and pain, particularly for children undergoing medical procedures. Sedation is commonly used to alleviate patient anxiety, but it poses additional health risks. Caregivers, usually the parents, also experience emotional distress during the child?s hospital stay, which can further exacerbate the child?s anxiety and pain. While various interventions exist to ease patient distress, few consider the emotional well-being of caregivers. Objective: This study aims to explore the effectiveness of a cooperative virtual reality (VR) game as a novel nonpharmacological solution to reduce anxiety and pain for both pediatric patients and their caregivers during medical procedures. Specifically, we aim to investigate whether the VR game ?Sweet Dive VR? (SDVR), designed for children aged between 6 and 12 years to play with 1 caregiver, can alleviate anxiety and pain during different types of needle punctures and Kirschner-wire removal. Methods: A prospective multicenter randomized clinical trial will be conducted. Eligible participants will be identified by scanning the hospital information system, and group allocation will follow stratified randomization. During the medical procedure, patients in the VR condition will play SDVR with a caregiver present, while patients in the control group will listen to a recording of gently crashing waves. Data collection will be carried out through self-reports of patients and caregivers using visual analog scales and questionnaires at 2 measurement time points: before and after the intervention. In addition, observation by the interviewers will occur during the intervention to capture emotional and pain reactions as well as interaction quality between patients and caregivers and smoothness of the procedure flow using a structured observation protocol. The measured variables will encompass patient affect and pain, caregiver affect, player experience, patient experience, and the flow of the procedure. Results: As of November 2024, we enrolled 39 patients and caregivers, 28 of whom completed the study. Data collection is still ongoing. Conclusions: Cooperative VR gaming, as exemplified by SDVR, emerges as a promising intervention to address anxiety and pain in pediatric patients while involving caregivers to support the emotional well-being of both parties. Our approach strives to foster positive shared experiences and to maintain trust between children and caregivers during emotionally challenging medical situations. Trial Registration: German Clinical Trial Register (DRKS) DRKS00033544; https://drks.de/search/en/trial/DRKS00033544 International Registered Report Identifier (IRRID): DERR1-10.2196/63098 UR - https://www.researchprotocols.org/2025/1/e63098 UR - http://dx.doi.org/10.2196/63098 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63098 ER - TY - JOUR AU - Hewko, Mark AU - Gagnon Shaigetz, Vincent AU - Smith, S. Michael AU - Kohlenberg, Elicia AU - Ahmadi, Pooria AU - Hernandez Hernandez, Elena Maria AU - Proulx, Catherine AU - Cabral, Anne AU - Segado, Melanie AU - Chakrabarty, Trisha AU - Choudhury, Nusrat PY - 2025/3/31 TI - Considering Theory-Based Gamification in the Co-Design and Development of a Virtual Reality Cognitive Remediation Intervention for Depression (bWell-D): Mixed Methods Study JO - JMIR Serious Games SP - e59514 VL - 13 KW - virtual reality KW - clinical psychology KW - cognitive assessment KW - neuropsychology KW - mental health KW - cognitive training KW - cognitive remediation KW - cognitive rehabilitation KW - digital therapeutics N2 - Background: In collaboration with clinical domain experts, we developed a prototype of immersive virtual reality (VR) cognitive remediation for major depressive disorder (bWell-D). In the development of a new digital intervention, there is a need to determine the effective components and clinical relevance using systematic methodologies. From an implementation perspective, the effectiveness of digital intervention delivery is challenged by low uptake and high noncompliance rates. Gamification may play a role in addressing this as it can boost adherence. However, careful consideration is required in its application to promote user motivation intrinsically. Objective: We aimed to address these challenges through an iterative process for development that involves co-design for developing content as well as in the application of gamification while also taking into consideration behavior change theories. This effort followed the methodological framework guidelines outlined by an international working group for development of VR therapies. Methods: In previously reported work, we collected qualitative data from patients and care providers to understand end-user perceptions on the use of VR technologies for cognitive remediation, reveal insights on the drivers for behavior change, and obtain suggestions for changes specific to the VR program. In this study, we translated these findings into concrete representative software functionalities or features and evaluated them against behavioral theories to characterize gamification elements in terms of factors that drive behavior change and intrinsic engagement, which is of particular importance in the context of cognitive remediation. The implemented changes were formally evaluated through user trials. Results: The results indicated that feedback from end users centered on using gamification to add artificial challenges, personalization and customization options, and artificial assistance while focusing on capability as the behavior change driver. It was also found that, in terms of promoting intrinsic engagement, the need to meet competence was most frequently raised. In user trials, bWell-D was well tolerated, and preliminary results suggested an increase in user experience ratings with high engagement reported throughout a 4-week training program. Conclusions: In this paper, we present a process for the application of gamification that includes characterizing what was applied in a standardized way and identifying the underlying mechanisms that are targeted. Typical gamification elements such as points and scoring and rewards and prizes target motivation in an extrinsic fashion. In this work, it was found that modifications suggested by end users resulted in the inclusion of gamification elements less commonly observed and that tend to focus more on individual ability. It was found that the incorporation of end-user feedback can lead to the application of gamification in broader ways, with the identification of elements that are potentially better suited for mental health domains. UR - https://games.jmir.org/2025/1/e59514 UR - http://dx.doi.org/10.2196/59514 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59514 ER - TY - JOUR AU - Talan, Jordan AU - Forster, Molly AU - Joseph, Leian AU - Pradhan, Deepak PY - 2025/3/12 TI - Exploring the Role of Immersive Virtual Reality Simulation in Health Professions Education: Thematic Analysis JO - JMIR Med Educ SP - e62803 VL - 11 KW - virtual reality KW - medical education KW - virtual reality simulation KW - extended reality KW - simulation KW - VR KW - health professions education KW - health education KW - thematic analysis KW - evolving technology KW - qualitative study KW - qualitative KW - semistructured interviews KW - educational experiences KW - theoretical framework N2 - Background: Although technology is rapidly advancing in immersive virtual reality (VR) simulation, there is a paucity of literature to guide its implementation into health professions education, and there are no described best practices for the development of this evolving technology. Objective: We conducted a qualitative study using semistructured interviews with early adopters of immersive VR simulation technology to investigate use and motivations behind using this technology in educational practice, and to identify the educational needs that this technology can address. Methods: We conducted 16 interviews with VR early adopters. Data were analyzed via directed content analysis through the lens of the Unified Theory of Acceptance and Use of Technology. Results: The main themes that emerged included focus on cognitive skills, access to education, resource investment, and balancing immersion. These findings help to clarify the intended role of VR simulation in health professions education. Based on our data, we synthesized a set of research questions that may help define best practices for future VR development and implementation. Conclusions: Immersive VR simulation technology primarily serves to teach cognitive skills, expand access to educational experiences, act as a collaborative repository of widely relevant and diverse simulation scenarios, and foster learning through deep immersion. By applying the Unified Theory of Acceptance and Use of Technology theoretical framework to the context of VR simulation, we not only collected validation evidence for this established theory, but also proposed several modifications to better explain use behavior in this specific setting. UR - https://mededu.jmir.org/2025/1/e62803 UR - http://dx.doi.org/10.2196/62803 ID - info:doi/10.2196/62803 ER - TY - JOUR AU - Pallavicini, Federica AU - Orena, Eleonora AU - Arnoldi, Lisa AU - Achille, Federica AU - Stefanini, Stefano AU - Cassa, Maddalena AU - Pepe, Alessandro AU - Veronese, Guido AU - Bernardelli, Luca AU - Sforza, Francesca AU - Fascendini, Sara AU - Defanti, Alberto Carlo AU - Gemma, Marco AU - Clerici, Massimo AU - Riva, Giuseppe AU - Mantovani, Fabrizia PY - 2025/3/6 TI - Effects and Acceptability of a 1-Week Home-Based Virtual Reality Training for Supporting the Management of Stress and Anxiety: Randomized Pilot Trial JO - JMIR Serious Games SP - e50326 VL - 13 KW - virtual reality KW - relaxation KW - anxiety KW - depression KW - emotions KW - health care professionals KW - health care workers KW - hospital KW - randomized clinicial trial KW - hospitals N2 - Background: Virtual reality (VR) is helpful for the management of stress and anxiety. However, current interventions have limitations related to location (ie, therapist?s office or hospitals) and content (ie, virtual experiences only for relaxation). Objective: This randomized pilot trial aims to investigate the efficacy and acceptability of a brief remote VR-based training for supporting stress and anxiety management in a sample of Italian health care workers. Methods: A total of 29 doctors and nurses (n=21; 72% female; mean age 35.6, SD 10.3 years) were recruited and randomized to a VR intervention group or a control group in a passive control condition. Participants assigned to the VR intervention group received remote VR-based training consisting of 3 sessions at home delivered in 1 week using the VR psychoeducational experience ?MIND-VR? and the 360° relaxing video ?The Secret Garden.? The primary outcome measures were stress, anxiety, depression, and the knowledge of stress and anxiety assessed at baseline and posttreatment. We also evaluated the immediate effect of the remote VR-based training sessions on the perceived state of anxiety and negative and positive emotions. The secondary outcome measure was the usability at home of the VR system and content. Results: The VR intervention significantly reduced stress levels as assessed by the Perceived Stress Scale (6.46, 95% CI 2.77 to 10.5; P=.046) and increased the knowledge of stress and anxiety, as evaluated by the ad hoc questionnaire adopted (?2.09, 95% CI ?3.86 to ?0.529; P=.046). However, the home-based VR training did not yield similar reductions in stress, anxiety, and depression levels as assessed by the Depression, Anxiety, and Stress Scale-21 items or in trait anxiety as evaluated through the State-Trait Anxiety Inventory Form Y-1. After the home training sessions with VR, there was a significant decrease in anxiety, anger, and sadness and an increase in happiness levels. Analyses of the questionnaires on usability indicated that the health care workers found using the VR system at home easy and without adverse effects related to cybersickness. Of 33 participants, 29 (88%) adhered to the protocol. Conclusions: The results of this randomized pilot study suggest that a week-long home VR intervention, created with content created specifically for this purpose and available free of charge, can help individuals manage stress and anxiety, encouraging further research investigating the potential of remote VR interventions to support mental health. Trial Registration: ClinicalTrials.gov NCT04611399; https://tinyurl.com/scxunprd UR - https://games.jmir.org/2025/1/e50326 UR - http://dx.doi.org/10.2196/50326 UR - http://www.ncbi.nlm.nih.gov/pubmed/40053782 ID - info:doi/10.2196/50326 ER - TY - JOUR AU - Slatman, Syl AU - Heesink, Lieke AU - Achterkamp, Reinoud AU - Broeks, José AU - Monteiro de Oliveira, Nelson AU - ter Riet, Remko AU - Stegeman, Marjolein AU - Tabak, Monique PY - 2025/3/4 TI - At-Home Virtual Reality Intervention for Patients With Chronic Musculoskeletal Pain: Single-Case Experimental Design Study JO - JMIR XR Spatial Comput SP - e58784 VL - 2 KW - virtual reality KW - VR KW - chronic musculoskeletal pain KW - CMP KW - single-case experimental design KW - SCED KW - user experience KW - self-management KW - musculoskeletal pain N2 - Background: Virtual reality (VR) could possibly alleviate complaints related to chronic musculoskeletal pain (CMP); however, little is known about how it affects pain-related variables on an individual level and how patients experience this intervention. Objective: This study aimed to gain detailed insight into the influence of an at-home VR intervention for pain education and management on pain-related variables, and to explore its feasibility and general experience. Methods: The study applied a single-case experimental design in which an at-home VR intervention was used for 4 weeks by patients with CMP who were on a waiting list for regular pain treatment. Outcome measures included pain-related variables, functioning, and objectively measured outcomes (ie, stress, sleep, and steps). Outcomes were analyzed using data visualization (based on line plots) and statistical methods (ie, Tau-U and reliable change index) on an individual and group level. In addition, a focus group was conducted to assess feasibility and general experience to substantiate findings from the single-case experimental design study. This focus group was analyzed using inductive thematic analysis. Results: A total of 7 participants (female: n=6, 86%) with a median age of 45 (range 31?61) years participated in this study. A dataset with 42 measurement moments was collected with a median of 280 (range 241?315) data points per participant. No statistically significant or clinically relevant differences between the intervention and no-intervention phases were found. Results of the visual analysis of the diary data showed that patients responded differently to the intervention. Results of the focus group with 3 participants showed that the VR intervention was perceived as a feasible and valued additional intervention. Conclusions: Although patients expressed a positive perspective on this VR intervention, it did not seem to influence pain-related outcomes. Individual patients responded differently to the intervention, which implies that this intervention might not be suitable for all patients. Future studies should examine which CMP patients VR is effective for and explore its working mechanisms. In addition, future larger trials should be conducted to complement this study?s findings on the effectiveness of this intervention for patients with CMP and whether VR prevents deterioration on the waiting list compared with a control group. UR - https://xr.jmir.org/2025/1/e58784 UR - http://dx.doi.org/10.2196/58784 ID - info:doi/10.2196/58784 ER - TY - JOUR AU - Herren, Silvia AU - Seebacher, Barbara AU - Mildner, Sarah AU - Riederer, Yanick AU - Pachmann, Ulrike AU - Böckler, Sonja Nija AU - Niedecken, Stephan AU - Sgandurra, Alicia Sabrina AU - Bonati, Leo AU - Hotz, Isabella AU - Schättin, Alexandra AU - Jurt, Roman AU - Brenneis, Christian AU - Lenfert, Katharina AU - Behrendt, Frank AU - Schmidlin, Stefan AU - Nacke, Lennart AU - Schuster-Amft, Corina AU - Martin-Niedecken, Lisa Anna PY - 2025/2/14 TI - Exergame (ExerG)-Based Physical-Cognitive Training for Rehabilitation in Adults With Motor and Balance Impairments: Usability Study JO - JMIR Serious Games SP - e66515 VL - 13 KW - exergame KW - rehabilitation KW - user-centered design KW - usability testing KW - mixed-methods KW - interdisciplinary research KW - concept functional model proofs KW - exercise KW - cognitive training KW - technology acceptance KW - motor KW - cognitive impairment KW - safety KW - user experience KW - balance impairments KW - balance N2 - Background: Exergames are increasingly used in rehabilitation, yet their usability and user experience for patients and therapists, particularly for functional model systems, are underresearched. The diverse needs and preferences of users make conducting usability studies challenging, emphasizing the need for further investigation in real-world settings. Objective: This study aimed to evaluate the usability, safety, and user experience of a novel exergame functional model, the ExerG, from the perspectives of patients and therapists in a rehabilitation setting. Methods: In this mixed methods study, 15 patients undergoing rehabilitation (primary end users [PEUs]) and 20 therapists (secondary end users [SEUs]) from 2 rehabilitation centers in Switzerland and Austria participated in exercising and observation sessions with the ExerG. SEUs received training on system use and technical issue management, enabling them to fulfill their therapist roles while treating patients or mock patients. Rapid Iterative Testing and Evaluation was used and the training software adjusted based on participant feedback. Usability was assessed with questionnaires, semistructured interviews, and through observations during the ExerG testing. System acceptability was evaluated using specific quantitative thresholds based on PEU performance and feedback. An observation protocol tracked SEUs? correct use, errors, hesitations, task completion time, and needed assistance across scenarios. Results: Patients and therapists reported overall good usability and positive experiences with the exergame. PEUs rated 23/29 (79%) instructions as acceptable, showed good-to-very-good exercise performance in 19/29 (65%) tasks, and completed 28/29 (97%) tasks. Patients reported no adverse events, showing improved performance and enjoyment across ExerG exercising rounds, with 79/90 (88%) expressing positive emotions and reporting median scores of 9 (IQR 7.5?10) on a 1?10 user satisfaction scale. Patients were willing to continue using the device if the graphic design was improved (5/15), tracking systems and projector quality were enhanced (each 3/15), instructions clarified (12/15), and the game variety increased (2/15). PEUs felt secure in the safety harness (15/15) but recommended swivel arm movement enhancements (5/15). SEUs effectively executed scenarios, with hesitation and difficulties observed in only 14/41 tasks and 2/41 tasks, across all 20 therapists, accounting for 1.7% and 0.2% of the 820 total task cases, respectively. Therapists? quantitative usability ratings were high (median System Usability Scale score 82.5, IQR 65?95). All SEUs expressed their willingness to use the ExerG (20/20) and reported being able to operate the system using the user handbook (20/20). They emphasized the motivation-enhancing effect of video-game based training (12/20) and considered the activities supportive for physical and cognitive skills (20/20). They suggested incorporating daily living task simulations (13/20), more customizable options (6/20), more targeted motivational feedback (9/20), clearer performance ratings (9/20), and more concise activity instructions (6/20). Conclusions: The interdisciplinary, iterative ExerG development approach shows promise. The findings will inform future optimizations. Future work will assess long-term impact. Trial Registration: ClinicalTrials.gov NCT05967078; https://clinicaltrials.gov/study/NCT05967078 and OSF Registries OSFCQ9AT; https://osf.io/cq9at UR - https://games.jmir.org/2025/1/e66515 UR - http://dx.doi.org/10.2196/66515 ID - info:doi/10.2196/66515 ER - TY - JOUR AU - Koivisto, Jaana-Maija AU - Kämäräinen, Sanna AU - Mattsson, Katri AU - Jumisko-Pyykkö, Satu AU - Ikonen, Riikka AU - Haavisto, Elina PY - 2025/2/13 TI - Exploring Nursing Students? Experiences of Empathy and User Experiences in an Immersive Virtual Reality Simulation Game: Cross-Sectional Study JO - JMIR Serious Games SP - e62688 VL - 13 KW - education KW - nursing KW - learning KW - empathy KW - virtual reality KW - simulation KW - user experience KW - cross sectional N2 - Background: Empathy is associated with better clinical outcomes and patient-care experiences, and it has been demonstrated that training can improve nursing students? empathy. The use of virtual reality (VR) as an experiential learning strategy may increase the empathetic behavior of caregivers. Although much research exists on the use of VR in education, there is still little research on learning empathy in nursing education through immersive VR games that include a head-mounted display and hand controllers. In addition, it is important to study both learning and user experiences in nursing education that utilizes VR technology. Objective: This study aims to explore nursing students? experiences of empathy and user experiences in an immersive VR simulation game. Methods: A cross-sectional design was used. A total of 52 graduating nursing students from 3 universities of applied sciences in Finland participated in the study. The immersive VR simulation game employed in the study was played with a head-mounted display and hand controllers. The instruments used were the Basic Empathy Scale in Adults (BES-A) before the VR simulation gaming session and the Comprehensive State Empathy Scale (CSES) and AttrakDiff 2.0 Scale after the session. Results: The students? overall level of empathy experienced in the immersive VR simulation game was favorable (CSES; mean 2.9, SD 0.57). Participants who had a higher level of empathy (BES-A) before playing the immersive VR simulation game also experienced slightly more feelings of empathy after playing (CSES). However, the association between the measures was not statistically significant (r=0.187, P=.18). The overall empathy (CSES) experienced in the immersive VR simulation game was positively correlated with its subscales. The use of the VR simulation provided a positive user experience in all 4 factors of the AttrakDiff 2.0 Scale. Overall User Experience and Emotion Sharing correlated negatively (r=?0.248, P=.042), as did Attractiveness and Emotion Sharing (r=?0.327, P=.018). Hedonic Quality Stimulation correlated negatively with Cognitive Empathy (r=?0.279, P=.045). Conclusions: The results of this study indicate that the use of an immersive VR simulation game in nursing education as a means of increasing empathy seems promising and justified. The immersive VR simulation game offered positive user experiences, which further supported the idea of implementing it in education. However, more research is needed on what kinds of VR environments are the most effective in promoting empathy among nursing students. Furthermore, when using VR technology in learning, one should consider that the VR setting must not be too technical but rather simple, straightforward, and predictable. UR - https://games.jmir.org/2025/1/e62688 UR - http://dx.doi.org/10.2196/62688 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/62688 ER - TY - JOUR AU - Verstegen, Amandine AU - Van Daele, Tom AU - Bonroy, Bert AU - Debard, Glen AU - Sels, Romy AU - van Loo, Marlon AU - Bernaerts, Sylvie PY - 2025/2/13 TI - Designing a Smartphone-Based Virtual Reality App for Relaxation: Qualitative Crossover Study JO - JMIR Form Res SP - e62663 VL - 9 KW - smartphone-based virtual reality KW - virtual reality KW - relaxation KW - stress KW - user experience KW - mobile phone N2 - Background: Accumulating evidence supports the use of virtual reality (VR) in mental health care, with one potential application being its use to assist individuals with relaxation exercises. Despite studies finding support for the potential of VR to effectively aid in relaxation, its implementation remains limited outside of specialized clinics. Known barriers are insufficient knowledge regarding VR operation, lack of availability of VR relaxation apps tailored to local health care systems, and cost concerns. Unfortunately, many VR relaxation apps are designed exclusively for stand-alone headsets, limiting accessibility for a broad audience. Objective: We aimed to design an accessible, smartphone-based VR relaxation app based on user preferences. This paper describes the assessment of 2 stand-alone VR relaxation apps and the resulting smartphone-based VR relaxation app design. Methods: Overall, 30 participants (n=23, 77% women; n=7, 23% men) took part in 2 separate VR sessions, assessing 1 of the 2 VR relaxation apps (Flowborne and Calm Place) in each session. After each session, participants were presented with open-ended questions to assess their experiences via a web-based survey tool. These questions explored positive and negative features, shortcomings, and suggestions for improvements while also allowing space for additional remarks concerning the 2 VR relaxation apps. Three of the authors analyzed the responses using inductive thematic analysis, a process comprising 6 phases. Results: Across both the apps, 5 recurring themes and 13 recurring subthemes were identified in the participants? answers: audio (music and sounds, guidance), visuals (content, realism, variation and dynamics in the environment), features (language, options, feedback and instructions, duration, exercise), implementation (technical aspects, cybersickness, acceptability and usability), and experience. We analyzed the participants? findings and conducted a literature review, which served as the basis for developing the app. The resulting app is a Dutch-language, smartphone-based VR relaxation app, with customization options including 3 types of relaxation exercises, 2 guiding voices, and 3 different environments. Efforts have been made to ensure maximum variation and dynamism in the environments. Calming music and nature sounds accompany the exercises. The efficacy and effectiveness of the resulting app design were not assessed. Conclusions: This study provides insights into key features of VR relaxation apps, which were subsequently used for the development of a novel smartphone-based VR relaxation app. Further research concerning the effectiveness of this app, along with a broader evaluation of the efficacy and user feedback for smartphone-based VR relaxation apps, is needed. More generally, there is a clear need for more research on the impact of interactivity, biofeedback, and type of environment in VR relaxation. UR - https://formative.jmir.org/2025/1/e62663 UR - http://dx.doi.org/10.2196/62663 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/62663 ER - TY - JOUR AU - Beverly, A. Elizabeth AU - Miller, Samuel AU - Love, Matthew AU - Love, Carrie PY - 2025/2/12 TI - Feasibility of a Cinematic?Virtual Reality Program Educating Health Professional Students About the Complexity of Geriatric Care: Pilot Pre-Post Study JO - JMIR Aging SP - e64633 VL - 8 KW - virtual reality KW - VR KW - aging KW - geriatric syndromes KW - diabetes KW - elder abuse and neglect KW - gerontology KW - geriatrics KW - older KW - elderly KW - education KW - student KW - cinematic KW - video KW - head mounted KW - feasibility KW - experience KW - attitude KW - opinion KW - perception KW - elder abuse KW - chronic conditions KW - older adult care KW - health intervention KW - randomized controlled trial N2 - Background: The US population is aging. With this demographic shift, more older adults will be living with chronic conditions and geriatric syndromes. To prepare the next generation of health care professionals for this aging population, we need to provide training that captures the complexity of geriatric care. Objective: This pilot study aimed to assess the feasibility of the cinematic?virtual reality (cine-VR) training in the complexity of geriatric care. We measured changes in attitudes to disability, self-efficacy to identify and manage elder abuse and neglect, and empathy before and after participating in the training program. Methods: We conducted a single-arm, pretest-posttest pilot study to assess the feasibility of a cine-VR training and measure changes in attitudes to disability, self-efficacy to identify and manage elder abuse and neglect, and empathy. Health professional students from a large university in the Midwest were invited to participate in 1 of 4 cine-VR trainings. Participants completed 3 surveys before and after the cine-VR training. We performed paired t tests to examine changes in these constructs before and after the training. Results: A total of 65 health professional students participated in and completed the full cine-VR training for 100% retention. Participants did not report any technological difficulties or adverse effects from wearing the head-mounted displays or viewing the 360-degree video. Out of the 65 participants, 48 completed the pre- and postassessments. We observed an increase in awareness of discrimination towards people with disability (t47=?3.97; P<.001). In addition, we observed significant improvements in self-efficacy to identify and manage elder abuse and neglect (t47=?3.36; P=.002). Finally, we observed an increase in participants? empathy (t47=?2.33; P=.02). Conclusions: We demonstrated that our cine-VR training program was feasible and acceptable to health professional students at our Midwestern university. Findings suggest that the cine-VR training increased awareness of discrimination towards people with disabilities, improved self-efficacy to identify and manage elder abuse and neglect, and increased empathy. Future research using a randomized controlled trial design with a larger, more diverse sample and a proper control condition is needed to confirm the effectiveness of our cine-VR training. UR - https://aging.jmir.org/2025/1/e64633 UR - http://dx.doi.org/10.2196/64633 ID - info:doi/10.2196/64633 ER - TY - JOUR AU - Anguera, A. Joaquin AU - Choudhry, Aleem AU - Seaman, Michael AU - Fedele, Dominick PY - 2025/2/7 TI - Assessing the Impact of a Virtual Reality Cognitive Intervention on Tennis Performance in Junior Tennis Players: Pilot Study JO - JMIR Form Res SP - e66979 VL - 9 KW - executive function KW - serious games KW - cognitive training KW - performance enhancement KW - athletes KW - sport KW - pilot study KW - VR KW - virtual reality KW - serious game KW - tennis KW - adolescents KW - teenagers KW - youth KW - randomized controlled trial KW - players N2 - Background: There is evidence that cognitive training interventions can positively impact executive functions, and that some studies have demonstrated that athletes typically exhibit greater accuracy and faster response times on select cognitive tasks. While the engagement of executive functions is suggested to be part of high-level sporting activities, it is unclear whether such training approaches could directly benefit athletic performance. Objective: The objective of this study was to evaluate the impact of a combined virtual reality (VR)? and tablet-based cognitive training intervention on adolescent tennis players? performance. Here, we examined differences in Universal Tennis Rating (UTR) between players who supplemented their regular tennis training with a cognitive training intervention and a group that continued regular tennis training alone. This custom cognitive training program targeted specific cognitive control abilities including attention, working memory, and goal management. Methods: Data were collected from a cohort of tennis players in a randomized controlled trial design led by the dedicated research team. Participants (N=23, age: mean 14.8, SD 2.4 years) from the Czech Lawn Tenis Klub (Prague, Czech Republic) were invited to participate in this study. These individuals were randomized into an intervention + training-as-usual group (n=13) or training-as-usual group (control group; n=10), with the change in UTR score being the primary metric of interest. Results: There was no difference in UTR between the 2 groups at baseline (intervention: mean 8.32, SD 2.7; control: mean 7.60, SD 2.3). Following the treatment period, individuals in the intervention group showed a significant improvement in their UTR (an increase of 0.5; t12=4.88, P<.001) unlike the control group (an increase of 0.02; t9=1.77, P=.12). On comparing the change in UTR (posttraining UTR minus pretraining UTR) attained by each group, we found that the intervention group had a 38% greater improvement in UTR than the control group. An analysis of covariance revealed a significantly greater improvement in UTR for the intervention group than for the control group (F1,20=8.82, P=.008). Conclusions: The present findings suggest that training cognitive abilities through an immersive visual platform may benefit athletic performance, including tennis. Such a result warrants careful consideration, given the known difficulties in evidencing far transfer not only in cognitive studies but also in athletic activities. These preliminary pilot findings suggest that the Mastermind Cognitive Training program may be a viable tool for supplementing athletic training practices, although this result warrants further investigation and replication. However, many questions remain unanswered, and further work is needed to better understand the potential utility and mechanisms underlying potential effects of such a platform. UR - https://formative.jmir.org/2025/1/e66979 UR - http://dx.doi.org/10.2196/66979 UR - http://www.ncbi.nlm.nih.gov/pubmed/39918854 ID - info:doi/10.2196/66979 ER - TY - JOUR AU - Zhao, Jing AU - Yasunaga, Akitomo AU - Kaczynski, T. Andrew AU - Park, Hyuntae AU - Luo, Yufeng AU - Li, Jiuling AU - Shibata, Ai AU - Ishii, Kaori AU - Yano, Shohei AU - Oka, Koichiro AU - Koohsari, Javad Mohammad PY - 2025/1/20 TI - At-Home Immersive Virtual Reality Exergames to Reduce Cardiometabolic Risk Among Office Workers: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e64560 VL - 14 KW - metabolic syndrome KW - noncommunicable diseases KW - active video game KW - interactive virtual reality environment KW - physical activity KW - workplace health KW - at-home intervention N2 - Background: The worldwide rise in the prevalence of noncommunicable diseases has increased the recognition of the need to identify modifiable risk factors for preventing and managing these diseases. The office worker, as a representative group of physically inactive workers, is exposed to risk factors for metabolic syndrome, which is a primary driver of noncommunicable diseases. The use of virtual reality (VR) exergames may offer a potential solution to the problem of increasing noncommunicable disease prevalence, as it can help individuals increase their physical activity levels while providing a more immersive experience. Objective: This exploratory study aims to examine the interventional efficacy of at-home immersive VR exergames on metabolic syndrome biomarkers among office workers. Additionally, it seeks to investigate the impacts of at-home immersive VR exergames on the active and sedentary behaviors of office workers. Methods: A 3-arm, single-blinded pilot randomized controlled trial will be conducted to examine the therapeutic effects of at-home immersive VR exergames. A total of 120 Chinese office workers, engaging in less than 150 minutes per week of moderate to vigorous intensity physical activity, will be recruited via a convenience sampling method. The participants, who will be tested over a 12-week period, will be randomly assigned to one of three groups: (1) the VR exergame intervention group, (2) the regular physical activity control group, and (3) the nonexercise control group. Throughout the 12-week trial, three categories of variables will be collected across the three groups: clinical risk factors associated with metabolic syndrome, active and sedentary behaviors, and demographics. To analyze variance among the groups, a mixed linear model will be applied to assess the efficacy of each group. Differences in metabolic syndrome clinical risk factors among all groups will be used to evaluate the effects of at-home immersive VR exergames. Changes in active and sedentary behaviors will also be used to determine the impacts of VR exergames on metabolic syndrome. Results: The ethics committee of Guangzhou University, China, approved this study on September 25, 2024. Participant recruitment will begin in early 2025 and continue for approximately 3 months. Data will be analyzed after the 12-week trial is completed, with full results expected to be presented in early 2026. Conclusions: This study explores an emerging topic by applying an at-home immersive VR exergame intervention, potentially contributing to understanding the effects of an exergame program on metabolic syndrome risk among office workers. Trial Registration: ClinicalTrials.gov NCT06556784; https://clinicaltrials.gov/study/NCT06556784 International Registered Report Identifier (IRRID): PRR1-10.2196/64560 UR - https://www.researchprotocols.org/2025/1/e64560 UR - http://dx.doi.org/10.2196/64560 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64560 ER - TY - JOUR AU - Kim, Minha AU - Son, Hi Meong AU - Moon, Suhyeon AU - Cha, Chul Won AU - Jo, Joon Ik AU - Yoon, Hee PY - 2025/1/16 TI - A Mixed Reality?Based Telesupervised Ultrasound Education Platform on 5G Network Compared to Direct Supervision: Prospective Randomized Pilot Trial JO - JMIR Serious Games SP - e63448 VL - 13 KW - ultrasonography KW - telemedicine KW - medical education KW - distance learning KW - fifth-generation network KW - mixed reality KW - ultrasound education KW - hospital KW - randomized pilot trial KW - pilot study KW - doctor KW - telesupervision KW - head-mounted display KW - primary outcomes KW - user experience KW - self-confidence KW - image quality KW - educational intervention KW - training experience KW - South Korea KW - telehealth N2 - Background: Ultrasound education is transitioning from in-person training to remote methods using mixed reality (MR) and 5G networks. Previous studies are mainly experimental, lacking randomized controlled trials in direct training scenarios. Objective: This study aimed to compare an MR-based telesupervised ultrasound education platform on private 5G networks with traditional in-person training for novice doctors. Methods: Conducted at a tertiary academic hospital from November to December 2023, the prospective unblinded randomized controlled pilot study assigned doctors without prior abdominal ultrasound education experience to either the telesupervision group (TG; n=20) or direct supervision group (DG; n=20). Participants received a 15-minute video lecture, conducted ultrasound on a phantom, and had 18 images scored by 2 blinded experts. Additionally, the TG received 5 minutes of training on the basic operation of a head-mounted display. Communication between doctors in the TG and supervisors was facilitated through a head-mounted display, whereas those in the DG interacted directly with supervisors. Primary outcomes were image quality scores, while secondary outcomes included procedure time, number of supervisor interventions, user experience using National Aeronautics and Space Administration-Task Load Index (NASA-TLX), System Usability Scale (SUS), and self-confidence through pre- and postsurveys. Results: Image quality scores and procedure times showed no significant differences between the groups (TG: 66.8 [SD 10.3] vs DG: 66.8 [SD 10.4], P=.84; TG: 23.8 [SD 8.0] min vs DG: 24.0 [SD 8.1] min, P=.95, respectively). However, the TG engaged in more educational interventions (TG: 4.0 [SD 2.5] vs DG: 0.8 [SD 1.1], P<.001), reflecting a more interactive training environment. TG participants reported lower NASA-TLX scores for mental demand (43.8 [SD 24.8] vs 60.6 [SD 22.4], P=.03), effort (43.1 [SD 22.9] vs 67.9 [SD 17], P<.001), and frustration (26.9 [SD 20.3] vs 45.2 [SD 27.8], P=.02), indicating a reduced cognitive load compared to the DG. The mean SUS score was also higher in the TG (66.6 [SD 9.1] vs 60.2 [SD 10.4], P=.046), suggesting better usability. Both groups showed significant improvements in confidence, with the TG showing notably greater improvement in abdominal ultrasound proficiency (pre-education TG: 1.6 [SD 0.9] vs DG: 1.7 [SD 0.9], P=.73; post-education TG: 3.8 [SD 0.9] vs DG: 2.8 [SD 1.0], P=.006). Conclusions: Although no significant differences in image quality scores were observed between groups, considerable differences in positive educational interactions, workload, and usability were evident. These findings emphasize the platform?s potential to enhance the ultrasound training experience, suggesting more interactive and efficient learning. Trial Registration: ClinicalTrials.gov NCT06171828; https://clinicaltrials.gov/study/NCT06171828 UR - https://games.jmir.org/2025/1/e63448 UR - http://dx.doi.org/10.2196/63448 ID - info:doi/10.2196/63448 ER - TY - JOUR AU - Schneider, Tim AU - Cetin, Timur AU - Uppenkamp, Stefan AU - Weyhe, Dirk AU - Muender, Thomas AU - Reinschluessel, V. Anke AU - Salzmann, Daniela AU - Uslar, Verena PY - 2025/1/8 TI - Measuring Bound Attention During Complex Liver Surgery Planning: Feasibility Study JO - JMIR Form Res SP - e62740 VL - 9 KW - workload measurement KW - virtual reality KW - VR KW - augmented reality KW - AR KW - electroencephalography KW - EEG KW - event-related potential KW - ERP KW - auditory evoked potential KW - AEP KW - oddball experiment KW - National Aeronautics and Space Administration Task Load Index KW - NASA-TLX KW - surgical planning N2 - Background: The integration of advanced technologies such as augmented reality (AR) and virtual reality (VR) into surgical procedures has garnered significant attention. However, the introduction of these innovations requires thorough evaluation in the context of human-machine interaction. Despite their potential benefits, new technologies can complicate surgical tasks and increase the cognitive load on surgeons, potentially offsetting their intended advantages. It is crucial to evaluate these technologies not only for their functional improvements but also for their impact on the surgeon?s workload in clinical settings. A surgical team today must increasingly navigate advanced technologies such as AR and VR, aiming to reduce surgical trauma and enhance patient safety. However, each innovation needs to be evaluated in terms of human-machine interaction. Even if an innovation appears to bring advancements to the field it is applied in, it may complicate the work and increase the surgeon?s workload rather than benefiting the surgeon. Objective: This study aims to establish a method for objectively determining the additional workload generated using AR or VR glasses in a clinical context for the first time. Methods: Electroencephalography (EEG) signals were recorded using a passive auditory oddball paradigm while 9 participants performed surgical planning for liver resection across 3 different conditions: (1) using AR glasses, (2) VR glasses, and (3) the conventional planning software on a computer. Results: The electrophysiological results, that is, the potentials evoked by the auditory stimulus, were compared with the subjectively perceived stress of the participants, as determined by the National Aeronautics and Space Administration-Task Load Index (NASA-TLX) questionnaire. The AR condition had the highest scores for mental demand (median 75, IQR 70-85), effort (median 55, IQR 30-65), and frustration (median 40, IQR 15-75) compared with the VR and PC conditions. The analysis of the EEG revealed a trend toward a lower amplitude of the N1 component as well as for the P3 component at the central electrodes in the AR condition, suggesting a higher workload for participants when using AR glasses. In addition, EEG components in the VR condition did not reveal any noticeable differences compared with the EEG components in the conventional planning condition. For the P1 component, the VR condition elicited significantly earlier latencies at the Fz electrode (mean 75.3 ms, SD 25.8 ms) compared with the PC condition (mean 99.4 ms, SD 28.6 ms). Conclusions: The results suggest a lower stress level when using VR glasses compared with AR glasses, likely due to the 3D visualization of the liver model. Additionally, the alignment between subjectively determined results and objectively determined results confirms the validity of the study design applied in this research. UR - https://formative.jmir.org/2025/1/e62740 UR - http://dx.doi.org/10.2196/62740 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/62740 ER - TY - JOUR AU - Chen, Jiayin AU - Or, Kalun Calvin AU - Li, Zhixian AU - Yeung, Kwong Eric Hiu AU - Chen, Tianrong PY - 2025/1/1 TI - Perceptions of Patients With Stroke Regarding an Immersive Virtual Reality?Based Exercise System for Upper Limb Rehabilitation: Questionnaire and Interview Study JO - JMIR Serious Games SP - e49847 VL - 13 KW - virtual reality KW - stroke KW - perception KW - rehabilitation KW - questionnaire KW - interview N2 - Background: With substantial resources allocated to develop virtual reality (VR)?based rehabilitation exercise programs for poststroke motor rehabilitation, it is important to understand how patients with stroke perceive these technology-driven approaches, as their perceptions can determine acceptance and adherence. Objective: This study aimed to examine the perceptions of patients with stroke regarding an immersive VR-based exercise system developed to deliver shoulder, elbow, forearm, wrist, and reaching exercises. Methods: A questionnaire was used to assess the perceptions of 21 inpatients who had experienced stroke (mean time from stroke onset: 37.2, SD 25.9 days; Brunnstrom stage of stroke recovery for the arm: 3-5) regarding the perceived usefulness of, ease of use of, attitude toward, intrinsic motivation for, and intention to use the exercise system. The measurement items were rated on a 7-point Likert scale ranging from 1 (very strongly disagree) to 7 (very strongly agree), with higher values indicating more positive perceptions. Descriptive statistics were used to summarize the responses. Moreover, we conducted semistructured interviews that were audio recorded, transcribed, and subjected to content analysis to identify thematic patterns. Results: The questionnaire results revealed that the patients? perceptions of the exercise system were positive (mean ratings >6). The content analysis revealed 6 positive themes from 73 statements about the exercise system: ease of use, usefulness, enjoyment, motivation, accessibility, and game design. Conversely, 15 statements reflected negative perceptions, which were clustered into 3 themes: difficulty in handling VR devices, uncomfortable experiences when using VR devices, and monotony. Conclusions: Integrating VR technology into poststroke functional exercises holds significant promise based on patient interests. However, patient preferences and adaptability must be considered to promote the technology?s success. VR-guided exercises should be user-friendly, health-promoting, engaging, and well-designed. Furthermore, addressing challenges, such as bulkiness, motion sickness, discomfort, and exercise monotony, is crucial for the widespread adoption and diffusion of this technology. UR - https://games.jmir.org/2025/1/e49847 UR - http://dx.doi.org/10.2196/49847 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/49847 ER - TY - JOUR AU - Chen, Yanya AU - Guan, Lina AU - Wu, Weixin AU - Ye, Liang AU - He, Yan AU - Zheng, Xiaofen AU - Li, Sicun AU - Guan, Bingsheng AU - Ming, Wai-kit PY - 2024/12/30 TI - Factors That Influence Young Adults? Preferences for Virtual Reality Exergames in a Weight Control Setting: Qualitative Study JO - J Med Internet Res SP - e58422 VL - 26 KW - virtual reality KW - games KW - weight control KW - preferences KW - young adults KW - qualitative research N2 - Background: Obesity could compromise people?s health and elevate the risk of numerous severe chronic conditions and premature mortality. Young adults are at high risk of adopting unhealthy lifestyles related to overweight and obesity, as they are at a phase marked by several significant life milestones that have been linked to weight gain. They gain weight rapidly and excess adiposity mostly accrues, compared with middle-aged and older adults when weight stabilizes or even decreases. Virtual reality exergames have the potential to increase physical activity in people?s daily lives. However, the factors that influence young adults? preference for using virtual reality exergames for weight control remain unclear. Objective: The objective of this study is to identify, characterize, and explain the factors influencing young adults' preference for weight control using virtual reality exergames. Methods: This qualitative study used semistructured interviews. In total, 4 focus group interviews were conducted with 23 young adults aged between 18 and 25 years. The qualitative data were analyzed using the Colaizzi phenomenological methodology. Results: In total, 3 major factors were found to influence young adults? preference for virtual reality exergames in weight control settings: individual factors, social or environmental factors, and expectations of virtual reality exergames. Individual factors included experience with previous weight control methods, previous experience with virtual reality, psychological status, attitudes toward personal BMI, preference for exercise type, and acceptance of virtual reality exergames. Social or environmental factors included social definitions of beauty, weather or public health events, and knowledge of virtual reality provided. Expectations of virtual reality exergames included cost of the device, the fun of virtual reality exergames, supervision, modality of virtual reality exergames, feedback after exercise, convenience to use, and weight loss effect. Conclusions: Young adults take various factors into account when deciding whether to use virtual reality exergames for weight control. These factors can inform the development and further refinement of devices, guides, and policies related to virtual reality exergames for controlling weight. UR - https://www.jmir.org/2024/1/e58422 UR - http://dx.doi.org/10.2196/58422 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58422 ER - TY - JOUR AU - Wang, Y. Ellen AU - Qian, Daniel AU - Zhang, Lijin AU - Li, S-K Brian AU - Ko, Brian AU - Khoury, Michael AU - Renavikar, Meghana AU - Ganesan, Avani AU - Caruso, J. Thomas PY - 2024/12/23 TI - Acceptance of Virtual Reality in Trainees Using a Technology Acceptance Model: Survey Study JO - JMIR Med Educ SP - e60767 VL - 10 KW - virtual reality KW - technology assessment KW - graduate medical education trainees KW - medical education KW - technology adoption KW - Technology Acceptance Model KW - factor analysis KW - VR KW - TAM KW - United Theory of Acceptance and Use of Technology KW - UTAUT N2 - Background: Virtual reality (VR) technologies have demonstrated therapeutic usefulness across a variety of health care settings. However, graduate medical education (GME) trainee perspectives on VR acceptability and usability are limited. The behavioral intentions of GME trainees with regard to VR as an anxiolytic tool have not been characterized through a theoretical framework of technology adoption. Objective: The primary aim of this study was to apply a hybrid Technology Acceptance Model (TAM) and a United Theory of Acceptance and Use of Technology (UTAUT) model to evaluate factors that predict the behavioral intentions of GME trainees to use VR for patient anxiolysis. The secondary aim was to assess the reliability of the TAM-UTAUT. Methods: Participants were surveyed in June 2023. GME trainees participated in a VR experience used to reduce perioperative anxiety. Participants then completed a survey evaluating demographics, perceptions, attitudes, environmental factors, and behavioral intentions that influence the adoption of new technologies. Results: In total, 202 of 1540 GME trainees participated. Only 198 participants were included in the final analysis (12.9% participation rate). Perceptions of usefulness, ease of use, and enjoyment; social influence; and facilitating conditions predicted intention to use VR. Age, past use, price willing to pay, and curiosity were less strong predictors of intention to use. All confirmatory factor analysis models demonstrated a good fit. All domain measurements demonstrated acceptable reliability. Conclusions: This TAM-UTAUT demonstrated validity and reliability for predicting the behavioral intentions of GME trainees to use VR as a therapeutic anxiolytic in clinical practice. Social influence and facilitating conditions are modifiable factors that present opportunities to advance VR adoption, such as fostering exposure to new technologies and offering relevant training and social encouragement. Future investigations should study the model?s reliability within specialties in different geographic locations. UR - https://mededu.jmir.org/2024/1/e60767 UR - http://dx.doi.org/10.2196/60767 ID - info:doi/10.2196/60767 ER - TY - JOUR AU - Krohn, Maria AU - Rintala, Aki AU - Immonen, Jaakko AU - Sjögren, Tuulikki PY - 2024/12/2 TI - The Effectiveness of Therapeutic Exercise Interventions With Virtual Reality on Balance and Walking Among Persons With Chronic Stroke: Systematic Review, Meta-Analysis, and Meta-Regression of Randomized Controlled Trials JO - J Med Internet Res SP - e59136 VL - 26 KW - stroke KW - chronic KW - virtual reality KW - physiotherapy KW - therapeutic exercise KW - balance KW - walking N2 - Background: Well-targeted balance, walking, and weight-shift training can improve balance capabilities in the chronic phase of stroke. There is an urgent need for a long-term approach to rehabilitation that extends beyond the acute and subacute phases, supporting participation without increasing the demand for health care staff. Objective: This study aims to evaluate the effectiveness of therapeutic exercise interventions with virtual reality (VR) training on balance and walking at the activity and participation levels in individuals with chronic stroke, compared with control groups receiving no treatment, conventional physical therapy, specific training, similar treatment, or identical treatment without VR. Methods: Studies were searched across 6 databases. The inclusion criteria were as follows: Adults aged 18 years or older with a stroke diagnosis for at least 6 months (population). Therapeutic exercises within a VR environment, using VR glasses or interactive games (intervention). Control groups without the use of VR (including no treatment, conventional physical therapy, specific training, similar treatment without VR, or identical treatment without the additional use of VR; comparison). We evaluated the Berg Balance Scale score, Functional Reach Test performance, Activities-specific Balance Confidence Scale score, Six-minute Walk Test, Two-minute Walk Test, 10-meter Walk Test results, and cadence (outcome measures). We investigated randomized controlled trials (study design). A meta-analysis and a meta-regression analysis were conducted to evaluate whether the content of VR interventions or control groups, as well as the level of VR immersion used, was related to balance or walking outcomes. Results: A total of 43 randomized controlled trials involving 1136 participants were included in this review. The use of VR training in therapeutic exercise interventions had a large effect on balance (standardized mean difference 0.51, 95% CI 0.29-0.72; P<.001) and a moderate effect on walking (standardized mean difference 0.31, 95% CI 0.09-0.53; P=.006) in individuals with chronic stroke, compared with pooled control groups (no treatment, conventional physical therapy, specific training, similar treatment, or identical treatment without the use of VR). According to the meta-regression findings, the content of VR interventions (P=.52), the type of control groups (P=.79), and the level of VR immersion (P=.82) were not significantly related to the pooled balance or walking outcomes. The GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) was moderate for balance and low for walking. Conclusions: Therapeutic exercise training with VR had a positive, albeit moderate, effect on balance and a low impact on walking at the level of activity (capacity), even in the chronic phase of stroke, without serious side effects. The results are applicable to working-aged stroke rehabilitees who are able to walk without assistance. Further research is needed with defined VR methods and outcomes that assess performance at the level of real-life participation. UR - https://www.jmir.org/2024/1/e59136 UR - http://dx.doi.org/10.2196/59136 UR - http://www.ncbi.nlm.nih.gov/pubmed/39621381 ID - info:doi/10.2196/59136 ER - TY - JOUR AU - Peterson, M. Colleen AU - Visclosky, Timothy AU - Flannagan, A. Carol AU - Mahajan, Prashant AU - Gabanyicz, Andrew AU - Bouchard, Jean-Jacques AU - Cervantes, Vincent AU - Gribbin, William AU - Hashikawa, Nobuhide Andrew PY - 2024/11/26 TI - Evaluating a Virtual Reality Game to Enhance Teen Distracted Driving Education: Mixed Methods Pilot Study JO - JMIR Form Res SP - e60674 VL - 8 KW - safety KW - virtual reality KW - VR KW - distracted driving KW - intervention KW - inattention KW - smartphone KW - novice drivers KW - risky driving KW - mobile phone KW - awareness KW - game KW - driving education KW - gamification KW - adolescent N2 - Background: Inexperienced adolescent drivers are particularly susceptible to engaging in distracted driving behaviors (DDBs) such as texting while driving (TWD). Traditional driver education approaches have shown limited success in reducing motor vehicle crashes among young drivers. Objective: We tested an innovative approach to help address the critical issue of DDB among teenagers. We investigated the effectiveness of using a novel virtual reality (VR) game ?Distracted Navigator? to educate novice teenage drivers about DDB. Methods: The game consisted of maneuvering a spaceship around asteroids while engaging in simulated DDB (eg, inputting numbers into a keypad). A physician-facilitated discussion, based on the theory of planned behavior, linked gameplay to real-life driving. Teenagers were recruited for the in-person study and randomly assigned at the block level to intervention (VR gameplay or discussion) and control groups (discussion only), approximating a 2:1 ratio. Unblinded, bivariate statistical analyses (all 2-tailed t tests or chi-square tests) and regression analyses measured programming impact on TWD-related beliefs and intentions. Content analysis of focus group interviews identified thematic feedback on the programming. Results: Of the 24 participants, 15 (63%) were male; their ages ranged from 14 to 17 (mean 15.8, SD 0.92) years, and all owned cell phones. Compared to the control group (n=7, 29%), the intervention group (n=17, 71%) was more likely to report that the programming had positively changed how they felt about texting and driving (?218=?8.3; P=.02). However, specific TWD attitudes and intentions were not different by treatment status. Irrespective of treatment, pre- and postintervention scores indicated reduced confidence in safely TWD (ie, perceived behavioral control; ?=?.78; t46=?2.66; P=.01). Thematic analysis revealed the following: (1) the VR gameplay adeptly portrayed real-world consequences of texting and driving, (2) participants highly valued the interactive nature of the VR game and discussion, (3) both the VR game and facilitated discussion were deemed as integral and complementary components, and (4) feedback for improving the VR game and discussion. Conclusions: Our findings show that the novel use of immersive VR experiences with interactive discussions can raise awareness of DDB consequences and is a promising method to enhance driving safety education. The widespread accessibility of VR technology allows for scalable integration into driver training programs, warranting a larger, prospective, randomized study. UR - https://formative.jmir.org/2024/1/e60674 UR - http://dx.doi.org/10.2196/60674 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60674 ER - TY - JOUR AU - Mørk, Gry AU - Bonsaksen, Tore AU - Larsen, Sønnik Ole AU - Kunnikoff, Martin Hans AU - Lie, Stangeland Silje PY - 2024/11/19 TI - Virtual Reality Simulation in Undergraduate Health Care Education Programs: Usability Study JO - JMIR Med Educ SP - e56844 VL - 10 KW - 360° videos KW - health professions education KW - virtual reality KW - usability study KW - undergraduates KW - university KW - students KW - simulation N2 - Background: Virtual reality (VR) is increasingly being used in higher education for clinical skills training and role-playing among health care students. Using 360° videos in VR headsets, followed by peer debrief and group discussions, may strengthen students? social and emotional learning. Objective: This study aimed to explore student-perceived usability of VR simulation in three health care education programs in Norway. Methods: Students from one university participated in a VR simulation program. Of these, students in social education (n=74), nursing (n=45), and occupational therapy (n=27) completed a questionnaire asking about their perceptions of the usability of the VR simulation and the related learning activities. Differences between groups of students were examined with Pearson chi-square tests and with 1-way ANOVA. Qualitative content analysis was used to analyze data from open-ended questions. Results: The nursing students were most satisfied with the usability of the VR simulation, while the occupational therapy students were least satisfied. The nursing students had more often prior experience from using VR technology (60%), while occupational therapy students less often had prior experience (37%). Nevertheless, high mean scores indicated that the students experienced the VR simulation and the related learning activities as very useful. The results also showed that by using realistic scenarios in VR simulation, health care students can be prepared for complex clinical situations in a safe environment. Also, group debriefing sessions are a vital part of the learning process that enhance active involvement with peers. Conclusions: VR simulation has promise and potential as a pedagogical tool in health care education, especially for training soft skills relevant for clinical practice, such as communication, decision-making, time management, and critical thinking. UR - https://mededu.jmir.org/2024/1/e56844 UR - http://dx.doi.org/10.2196/56844 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56844 ER - TY - JOUR AU - Drummond, David AU - Gonsard, Apolline PY - 2024/11/13 TI - Definitions and Characteristics of Patient Digital Twins Being Developed for Clinical Use: Scoping Review JO - J Med Internet Res SP - e58504 VL - 26 KW - patient simulation KW - cyber-physical systems KW - telemonitoring KW - personalized medicine KW - precision medicine KW - digital twin N2 - Background: The concept of digital twins, widely adopted in industry, is entering health care. However, there is a lack of consensus on what constitutes the digital twin of a patient. Objective: The objective of this scoping review was to analyze definitions and characteristics of patient digital twins being developed for clinical use, as reported in the scientific literature. Methods: We searched PubMed, Scopus, Embase, IEEE, and Google Scholar for studies claiming digital twin development or evaluation until August 2023. Data on definitions, characteristics, and development phase were extracted. Unsupervised classification of claimed digital twins was performed. Results: We identified 86 papers representing 80 unique claimed digital twins, with 98% (78/80) in preclinical phases. Among the 55 papers defining ?digital twin,? 76% (42/55) described a digital replica, 42% (23/55) mentioned real-time updates, 24% (13/55) emphasized patient specificity, and 15% (8/55) included 2-way communication. Among claimed digital twins, 60% (48/80) represented specific organs (primarily heart: 15/48, 31%; bones or joints: 10/48, 21%; lung: 6/48, 12%; and arteries: 5/48, 10%); 14% (11/80) embodied biological systems such as the immune system; and 26% (21/80) corresponded to other products (prediction models, etc). The patient data used to develop and run the claimed digital twins encompassed medical imaging examinations (35/80, 44% of publications), clinical notes (15/80, 19% of publications), laboratory test results (13/80, 16% of publications), wearable device data (12/80, 15% of publications), and other modalities (32/80, 40% of publications). Regarding data flow between patients and their virtual counterparts, 16% (13/80) claimed that digital twins involved no flow from patient to digital twin, 73% (58/80) used 1-way flow from patient to digital twin, and 11% (9/80) enabled 2-way data flow between patient and digital twin. Based on these characteristics, unsupervised classification revealed 3 clusters: simulation patient digital twins in 54% (43/80) of publications, monitoring patient digital twins in 28% (22/80) of publications, and research-oriented models unlinked to specific patients in 19% (15/80) of publications. Simulation patient digital twins used computational modeling for personalized predictions and therapy evaluations, mostly for one-time assessments, and monitoring digital twins harnessed aggregated patient data for continuous risk or outcome forecasting and care optimization. Conclusions: We propose defining a patient digital twin as ?a viewable digital replica of a patient, organ, or biological system that contains multidimensional, patient-specific information and informs decisions? and to distinguish simulation and monitoring digital twins. These proposed definitions and subtypes offer a framework to guide research into realizing the potential of these personalized, integrative technologies to advance clinical care. UR - https://www.jmir.org/2024/1/e58504 UR - http://dx.doi.org/10.2196/58504 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58504 ER - TY - JOUR AU - Oliveira, Joana AU - Aires Dias, Joana AU - Correia, Rita AU - Pinheiro, Raquel AU - Reis, Vítor AU - Sousa, Daniela AU - Agostinho, Daniel AU - Simões, Marco AU - Castelo-Branco, Miguel PY - 2024/10/24 TI - Exploring Immersive Multimodal Virtual Reality Training, Affective States, and Ecological Validity in Healthy Firefighters: Quasi-Experimental Study JO - JMIR Serious Games SP - e53683 VL - 12 KW - virtual reality KW - firefighter KW - training KW - posttraumatic stress disorder KW - PTSD KW - emotion KW - situational awareness KW - engagement KW - ecological validity KW - multivariate approach N2 - Background: Firefighters face stressful life-threatening events requiring fast decision-making. To better prepare for those situations, training is paramount, but errors in real-life training can be harmful. Virtual reality (VR) simulations provide the desired realism while enabling practice in a secure and controlled environment. Firefighters? affective states are also crucial as they are a higher-risk group. Objective: To assess the impact on affective states of 2 simulated immersive experiences in a sample of healthy firefighters (before, during, and after the simulation), we pursued a multivariate approach comprising cognitive performance, situational awareness, depression, anxiety, stress, number of previous adverse events experienced, posttraumatic stress disorder (PTSD) severity, and emotions. The efficacy and ecological validity of an innovative VR haptic system were also tested, exploring its impact on performance. Methods: In collaboration with the Portuguese National Fire Service School, we exposed 22 healthy firefighters to 2 immersive scenarios using the FLAIM Trainer VR system (neutral and arousing scenarios) while recording physiological data in a quasi-experimental study. Baseline cognitive performance, depression, anxiety, stress, number of adverse events, and severity of PTSD symptoms were evaluated. Positive and negative affective states were measured before, between, and after each scenario. Situational awareness, sense of presence, ecological validity, engagement, and negative effects resulting from VR immersion were tested. Results: Baseline positive affect score was high (mean 32.4, SD 7.2) and increased after the VR tasks (partial ?2=0.52; Greenhouse-Geisser F1.82,32.78=19.73; P<.001). Contrarily, mean negative affect score remained low (range 11.0-11.9) throughout the study (partial ?2=0.02; Greenhouse-Geisser F2.13,38.4=0.39; P=.69). Participants? feedback on the VR sense of presence was also positive, reporting a high sense of physical space (mean score 3.9, SD 0.8), ecological validity (mean score 3.8, SD 0.6), and engagement (mean score 3.8, SD 0.6). Engagement was related to the number of previously experienced adverse events (r=0.49; P=.02) and positive affect (after the last VR task; r=0.55; P=.02). Conversely, participants reported few negative effects (mean score 1.7, SD 0.6). The negative effects correlated positively with negative affect (after the last VR task; r=0.53; P=.03); and avoidance (r=0.73; P<.001), a PTSD symptom, controlling for relevant baseline variables. Performance related to situational awareness was positive (mean 46.4, SD 34.5), although no relation was found to metacognitively perceived situational awareness (r=?0.12; P=.59). Conclusions: We show that VR is an effective alternative to in-person training as it was considered ecologically valid and engaging while promoting positive emotions, with few negative repercussions. This corroborates the use of VR to test firefighters? performance and situational awareness. Further research is needed to ascertain that firefighters with PTSD symptomatology are not negatively affected by VR. This study favors the use of VR training and provides new insights on its emotional and cognitive impact on the trainee. UR - https://games.jmir.org/2024/1/e53683 UR - http://dx.doi.org/10.2196/53683 UR - http://www.ncbi.nlm.nih.gov/pubmed/39446479 ID - info:doi/10.2196/53683 ER - TY - JOUR AU - Li, Yijun AU - Shiyanov, Irina AU - Muschalla, Beate PY - 2024/10/4 TI - Older Adults? Acceptance of a Virtual Reality Group Intervention in Nursing Homes: Pre-Post Study Under Naturalistic Conditions JO - JMIR Hum Factors SP - e56278 VL - 11 KW - virtual reality KW - VR KW - computer-generated simulation KW - simulation KW - technology acceptance KW - nursing home KW - nursing facility KW - long-term care center KW - long-term care facility KW - older adult KW - elder KW - elderly KW - older person KW - older people KW - senior KW - understanding human behavior KW - meaningful activity KW - group intervention KW - human behavior N2 - Background: Virtual reality (VR) group activities can act as interventions against inactivity and lack of meaningful activities in nursing homes. The acceptance of VR among older adults has been explored from different perspectives. However, research on the impact of older adults? individual characteristics on the acceptance of VR group activities in nursing homes is necessary. Objective: This study investigates the impact of individual characteristics (eg, psychosocial capacities) on VR acceptance among older adults in nursing homes, as well as this group?s perceptions of VR after participating in a VR intervention. Methods: In this pre-post study conducted in nursing homes, we applied a VR group intervention with 113 older adult participants. These participants were categorized into two groups based on their naturalistic choice to join the intervention: a higher VR acceptance group (n=90) and a lower VR acceptance group (n=23). We compared the two groups with respect to their sociodemographic characteristics, psychosocial capacities, and attitudes toward new technologies. Additionally, we examined the participants? perceptions of VR. Results: The results show that those with lower acceptance of VR initially reported higher capacities in organizing daily activities and stronger interpersonal relationships compared to older adults with higher VR acceptance. The VR group activity might hold limited significance for the latter group, but it offers the chance to activate older adults with lower proactivity. Openness to new technology was associated with a favorable perception of VR. After the VR intervention, the acceptance of VR remained high. Conclusions: This study investigates the acceptance of VR group events as meaningful activities for older adults in nursing homes under naturalistic conditions. The results indicate that the VR group intervention effectively addressed low proactivity and interpersonal relationship issues among older adults in nursing homes. Older adults should be encouraged to experience VR if the opportunity to participate is offered, potentially facilitated by caregivers or trusted individuals. UR - https://humanfactors.jmir.org/2024/1/e56278 UR - http://dx.doi.org/10.2196/56278 ID - info:doi/10.2196/56278 ER - TY - JOUR AU - Kiani, Parmiss AU - Dolling-Boreham, Roberta AU - Hameed, Saif Mohamed AU - Masino, Caterina AU - Fecso, Andras AU - Okrainec, Allan AU - Madani, Amin PY - 2024/9/10 TI - Usability, Ergonomics, and Educational Value of a Novel Telestration Tool for Surgical Coaching: Usability Study JO - JMIR Hum Factors SP - e57243 VL - 11 KW - augmented reality KW - AR KW - surgical training KW - telestration KW - tele-stration KW - surgical training technology KW - minimally invasive surgery KW - surgery KW - surgeon KW - surgeons KW - surgical KW - surgical coaching KW - surgical teaching KW - telemonitoring KW - telemonitor KW - tele-monitoring KW - tele-monitor KW - usability KW - usable KW - usableness KW - usefulness KW - utility KW - digital health KW - digital technology KW - digital intervention KW - digital interventions N2 - Background: Telementoring studies found technical challenges in achieving accurate and stable annotations during live surgery using commercially available telestration software intraoperatively. To address the gap, a wireless handheld telestration device was developed to facilitate dynamic user interaction with live video streams. Objective: This study aims to find the perceived usability, ergonomics, and educational value of a first-generation handheld wireless telestration platform. Methods: A prototype was developed with four core hand-held functions: (1) free-hand annotation, (2) cursor navigation, (3) overlay and manipulation (rotation) of ghost (avatar) instrumentation, and (4) hand-held video feed navigation on a remote monitor. This device uses a proprietary augmented reality platform. Surgeons and trainees were invited to test the core functions of the platform by performing standardized tasks. Usability and ergonomics were evaluated with a validated system usability scale and a 5-point Likert scale survey, which also evaluated the perceived educational value of the device. Results: In total, 10 people (9 surgeons and 1 senior resident; 5 male and 5 female) participated. Participants strongly agreed or agreed (SA/A) that it was easy to perform annotations (SA/A 9, 90% and neutral 0, 0%), video feed navigation (SA/A 8, 80% and neutral 1, 10%), and manipulation of ghost (avatar) instruments on the monitor (SA/A 6, 60% and neutral 3, 30%). Regarding ergonomics, 40% (4) of participants agreed or strongly agreed (neutral 4, 40%) that the device was physically comfortable to use and hold. These results are consistent with open-ended comments on the device?s size and weight. The average system usability scale was 70 (SD 12.5; median 75, IQR 63-84) indicating an above average usability score. Participants responded favorably to the device?s perceived educational value, particularly for postoperative coaching (agree 6, 60%, strongly agree 4, 40%). Conclusions: This study presents the preliminary usability results of a novel first-generation telestration tool customized for use in surgical coaching. Favorable usability and perceived educational value were reported. Future iterations of the device should focus on incorporating user feedback and additional studies should be conducted to evaluate its effectiveness for improving surgical education. Ultimately, such tools can be incorporated into pedagogical models of surgical coaching to optimize feedback and training. UR - https://humanfactors.jmir.org/2024/1/e57243 UR - http://dx.doi.org/10.2196/57243 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57243 ER - TY - JOUR AU - Locke, W. Brian AU - Tsai, Te-yi AU - Reategui-Rivera, Mahony C. AU - Gabriel, S. Aileen AU - Smiley, Aref AU - Finkelstein, Joseph PY - 2024/8/9 TI - Immersive Virtual Reality Use in Medical Intensive Care: Mixed Methods Feasibility Study JO - JMIR Serious Games SP - e62842 VL - 12 KW - immersive virtual reality KW - intensive care unit KW - distraction therapy KW - virtual reality KW - mixed methods KW - feasibility study KW - semistructured interview KW - therapy KW - therapist KW - critical illness KW - critically ill KW - adult KW - patient acceptance KW - user experience KW - games for health KW - serious games KW - gamification N2 - Background: Immersive virtual reality (VR) is a promising therapy to improve the experience of patients with critical illness and may help avoid postdischarge functional impairments. However, the determinants of interest and usability may vary locally and reports of uptake in the literature are variable. Objective: The aim of this mixed methods feasibility study was to assess the acceptability and potential utility of immersive VR in critically ill patients at a single institution. Methods: Adults without delirium who were admitted to 1 of 2 intensive care units were offered the opportunity to participate in 5-15 minutes of immersive VR delivered by a VR headset. Patient vital signs, heart rate variability, mood, and pain were assessed before and after the VR experience. Pre-post comparisons were performed using paired 2-sided t tests. A semistructured interview was administered after the VR experience. Patient descriptions of the experience, issues, and potential uses were summarized with thematic analysis. Results: Of the 35 patients offered the chance to participate, 20 (57%) agreed to partake in the immersive VR experience, with no difference in participation rate by age. Improvements were observed in overall mood (mean difference 1.8 points, 95% CI 0.6-3.0; P=.002), anxiety (difference of 1.7 points, 95% CI 0.8-2.7; P=.001), and pain (difference of 1.3 points, 95% CI 0.5-2.1; P=.003) assessed on 1-10 scales. The heart rate changed by a mean of ?1.1 (95% CI ?0.3 to ?1.9; P=.008) beats per minute (bpm) from a baseline of 86.1 (SD 11.8) bpm and heart rate variability, assessed by the stress index (SI), changed by a mean of ?5.0 (95% CI ?1.5 to ?8.5; P=.004) seconds?2 from a baseline SI of 40.0 (SD 23) seconds?2. Patients commented on the potential for the therapy to address pain, lessen anxiety, and facilitate calmness. Technical challenges were minimal and there were no adverse effects observed. Conclusions: Patient acceptance of immersive VR was high in a mostly medical intensive care population with little prior VR experience. Patients commented on the potential of immersive VR to ameliorate cognitive and emotional symptoms. Investigators can consider integrating minimally modified commercial VR headsets into the existing intensive care unit workflow to further assess VR?s efficacy for a variety of endpoints. UR - https://games.jmir.org/2024/1/e62842 UR - http://dx.doi.org/10.2196/62842 UR - http://www.ncbi.nlm.nih.gov/pubmed/39046869 ID - info:doi/10.2196/62842 ER - TY - JOUR AU - Lonati, Caterina AU - Wellhausen, Marie AU - Pennig, Stefan AU - Röhrßen, Thomas AU - Kircelli, Fatih AU - Arendt, Svenja AU - Tschulena, Ulrich PY - 2024/8/6 TI - The Use of a Novel Virtual Reality Training Tool for Peritoneal Dialysis: Qualitative Assessment Among Health Care Professionals JO - JMIR Med Educ SP - e46220 VL - 10 KW - peritoneal dialysis KW - virtual reality KW - patient education KW - patient training KW - chronic kidney disease KW - nursing KW - qualitative assessment N2 - Background: Effective peritoneal dialysis (PD) training is essential for performing dialysis at home and reducing the risk of peritonitis and other PD-related infections. Virtual reality (VR) is an innovative learning tool that is able to combine theoretical information, interactivity, and behavioral instructions while offering a playful learning environment. To improve patient training for PD, Fresenius Medical Care launched the stay?safe MyTraining VR, a novel educational program based on the use of a VR headset and a handheld controller. Objective: This qualitative assessment aims to investigate opinions toward the new tool among the health care professionals (HCPs) who were responsible for implementing the VR application. Methods: We recruited nursing staff and nephrologists who have gained practical experience with the stay?safe MyTraining VR within pilot dialysis centers. Predetermined open-ended questions were administered during individual and group video interviews. Results: We interviewed 7 HCPs who have 2 to 20 years of experience in PD training. The number of patients trained with the stay?safe MyTraining VR ranged from 2 to 5 for each professional. The stay?safe MyTraining VR was well accepted and perceived as a valuable supplementary tool for PD training. From the respondents? perspective, the technology improved patients? learning experience by facilitating the internalization of both medical information and procedural skills. HCPs highlighted that the opportunity offered by VR to reiterate training activities in a positive and safe learning environment, according to each patient?s needs, can facilitate error correction and implement a standardized training curriculum. However, VR had limited use in the final phase of the patient PD training program, where learners need to get familiar with the handling of the materials. Moreover, the traditional PD training was still considered essential to manage the emotional and motivational aspects and address any patient-specific application-oriented questions. In addition to its use within PD training, VR was perceived as a useful tool to support the decision-making process of patients and train other HCPs. Moreover, VR introduction was associated with increased efficiency and productivity of HCPs because it enabled them to perform other activities while the patient was practicing with the device. As for patients? acceptance of the new tool, interviewees reported positive feedback, including that of older adults. Limited use with patients experiencing dementia or severe visual impairment or lacking sensomotoric competence was mentioned. Conclusions: The stay?safe MyTraining VR is suggested to improve training efficiency and efficacy and thus could have a positive impact in the PD training scenario. Our study offers a process proposal that can serve as a guide to the implementation of a VR-based PD training program within other dialysis centers. Dedicated research is needed to assess the operational benefits and the consequences on patient management. UR - https://mededu.jmir.org/2024/1/e46220 UR - http://dx.doi.org/10.2196/46220 UR - http://www.ncbi.nlm.nih.gov/pubmed/39106093 ID - info:doi/10.2196/46220 ER - TY - JOUR AU - Imai, Ayu AU - Matsuoka, Teruyuki AU - Nakayama, Chikara AU - Hashimoto, Nana AU - Sano, Mutsuo AU - Narumoto, Jin PY - 2024/8/1 TI - Effectiveness of a Virtual Reality Open-Air Bath Program in Reducing Loneliness and Improving Brain Function for Dementia Prevention in Older Adults: Protocol for a Prospective Randomized Crossover Study JO - JMIR Res Protoc SP - e57101 VL - 13 KW - loneliness KW - virtual reality KW - VR KW - Alzheimer disease KW - predementia KW - intervention KW - subjective cognitive decline KW - mild cognitive impairment KW - dementia KW - older adult KW - geriatric KW - depression KW - cognitive impairments N2 - Background: Older adults often face loneliness due to chronic illness or loss of close ones, a situation worsened by the COVID-19 pandemic. Increased loneliness heightens the risk of diseases, especially dementia, necessitating urgent action. Objective: This study aims to assess the impact of a virtual reality (VR)?based open-air bath program on depression and loneliness in older individuals with subjective cognitive decline/mild cognitive impairment attending the Dementia Medical Center in Kyoto, Japan. We further aim to evaluate the feasibility of the program (participant recruitment and adherence) and to measure program enjoyment and satisfaction. Methods: The study design is a crossover trial with a 1:1 ratio, wherein 12 participants will be randomly assigned to groups 1 and 2, with group 2 serving as a waitlist control and group 1 receiving the VR program from the onset for 6 months; the VR program will be conducted 6 times (monthly). Program completion for group 1 will be followed by an observation period from months 7 to 12. Group 2 will participate in the VR program from months 7 to 12, with an observation period from months 1 to 6. Cognitive tests, psychiatric assessments, and the University of California, Los Angeles Loneliness Scale will be conducted before the study, at 6 months, and at 12 months. Results will be analyzed using repeated-measures ANOVA. Head magnetic resonance imaging and single-photon emission computed tomography scans will be performed before and after the VR program to evaluate changes and effects on brain regions. Results: Recruitment began in September 2023 and data collection is expected to be completed by March 2025. Complete study results will be published by September 2025. Conclusions: This study examines the preliminary effects of VR on loneliness in older adults with predementia through open-air bath simulations. VR experiences could benefit this population, particularly those with limited outdoor activities. Quantifying VR?s impact will aid in determining the size for a larger clinical trial. Qualitative results will inform participation mechanisms and guide the implementation and design of future trials. Trial Registration: University hospital Medical Information Network UMIN000052667; https://tinyurl.com/3yaccay5 International Registered Report Identifier (IRRID): DERR1-10.2196/57101 UR - https://www.researchprotocols.org/2024/1/e57101 UR - http://dx.doi.org/10.2196/57101 UR - http://www.ncbi.nlm.nih.gov/pubmed/39088243 ID - info:doi/10.2196/57101 ER - TY - JOUR AU - Park, Subin AU - Shin, Ju Hui AU - Kwak, Hyoeun AU - Lee, Joo Hyun PY - 2024/7/24 TI - Effects of Immersive Technology?Based Education for Undergraduate Nursing Students: Systematic Review and Meta-Analysis Using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) Approach JO - J Med Internet Res SP - e57566 VL - 26 KW - nursing education KW - nursing students KW - immersive technology KW - systematic review KW - meta-analysis KW - virtual reality KW - augmented reality KW - extended reality KW - simulation-based learning KW - medical education N2 - Background: The adoption of immersive technology in simulation-based nursing education has grown significantly, offering a solution to resource limitations and enabling safe access to clinical environments. Despite its advantages, there are still diverse reports regarding the effectiveness of immersive technology. It is crucial to verify the effectiveness of immersive technology in nursing education to inform future educational programs. Objective: This systematic review aimed to identify the contents of immersive technology?based education for undergraduate nursing students and evaluate the effectiveness of immersive technology compared to traditional teaching methods. Methods: A literature search was performed using 4 databases: PubMed, CINAHL, Embase, and Web of Science; the latest search was completed on January 19, 2023. The inclusion criteria were as follows: participants were undergraduate nursing students; studies were published in Korean or English; designs included randomized controlled trials (RCTs) or nonrandomized studies; and interventions involved virtual reality (VR), augmented reality (AR), mixed reality, or extended reality. Quality assessment was conducted using Cochrane Risk-of-Bias Tool version 2 for RCTs and the Risk-of-Bias Assessment Tool for Nonrandomized Studies. The main outcomes of the included studies were classified according to the New World Kirkpatrick Model (NWKM), ranging from level 1 (reaction) to level 4 (results). Meta-analysis was conducted using RevMan 5.4 software, and subgroup analysis was conducted due to heterogeneity of the results of the meta-analysis. The Grading of Recommendations, Assessment, Development, and Evaluation approach was adopted for assessing certainty and synthesizing results of the relevant literature. Results: A total of 23 studies were included, with participant numbers ranging from 33 to 289. Of these, 19 (82.6%) studies adopted VR to simulate various nursing scenarios, including disaster training, resuscitation, health assessments, and home health care; 4 (17.4%) studies used AR technologies; and 15 (65.2%) studies involved virtual patients in their scenarios. Based on the NWKM, the main outcome variables were classified as level 1 (usability and satisfaction), level 2 (knowledge, motivation, confidence, performance, attitude, and self-efficacy), and level 3 (clinical reasoning); level 4 outcomes were not found in the selected studies. Results of the subgroup analysis showed that immersive technology?based nursing education is more effective than traditional education in knowledge attainment (standard mean difference [SMD]=0.59, 95% CI 0.28-0.90, P<.001, I2=49%). Additionally, there were significant difference differences between the experimental and control group in confidence (SMD=0.70, 95% CI 0.05-1.35, P=.03, I2=82%) and self-efficacy (SMD=0.86, 95% CI 0.42-1.30, P<.001, I2=63%). Conclusions: These findings support the effectiveness of immersive technology?based education for undergraduate nursing students, despite heterogeneity in methods and interventions. We suggest that long-term cohort studies be conducted to evaluate the effects of immersive technology?based nursing education on NWKM level 4. UR - https://www.jmir.org/2024/1/e57566 UR - http://dx.doi.org/10.2196/57566 UR - http://www.ncbi.nlm.nih.gov/pubmed/38978483 ID - info:doi/10.2196/57566 ER - TY - JOUR AU - Bonneterre, Solenne AU - Zerhouni, Oulmann AU - Boffo, Marilisa PY - 2024/7/9 TI - The Influence of Billboard-Based Tobacco Prevention Posters on Memorization, Attitudes, and Craving: Immersive Virtual Reality Study JO - J Med Internet Res SP - e49344 VL - 26 KW - tobacco KW - smoking KW - health promotion KW - health prevention campaigns KW - immersive virtual reality KW - incidental exposure KW - advertising N2 - Background: Health prevention campaigns often face challenges in reaching their target audience and achieving the desired impact on health behaviors. These campaigns, particularly those aimed at reducing tobacco use, require rigorous evaluation methods to assess their effectiveness. Objective: This study aims to use immersive virtual reality (iVR) to systematically evaluate recall, attitudinal, and craving responses to antitobacco prevention messages when presented in a realistic virtual environment, thereby exploring the potential of iVR as a novel tool to improve the effectiveness of public health campaigns. Methods: A total of 121 undergraduate students (mean age 19.6, SD 3.7 years), mostly female (n=99, 82.5%), were invited to take a guided walk in the virtual environment, where they were randomly exposed to a different ratio of prevention and general advertising posters (80/20 or 20/80) depending on the experimental condition. Participants? gaze was tracked throughout the procedure, and outcomes were assessed after the iVR exposure. Results: Incidental exposure to antitobacco prevention and general advertising posters did not significantly alter attitudes toward tobacco. Memorization of prevention posters was unexpectedly better in the condition where advertising was more frequent (?=?6.15; P<.001), and high contrast between poster types led to a better memorization of the less frequent type. Despite a nonsignificant trend, directing attention to prevention posters slightly improved their memorization (?=.02; P=.07). In addition, the duration of exposure to prevention posters relative to advertisements negatively affected memorization of advertising posters (?=?2.30; P=.01). Conclusions: Although this study did not find significant changes in attitudes toward tobacco after exposure to prevention campaigns using iVR, the technology does show promise as an evaluation tool. To fully evaluate the use of iVR in public health prevention strategies, future research should examine different types of content, longer exposure durations, and different contexts. Trial Registration: Open Science Framework E3YK7; https://osf.io/e3yk7 UR - https://www.jmir.org/2024/1/e49344 UR - http://dx.doi.org/10.2196/49344 UR - http://www.ncbi.nlm.nih.gov/pubmed/38980707 ID - info:doi/10.2196/49344 ER - TY - JOUR AU - Steindorff, Jenny-Victoria AU - Redlich, Lisa-Marie AU - Paulicke, Denny AU - Jahn, Patrick PY - 2024/7/8 TI - Use and Design of Virtual Reality?Supported Learning Scenarios in the Vocational Qualification of Nursing Professionals: Scoping Review JO - JMIR Serious Games SP - e53356 VL - 12 KW - scoping review KW - generalist nursing education KW - digital teaching formats KW - virtual reality application KW - co-creation N2 - Background: Numerous reviews advocate using virtual reality (VR) in educational contexts. This medium allows learners to test experiences in realistic environments. Virtually supported scenarios offer a safe and motivating way to explore, practice, and consolidate nursing skills in rare and critical nursing tasks. This is also cited as one of the reasons why VR can significantly increase the knowledge acquisition of nursing students. Nevertheless, studies are limited in their significance owing to the chosen design. Despite great interest, this results in a low level of confidence in VR as a curricular teaching method for nursing education. Therefore, defining concrete design and didactic-methodological parameters that support teachers in the use and implementation of VR is more relevant. Objective: This scoping review aims to provide an overview of significant design aspects for VR scenario conception and its transfer to generalist nursing education to generate value for the development of teaching scenarios and their sustainable implementation in teaching. Methods: A comprehensive literature search was performed using the MEDLINE (via PubMed) and CINAHL databases, and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist was applied. The search was conducted from May to July 2022, using a specific search principle corresponding to the focus and the growing study corpus. A previously defined ?population, concept, and context? scheme was employed as the basis for the double-blind review of all relevant international German and English publications released up to May 1, 2022. Results: In accordance with the predefined selection procedure, 22 publications were identified. The identified aspects aided in the development of design, didactic, and research recommendations. The intuitive operation of realistically designed VR scenarios, which are standardized, reliable, and modifiable, as well as clear instructions and specific multimodal feedback functions were described positively. The same applied to the linear structure of the sequences with graduated demands and high image quality for increased immersion with low sensory overload. Changes in perspectives, multiuser options, dialogs, and recording functions can contribute to an interactive care practice. On the research side, it is advisable to define VR terminologies. In addition to considering larger samples, varying settings, and financial issues, it is recommended to conduct long-term studies on knowledge acquisition or improved patient outcomes. Conclusions: VR scenarios offer high potential in the context of nursing education if teachers and learners develop them co-creatively according to design features and implement them by means of a well-conceived concept. VR enables trainees to develop practical skills continuously in a standardized way. In addition, its deployment supports the sensitization of trainees to digital nursing technologies and the expansion of their digital skills in a practical setting. Furthermore, it allows sustainability issues to be addressed. UR - https://games.jmir.org/2024/1/e53356 UR - http://dx.doi.org/10.2196/53356 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53356 ER - TY - JOUR AU - Yang, Jingzhen AU - Alshaikh, Enas AU - Yu, Deyue AU - Kerwin, Thomas AU - Rundus, Christopher AU - Zhang, Fangda AU - Wrabel, G. Cameron AU - Perry, Landon AU - Lu, Zhong-Lin PY - 2024/6/26 TI - Visual Function and Driving Performance Under Different Lighting Conditions in Older Drivers: Preliminary Results From an Observational Study JO - JMIR Form Res SP - e58465 VL - 8 KW - nighttime driving KW - functional vision KW - driving simulation KW - older drivers KW - visual functions KW - photopic KW - mesopic KW - glare KW - driving simulator N2 - Background: Age-related vision changes significantly contribute to fatal crashes at night among older drivers. However, the effects of lighting conditions on age-related vision changes and associated driving performance remain unclear. Objective: This pilot study examined the associations between visual function and driving performance assessed by a high-fidelity driving simulator among drivers 60 and older across 3 lighting conditions: daytime (photopic), nighttime (mesopic), and nighttime with glare. Methods: Active drivers aged 60 years or older participated in visual function assessments and simulated driving on a high-fidelity driving simulator. Visual acuity (VA), contrast sensitivity function (CSF), and visual field map (VFM) were measured using quantitative VA, quantitative CSF, and quantitative VFM procedures under photopic and mesopic conditions. VA and CSF were also obtained in the presence of glare in the mesopic condition. Two summary metrics, the area under the log CSF (AULCSF) and volume under the surface of VFM (VUSVFM), quantified CSF and VFM. Driving performance measures (average speed, SD of speed [SDspeed], SD of lane position (SDLP), and reaction time) were assessed under daytime, nighttime, and nighttime with glare conditions. Pearson correlations determined the associations between visual function and driving performance across the 3 lighting conditions. Results: Of the 20 drivers included, the average age was 70.3 years; 55% were male. Poor photopic VA was significantly correlated with greater SDspeed (r=0.26; P<.001) and greater SDLP (r=0.31; P<.001). Poor photopic AULCSF was correlated with greater SDLP (r=?0.22; P=.01). Poor mesopic VUSFVM was significantly correlated with slower average speed (r=?0.24; P=.007), larger SDspeed (r=?0.19; P=.04), greater SDLP (r=?0.22; P=.007), and longer reaction times (r=?0.22; P=.04) while driving at night. For functional vision in the mesopic condition with glare, poor VA was significantly correlated with longer reaction times (r=0.21; P=.046) while driving at night with glare; poor AULCSF was significantly correlated with slower speed (r=?0.32; P<.001), greater SDLP (r=?0.26; P=.001) and longer reaction times (r=?0.2; P=.04) while driving at night with glare. No other significant correlations were observed between visual function and driving performance under the same lighting conditions. Conclusions: Visual functions differentially affect driving performance in different lighting conditions among older drivers, with more substantial impacts on driving during nighttime, especially in glare. Additional research with larger sample sizes is needed to confirm these results. UR - https://formative.jmir.org/2024/1/e58465 UR - http://dx.doi.org/10.2196/58465 UR - http://www.ncbi.nlm.nih.gov/pubmed/38922681 ID - info:doi/10.2196/58465 ER - TY - JOUR AU - Jung, Youn Soo AU - Moon, Ja Kyoung PY - 2024/6/24 TI - Pressure Ulcer Management Virtual Reality Simulation (PU-VRSim) for Novice Nurses: Mixed Methods Study JO - JMIR Serious Games SP - e53165 VL - 12 KW - virtual reality KW - nursing KW - simulation KW - virtual training KW - pressure ulcer KW - simulation training KW - nurse KW - clinician KW - health care worker KW - ulcer KW - hospital KW - health care center KW - PU-VRSim KW - mixed methods study KW - health professional KW - medical education KW - training KW - games KW - gamification KW - learning KW - decubitus ulcer N2 - Background: Pressure ulcers (PUs) are a common and serious complication in patients who are immobile in health care settings. Nurses play a fundamental role in the prevention of PUs; however, novice nurses lack experience in clinical situations. Virtual reality (VR) is highly conducive to clinical- and procedure-focused training because it facilitates simulations. Objective: We aimed to explore the feasibility of a novel PU management VR simulation (PU-VRSim) program using a head-mounted display for novice nurses and to investigate how different types of learning materials (ie, VR or a video-based lecture) impact learning outcomes and experiences. Methods: PU-VRSim was created in the Unity 3D platform. This mixed methods pilot quasi-experimental study included 35 novice nurses categorized into the experimental (n=18) and control (n=17) groups. The PU-VRSim program was applied using VR in the experimental group, whereas the control group received a video-based lecture. The PU knowledge test, critical thinking disposition measurement tool, and Korean version of the General Self-Efficacy Scale were assessed before and after the intervention in both groups. After the intervention, the experimental group was further assessed using the Clinical Judgment Rubric and interviewed to evaluate their experience with PU-VRSim. Results: The results compared before and after the intervention showed significant improvements in PU knowledge in both the experimental group (P=.001) and control group (P=.005). There were no significant differences in self-efficacy and critical thinking in either group. The experimental group scored a mean of 3.23 (SD 0.44) points (accomplished) on clinical judgment, assessed using a 4-point scale. The experimental group interviews revealed that the VR simulation was realistic and helpful for learning about PU management. Conclusions: The results revealed that PU-VRSim could improve novice nurses? learning of PU management in realistic environments. Further studies using VR for clinical training are recommended for novice nurses. UR - https://games.jmir.org/2024/1/e53165 UR - http://dx.doi.org/10.2196/53165 UR - http://www.ncbi.nlm.nih.gov/pubmed/38913417 ID - info:doi/10.2196/53165 ER - TY - JOUR AU - Elser, Alexander AU - Lange, Marina AU - Kopkow, Christian AU - Schäfer, Georg Axel PY - 2024/5/15 TI - Barriers and Facilitators to the Implementation of Virtual Reality Interventions for People With Chronic Pain: Scoping Review JO - JMIR XR Spatial Comput SP - e53129 VL - 1 KW - virtual reality KW - VR KW - chronic pain KW - implementation science KW - scoping review KW - barriers KW - facilitators N2 - Background: Chronic pain is a growing health problem worldwide with a significant impact on individuals and societies. In regard to treatment, there is a gap between guideline recommendations and common practice in health care, especially concerning cognitive and psychological interventions. Virtual reality (VR) may provide a way to improve this situation. A growing body of evidence indicates that VR therapy has positive effects on pain and physical function. However, there is limited knowledge about barriers and facilitators to the implementation of VR interventions for people with chronic pain in health care settings. Objective: The aim of this study was to identify and analyze the barriers and facilitators involved in implementing VR interventions for people with chronic pain. Methods: We conducted a scoping review of the German and English literature using the MEDLINE, Cochrane Central Register of Controlled Trials, CINAHL, PEDro, LILACS, and Web of Science (inception to November 2023) databases, including quantitative, qualitative, and mixed methods studies reporting barriers and facilitators to the implementation of VR interventions for people with chronic pain, as reported by patients or health care professionals. Two reviewers systematically screened the abstracts and full texts of retrieved articles according to the inclusion criteria. All mentioned barriers and facilitators were extracted and categorized according to the Theoretical Domains Framework (TDF). Results: The database search resulted in 1864 records after removal of duplicates. From the 14 included studies, 30 barriers and 33 facilitators from the patient perspective and 2 facilitators from the health care professional perspective were extracted. Barriers reported by people with chronic pain were most frequently assigned to the TDF domains environmental context (60%) and skills (16.7%). Most facilitators were found in three domains for both the patients and health care professionals: beliefs about consequences (30.3%), emotions (18.2%), and environmental context (18.2%). Conclusions: The findings of this review can inform the development of strategies for future implementations of VR interventions for people with chronic pain. Additionally, further research should address knowledge gaps about the perspective of health care professionals regarding the implementation of VR interventions for people with chronic pain. UR - https://xr.jmir.org/2024/1/e53129 UR - http://dx.doi.org/10.2196/53129 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53129 ER - TY - JOUR AU - Bould, Helen AU - Kennedy, Mari-Rose AU - Penton-Voak, Ian AU - Thomas, May Lisa AU - Bird, Jon AU - Biddle, Lucy PY - 2024/5/14 TI - Exploring How Virtual Reality Could Be Used to Treat Eating Disorders: Qualitative Study of People With Eating Disorders and Clinicians Who Treat Them JO - JMIR XR Spatial Comput SP - e47382 VL - 1 KW - eating disorders KW - virtual reality KW - anorexia nervosa KW - bulimia nervosa KW - EDNOS KW - treatment KW - immersive KW - clinicians KW - qualitative data KW - psychoeducation KW - therapeutic KW - limitations N2 - Background: Immersive virtual reality (VR) interventions are being developed and trialed for use in the treatment of eating disorders. However, little work has explored the opinions of people with eating disorders, or the clinicians who treat them, on the possible use of VR in this context. Objective: This study aims to use qualitative methodology to explore the views of people with eating disorders, and clinicians who treat them, on the possible use of VR in the treatment of eating disorders. Methods: We conducted a series of focus groups and interviews with people with lived experience of eating disorders and clinicians on their views about VR and how it could potentially be used in the treatment of eating disorders. People with lived experience of eating disorders were recruited between October and December 2020, with focus groups held online between November 2020 and February 2021; clinicians were recruited in September 2021 and interviewed between September and October 2021. We took a thematic approach to analyzing the resulting qualitative data. Results: We conducted 3 focus groups with 10 individuals with a current or previous eating disorder, 2 focus groups with 4 participants, and 1 with 2 participants. We held individual interviews with 4 clinicians experienced in treating people with eating disorders. Clinicians were all interviewed one-to-one because of difficulties in scheduling mutually convenient groups. We describe themes around representing the body in VR, potential therapeutic uses for VR, the strengths and limitations of VR in this context, and the practicalities of delivering VR therapy. Suggested therapeutic uses were to practice challenging situations around food-related and weight/appearance-related scenarios and interactions, to retrain attention, the representation of the body, to represent the eating disorder, for psychoeducation, and to enable therapeutic conversations with oneself. There was a substantial agreement between the groups on these themes. Conclusions: People with lived experience of eating disorders and clinicians with experience in treating eating disorders generated many ideas as to how VR could be used as a part of eating disorders treatment. They were also aware of potential limitations and expressed the need for caution around how bodies are represented in a VR setting. UR - https://xr.jmir.org/2024/1/e47382 UR - http://dx.doi.org/10.2196/47382 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/47382 ER - TY - JOUR AU - Mittal, Ajay AU - Wakim, Jonathan AU - Huq, Suhaiba AU - Wynn, Tung PY - 2024/5/9 TI - Effectiveness of Virtual Reality in Reducing Perceived Pain and Anxiety Among Patients Within a Hospital System: Protocol for a Mixed Methods Study JO - JMIR Res Protoc SP - e52649 VL - 13 KW - virtual reality KW - digital health KW - feasibility KW - acceptability KW - pain KW - anxiety KW - hospital KW - hospitalization KW - in-patient KW - observational study KW - pharmacologic pain management KW - pain management KW - topical anesthetic creams KW - topical cream N2 - Background: Within hospital systems, diverse subsets of patients are subject to minimally invasive procedures that provide therapeutic relief and necessary health data that are often perceived as anxiogenic or painful. These feelings are particularly relevant to patients experiencing procedures where they are conscious and not sedated or placed under general anesthesia that renders them incapacitated. Pharmacologic pain management and topical anesthetic creams are used to manage these feelings; however, distraction-based methods can provide nonpharmacologic means to modify the painful experience and discomfort often associated with these procedures. Recent studies support distraction as a useful method for reducing anxiety and pain and as a result, improving patient experience. Virtual reality (VR) is an emerging technology that provides an immersive user experience and can operate through a distraction-based method to reduce the negative or painful experience often related to procedures where the patient is conscious. Given the possible short-term and long-term outcomes of poorly managed pain and enduring among patients, health care professionals are challenged to improve patient well-being during medically essential procedures. Objective: The purpose of this pilot project is to assess the efficacy of using VR as a distraction-based intervention for anxiety or pain management compared to other nonpharmacologic interventions in a variety of hospital settings, specifically in patients undergoing lumbar puncture procedures and bone marrow biopsies at the oncology ward, patients receiving nerve block for a broken bone at an anesthesia or surgical center, patients undergoing a cleaning at a dental clinic, patients conscious during an ablation procedure at a cardiology clinic, and patients awake during a kidney biopsy at a nephrology clinic. This will provide the framework for additional studies in other health care settings. Methods: In a single visit, patients eligible for the study will complete brief preprocedural and postprocedural questionnaires about their perceived fear, anxiety, and pain levels. During the procedure, research assistants will place a VR headset on the patient and the patient will undergo a VR experience to distract from any pain felt from the procedure. Participants? vitals, including blood pressure, heart rate, and rate of respiration, will also be recorded before, during, and after the procedure. Results: The study is already underway, and results support a decrease in perceived pain by 1.00 and a decrease in perceived anxiety by 0.3 compared to the control group (on a 10-point Likert scale). Among the VR intervention group, the average rating for comfort was 4.35 out of 5. Conclusions: This study will provide greater insight into how patients? perception of anxiety and pain could potentially be altered. Furthermore, metrics related to the operational efficiency of providing a VR intervention compared to a control will provide insight into the feasibility and integration of such technologies in routine practice. International Registered Report Identifier (IRRID): DERR1-10.2196/52649 UR - https://www.researchprotocols.org/2024/1/e52649 UR - http://dx.doi.org/10.2196/52649 UR - http://www.ncbi.nlm.nih.gov/pubmed/38722681 ID - info:doi/10.2196/52649 ER - TY - JOUR AU - Shetty, Shishir AU - Bhat, Supriya AU - Al Bayatti, Saad AU - Al Kawas, Sausan AU - Talaat, Wael AU - El-Kishawi, Mohamed AU - Al Rawi, Natheer AU - Narasimhan, Sangeetha AU - Al-Daghestani, Hiba AU - Madi, Medhini AU - Shetty, Raghavendra PY - 2024/5/8 TI - The Scope of Virtual Reality Simulators in Radiology Education: Systematic Literature Review JO - JMIR Med Educ SP - e52953 VL - 10 KW - virtual reality KW - simulators KW - radiology education KW - medical imaging KW - radiology KW - education KW - systematic review KW - literature review KW - imaging KW - meta analysis KW - student KW - students KW - VR KW - PRISMA KW - Preferred Reporting Items for Systematic Reviews and Meta-Analyses N2 - Background: In recent years, virtual reality (VR) has gained significant importance in medical education. Radiology education also has seen the induction of VR technology. However, there is no comprehensive review in this specific area. This review aims to fill this knowledge gap. Objective: This systematic literature review aims to explore the scope of VR use in radiology education. Methods: A literature search was carried out using PubMed, Scopus, ScienceDirect, and Google Scholar for articles relating to the use of VR in radiology education, published from database inception to September 1, 2023. The identified articles were then subjected to a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)?defined study selection process. Results: The database search identified 2503 nonduplicate articles. After PRISMA screening, 17 were included in the review for analysis, of which 3 (18%) were randomized controlled trials, 7 (41%) were randomized experimental trials, and 7 (41%) were cross-sectional studies. Of the 10 randomized trials, 3 (30%) had a low risk of bias, 5 (50%) showed some concerns, and 2 (20%) had a high risk of bias. Among the 7 cross-sectional studies, 2 (29%) scored ?good? in the overall quality and the remaining 5 (71%) scored ?fair.? VR was found to be significantly more effective than traditional methods of teaching in improving the radiographic and radiologic skills of students. The use of VR systems was found to improve the students? skills in overall proficiency, patient positioning, equipment knowledge, equipment handling, and radiographic techniques. Student feedback was also reported in the included studies. The students generally provided positive feedback about the utility, ease of use, and satisfaction of VR systems, as well as their perceived positive impact on skill and knowledge acquisition. Conclusions: The evidence from this review shows that the use of VR had significant benefit for students in various aspects of radiology education. However, the variable nature of the studies included in the review reduces the scope for a comprehensive recommendation of VR use in radiology education. UR - https://mededu.jmir.org/2024/1/e52953 UR - http://dx.doi.org/10.2196/52953 ID - info:doi/10.2196/52953 ER - TY - JOUR AU - Lee, J. Edmund W. AU - Tan, W. Warrick AU - Pham, Phat Ben Tan AU - Kawaja, Ariffin AU - Theng, Yin-Leng PY - 2024/4/24 TI - Addressing Data Absenteeism and Technology Chauvinism in the Use of Gamified Wearable Gloves Among Older Adults: Moderated Usability Study JO - JMIR Serious Games SP - e47600 VL - 12 KW - wearables KW - exergames KW - older adults KW - active aging KW - rehabilitation KW - stroke N2 - Background: Digital health technologies have the potential to improve health outcomes for older adults, especially for those recovering from stroke. However, there are challenges to developing these technologies, such as data absenteeism (where older adults? views are often underrepresented in research and development) and technology chauvinism (the belief that sophisticated technology alone is the panacea to addressing health problems), which hinder their effectiveness. Objective: In this study, we aimed to address these challenges by developing a wearable glove integrated with culturally relevant exergames to motivate older adults to exercise and, for those recovering from stroke, to adhere to rehabilitation. Methods: We conducted a moderated usability study with 19 older adults, of which 11 (58%) had a history of stroke. Our participants engaged in a 30-minute gameplay session with the wearable glove integrated with exergames, followed by a quantitative survey and an in-depth interview. We used descriptive analysis to compare responses to the System Usability Scale between those who had a history of stroke and those who did not. In addition, we analyzed the qualitative interviews using a bottom-up thematic analysis to identify key themes related to the motivations and barriers regarding the use of wearable gloves for rehabilitation and exercise. Results: Our study generated several key insights. First, making the exergames exciting and challenging could improve exercise and rehabilitation motivation, but it could also have a boomerang effect, where participants may become demotivated if the games were very challenging. Second, the comfort and ease of use of the wearable gloves were important for older adults, regardless of their stroke history. Third, for older adults with a history of stroke, the functionality and purpose of the wearable glove were important in helping them with specific exercise movements. Conclusions: Our findings highlight the importance of providing contextual support for the effective use of digital technologies, particularly for older adults recovering from stroke. In addition to technology and usability factors, other contextual factors such as gamification and social support (from occupational therapists or caregivers) should be considered to provide a comprehensive approach to addressing health problems. To overcome data absenteeism and technology chauvinism, it is important to develop digital health technologies that are tailored to the needs of underserved communities. Our study provides valuable insights for the development of digital health technologies that can motivate older adults recovering from stroke to exercise and adhere to rehabilitation. UR - https://games.jmir.org/2024/1/e47600 UR - http://dx.doi.org/10.2196/47600 UR - http://www.ncbi.nlm.nih.gov/pubmed/38656778 ID - info:doi/10.2196/47600 ER - TY - JOUR AU - Björling, A. Elin AU - Sonney, Jennifer AU - Zade, Himanshu AU - Rodriguez, Sofia AU - Pullmann, D. Michael AU - Moon, Hyun Soo PY - 2024/4/22 TI - Using Virtual Reality to Reduce Stress in Adolescents: Mixed Methods Usability Study JO - JMIR XR Spatial Comput SP - e49171 VL - 1 KW - virtual reality KW - adolescents KW - perceived stress KW - participatory design KW - depression N2 - Background: Adolescent mental health is a national mental health emergency amid surging rates of anxiety and depression. Given the scarcity and lack of scalable mental health services, the use of self-administered, evidence-based technologies to support adolescent mental health is both timely and imperative. Objective: The goal of this study was 2-fold: (1) to determine the feasibility, usability, and engagement of a participatory designed, nature-based virtual reality (VR) environment and (2) to determine the preliminary outcomes of our self-administered VR environment on depression, mindfulness, perceived stress, and momentary stress and mood. Methods: We conducted a within-person, 3-week, in-home study with a community-based sample of 44 adolescents. Participants completed surveys of perceived stress, depression, cognitive fusion, and mindfulness at intake, postintervention, and a 3-week follow-up. Participants were invited to use a nature-based, VR environment that included 6 evidence-based activities 3 to 5 times per week. They completed momentary stress and mood surveys 5 times each day and before and after each VR session. Postintervention, participants completed surveys on system and intervention usability and their experiences with using the VR system. Quantitative data were analyzed using descriptive statistics and mixed effects modeling to explore the effect of the VR environment on stress. Qualitative data were analyzed using collaborative thematic analysis. Results: Participants? use of the VR environment ranged from 1 session to 24 sessions (mean 6.27 sessions) at home over a 3-week period. The 44 participants completed all study protocols, indicating our protocol was feasible and the VR environment was engaging for most. Both the use of the VR system and novel VR intervention received strong usability ratings (mean 74.87 on the System Usability Scale). Most teens indicated that they found the tool to be easily administered, relaxing, and helpful with stress. For some, it offered space to process difficult emotions. The themes calm, regulating, and forget about everything resulted from open-ended exit interview data. Although the Relaxation Environment for Stress in Teens (RESeT) did not significantly affect repeated survey measurements of depression, mindfulness, nor cognitive fusion, it did positively affect momentary mood (pre-intervention: 10.8, post-intervention: 12.0, P=.001) and decrease momentary stress (pre-intervention: 37.9, post-intervention: 20.6, P=.001). We found a significant reduction in within-day momentary stress that strengthened with increased VR use over time during the study period (P=.03). Conclusions: These preliminary data inform our own VR environment design but also provide evidence of the potential for self-administered VR as a promising tool to support adolescent mental health. Self-administered VR for mental health may be an effective intervention for reducing adolescent stress. However, understanding barriers (including disengagement) to using VR, as well as further encouraging participatory design with teens, may be imperative to the success of future mental health interventions. UR - https://xr.jmir.org/2024/1/e49171 UR - http://dx.doi.org/10.2196/49171 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/49171 ER - TY - JOUR AU - Fortuna, Karen AU - Bohm, Andrew AU - Lebby, Stephanie AU - Holden, Kisha AU - Agic, Branka AU - Cosco, D. Theodore AU - Walker, Robert PY - 2024/3/1 TI - Examining the Feasibility, Acceptability, and Effectiveness of Remote Training on Community-Based Participatory Research: Single-Arm Pre-Post Pilot Study JO - J Particip Med SP - e48707 VL - 16 KW - community-based participatory research KW - CBPR KW - peer support KW - health literacy KW - remote training KW - community-based KW - user KW - mental health N2 - Background: Over the past decade, a growing body of scientific evidence has demonstrated that community engagement in research leads to more relevant research, enhances the uptake of research findings, and improves clinical outcomes. Despite the increasing need for the integration of community engagement methodologies into the scientific inquiry, doctoral and master's level competencies in the field of psychiatry often lack dedicated training or coursework on community engagement methodologies. Objective: A total of 13 service users, peer support specialists, caregivers of people with mental health challenges, and scientists (with specialties ranging from basic science to implementation science) aged 18 and older participated in remote training on community-based participatory research. Data were collected at baseline, 2 days, and 3 months. Methods: A total of 13 service users, peer support specialists, caregivers of people with mental health challenges, and scientists (with specialties ranging from basic science to implementation science) aged 18 and older participated in remote training on community-based participatory research. Data were collected at baseline, 2 days, and 3 months. Results: The pilot study demonstrated that a 3-month remote training on community-based participatory research (?Partnership Academy?) was deemed feasible and acceptable by service users, peer support specialists, caregivers of people with mental health challenges, and scientists. Improvements were found in research engagement and the quality of partnership. A marked increase in distrust in the medical system was also found. Groups submitted 4 grant applications and published 1 peer-reviewed journal at a 3-month follow-up. Conclusions: This pre- and postpilot study demonstrated it is possible to train groups of service users, peer support specialists, caregivers of people with mental health challenges, and scientists in community-based participatory research. These findings provide preliminary evidence that a 3-month remote training on community-based participatory research (?Partnership Academy?) is feasible, acceptable, and potentially associated with improvements in research engagement as well as the quality of partnership and output, such as manuscripts and grant applications. UR - https://jopm.jmir.org/2024/1/e48707 UR - http://dx.doi.org/10.2196/48707 UR - http://www.ncbi.nlm.nih.gov/pubmed/38427414 ID - info:doi/10.2196/48707 ER - TY - JOUR AU - Le Roy, Barbara AU - Martin-Krumm, Charles AU - Poupon, Charlotte AU - Richieri, Raphaëlle AU - Malbos, Eric AU - Barthélémy, Fanny AU - Guedj, Eric AU - Trousselard, Marion PY - 2024/1/22 TI - Virtual Exercise in Medicine: A Proof of Concept in a Healthy Population JO - JMIR Form Res SP - e45637 VL - 8 KW - countermeasures KW - mental health KW - physical activity KW - virtual reality KW - user experience N2 - Background: Science is beginning to establish the benefits of the use of virtual reality (VR) in health care. This therapeutic approach may be an appropriate complementary treatment for some mental illnesses. It could prevent high levels of morbidity and improve the physical health of patients. For many years, the literature has shown the health benefits of physical exercise. Physical exercise in a VR environment may improve the management of mild to moderate mental health conditions. In this context, we developed a virtual environment combined with an ergocycle (the augmented physical training for isolated and confined environments [APTICE] system). Objective: This study aims to investigate the impact of physical exercise in a VR environment. Methods: A total of 14 healthy participants (11 men and 3 women; mean age 43.28, SD 10.60 years) undertook 15 minutes of immersive physical exercise using the system. Measures included mindfulness and immersion disposition, subjective perceptions of sensory information, user experience, and VR experience (ie, psychological state, flow, and presence). Results: First, the APTICE system appears to be a useful tool because the user experience is positive (subscales in the AttrakDiff questionnaire: pragmatic quality=0.99; hedonic quality?stimulation=1.90; hedonic quality?identification=0.67; attractiveness=1.58). Second, the system can induce a positive psychological state (negative emotion, P=.06) and an experience of flow and presence (P values ranging from <.001 to .04). Third, individual immersive and mindful disposition plays a role in the VR experience (P values ranging from <.02 to .04). Finally, our findings suggest that there is a link between the subjective perception of sensory information and the VR experience (P values ranging from <.02 to .04). Conclusions: These results indicate that the device is well accepted with positive psychological and exteroceptive outcomes. Overall, the APTICE system could be a proof of concept to explore the benefits of virtual physical exercise in clinical medicine. UR - https://formative.jmir.org/2024/1/e45637 UR - http://dx.doi.org/10.2196/45637 UR - http://www.ncbi.nlm.nih.gov/pubmed/38252484 ID - info:doi/10.2196/45637 ER - TY - JOUR AU - Kim, Sunghak AU - Jung, Timothy AU - Sohn, Kyung Dae AU - Chae, Yoon AU - Kim, Ae Young AU - Kang, Hyun Seung AU - Park, Yujin AU - Chang, Jung Yoon PY - 2023/11/30 TI - The Multidomain Metaverse Cancer Care Digital Platform: Development and Usability Study JO - JMIR Serious Games SP - e46242 VL - 11 KW - metaverse KW - virtual reality KW - cancer education KW - cancer care KW - digital health KW - cancer treatment KW - patient care KW - cross-sectional survey KW - digital health intervention N2 - Background: As cancer treatment methods have diversified and the importance of self-management, which lowers the dependence rate on direct hospital visits, has increased, effective cancer care education and management for health professionals and patients have become necessary. The metaverse is in the spotlight as a means of digital health that allows users to engage in cancer care education and management beyond physical constraints. However, it is difficult to find a multipurpose medical metaverse that can not only be used in the field but also complements current cancer care. Objective: This study aimed to develop an integrated metaverse cancer care platform, Dr. Meta, and examine its usability. Methods: We conducted a multicenter, cross-sectional survey between November and December 2021. A descriptive analysis was performed to examine users? experiences with Dr. Meta. In addition, a supplementary open-ended question was used to ask users for their suggestions and improvements regarding the platform. Results: Responses from 70 Korean participants (male: n=19, 27% and female: n=51, 73%) were analyzed. More than half (n=37, 54%) of the participants were satisfied with Dr. Meta; they responded that it was an interesting and immersive platform (n=50, 72%). Less than half perceived no discomfort when using Dr. Meta (n=34, 49%) and no difficulty in wearing and operating the device (n=30, 43%). Furthermore, more than half (n=50, 72%) of the participants reported that Dr. Meta would help provide non?face-to-face and noncontact services. More than half also wanted to continue using this platform in the future (n=41, 59%) and recommended it to others (n=42, 60%). Conclusions: We developed a multidomain metaverse cancer care platform that can support both health professionals and patients in non?face-to-face cancer care. The platform was uniquely disseminated and implemented in multiple regional hospitals and showed the potential to perform successful cancer care. UR - https://games.jmir.org/2023/1/e46242 UR - http://dx.doi.org/10.2196/46242 UR - http://www.ncbi.nlm.nih.gov/pubmed/38032697 ID - info:doi/10.2196/46242 ER - TY - JOUR AU - Knudsen, Høxbro Marie AU - Breindahl, Niklas AU - Dalsgaard, Tor-Salve AU - Isbye, Dan AU - Mølbak, Grethe Anne AU - Tiwald, Gerhard AU - Svendsen, Søndergaard Morten Bo AU - Konge, Lars AU - Bergström, Joanna AU - Todsen, Tobias PY - 2023/6/6 TI - Using Virtual Reality Head-Mounted Displays to Assess Skills in Emergency Medicine: Validity Study JO - J Med Internet Res SP - e45210 VL - 25 KW - virtual reality KW - simulation-based education KW - undergraduate medical education KW - emergency medicine KW - assessment, acute medicine KW - Messick framework KW - medical education KW - head-mounted display KW - medical student KW - emergency N2 - Background: Many junior doctors must prepare to manage acutely ill patients in the emergency department. The setting is often stressful, and urgent treatment decisions are needed. Overlooking symptoms and making wrong choices may lead to substantial patient morbidity or death, and it is essential to ensure that junior doctors are competent. Virtual reality (VR) software can provide standardized and unbiased assessment, but solid validity evidence is necessary before implementation. Objective: This study aimed to gather validity evidence for using 360-degree VR videos with integrated multiple-choice questions (MCQs) to assess emergency medicine skills. Methods: Five full-scale emergency medicine scenarios were recorded with a 360-degree video camera, and MCQs were integrated into the scenarios to be played in a head-mounted display. We invited 3 groups of medical students with different experience levels to participate: first- to third-year medical students (novice group), last-year medical students without emergency medicine training (intermediate group), and last-year medical students with completed emergency medicine training (experienced group). Each participant?s total test score was calculated based on the number of correct MCQ answers (maximum score of 28), and the groups? mean scores were compared. The participants rated their experienced presence in emergency scenarios using the Igroup Presence Questionnaire (IPQ) and their cognitive workload with the National Aeronautics and Space Administration Task Load Index (NASA-TLX). Results: We included 61 medical students from December 2020 to December 2021. The experienced group had significantly higher mean scores than the intermediate group (23 vs 20; P=.04), and the intermediate group had significantly higher scores than the novice group (20 vs 14; P<.001). The contrasting groups? standard-setting method established a pass-or-fail score of 19 points (68% of the maximum possible score of 28). Interscenario reliability was high, with a Cronbach ? of 0.82. The participants experienced the VR scenarios with a high degree of presence with an IPQ score of 5.83 (on a scale from 1-7), and the task was shown to be mentally demanding with a NASA-TLX score of 13.30 (on a scale from 1-21). Conclusions: This study provides validity evidence to support using 360-degree VR scenarios to assess emergency medicine skills. The students evaluated the VR experience as mentally demanding with a high degree of presence, suggesting that VR is a promising new technology for emergency medicine skills assessment. UR - https://www.jmir.org/2023/1/e45210 UR - http://dx.doi.org/10.2196/45210 UR - http://www.ncbi.nlm.nih.gov/pubmed/37279049 ID - info:doi/10.2196/45210 ER - TY - JOUR AU - Lundstedt, Rikard AU - Persson, Johanna AU - Håkansson, Carita AU - Frennert, Susanne AU - Wallergård, Mattias PY - 2023/4/7 TI - Designing Virtual Natural Environments for Older Adults: Think-Aloud Study JO - JMIR Hum Factors SP - e40932 VL - 10 KW - virtual natural environments KW - user-centered design KW - qualitative method KW - real-time 3D graphics KW - older adults N2 - Background: Spending time in natural environments is beneficial for human health, but many older adults have limited or no access to natural environments. Virtual reality technology may be a means to facilitate nature experiences, and so, there is a need for knowledge on how to design virtual restorative natural environments for older adults. Objective: The aim of this study was to identify, implement, and test older adults? preferences and ideas regarding virtual natural environments. Methods: A total of 14 older adults (mean age 75, SD 5.9 years) participated in an iterative process to design such an environment. We used think-aloud protocols and qualitative content analysis and established questionnaires that targeted usability, affective aspects, and side effects. These data guided the design decisions for incremental implementations of a prototype. Results: The participants? preferences included trueness to reality in terms of rendition and behavior; traces of human activity and natural processes that trigger the imagination and provide believability; the ability to roam, explore, and interact with the environment; and a familiar, relatable environment that evokes memories. The iterative design process resulted in a prototype featuring many of the participants? ideas and preferences, including a seated locomotion technique, animals, a boat ride, the discovery of a boat wreck, and apple picking. The questionnaire results indicated high perceived usability, interest, and enjoyment; low pressure and tension; moderate value and usefulness; and negligible side effects. Conclusions: We suggested 3 principles for virtual natural environments for older adults: realness, interactivity, and relatedness. Virtual natural environments should also provide a diversity of content and activities to accommodate the heterogeneity in older adults? preferences. These results can contribute to a framework for designing virtual natural environments for older adults. However, these findings need to be tested and potentially revised in future studies. UR - https://humanfactors.jmir.org/2023/1/e40932 UR - http://dx.doi.org/10.2196/40932 UR - http://www.ncbi.nlm.nih.gov/pubmed/37027206 ID - info:doi/10.2196/40932 ER - TY - JOUR AU - Ljubenovic, Arsène AU - Said, Sadiq AU - Braun, Julia AU - Grande, Bastian AU - Kolbe, Michaela AU - Spahn, R. Donat AU - Nöthiger, B. Christoph AU - Tscholl, W. David AU - Roche, R. Tadzio PY - 2022/3/22 TI - Visual Attention of Anesthesia Providers in Simulated Anesthesia Emergencies Using Conventional Number-Based and Avatar-Based Patient Monitoring: Prospective Eye-Tracking Study JO - JMIR Serious Games SP - e35642 VL - 10 IS - 1 KW - Anesthesia KW - eye-tracking technology KW - patient monitoring KW - patient simulation KW - situation awareness KW - task performance KW - visual attention KW - avatar based model KW - simulated anesthesia KW - perioperative N2 - Background: Inadequate situational awareness accounts for two-thirds of preventable complications in anesthesia. An essential tool for situational awareness in the perioperative setting is the patient monitor. However, the conventional monitor has several weaknesses. Avatar-based patient monitoring may address these shortcomings and promote situation awareness, a prerequisite for good decision making. Objective: The spatial distribution of visual attention is a fundamental process for achieving adequate situation awareness and thus a potential quantifiable surrogate for situation awareness. Moreover, measuring visual attention with a head-mounted eye-tracker may provide insights into usage and acceptance of the new avatar-based patient monitoring modality. Methods: This prospective eye-tracking study compared anesthesia providers' visual attention on conventional and avatar-based patient monitors during simulated critical anesthesia events. We defined visual attention, measured as fixation count and dwell time, as our primary outcome. We correlated visual attention with the potential confounders: performance in managing simulated critical anesthesia events (task performance), work experience, and profession. We used mixed linear models to analyze the results. Results: Fifty-two teams performed 156 simulations. After a manual quality check of the eye-tracking footage, we excluded 57 simulations due to technical problems and quality issues. Participants had a median of 198 (IQR 92.5-317.5) fixations on the patient monitor with a median dwell time of 30.2 (IQR 14.9-51.3) seconds. We found no significant difference in participants' visual attention when using avatar-based patient monitoring or conventional patient monitoring. However, we found that with each percentage point of better task performance, the number of fixations decreased by about 1.39 (coefficient ?1.39; 95% CI ?2.44 to ?0.34; P=.02), and the dwell time diminished by 0.23 seconds (coefficient ?0.23; 95% CI: ?0.4 to ?0.06; P=.01). Conclusions: Using eye tracking, we found no significant difference in visual attention when anesthesia providers used avatar-based monitoring or conventional patient monitoring in simulated critical anesthesia events. However, we identified visual attention in conjunction with task performance as a surrogate for situational awareness. UR - https://games.jmir.org/2022/1/e35642 UR - http://dx.doi.org/10.2196/35642 UR - http://www.ncbi.nlm.nih.gov/pubmed/35172958 ID - info:doi/10.2196/35642 ER - TY - JOUR AU - Aardoom, J. Jiska AU - Hilt, D. Alexander AU - Woudenberg, Tamar AU - Chavannes, H. Niels AU - Atsma, E. Douwe PY - 2022/2/22 TI - A Preoperative Virtual Reality App for Patients Scheduled for Cardiac Catheterization: Pre?Post Questionnaire Study Examining Feasibility, Usability, and Acceptability JO - JMIR Cardio SP - e29473 VL - 6 IS - 1 KW - virtual reality KW - cardiac catheterization KW - stress inoculation training KW - preoperative anxiety KW - acceptability KW - feasibility KW - presence KW - immersive tendencies KW - patient education KW - mobile phone N2 - Background: Pre- and postoperative anxiety is a common phenomenon associated with negative postoperative outcomes. Symptoms of posttraumatic stress disorder, such as fear, nightmares, and sleep deprivation, are prevalent in approximately 30% to 50% of patients following discharge from intensive care units after cardiac surgery. Preliminary evidence suggests a promising role of virtual reality (VR) in preventing stress-related reactions using stress inoculation training. Such training enables cognitive preparation of individuals for stressful situations, thereby becoming more tolerant and resistant to stress, subsequently reducing the risk of potential negative psychological consequences. This study investigated a preoperative VR app?Pre-View?aimed at better informing and preparing patients for cardiac catheterization. Objective: This study aims to assess the feasibility, usability, and acceptability of Pre-View in patients undergoing cardiac catheterization. Methods: Eligible participants were adults scheduled for elective cardiac catheterization. Pre-View comprised an interactive virtual representation of the whole care process related to cardiac catheterization, from entering the hospital for admission to postprocedural stay and discharge. These processes were represented through 360° videos and interactive photos. Self-report questionnaires were completed at baseline (ie, before catheterization and after undergoing the VR experience) and after cardiac catheterization. Outcome measures included user experience and satisfaction, VR presence and immersive tendencies, and user friendliness. The perceived effectiveness was assessed exploratively. Results: A total of 8 individuals, with a mean age of 67 (SD 7.5) years, participated in this study. Half of them underwent the VR experience at the hospital and the other half at home. Participants reported high levels of presence in the virtual environment (Presence Questionnaire score: mean 129.1, SD 13.4). The usability of Pre-View was well evaluated (System Usability Scale score: mean 89.1, SD 12.0), and patient satisfaction was high (Client Satisfaction Questionnaire score: mean 27.1, SD 3.2). Usability and satisfaction scores were higher for participants who underwent Pre-View at home versus those who underwent Pre-View at the hospital, although the latter group was significantly older; 72.8 versus 61.3, respectively. All participants reported Pre-View to be effective in terms of feeling better informed about the care process of cardiac catheterization. Most participants (7/8, 88%) reported Pre-View to be effective in terms of feeling better prepared for cardiac catheterization, acknowledging the potential of Pre-View in reducing negative psychological consequences after catheterization. Conclusions: The results provide initial support for the feasibility and acceptability of a preoperative VR app, creating a virtual environment that supports patient education and preparation for upcoming cardiac catheterization. More studies are needed to further investigate the effects of VR as a tool to better prepare patients for medical procedures, its effectiveness in reducing negative patient outcomes (eg, anxiety, stress, and postoperative recovery outcomes), and the generalizability of effects across different settings and patient populations. UR - https://cardio.jmir.org/2022/1/e29473 UR - http://dx.doi.org/10.2196/29473 UR - http://www.ncbi.nlm.nih.gov/pubmed/35191839 ID - info:doi/10.2196/29473 ER - TY - JOUR AU - Janssen, Anna AU - Fletcher, Jennifer AU - Keep, Melanie AU - Ahmadpour, Naseem AU - Rouf, Anika AU - Marthick, Michael AU - Booth, Rebecca PY - 2022/2/21 TI - Experiences of Patients Undergoing Chemotherapy With Virtual Reality: Mixed Methods Feasibility Study JO - JMIR Serious Games SP - e29579 VL - 10 IS - 1 KW - eHealth KW - digital health KW - virtual reality KW - cancer KW - chemotherapy KW - mixed methods research KW - virtual health KW - serious games KW - treatment N2 - Background: Current research into virtual reality (VR) use during chemotherapy shows that it can be an effective distraction intervention. However, there is limited research in adult patients and to investigate how VR can be sustainably implemented in health care organizations. Objective: The aim of this study was to explore the feasibility and acceptability of using VR for adult patients undergoing chemotherapy, and to identify the factors that would enable the sustained use of VR during chemotherapy in health care organizations. Methods: Patients undergoing chemotherapy were recruited to participate in a VR intervention during chemotherapy infusion. Participants were observed during the session and completed a postintervention survey. Each participant was invited to participate in a semistructured interview about their experience. Results: A total of 18 patients participated in the study, 5 of whom participated in semistructured interviews. Findings indicated that the use of VR was acceptable for patients undergoing chemotherapy and the intervention was also feasible. Some participants felt that the VR was an effective distraction during chemotherapy infusion, although most still seemed to be aware of how long their treatment was taking. Although VR was acceptable and feasible to patients, interviews identified several barriers to sustained implementation, including access to a reliable app library and impact on staff workloads. Conclusions: VR was acceptable to patients with a diagnosis of cancer undergoing chemotherapy treatment. Patients found VR beneficial for breaking up the monotony of treatment, to provide an additional choice of activity in addition to other recreation, and in some instances as a distraction from the treatment itself. However, there are challenges to address if VR is to be implemented in practice for this patient group. UR - https://games.jmir.org/2022/1/e29579 UR - http://dx.doi.org/10.2196/29579 UR - http://www.ncbi.nlm.nih.gov/pubmed/35188474 ID - info:doi/10.2196/29579 ER - TY - JOUR AU - Beltran-Alacreu, Hector AU - Navarro-Fernández, Gonzalo AU - Godia-Lledó, Daniela AU - Graell-Pasarón, Lucas AU - Ramos-González, Álvaro AU - Raya, Rafael AU - Martin-Pintado Zugasti, Aitor AU - Fernandez-Carnero, Josue PY - 2022/2/1 TI - A Serious Game for Performing Task-Oriented Cervical Exercises Among Older Adult Patients With Chronic Neck Pain: Development, Suitability, and Crossover Pilot Study JO - JMIR Serious Games SP - e31404 VL - 10 IS - 1 KW - video games KW - neck pain KW - aged KW - virtual reality KW - exercise therapy KW - physical therapy modalities KW - technology N2 - Background: There is sparse research on the effectiveness of therapeutic exercise for the treatment of neck pain in older adult populations. Moreover, there is a lack of research on the use of serious games or virtual reality for the treatment of neck pain in this population. Objective: The primary aim of this study was to develop and assess the suitability of a serious game for performing task-oriented cervical exercises in patients with neck pain. Methods: A serious game was designed based on the key features identified by previous studies that designed serious video games for physical and cognitive rehabilitation or exercise. The game in this study was designed to provide an interactive scenario, with the main functionality of the software solution to control a virtual airplane to reach targets using head motions. At the end of the exercise, the application stores the targets reached and missed and the airplane?s trajectory. A crossover pilot study was carried out for preliminary evaluation of the suitability of the technology in the older adult population. Men and women over 65 years of age with chronic neck pain were included. Subjects were randomly assigned to two study arms; each arm consisted of a sequence of two 4-week treatments with an intermediate washout period of 4 weeks. The total study duration was 16 weeks due to a final follow-up measure 4 weeks after the end of all treatments. Treatment A consisted of the use of the serious game developed in this study, and treatment B consisted of conventional exercises. Subjects allocated to the A-B study arm received treatment A first, followed by treatment B, and vice versa in the B-A arm. The following variables were assessed: Suitability Evaluation Questionnaire (SEQ) scores, Visual Analog Scale scores, and the number of targets reached in the serious game. Results: A total of 18 subjects were assessed for eligibility. A total of 13 subjects, aged between 71 and 92 years (mean 81.85, SD 6.82), were finally included and completed the study protocol. The global mean SEQ score was 50.38 (SD 5.35) out of 65 points, showing good suitability of the serious game. Most patients considered the experience very enjoyable and ?real? in terms of the virtual environment and found the information provided to be clear. Also, they believed that the game could be very helpful for their rehabilitation. None of the patients felt any neck pain or discomfort when playing the game, and only 2 patients out of 13 (15%) reported some degree of dizziness, eye discomfort, or disorientation, which did not limit their capacity to finish the session. Conclusions: The serious game developed in this study showed good suitability for use in adults over 70 years of age with chronic neck pain. The game was a safe method for performing task-oriented cervical exercises, and patients reported very high levels of satisfaction and acceptance after the use of this technology. UR - https://games.jmir.org/2022/1/e31404 UR - http://dx.doi.org/10.2196/31404 UR - http://www.ncbi.nlm.nih.gov/pubmed/35103608 ID - info:doi/10.2196/31404 ER - TY - JOUR AU - Goh, Lina AU - Allen, E. Natalie AU - Ahmadpour, Naseem AU - Ehgoetz Martens, A. Kaylena AU - Song, Jooeun AU - Clemson, Lindy AU - Lewis, G. Simon J. AU - MacDougall, G. Hamish AU - Canning, G. Colleen PY - 2021/11/3 TI - A Video Self-Modeling Intervention Using Virtual Reality Plus Physical Practice for Freezing of Gait in Parkinson Disease: Feasibility and Acceptability Study JO - JMIR Form Res SP - e28315 VL - 5 IS - 11 KW - Parkinson disease KW - freezing of gait KW - action observation KW - video self-modelling KW - virtual reality N2 - Background: Despite optimal medical and surgical intervention, freezing of gait commonly occurs in people with Parkinson disease. Action observation via video self-modeling, combined with physical practice, has potential as a noninvasive intervention to reduce freezing of gait. Objective: The aim of this study is to determine the feasibility and acceptability of a home-based, personalized video self-modeling intervention delivered via a virtual reality head-mounted display (HMD) to reduce freezing of gait in people with Parkinson disease. The secondary aim is to investigate the potential effect of this intervention on freezing of gait, mobility, and anxiety. Methods: The study was a single-group pre-post mixed methods pilot trial for which 10 participants with Parkinson disease and freezing of gait were recruited. A physiotherapist assessed the participants in their homes to identify person-specific triggers of freezing and developed individualized movement strategies to overcome freezing of gait. 180° videos of the participants successfully performing their movement strategies were created. Participants watched their videos using a virtual reality HMD, followed by physical practice of their strategies in their own homes over a 6-week intervention period. The primary outcome measures included the feasibility and acceptability of the intervention. Secondary outcome measures included freezing of gait physical tests and questionnaires, including the Timed Up and Go Test, 10-meter walk test, Goal Attainment Scale, and Parkinson Anxiety Scale. Results: The recruitment rate was 24% (10/42), and the retention rate was 90% (9/10). Adherence to the intervention was high, with participants completing a mean of 84% (SD 49%) for the prescribed video viewing and a mean of 100% (SD 56%) for the prescribed physical practice. One participant used the virtual reality HMD for 1 week and completed the rest of the intervention using a flat-screen device because of a gradual worsening of his motion sickness. No other adverse events occurred during the intervention or assessment. Most of the participants found using the HMD to view their videos interesting and enjoyable and would choose to use this intervention to manage their freezing of gait in the future. Five themes were constructed from the interview data: reflections when seeing myself, my experience of using the virtual reality system, the role of the virtual reality system in supporting my learning, developing a deeper understanding of how to manage my freezing of gait, and the impact of the intervention on my daily activities. Overall, there were minimal changes to the freezing of gait, mobility, or anxiety measures from baseline to postintervention, although there was substantial variability between participants. The intervention showed potential in reducing anxiety in participants with high levels of anxiety. Conclusions: Video self-modeling using an immersive virtual reality HMD plus physical practice of personalized movement strategies is a feasible and acceptable method of addressing freezing of gait in people with Parkinson disease. UR - https://formative.jmir.org/2021/11/e28315 UR - http://dx.doi.org/10.2196/28315 UR - http://www.ncbi.nlm.nih.gov/pubmed/34730537 ID - info:doi/10.2196/28315 ER - TY - JOUR AU - Rigamonti, Lia AU - Secchi, Matteo AU - Lawrence, B. Jimmy AU - Labianca, Luca AU - Wolfarth, Bernd AU - Peters, Harm AU - Bonaventura, Klaus AU - Back, Alexander David PY - 2021/10/5 TI - An Augmented Reality Device for Remote Supervision of Ultrasound Examinations in International Exercise Science Projects: Usability Study JO - J Med Internet Res SP - e28767 VL - 23 IS - 10 KW - augmented reality KW - ultrasound KW - social media KW - remote KW - exercise science N2 - Background: Support for long-distance research and clinical collaborations is in high demand and has increased owing to COVID-19?related restrictions on travel and social contact. New digital approaches are required for remote scientific exchange. Objective: This study aims to analyze the options of using an augmented reality device for remote supervision of exercise science examinations. Methods: A mobile ultrasound examination of the diameter and intima-media thickness of the femoral and carotid arteries was remotely supervised using a head-mounted augmented reality device. All participants were provided with a link to a YouTube video of the technique in advance. In part 1, 8 international experts from the fields of engineering and sports science were remotely connected to the study setting. Internet connection speed was noted, and a structured interview was conducted. In part 2, 2 remote supervisors evaluated 8 physicians performing an examination on a healthy human subject. The results were recorded, and an evaluation was conducted using a 25-item questionnaire. Results: In part 1, the remote experts were connected over a mean distance of 1587 km to the examination site. Overall transmission quality was good (mean upload speed: 28.7 Mbps, mean download speed: 97.3 Mbps, mean ping: 21.6 milliseconds). In the interview, participants indicated that the main potential benefits would be to the fields of education, movement analysis, and supervision. Challenges regarding internet connection stability and previous training with the devices used were reported. In part 2, physicians? examinations showed good interrater correlation (interclass correlation coefficient: 0.84). Participants valued the experienced setting as highly positive. Conclusions: The study showed the good feasibility of the chosen design and a highly positive attitude of all participants toward this digital approach. Head-mounted augmented reality devices are generally recommended for collaborative research projects with physical examination?based research questions. UR - https://www.jmir.org/2021/10/e28767 UR - http://dx.doi.org/10.2196/28767 UR - http://www.ncbi.nlm.nih.gov/pubmed/34609312 ID - info:doi/10.2196/28767 ER - TY - JOUR AU - Boustani, Maya AU - Lunn, Stephanie AU - Visser, Ubbo AU - Lisetti, Christine PY - 2021/9/29 TI - Development, Feasibility, Acceptability, and Utility of an Expressive Speech-Enabled Digital Health Agent to Deliver Online, Brief Motivational Interviewing for Alcohol Misuse: Descriptive Study JO - J Med Internet Res SP - e25837 VL - 23 IS - 9 KW - digital health agent KW - virtual health assistant KW - online intervention KW - alcohol abuse KW - brief intervention KW - motivational interviewing KW - intelligent virtual agent KW - embodied conversational agent N2 - Background: Digital health agents ? embodied conversational agents designed specifically for health interventions ? provide a promising alternative or supplement to behavioral health services by reducing barriers to access to care. Objective: Our goals were to (1) develop an expressive, speech-enabled digital health agent operating in a 3-dimensional virtual environment to deliver a brief behavioral health intervention over the internet to reduce alcohol use and to (2) understand its acceptability, feasibility, and utility with its end users. Methods: We developed an expressive, speech-enabled digital health agent with facial expressions and body gestures operating in a 3-dimensional virtual office and able to deliver a brief behavioral health intervention over the internet to reduce alcohol use. We then asked 51 alcohol users to report on the digital health agent acceptability, feasibility, and utility. Results: The developed digital health agent uses speech recognition and a model of empathetic verbal and nonverbal behaviors to engage the user, and its performance enabled it to successfully deliver a brief behavioral health intervention over the internet to reduce alcohol use. Descriptive statistics indicated that participants had overwhelmingly positive experiences with the digital health agent, including engagement with the technology, acceptance, perceived utility, and intent to use the technology. Illustrative qualitative quotes provided further insight about the potential reach and impact of digital health agents in behavioral health care. Conclusions: Web-delivered interventions delivered by expressive, speech-enabled digital health agents may provide an exciting complement or alternative to traditional one-on-one treatment. They may be especially helpful for hard-to-reach communities with behavioral workforce shortages. UR - https://www.jmir.org/2021/9/e25837 UR - http://dx.doi.org/10.2196/25837 UR - http://www.ncbi.nlm.nih.gov/pubmed/34586074 ID - info:doi/10.2196/25837 ER - TY - JOUR AU - Stunden, Chelsea AU - Stratton, Kirsten AU - Zakani, Sima AU - Jacob, John PY - 2021/9/22 TI - Comparing a Virtual Reality?Based Simulation App (VR-MRI) With a Standard Preparatory Manual and Child Life Program for Improving Success and Reducing Anxiety During Pediatric Medical Imaging: Randomized Clinical Trial JO - J Med Internet Res SP - e22942 VL - 23 IS - 9 KW - virtual reality KW - magnetic resonance imaging simulation KW - certified child life specialists KW - pediatrics KW - magnetic resonance imaging procedures KW - alternatives to sedation KW - preparing children for MRI N2 - Background: The experience of undergoing magnetic resonance imaging (MRI) can be anxiety provoking, particularly for pediatric patients and their families. Alternative methods to improve success and experiences without the use of sedation are needed. Objective: This study aims to compare the effectiveness of a virtual reality (VR)?based simulation app (VR-MRI) with a standard preparatory manual (SPM) and a hospital-based Child Life Program (CLP) on success and anxiety during a simulated pediatric MRI scan. Our secondary aim is to compare caregivers? reported anxiety, procedural data, caregiver usability, child satisfaction, and fun. Methods: This unblinded, randomized, triple-arm clinical trial involved 92 children aged 4-13 years and their caregivers. Recruitment was conducted through posters, public libraries, community centers, and social media. At a 2-hour session, participants were instructed to prepare for a simulated MRI head scan using one of three randomly assigned preparation materials: the VR-MRI app, SPM, or the CLP. Data were collected before preparation, during a simulated MRI head scan, and after the simulated scan. The primary outcomes were the success of the simulated MRI scan (MoTrak head motion tracking system), and child-reported anxiety (Venham picture test). We secondarily measured caregivers? reported anxiety (short State-Trait Anxiety Inventory), procedural data (minutes), usability (Usefulness, Satisfaction, and Ease of Use Questionnaire), and child-reported satisfaction and fun (visual analog scales). Results: A total of 84 participants were included in the final analysis (VR-MRI: 30/84, 36%; SPM: 24/84, 29%; and CLP: 30/84, 36%). There were no clinically significant differences between the groups in terms of success during the MRI simulation (P=.27) or the children?s reported anxiety at any timepoint (timepoint 1, P=.99; timepoint 2, P=.008; timepoint 3, P=.10). Caregivers reported being significantly more anxious after preparing with the manual than caregivers in the other 2 groups (P<.001). Child and caregiver anxiety had a significant relationship, increasing together with moderate effect (r84=0.421; P<.001). Participants using VR-MRI took the most time to prepare (P<.001) and participants using the manual took the least time (P<.001). No statistically significant relationships were found between time preparing and time completing the simulated assessment (P=.13). There were no differences found in ease of use (P=.99), ease of learning (P=.48), and usefulness (P=.11) between the groups; however, caregivers reported being significantly more satisfied with the VR-MRI app and CLP than SPM (P<.001). Children reported the most satisfaction with the CLP (P<.001). There were no differences in how much fun the preparation materials were perceived to be (P=.37). Conclusions: Digital preparation experiences using VR-based media could be a viable solution to improve the success of nonsedated MRI scans, with outcomes comparable with hospital-based in-person preparatory programs. Future research should focus on validating the results in a real MRI setting. Trial Registration: Clinicaltrials.gov NCT03931382; https://clinicaltrials.gov/ct2/show/NCT03931382 UR - https://www.jmir.org/2021/9/e22942 UR - http://dx.doi.org/10.2196/22942 UR - http://www.ncbi.nlm.nih.gov/pubmed/34550072 ID - info:doi/10.2196/22942 ER - TY - JOUR AU - Liu, Songxiang AU - Xie, Mao AU - Zhang, Zhicai AU - Wu, Xinghuo AU - Gao, Fei AU - Lu, Lin AU - Zhang, Jiayao AU - Xie, Yi AU - Yang, Fan AU - Ye, Zhewei PY - 2021/9/10 TI - A 3D Hologram With Mixed Reality Techniques to Improve Understanding of Pulmonary Lesions Caused by COVID-19: Randomized Controlled Trial JO - J Med Internet Res SP - e24081 VL - 23 IS - 9 KW - COVID-19 KW - mixed reality KW - hologram KW - pulmonary KW - lesion KW - diagnostic KW - imaging N2 - Background: The COVID-19 outbreak has now become a pandemic and has had a serious adverse impact on global public health. The effect of COVID-19 on the lungs can be determined through 2D computed tomography (CT) imaging, which requires a high level of spatial imagination on the part of the medical provider. Objective: The purpose of this study is to determine whether viewing a 3D hologram with mixed reality techniques can improve medical professionals? understanding of the pulmonary lesions caused by COVID-19. Methods: The study involved 60 participants, including 20 radiologists, 20 surgeons, and 20 medical students. Each of the three groups was randomly divided into two groups, either the 2D CT group (n=30; mean age 29 years [range 19-38 years]; males=20) or the 3D holographic group (n=30; mean age 30 years [range 20=38 years]; males=20). The two groups completed the same task, which involved identifying lung lesions caused by COVID-19 for 6 cases using a 2D CT or 3D hologram. Finally, an independent radiology professor rated the participants' performance (out of 100). All participants in two groups completed a Likert scale questionnaire regarding the educational utility and efficiency of 3D holograms. The National Aeronautics and Space Administration Task Load Index (NASA-TLX) was completed by all participants. Results: The mean task score of the 3D hologram group (mean 91.98, SD 2.45) was significantly higher than that of the 2D CT group (mean 74.09, SD 7.59; P<.001). With the help of 3D holograms, surgeons and medical students achieved the same score as radiologists and made obvious progress in identifying pulmonary lesions caused by COVID-19. The Likert scale questionnaire results showed that the 3D hologram group had superior results compared to the 2D CT group (teaching: 2D CT group median 2, IQR 1-2 versus 3D group median 5, IQR 5-5; P<.001; understanding and communicating: 2D CT group median 1, IQR 1-1 versus 3D group median 5, IQR 5-5; P<.001; increasing interest: 2D CT group median 2, IQR 2-2 versus 3D group median 5, IQR 5-5; P<.001; lowering the learning curve: 2D CT group median 2, IQR 1-2 versus 3D group median 4, IQR 4-5; P<.001; spatial awareness: 2D CT group median 2, IQR 1-2 versus 3D group median 5, IQR 5-5; P<.001; learning: 2D CT group median 3, IQR 2-3 versus 3D group median 5, IQR 5-5; P<.001). The 3D group scored significantly lower than the 2D CT group for the ?mental,? ?temporal,? ?performance,? and ?frustration? subscales on the NASA-TLX. Conclusions: A 3D hologram with mixed reality techniques can be used to help medical professionals, especially medical students and newly hired doctors, better identify pulmonary lesions caused by COVID-19. It can be used in medical education to improve spatial awareness, increase interest, improve understandability, and lower the learning curve. Trial Registration: Chinese Clinical Trial Registry ChiCTR2100045845; http://www.chictr.org.cn/showprojen.aspx?proj=125761 UR - https://www.jmir.org/2021/9/e24081 UR - http://dx.doi.org/10.2196/24081 UR - http://www.ncbi.nlm.nih.gov/pubmed/34061760 ID - info:doi/10.2196/24081 ER - TY - JOUR AU - Holdnack, A. James AU - Brennan, Flatley Patricia PY - 2021/8/4 TI - Usability and Effectiveness of Immersive Virtual Grocery Shopping for Assessing Cognitive Fatigue in Healthy Controls: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e28073 VL - 10 IS - 8 KW - cognitive fatigue KW - immersive VR KW - user experience KW - virtual grocery shopping KW - instrumental activity of daily living N2 - Background: Cognitive fatigue (CF) is a human response to stimulation and stress and is a common comorbidity in many medical conditions that can result in serious consequences; however, studying CF under controlled conditions is difficult. Immersive virtual reality provides an experimental environment that enables the precise measurement of the response of an individual to complex stimuli in a controlled environment. Objective: We aim to examine the development of an immersive virtual shopping experience to measure subjective and objective indicators of CF induced by instrumental activities of daily living. Methods: We will recruit 84 healthy participants (aged 18-75 years) for a 2-phase study. Phase 1 is a user experience study for testing the software functionality, user interface, and realism of the virtual shopping environment. Phase 2 uses a 3-arm randomized controlled trial to determine the effect that the immersive environment has on fatigue. Participants will be randomized into 1 of 3 conditions exploring fatigue response during a typical human activity (grocery shopping). The level of cognitive and emotional challenges will change during each activity. The primary outcome of phase 1 is the experience of user interface difficulties. The primary outcome of phase 2 is self-reported CF. The core secondary phase 2 outcomes include subjective cognitive load, change in task performance behavior, and eye tracking. Phase 2 uses within-subject repeated measures analysis of variance to compare pre- and postfatigue measures under 3 conditions (control, cognitive challenge, and emotional challenge). Results: This study was approved by the scientific review committee of the National Institute of Nursing Research and was identified as an exempt study by the institutional review board of the National Institutes of Health. Data collection will begin in spring 2021. Conclusions: Immersive virtual reality may be a useful research platform for simulating the induction of CF associated with the cognitive and emotional challenges of instrumental activities of daily living. Trial Registration: ClinicalTrials.gov NCT04883359; http://clinicaltrials.gov/ct2/show/NCT04883359 International Registered Report Identifier (IRRID): PRR1-10.2196/28073 UR - https://www.researchprotocols.org/2021/8/e28073 UR - http://dx.doi.org/10.2196/28073 UR - http://www.ncbi.nlm.nih.gov/pubmed/34346898 ID - info:doi/10.2196/28073 ER - TY - JOUR AU - Seok, Kwang-Ho AU - Kim, YeolHo AU - Son, Wookho AU - Kim, Sang Yoon PY - 2021/7/15 TI - Using Visual Guides to Reduce Virtual Reality Sickness in First-Person Shooter Games: Correlation Analysis JO - JMIR Serious Games SP - e18020 VL - 9 IS - 3 KW - virtual reality KW - motion sickness KW - VR sickness KW - visual guide KW - VR fidelity N2 - Background: The virtual reality (VR) content market is rapidly growing due to an increased supply of VR devices such as head-mounted displays (HMDs), whereas VR sickness (reported to occur while experiencing VR) remains an unsolved problem. The most widely used method of reducing VR sickness is the use of a rest frame that stabilizes the user's viewpoint by providing fixed visual stimuli in VR content (including video). However, the earth-fixed grid and natural independent visual background that are widely used as rest frames cannot maintain VR fidelity, as they reduce the immersion and the presence of the user. A visual guide is a visual element (eg, a crosshair of first-person shooter [FPS]) that induces a user's gaze movement within the VR content while maintaining VR fidelity, whereas there are no studies on the correlation of visual guide with VR sickness. Objective: This study aimed to analyze the correlation between VR sickness and crosshair, which is widely used as a visual guide in FPS games. Methods: Eight experimental scenarios were designed and evaluated, including having the visual guide on/off, the game controller on/off, and varying the size and position of the visual guide to determine the effect of visual guide on VR sickness. Results: The results showed that VR sickness significantly decreased when visual guide was applied in an FPS game. In addition, VR sickness was lower when the visual guide was adjusted to 30% of the aspect ratio and positioned in the head-tracking direction. Conclusions: The experimental results of this study indicate that the visual guide can achieve VR sickness reduction while maintaining user presence and immersion in the virtual environment. In other words, the use of a visual guide is expected to solve the existing limitation of distributing various types of content due to VR sickness. UR - https://games.jmir.org/2021/3/e18020 UR - http://dx.doi.org/10.2196/18020 UR - http://www.ncbi.nlm.nih.gov/pubmed/34264196 ID - info:doi/10.2196/18020 ER - TY - JOUR AU - Zhang, Timothy AU - Booth, Richard AU - Jean-Louis, Royce AU - Chan, Ryan AU - Yeung, Anthony AU - Gratzer, David AU - Strudwick, Gillian PY - 2020/10/28 TI - A Primer on Usability Assessment Approaches for Health-Related Applications of Virtual Reality JO - JMIR Serious Games SP - e18153 VL - 8 IS - 4 KW - virtual reality KW - simulated environment KW - usability KW - evaluation KW - assessment methods KW - medical informatics KW - nursing informatics UR - http://games.jmir.org/2020/4/e18153/ UR - http://dx.doi.org/10.2196/18153 UR - http://www.ncbi.nlm.nih.gov/pubmed/33112243 ID - info:doi/10.2196/18153 ER - TY - JOUR AU - Lange, Ann-Kathrin AU - Koch, Jana AU - Beck, Anastasia AU - Neugebauer, Till AU - Watzema, Frauke AU - Wrona, J. Kamil AU - Dockweiler, Christoph PY - 2020/9/1 TI - Learning With Virtual Reality in Nursing Education: Qualitative Interview Study Among Nursing Students Using the Unified Theory of Acceptance and Use of Technology Model JO - JMIR Nursing SP - e20249 VL - 3 IS - 1 KW - virtual reality KW - edutainment KW - serious games KW - education KW - health care KW - gamification KW - anatomy KW - digital game?based learning KW - nursing KW - nursing informatics N2 - Background: Digital games?based learning is a method of using digital games to impart knowledge. Virtual reality (VR) programs are a practical application of this method. Due to demographic changes, the nursing profession will become increasingly important. These VR applications can be of use in training nurses for future professional challenges they may encounter. The continuous development of VR applications enables trainees to encounter simulated real life effectively and to experience increasingly concrete situations. This can be of great importance in nursing education, since 3-dimensionality enables a better visualization of many fields of activity and can prevent potential future errors. In addition to this learning effect, VR applications also bring an element of fun to learning. Objective: The aim of this qualitative research effort is to observe the degree of acceptance of VR applications by nursing students in Germany. Various factors, including social influences, performance expectations, and effort expectations, are taken into consideration. Methods: With a qualitative cohort study, the acceptance of nursing students towards VR applications in anatomy teaching was determined. The 12 participants were first asked to fill out a quantitative questionnaire on their sociodemographic characteristics and the extent to which they valued and liked using technology. The participants were then allowed to test the VR application themselves and were finally asked about their experience in a qualitative interview. For the collection of data and the analysis of results, the unified theory of acceptance and use of technology was used in this study. Results: Overall, the study shows that the interviewed persons rated the VR application quite positively. The greatest influence in this was the personal attitude towards technology; the higher this affinity is, the more useful the VR application appears. Social influences can also increase the participant?s own acceptance if peers have a positive attitude towards such applications. The study shows that the trainees' motivation to learn was increased by using VR. We believe this is because each trainee could learn individually and the VR application was perceived as an enjoyable activity. Nevertheless, the cost factor of implementing VR applications in nursing training is currently still an obstacle, as not every institution has such financial capacities. Conclusions: The extent to which the use of VR applications in the training of nursing staff is justified depends on the degree of personal acceptance. The collected results give good practice-oriented insight into the attitude of trainees towards VR. Many of the interviewed persons saw benefits in the use of VR technologies. As VR applications are constantly developing, it is necessary to conduct further studies on VR applications in nursing education and to include other possible disciplines in which these applications can be helpful. UR - https://nursing.jmir.org/2020/1/e20249/ UR - http://dx.doi.org/10.2196/20249 UR - http://www.ncbi.nlm.nih.gov/pubmed/34345791 ID - info:doi/10.2196/20249 ER - TY - JOUR AU - Lerner, Dieter AU - Mohr, Stefan AU - Schild, Jonas AU - Göring, Martin AU - Luiz, Thomas PY - 2020/7/31 TI - An Immersive Multi-User Virtual Reality for Emergency Simulation Training: Usability Study JO - JMIR Serious Games SP - e18822 VL - 8 IS - 3 KW - virtual reality KW - educational virtual realities KW - virtual patient simulation KW - virtual emergency scenario KW - simulation training KW - head-mounted display KW - immersive media KW - training effectiveness KW - presence experience KW - anaphylaxis KW - emergency medicine N2 - Background: Virtual reality (VR) is increasingly used as simulation technology in emergency medicine education and training, in particular for training nontechnical skills. Experimental studies comparing teaching and learning in VR with traditional training media often demonstrate the equivalence or even superiority regarding particular variables of learning or training effectiveness. Objective: In the EPICSAVE (Enhanced Paramedic Vocational Training with Serious Games and Virtual Environments) project, a highly immersive room-scaled multi-user 3-dimensional VR simulation environment was developed. In this feasibility study, we wanted to gain initial insights into the training effectiveness and media use factors influencing learning and training in VR. Methods: The virtual emergency scenario was anaphylaxis grade III with shock, swelling of the upper and lower respiratory tract, as well as skin symptoms in a 5-year-old girl (virtual patient) visiting an indoor family amusement park with her grandfather (virtual agent). A cross-sectional, one-group pretest and posttest design was used to evaluate the training effectiveness and quality of the training execution. The sample included 18 active emergency physicians. Results: The 18 participants rated the VR simulation training positive in terms of training effectiveness and quality of the training execution. A strong, significant correlation (r=.53, P=.01) between experiencing presence and assessing training effectiveness was observed. Perceived limitations in usability and a relatively high extraneous cognitive load reduced this positive effect. Conclusions: The training within the virtual simulation environment was rated as an effective educational approach. Specific media use factors appear to modulate training effectiveness (ie, improvement through ?experience of presence? or reduction through perceived limitations in usability). These factors should be specific targets in the further development of this VR simulation training. UR - https://games.jmir.org/2020/3/e18822 UR - http://dx.doi.org/10.2196/18822 UR - http://www.ncbi.nlm.nih.gov/pubmed/32735548 ID - info:doi/10.2196/18822 ER - TY - JOUR AU - Held, Oskar Jeremia Philipp AU - Yu, Kevin AU - Pyles, Connor AU - Veerbeek, Marieke Janne AU - Bork, Felix AU - Heining, Sandro-Michael AU - Navab, Nassir AU - Luft, Rüdiger Andreas PY - 2020/5/26 TI - Augmented Reality?Based Rehabilitation of Gait Impairments: Case Report JO - JMIR Mhealth Uhealth SP - e17804 VL - 8 IS - 5 KW - HoloLens 2 KW - gait KW - rehabilitation KW - stroke KW - augmented reality KW - sensors N2 - Background: Gait and balance impairments are common in neurological diseases, including stroke, and negatively affect patients? quality of life. Improving balance and gait are among the main goals of rehabilitation. Rehabilitation is mainly performed in clinics, which lack context specificity; therefore, training in the patient?s home environment is preferable. In the last decade, developed rehabilitation technologies such as virtual reality and augmented reality (AR) have enabled gait and balance training outside clinics. Here, we propose a new method for gait rehabilitation in persons who have had a stroke in which mobile AR technology and a sensor-based motion capture system are combined to provide fine-grained feedback on gait performance in real time. Objective: The aims of this study were (1) to investigate manipulation of the gait pattern of persons who have had a stroke based on virtual augmentation during overground walking compared to walking without AR performance feedback and (2) to investigate the usability of the AR system. Methods: We developed the ARISE (Augmented Reality for gait Impairments after StrokE) system, in which we combined a development version of HoloLens 2 smart glasses (Microsoft Corporation) with a sensor-based motion capture system. One patient with chronic minor gait impairment poststroke completed clinical gait assessments and an AR parkour course with patient-centered performance gait feedback. The movement kinematics during gait as well as the usability and safety of the system were evaluated. Results: The patient changed his gait pattern during AR parkour compared to the pattern observed during the clinical gait assessments. He recognized the virtual objects and ranked the usability of the ARISE system as excellent. In addition, the patient stated that the system would complement his standard gait therapy. Except for the symptom of exhilaration, no adverse events occurred. Conclusions: This project provided the first evidence of gait adaptation during overground walking based on real-time feedback through visual and auditory augmentation. The system has potential to provide gait and balance rehabilitation outside the clinic. This initial investigation of AR rehabilitation may aid the development and investigation of new gait and balance therapies. UR - http://mhealth.jmir.org/2020/5/e17804/ UR - http://dx.doi.org/10.2196/17804 UR - http://www.ncbi.nlm.nih.gov/pubmed/32452815 ID - info:doi/10.2196/17804 ER - TY - JOUR AU - García-Carbajal, Santiago AU - Pipa-Muniz, María AU - Múgica, Luis Jose PY - 2020/2/27 TI - Using String Metrics to Improve the Design of Virtual Conversational Characters: Behavior Simulator Development Study JO - JMIR Serious Games SP - e15349 VL - 8 IS - 1 KW - spoken interaction KW - string metrics KW - virtual conversational characters KW - serious games KW - e-learning N2 - Background: An emergency waiting room is a place where conflicts often arise. Nervous relatives in a hostile, unknown environment force security and medical staff to be ready to deal with some awkward situations. Additionally, it has been said that the medical interview is the first diagnostic and therapeutic tool, involving both intellectual and emotional skills on the part of the doctor. At the same time, it seems that there is something mysterious about interviewing that cannot be formalized or taught. In this context, virtual conversational characters (VCCs) are progressively present in most e-learning environments. Objective: In this study, we propose and develop a modular architecture for a VCC-based behavior simulator to be used as a tool for conflict avoidance training. Our behavior simulators are now being used in hospital environments, where training exercises must be easily designed and tested. Methods: We define training exercises as labeled, directed graphs that help an instructor in the design of complex training situations. In order to increase the perception of talking to a real person, the simulator must deal with a huge number of sentences that a VCC must understand and react to. These sentences are grouped into sets identified with a common label. Labels are then used to trigger changes in the active node of the graph that encodes the current state of the training exercise. As a consequence, we need to be able to map every sentence said by the human user into the set it belongs to, in a fast and robust way. In this work, we discuss two different existing string metrics, and compare them to one that we use to assess a designed exercise. Results: Based on the similarities found between different sets, the proposed metric provided valuable information about ill-defined exercises. We also described the environment in which our programs are being used and illustrated it with an example. Conclusions: Initially designed as a tool for training emergency room staff, our software could be of use in many other areas within the same environment. We are currently exploring the possibility of using it in speech therapy situations. UR - http://games.jmir.org/2020/1/e15349/ UR - http://dx.doi.org/10.2196/15349 UR - http://www.ncbi.nlm.nih.gov/pubmed/32130121 ID - info:doi/10.2196/15349 ER - TY - JOUR AU - Napa, Sandeep AU - Moore, Michael AU - Bardyn, Tania PY - 2019/01/16 TI - Advancing Cardiac Surgery Case Planning and Case Review Conferences Using Virtual Reality in Medical Libraries: Evaluation of the Usability of Two Virtual Reality Apps JO - JMIR Hum Factors SP - e12008 VL - 6 IS - 1 KW - virtual reality KW - cardiac surgery KW - usability study KW - system usability score KW - NASA-Task Load Index KW - medical libraries KW - case planning KW - presurgical planning N2 - Background: Care providers and surgeons prepare for cardiac surgery using case conferences to review, discuss, and run through the surgical procedure. Surgeons visualize a patient?s anatomy to decide the right surgical approach using magnetic resonance imaging and echocardiograms in a presurgical case planning session. Previous studies have shown that surgical errors can be reduced through the effective use of immersive virtual reality (VR) to visualize patient anatomy. However, inconsistent user interfaces, delegation of view control, and insufficient depth information cause user disorientation and interaction difficulties in using VR apps for case planning. Objective: The objective of the study was to evaluate and compare the usability of 2 commercially available VR apps?Bosc (Pyrus Medical systems) and Medical Holodeck (Nooon Web & IT GmbH)?using the Vive VR headset (HTC Corporation) to evaluate ease of use, physician attitudes toward VR technology, and viability for presurgical case planning. The role of medical libraries in advancing case planning is also explored. Methods: After screening a convenience sample of surgeons, fellows, and residents, ethnographic interviews were conducted to understand physician attitudes and experience with VR. Gaps in current case planning methods were also examined. We ran a usability study, employing a concurrent think-aloud protocol. To evaluate user satisfaction, we used the system usability scale (SUS) and the National Aeronautics and Space Administration-Task Load Index (NASA-TLX). A poststudy questionnaire was used to evaluate the VR experience and explore the role of medical libraries in advancing presurgical case planning. Semistructured interview data were analyzed using content analysis with feedback categorization. Results: Participants were residents, fellows, and surgeons from the University of Washington with a mean age of 41.5 (SD 11.67) years. A total of 8 surgeons participated in the usability study, 3 of whom had prior exposure to VR. Users found Medical Holodeck easier to use than Bosc. Mean adjusted NASA-TLX score for Medical Holodeck was 62.71 (SD 18.25) versus Bosc?s 40.87 (SD 13.90). Neither app passed the mean SUS score of 68 for an app to be considered usable, though Medical Holodeck (66.25 [SD 12.87]) scored a higher mean SUS than Bosc (37.19 [SD 22.41]). One user rated the Bosc usable, whereas 3 users rated Medical Holodeck usable. Conclusions: Interviews highlighted the importance of precise anatomical conceptualization in presurgical case planning and teaching, identifying it as the top reason for modifying a surgical procedure. The importance of standardized user interaction features such as labeling is justified. The study also sheds light on the new roles medical librarians can play in curating VR content and promoting interdisciplinary collaboration. UR - http://humanfactors.jmir.org/2019/1/e12008/ UR - http://dx.doi.org/10.2196/12008 UR - http://www.ncbi.nlm.nih.gov/pubmed/30664469 ID - info:doi/10.2196/12008 ER -