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Journal Description

JMIR Serious Games (JSG, ISSN 2291-9279; Impact Factor: 2.226) is a multidisciplinary journal devoted to computer/web/virtual reality/mobile applications that incorporate elements of gaming, gamification or novel hardware platforms such as virtual reality headsets or Microsoft Kinect to solve serious problems such as health behavior change, physical exercise promotion (exergaming), medical rehabilitation, diagnosis and treatment of psychological/psychiatric disorders, medical education, health promotion, teaching and education, or social change. The journal also considers commentary and research in the fields of video games violence and video games addiction.

The journal is indexed in PubMed, PubMed Central, DOAJ, and SCIE/Web of Science, and JCR (Journal Citation Reports) where it received an official impact factor by Clarivate. In June 2018, JSG received an official inaugural journal impact factor of 2.226 (Journal Citation Reports 2017, Clarivate Analytics), ranking JSG at the top of all gaming related academic journals, ahead of (for example) more established competitor journals such as the Games for Health Journal. 

 

Recent Articles:

  • Virtual reality head-mounted display in use. Source: B Garrett, University of British Columbia; Copyright: B Garrett, University of British Columbia; URL: http://games.jmir.org/2018/4/e10839; License: Licensed by JMIR.

    Virtual Reality Clinical Research: Promises and Challenges

    Abstract:

    Background: Virtual reality (VR) therapy has been explored as a novel therapeutic approach for numerous health applications, in which three-dimensional virtual environments can be explored in real time. Studies have found positive outcomes for patients using VR for clinical conditions such as anxiety disorders, addictions, phobias, posttraumatic stress disorder, eating disorders, stroke rehabilitation, and for pain management. Objective: This work aims to highlight key issues in the implementation of clinical research for VR technologies. Methods: A discussion paper was developed from a narrative review of recent clinical research in the field, and the researchers’ own experiences in conducting VR clinical research with chronic pain patients. Results: Some of the key issues in implementing clinical VR research include theoretical immaturity, a lack of technical standards, the problems of separating effects of media versus medium, practical in vivo issues, and costs. Conclusions: Over the last decade, some significant successes have been claimed for the use of VR. Nevertheless, the implementation of clinical VR research outside of the laboratory presents substantial clinical challenges. It is argued that careful attention to addressing these issues in research design and pilot studies are needed in order to make clinical VR research more rigorous and improve the clinical significance of findings.

  • Source: The Authors; Copyright: The Authors; URL: http://games.jmir.org/2018/4/e10213; License: Licensed by JMIR.

    Digital Gaming to Improve Adherence Among Adolescents and Young Adults Living With HIV: Mixed-Methods Study to Test Feasibility and Acceptability

    Abstract:

    Background: An estimated 50% of adolescents and young adults (AYA) living with HIV are failing to adhere to prescribed antiretroviral treatment (ART). Digital games are effective in chronic disease management; however, research on gaming to improve ART adherence among AYA is limited. Objective: We assessed the feasibility and acceptability of video gaming to improve AYA ART adherence. Methods: Focus group discussions and surveys were administered to health care providers and AYA aged 13 to 24 years living with HIV at a pediatric HIV program in Washington, DC. During focus group discussions, AYA viewed demonstrations of 3 game prototypes linked to portable Wisepill medication dispensers. Content analysis strategies and thematic coding were used to identify adherence themes and gaming acceptance and feasibility. Likert scale and descriptive statistics were used to summarize response frequencies. Results: Providers (n=10) identified common adherence barriers and strategies, including use of gaming analogies to improve AYA ART adherence. Providers supported exploration of digital gaming as an adherence intervention. In 6 focus group discussions, 12 AYA participants identified disclosure of HIV status and irregular daily schedules as major barriers to ART and use of alarms and pillboxes as reminders. Most AYA were very or somewhat likely to use the demonstrated game prototypes to help with ART adherence and desired challenging, individually tailored, user-friendly games with in-game incentives. Game prototypes were modified accordingly. Conclusions: AYA and their providers supported the use of digital games for ART adherence support. Individualization and in-game incentives were preferable and informed the design of an interactive technology-based adherence intervention among AYA living with HIV.

  • Source: Pexels.com; Copyright: Jamie McInall; URL: https://www.pexels.com/photo/man-playing-game-on-personal-computer-929831/; License: Licensed by JMIR.

    The Untapped Potential of the Gaming Community: Narrative Review

    Abstract:

    Background: Video gamers are a population at heightened risk of developing obesity due to the sedentary nature of gaming, increased energy intake, and the disruption caused to their sleep. This increases their risk of developing a number of noncommunicable diseases. To date, research seeking to improve health behaviors has focused on developing novel video games to promote behavior change. Although positive results have emerged from this research, large-scale success has been limited due to the lack of transferability to mainstream games and the focus on children and adolescents. The gaming community has a number of unique aspects, which have received comparatively less attention than the development of new video games. Objective: The purpose of this paper is to highlight under-researched areas that have the potential to encourage positive health behavior among this community. Methods: A narrative review of the lay and academic literature was conducted to provide context and support to our claims that further research could be beneficial in this area. Results: Research has found that advertising can have implicit effects on an individual’s memories, which could influence later decisions. However, the effect of the exponential growth of in-game advertisements and the brand sponsorship of gaming events and professional gamers have not been explored in the gaming community. The possibility of using advertising techniques to encourage positive health behaviors within games or at these events has also not been explored. Research suggests that virtual communities can be effective at disseminating health information, but the efficacy of this needs to be explored using known community influencers within the gaming community. Conclusions: This paper has highlighted a number of potential avenues for the development of interventions within the gaming community. Further research must be conducted alongside game developers to ensure that any in-game developed interventions do not deter gameplay and gamers to ensure that potential approaches are acceptable.

  • Participant playing the video game, Lifeguard (montage). Source: The Authors / Placeit.net; Copyright: JMIR Publications; URL: http://games.jmir.org/2018/3/e16/; License: Creative Commons Attribution (CC-BY).

    Investigating the Relationship Between Eye Movement and Brain Wave Activity Using Video Games: Pilot Study

    Abstract:

    Background: All eye movements are related in one way or another to our mental processes with lateral eye movements being associated with the different hemispheres of the brain. Eye movement techniques form the basis of eye movement desensitization and reprocessing therapy, wherein forced eye movements activate neurological pathways to treat the subject. Objective: The objective of our study was to examine the relationship between players' eye movements and their brain wave activities using a video game. Methods: We used similar eye movement techniques in the form of a video game called Lifeguard that could potentially stimulate different eye movement mode and create a more engaging experience for the user. By designing an experiment, we further explored the differences in electroencephalogram spectral power activity for the alpha, beta, theta, delta, and gamma frequency bands in Lifeguard and Tetris. Results: The game based on eye movement technologies resulted in decreased delta power and increased beta power, but significant difference between 2 games was not found. Conclusions: The applied uses of this research could mean that eye movement desensitization and reprocessing can be conducted in a more fun and engaging way through the use of gaming technology.

  • Participant wearing the Oculus Rift headset. Source: Image created by the Authors; Copyright: Megan Applegate; URL: http://games.jmir.org/2018/3/e10522/; License: Creative Commons Attribution (CC-BY).

    Determining Physiological and Psychological Predictors of Time to Task Failure on a Virtual Reality Sørensen Test in Participants With and Without Recurrent...

    Abstract:

    Background: Sørensen trunk extension endurance test performance predicts the development of low back pain and is a strong discriminator of those with and without low back pain. Performance may greatly depend on psychological factors, such as kinesiophobia, self-efficacy, and motivation. Virtual reality video games have been used in people with low back pain to encourage physical activity that would otherwise be avoided out of fear of pain or harm. Accordingly, we developed a virtual reality video game to assess the influence of immersive gaming on the Sørensen test performance. Objective: The objective of our study was to determine the physiological and psychological predictors of time to task failure (TTF) on a virtual reality Sørensen test in participants with and without a history of recurrent low back pain. Methods: We recruited 24 individuals with a history of recurrent low back pain and 24 sex-, age-, and body mass index–matched individuals without a history of low back pain. Participants completed a series of psychological measures, including the Center for Epidemiological Studies-Depression Scale, Pain Resilience Scale, Pain Catastrophizing Scale, Tampa Scale for Kinesiophobia, and a self-efficacy measure. The maximal isometric strength of trunk and hip extensors and TTF on a virtual reality Sørensen test were measured. Electromyography of the erector spinae, gluteus maximus, and biceps femoris was recorded during the strength and endurance trials. Results: A two-way analysis of variance revealed no significant difference in TTF between groups (P=.99), but there was a trend for longer TTF in females on the virtual reality Sørensen test (P=.06). Linear regression analyses were performed to determine predictors of TTF in each group. In healthy participants, the normalized median power frequency slope of erector spinae (beta=.450, P=.01), biceps femoris (beta=.400, P=.01), and trunk mass (beta=−.32, P=.02) predicted TTF. In participants with recurrent low back pain, trunk mass (beta=−.67, P<.001), Tampa Scale for Kinesiophobia (beta=−.43, P=.01), and self-efficacy (beta=.35, P=.03) predicted TTF. Conclusions: Trunk mass appears to be a consistent predictor of performance. Kinesiophobia appears to negatively influence TTF for those with a history of recurrent low back pain, but does not influence healthy individuals. Self-efficacy is associated with better performance in individuals with a history of recurrent low back pain, whereas a less steep median power frequency slope of the trunk and hip extensors is associated with better performance in individuals without a history of low back pain.

  • The 3MD (Model for Motivational Mobile-health Design) model for chronic conditions. Source: Image created by the Author; Copyright: The Author; URL: http://games.jmir.org/2018/3/e11631/; License: Creative Commons Attribution (CC-BY).

    3MD for Chronic Conditions, a Model for Motivational mHealth Design: Embedded Case Study

    Authors List:

    Abstract:

    Background: Chronic conditions are the leading cause of death in the world. Major improvements in acute care and diagnostics have created a tendency toward the chronification of formerly terminal conditions, requiring people with these conditions to learn how to self-manage. Mobile technologies hold promise as self-management tools due to their ubiquity and cost-effectiveness. The delivery of health-related services through mobile technologies (mobile health, mHealth) has grown exponentially in recent years. However, only a fraction of these solutions take into consideration the views of relevant stakeholders such as health care professionals or even patients. The use of behavioral change models (BCMs) has proven important in developing successful health solutions, yet engaging patients remains a challenge. There is a trend in mHealth solutions called gamification that attempts to use game elements to drive user behavior and increase engagement. As it stands, designers of mHealth solutions for behavioral change in chronic conditions have no clear way of deciding what factors are relevant to consider. Objective: The goal of this work is to discover factors for the design of mHealth solutions for chronic patients using negotiations between medical knowledge, BCMs, and gamification. Methods: This study uses an embedded case study research methodology consisting of 4 embedded units: 1) cross-sectional studies of mHealth applications; 2) statistical analysis of gamification presence; 3) focus groups and interviews to relevant stakeholders; and 4) research through design of an mHealth solution. The data obtained was thematically analyzed to create a conceptual model for the design of mHealth solutions. Results: The Model for Motivational Mobile-health Design (3MD) for chronic conditions guides the design of condition-oriented gamified behavioral change mHealth solutions. The main components are (1) condition specific, which describe factors that need to be adjusted and adapted for each particular chronic condition; (2) motivation related, which are factors that address how to influence behaviors in an engaging manner; and (3) technology based, which are factors that are directly connected to the technical capabilities of mobile technologies. The 3MD also provides a series of high-level illustrative design questions for designers to use and consider during the design process. Conclusions: This work addresses a recognized gap in research and practice, and proposes a unique model that could be of use in the generation of new solutions to help chronic patients.

  • Source: Wikicommons; Copyright: Rama; URL: https://commons.wikimedia.org/wiki/File:CPR_training-03.jpg; License: Creative Commons Attribution + ShareAlike (CC-BY-SA).

    The Modification of Vital Signs According to Nursing Students’ Experiences Undergoing Cardiopulmonary Resuscitation Training via High-Fidelity Simulation:...

    Abstract:

    Background: High-fidelity simulation represents a primary tool in nursing education, especially when hands-on practical training is involved. Objective: We sought to determine the influence of high-fidelity clinical simulation, applied during cardiopulmonary resuscitation (CPR) training, on blood pressure, heart rate, stress, and anxiety levels in 2 groups of nursing students. One group had experience in health contexts, whereas the other group had none. Methods: We performed a quasi-experimental study. Data were collected between May and June 2015 and included measurements of all the resting values, before and after participation in CPR clinical simulations regarding the 2 groups of university students (ie, with and without experience). Results: An increase in vital signs was observed in students after participating in a clinical simulation scenario, especially the heart rate. In all students, increased stress and anxiety levels were observed before the first simulation case scenario. Also, in all study groups, a decrease in vital signs, stress levels, and anxiety was observed throughout the study. Conclusions: Participation in high-fidelity simulation experiences has both physiological and psychological effects on students.

  • Source: US Department of Defence (John J Kruzel); Copyright: US Department of Defence; URL: http://archive.defense.gov/news/newsarticle.aspx?id=51297; License: Public Domain (CC0).

    Video Games as a Potential Modality for Behavioral Health Services for Young Adult Veterans: Exploratory Analysis

    Abstract:

    Background: Improving the reach of behavioral health services to young adult veterans is a policy priority. Objective: The objective of our study was to explore differences in video game playing by behavioral health need for young adult veterans to identify potential conditions for which video games could be used as a modality for behavioral health services. Methods: We replicated analyses from two cross-sectional, community-based surveys of young adult veterans in the United States and examined the differences in time spent playing video games by whether participants screened positive for behavioral health issues and received the required behavioral health services. Results: Pooling data across studies, participants with a positive mental health screen for depression or posttraumatic stress disorder (PTSD) spent 4.74 more hours per week (95% CI 2.54-6.94) playing video games. Among participants with a positive screen for a substance use disorder, those who had received substance use services since discharge spent 0.75 more days per week (95% CI 0.28-1.21) playing video games than participants who had not received any substance use services since discharge. Conclusions: We identified the strongest evidence that participants with a positive PTSD or depression screen and participants with a positive screen for a substance use disorder who also received substance use services since their discharge from active duty spent more time playing video games. Future development and evaluation of video games as modalities for enhancing and increasing access to behavioral health services should be explored for this population.

  • Man wearing a virtual reality head-mounted device while walking in nature. Source: Pexels; Copyright: Bradley Hook; URL: https://www.pexels.com/photo/sea-landscape-nature-sky-123318/; License: Licensed by the authors.

    Head-Mounted Virtual Reality and Mental Health: Critical Review of Current Research

    Abstract:

    Background: eHealth interventions are becoming increasingly used in public health, with virtual reality (VR) being one of the most exciting recent developments. VR consists of a three-dimensional, computer-generated environment viewed through a head-mounted display. This medium has provided new possibilities to adapt problematic behaviors that affect mental health. VR is no longer unaffordable for individuals, and with mobile phone technology being able to track movements and project images through mobile head-mounted devices, VR is now a mobile tool that can be used at work, home, or on the move. Objective: In line with recent advances in technology, in this review, we aimed to critically assess the current state of research surrounding mental health. Methods: We compiled a table of 82 studies that made use of head-mounted devices in their interventions. Results: Our review demonstrated that VR is effective in provoking realistic reactions to feared stimuli, particularly for anxiety; moreover, it proved that the immersive nature of VR is an ideal fit for the management of pain. However, the lack of studies surrounding depression and stress highlight the literature gaps that still exist. Conclusions: Virtual environments that promote positive stimuli combined with health knowledge could prove to be a valuable tool for public health and mental health. The current state of research highlights the importance of the nature and content of VR interventions for improved mental health. While future research should look to incorporate more mobile forms of VR, a more rigorous reporting of VR and computer hardware and software may help us understand the relationship (if any) between increased specifications and the efficacy of treatment.

  • The user's character riding te Hokioi, a giant eagle, within the SPARX program. Source: Image created by the Authors; Copyright: The Authors; URL: http://games.jmir.org/2018/3/e13/; License: Licensed by the authors.

    Indigenous Adolescents’ Perception of an eMental Health Program (SPARX): Exploratory Qualitative Assessment

    Abstract:

    Background: Depression is a major health issue for indigenous adolescents, yet there is little research conducted about the efficacy and development of psychological interventions for these populations. In New Zealand there is little known about taitamariki (Māori adolescent) opinions regarding the development and effectiveness of psychological interventions, let alone computerized cognitive behavioral therapy. SPARX (Smart, Positive, Active, Realistic, X-factor thoughts) is a computerized intervention developed in New Zealand to treat mild-to-moderate depression in young people. Users are engaged in a virtual 3D environment where they must complete missions to progress to the next level. In each level there are challenges and puzzles to completeIt was designed to appeal to all young people in New Zealand and incorporates several images and concepts that are specifically Māori. Objective: The aim was to conduct an exploratory qualitative study of Māori adolescents’ opinions about the SPARX program. This is a follow-up to an earlier study where taitamariki opinions were gathered to inform the design of a computerized cognitive behavior therapy program. Methods: Taitamariki were interviewed using a semistructured interview once they had completed work with the SPARX resource. Six participants agreed to complete the interview; the interviews ranged from 10 to 30 minutes. Results: Taitamariki participating in the interviews found SPARX to be helpful. The Māori designs from the SPARX game were appropriate and useful, and the ability to customize the SPARX characters with Māori designs was beneficial and appeared to enhance cultural identity. These helped young people to feel engaged with SPARX which, in turn, assisted with the acquisition of relaxation and cognitive restructuring skills. Overall, using SPARX led to improved mood and increased levels of hope for the participants. In some instances, SPARX was used by wider whānau (Māori word for family) members with reported beneficial effect. Conclusions: Overall, this small group of Māori adolescents reported that cultural designs made it easier for them to engage with SPARX, which, in turn, led to an improvement in their mood and gave them hope. Further research is needed about how SPARX could be best used to support the families of these young people.

  • Web-Based Immersive Patient Simulator ALICE (montage). Source: The Authors / Placeit.net; Copyright: JMIR Publications; URL: http://games.jmir.org/2018/3/e10693/; License: Creative Commons Attribution (CC-BY).

    Web-Based Immersive Patient Simulator as a Curricular Tool for Objective Structured Clinical Examination Preparation in Surgery: Development and Evaluation

    Abstract:

    Background: Objective Structured Clinical Examination is a standard method of testing declarative and process knowledge in clinical core competencies. It is desirable that students undergo Objective Structured Clinical Examination training before participating in the exam. However, establishing Objective Structured Clinical Examination training is resource intensive and therefore there is often limited practice time. Web-based immersive patient simulators such as ALICE (Artificial Learning Interface of Clinical Education) can possibly fill this gap as they allow for the training of complex medical procedures at the user’s individual pace and with an adaptable number of repetitions at home. ALICE has previously been shown to positively influence knowledge gain and motivation. Objective: Therefore, the aim of this study was to develop a Web-based curriculum that teaches declarative and process knowledge and prepares students for a real Objective Structured Clinical Examination station. Furthermore, we wanted to test the influence of ALICE on knowledge gain and student motivation. Methods: A specific curriculum was developed in order to implement the relevant medical content of 2 surgical Objective Structured Clinical Examination stations into the ALICE simulator framework. A total of 160 medical students were included in the study, where 100 students had access to ALICE and their performance was compared to 60 students in a control group. The simulator performance was validated on different levels and students’ knowledge gain and motivation were tested at different points during the study. Results: The curriculum was developed according to the Kern cycle. Four virtual clinical cases were implemented with different teaching methods (structured feedback, keynote speech, group discussion, and debriefing by a real instructor) in order to consolidate declarative and process knowledge. Working with ALICE had significant impact on declarative knowledge gain and Objective Structured Clinical Examination performance. Simulator validation was positive for face, content, construct, and predictive validity. Students showed high levels of motivation and enjoyed working with ALICE. Conclusions: ALICE offers Web-based training for Objective Structured Clinical Examination preparation and can be used as a selective didactic intervention as it has positive effect on knowledge gain and student motivation.

  • Adults playing tabletop board game at gaming convention. Source: Flickr; Copyright: dooley; URL: https://www.flickr.com/photos/dooleynoted/21607509202; License: Creative Commons Attribution (CC-BY).

    Physical Wellness Among Gaming Adults: Cross-Sectional Study

    Abstract:

    Background: Video and hobby gaming are immensely popular among adults; however, associations between gaming and health have primarily been investigated in children and adolescents. Furthermore, most research has focused on electronic gaming, despite traditional hobby gaming gaining prominence. Objective: To determine whether the number of platforms used, platform preference, and gaming time are associated with obesity, physical activity, sedentary behavior, and cardiovascular risk factors in an adult gaming population. Methods: We conducted a cross-sectional analysis using data obtained from 292 participants who attended a large Midwestern gaming convention. We collected data using a computer-based questionnaire that comprised questions on gaming behavior, demographics, physical activity (using the International Physical Activity Questionnaire), and health characteristics. In addition, we used multivariable-adjusted linear and logistic regression to model health outcomes as a function of the number of platforms used, platform preference, and weekday and weekend gaming time quartile. Results: After adjusting for covariates, we observed a significant linear trend for increasing odds of being obese and higher weekend sitting time by the number of platforms used (P=.03 for both). The platform preference and weekend gaming time quartile exhibited significant associations with odds of meeting physical activity recommendations (P=.047 and P=.03, respectively). In addition, we observed higher odds of being obese among those reporting that they sat most or all of the time while gaming [odds ratio (OR) 2.69 (95% CI 1.14-6.31) and OR 2.71 (95% CI 1.06-6.93), respectively]. Conclusions: In adult gamers, the number of platforms used, which platforms they prefer to play on, and the amount of time spent gaming on weekends could have significant implications for their odds of being obese and meeting physical activity recommendations.

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  • Development of CliniPup®, a serious game for health aimed at reducing perioperative anxiety and pain in children

    Date Submitted: Oct 5, 2018

    Open Peer Review Period: Oct 9, 2018 - Dec 4, 2018

    Background: Increasing numbers of children undergo ambulatory surgery each year and a significant proportion experiences substantial preoperative anxiety and postoperative pain. The management of peri...

    Background: Increasing numbers of children undergo ambulatory surgery each year and a significant proportion experiences substantial preoperative anxiety and postoperative pain. The management of perioperative anxiety and pain remains challenging in children and is inadequate, which negatively impacts physical, psychosocial, and economic outcomes. Existing non-pharmacological interventions are costly, time consuming, vary in availability, and lack benefits. Therefore, there is a need for an evidence-based, accessible, non-pharmacological intervention as an adjunct to existing pharmacological alternatives to reduce perioperative anxiety and pain in children undergoing ambulatory surgery. Technology-enabled interventions have been proposed as a method to address the unmet need in this setting. In particular, serious games for health (SGHs) hold unique potential to change health beliefs and behaviors in children. Objective: The objective of this research was to describe the rationale, scientific evidence, design aspects, and features of CliniPup, an SGH aimed at reducing perioperative anxiety and pain in children undergoing ambulatory surgery. Methods: The SERES framework for SGH development was used to create the SGH, CliniPup. In particular, a mixed-methods approach was applied that consisted of a structured literature review supplemented with ethnographic research, such as expert interviews and a time-motion exercise. The resulting scientific evidence base was leveraged to ensure that the resulting SGH was relevant, realistic, and theory-driven. A participatory design approach was applied wherein clinical experts qualitatively reviewed several versions of the SGH and an iterative creative process was used to integrate the applicable feedback. Results: CliniPup, an SGH, was developed to incorporate (1) scientific evidence base from a structured literature review, (2) realistic content collected during ethnographic research such as expert interviews, (3) explicit pedagogical objectives from scientific literature, and (4) game mechanics and user interface design that address key aspects of the evidence. Conclusions: This report details the systematic development of CliniPup, an SGH aimed at reducing perioperative anxiety and pain in children undergoing ambulatory surgery. Clinical experts validated CliniPup’s underlying scientific evidence base and design foundations, suggesting that it was well designed for preliminary evaluation in the target population. An evaluation plan is proposed and briefly described.

  • CliniPup®, a web-based serious game for health to reduce perioperative anxiety and pain in children: a Pilot Study

    Date Submitted: Oct 5, 2018

    Open Peer Review Period: Oct 9, 2018 - Dec 4, 2018

    Background: As pediatric ambulatory surgeries are rising and existing methods to reduce perioperative anxiety and pain are lacking in this population, a serious game for health (SGH), CliniPup, was de...

    Background: As pediatric ambulatory surgeries are rising and existing methods to reduce perioperative anxiety and pain are lacking in this population, a serious game for health (SGH), CliniPup, was developed to address this unmet need. CliniPup was generated using the SERES framework for serious game development. Objective: To clinically evaluate CliniPup, an SGH, as an adjunct therapy to existing pharmacological interventions aimed at reducing perioperative anxiety and pain in children undergoing ambulatory surgery. Methods: CliniPup was evaluated in a prospective, randomized, controlled pilot trial in 20 children aged 6-10 years who underwent elective surgery, and their parents. Study participants were randomly assigned to the test (n=12) or control group (n=8). Children in the test group played CliniPup 2-days prior to surgery and children in the control group received standard of care. On the day of surgery, pediatric anxiety was measured with the modified Yale Preoperative Anxiety Scale (mYPAS) and parental anxiety was assessed with the State-Trait Anxiety Inventory (STAI). Pediatric postoperative pain was assessed by the Wong-Baker Faces Pain Rating Scale (WBFPRS). Child and parent user experience and satisfaction was also evaluated in the test group using structured questionnaires. Results: Despite the small sample, preoperative anxiety scores were significantly lower (P = .01) in children who played CliniPup prior to surgery, compared to controls. Parental preoperative anxiety scores were also lower in the test group (P = .10), but did not reach significance. No significant differences were observed in postoperative pain scores between groups (P = .54). The evaluation of user experience and satisfaction revealed that both children and parents were satisfied with CliniPup and would recommend the game to peers. Conclusions: Results of the pilot trial introduce CliniPup as a potentially effective and attractive adjunct therapy, to reduce preoperative anxiety in children undergoing ambulatory surgery, with a trend towards positive impact on parental preoperative anxiety. These results support the use of the SERES framework to generate an evidence-based SGH, which results in positive health outcomes for patients. Based on these preliminary findings, we propose a research agenda to further develop and investigate this tool.

  • Building up Trunk Muscles 2.0? Full Body Exergaming in Virtual Reality

    Date Submitted: Sep 27, 2018

    Open Peer Review Period: Oct 1, 2018 - Nov 26, 2018

    Background: In recent years many studies have associated the long time spent sedentary in front of screens with health problems in infants, children, and adolescents. Yet options for exergaming – pl...

    Background: In recent years many studies have associated the long time spent sedentary in front of screens with health problems in infants, children, and adolescents. Yet options for exergaming – playing video games that require rigorous physical exercise – seem to fail short of the physical activity levels recommended by the WHO. Objective: Here we test a full immersive VR-based training system designed to improve its users’ cardiorespiratory and muscular fitness while providing an enjoyable workout. Methods: A cross-sectional experiment design was used to analyze muscle activity (sEMG), heart rate, perceived rate of exhaustion (RPE) as well as cybersickness symptoms (SSQ), perceived workload, and physical activity enjoyment (PACES) from 33 participants performing a 5-min VR-simulated flight on a new training device. Results: The participants’ attempt to hold the planking position required to play the game resulted in moderate aerobic intensity (108 bpm ± 18.69). Due to the mainly isometric contraction of the dorsal muscle chain (with a mean activation between 20.6% (± 10.57) and 26.7% MVC (± 17.39)) they described the exercise as a moderate to vigorous activity (RPE 14.6 ± 1.82). The majority of the participants reported that they enjoyed the exercise (PACES 3.74 ± 0.16). However, six participants had to drop out because of cybersickness symptoms. Conclusions: Our findings suggest that fully immersive VR training systems can contribute to muscle-strengthening activities for healthy users. However, the drop-out rate highlights the need for technological improvements in both software and hardware. In prevention and therapy, movement quality is a fundamental element in providing effective resistance training that benefits health. Exergaming on a regular basis has the potential to develop strong muscles and a healthy back. It is essential that future VR-based training systems take into account the recommendations of sport and exercise science.

  • A Data Visualization Dashboard like a Game to Show Associations Between Cited-by and Similar Journals related to JMIR Serious Games: A Bibliometric Study

    Date Submitted: Aug 28, 2018

    Open Peer Review Period: Sep 2, 2018 - Oct 28, 2018

    Background: Over 47,703 articles were found on Pubmed.com by searching for the keyword “association between[Title]” in the past. However, to date, none present the association between cited-by and...

    Background: Over 47,703 articles were found on Pubmed.com by searching for the keyword “association between[Title]” in the past. However, to date, none present the association between cited-by and similar journals related to a given journal. Authors need one effective and efficient way to find journals related to a specific journal. The strength of association between cited-by and similar journals for a given journal is required to report. Objective: This study aims (1) to present the feature of a given journal about their keyword topics and international author collaborations; (2) to show the cited-by and similar journals related to the given journal; (3) to investigate the association between their cited-by and similar journals. Methods: We obtained 85 abstracts since 2013 from Medline based on the keywords of ("JMIR Serious Games[Journal]) on June 30, 2018, and plotted the clusters, including (i) international author collaborations, (ii) keyword topics, (iii)cited-by and similar journals related to JMIR Serious Games(JSG), and (iv) association between cited-by and similar journals, on Google Maps by using social network analysis(SNA). Results: This study found that (1) the most number of papers are from the U.S.( 28, 32.9%) and the U.K. (11,12.9 %), the most frequently used keywords are serious games and video games; (2) the top two journals for cited-by and similar journals, respectively, are (i) JMIR mHealth uHealth(IF=4.541), J Med Internet Res (IF=4.671) and (ii) Games Health J (IF= 2.019), J Med Internet Res (IF=4.671); (3) a mild association(=0.14) exists between cited-by and similar journals related to JSG. Conclusions: SNA provides deep insight into the relationships of related journals to a given journal. The results of this research can provide readers with a knowledge and concept diagram to use with future manuscript submissions to JSG. Clinical Trial: Not available

  • A Dashboard-based Comparison of Author Impact Factors in JMIR Serious Games: A Bibliometric Study

    Date Submitted: Aug 25, 2018

    Open Peer Review Period: Aug 30, 2018 - Oct 25, 2018

    Background: Much emphasis continues to be placed on the Journal Impact Factor (JIF) typically used as a surrogate marker of quality of both the article and journal. The most pernicious aspect of this...

    Background: Much emphasis continues to be placed on the Journal Impact Factor (JIF) typically used as a surrogate marker of quality of both the article and journal. The most pernicious aspect of this culture has been a practice of using journal impact factors as a basis for assessment of individual researchers’ achievements. Objective: The objective of this study is to develop a scheme for quantifying author contributions which can be applied to calculate the author impact factor (AIF). Methods: We obtained 85 abstracts since 2013 from Medline by searching the keywords of ("JMIR Serious Games[Journal]) (JSG for short) on June 30, 2018. An authorship-weighted scheme (AWS) was used for quantifying coauthor contributions and calculating AIF. We plotted the clusters, including (i) international author collaborations, (ii) the most highly-cited authors who published in JSG, and (iii) the AIFs for all authors located on dashboards using social network analysis(SNA) and Google Maps to display, Results: This study found that (i) the most number of papers are from the U.S.( 28, 32.9%) and the U.K. (11,12.9 %), (ii) the AWS can be easily applied to JSG for calculating AIF, (iii) the most cited author in JSG is Alaa AlMarshedi (=11.44=weighted publications), two authors(i.e., Abdulrahman Abdulla El-Hilly and Andreas BEl-Hilly Eisingerich) have the highest AIF(=13.75), and (iv) the AWS-based AIF can be easily displayed on Google Maps in comparison. Conclusions: The AIFs incorporated with SNA shown on Google Maps provide insight into the relationships between citable and cited achievements for authors. The AWS-based AIF can be applied to other academic fields for understanding the most highly cited authors in a discipline. Clinical Trial: Not available

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