搜索结果：JMIR XR and spatial computing

Emerging technologies, such as virtual reality (VR), augmented reality (AR), mixed reality (MR), and 3D printing (3DP), have transformative potential in education and health care. However, complete integration has not yet been achieved, and routine use is limited. There may exist gaps in the perspectives of these technologies between users and developers, and improvement may be necessary in developing such technologies. The purpose of this study was to investigate the gaps in perspectives between medical students and developers in medical education regarding satisfaction and anticipated future use of VR, AR, MR, and 3DP technologies, as well as developers' perspectives on their advantages and current challenges. This retrospective survey study was conducted during a 4-hour elective course over a period of 4 weeks. In this course, computed tomography scans of congenital heart disease patients, medical image processing software, head-mounted displays, and a virtual table were used. Student pre- and postsurveys and the developer survey included demographic and other characteristics, satisfaction, and anticipated future use of VR, AR, MR, and 3DP technologies. The advantages and current challenges of these technologies were only assessed in the developer survey. The study enrolled 41 participants, including 15 first-year medical students and 26 software and content developers. Students were more satisfied than developers across AR, VR, and 3DP in terms of overall satisfaction (VR and AR: P<.001; 3DP: P=.002), esthetics (VR: all P<.001; AR: vividness, P=.006 and design, P<.001; 3DP: vividness, P=.001 and design, P=.002), and continuous use intention (VR: repetition, P=.04 and continuous use, P=.02). Particularly in VR, satisfaction with reality was higher among students than among developers (real world, P=.006). Developers anticipated future use of MR for educating medical students and residents, individual and collaborative surgical planning, and performing surgery on patients. In contrast, students anticipated future use of VR primarily for student education, 3DP for resident education and individual surgical planning, and AR for collaborative surgical planning and performing surgery on patients. Developers perceived the inherent capabilities of VR, AR, and MR technologies as strengths, with hardware performance identified as a drawback. For 3DP, the possibility of customized product manufacturing was seen as an advantage, while cost was seen as a disadvantage. This study elucidated the different perspectives between medical students and developers regarding 3D technologies, highlighting the discrepancy in potential applications and challenges within the medical field. These findings will guide the integration of 3D technologies in education and health care to fulfill the needs and goals of both medical students and developers.

Stroke is a leading cause of disability, often accompanied by unilateral spatial neglect (USN), which severely impairs recovery. Traditional assessments like paper-pencil tests provide limited insights into behaviors and eye-hand coordination during real-world tasks. Advances in hand pose estimation and eye tracking in combination with augmented reality (AR) offer potential for data-driven assessments of naturalistic interactions. This proof-of-concept study presents and evaluates a multimodal behavioral tracking system that captures gaze, body, and hand movements during interactions within an AR environment. Our primary goals are to (1) validate that this system can achieve robust and accurate interaction data capture in clinical settings, (2) show that the system can reliably detect known USN behavioral patterns, and (3) explore how comprehensive data can provide new understanding of eye-hand coordination deficits in USN. We developed an AR-based assessment system using Microsoft HoloLens 2 and an external body-tracking camera to capture real-time gaze, hand, and body movements in an interactive environment. Multimodal data streams were temporally synchronized, fused, and filtered to enhance spatial accuracy and availability. Tracking performance was benchmarked against a traditional optical motion-capture system to validate reliability. In a study, 7 patients with right-brain lesions with mild to moderate USN and 8 healthy controls participated. Each performed a designed reaching task, stamping virtual sheets of paper that appeared randomly on a table. We analyzed participants' search behavior patterns to assess attentional biases and examined gaze anchoring timing during targeted reaching motions to explore potential eye-hand coordination deficits. The fusion of hand-tracking data from the HoloLens 2 and external system reduced tracking loss from 25.7% to 2.4%, with an absolute trajectory error of 3.27 cm. The system demonstrated high usability and was well accepted by patients. Data from the control group confirmed the absence of intrinsic lateral biases in the system and task design. The USN group displayed typical search behavior through ipsilesional biases in gaze direction during visual exploration (median deviation 7.46 [1.61-9.48] deg, P<.05) and longer times to find contralesional targets (median difference 1.08 [0.20-1.80] s, P=.02). Additionally, the eye-hand coordination analysis revealed lateral differences in gaze anchoring during targeted reaching motions in the USN group, with earlier fixation on contralesional targets (median difference 112 [71-146] ms, P=.02). The proposed AR framework provides a novel, comprehensive data-driven method for capturing interaction behavior in a controlled, yet naturalistic environment. Our results demonstrated the system's effectiveness in measuring hallmark USN symptoms, such as gaze and head orientation biases, and highlighted its potential to complement traditional assessments by offering deep insights into torso rotation and eye-hand coordination with a high resolution and accuracy. This data-driven approach shows promise for enhancing current USN assessment practices and gaining new insights into patients' behaviors.

Extended reality (XR), encompassing virtual reality, augmented reality (AR), and mixed reality, is increasingly being used in neurorehabilitation to provide multisensory feedback and promote neural plasticity in sensorimotor networks. This scoping review aimed to (1) examine how XR technologies are applied in motor neurorehabilitation, (2) explore how body representation and somatic embodiment are addressed, and (3) analyze the methodological designs of XR-based interventions. This review was conducted in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, with a comprehensive search across PubMed, Embase, Scopus, and Web of Science from inception to December 2023. Eligible studies included original research involving XR-based interventions explicitly targeting neurorehabilitation. Studies related to somatic embodiment and reporting data on implementation and user outcomes were considered without date restriction. Three independent reviewers conducted screening in Covidence. The following variables were extracted: study design, participant characteristics, XR devices and software, experimentation details, treatment approaches, and evaluation methods. Methodological quality of the included studies was assessed using the Newcastle-Ottawa Scale and the Murad Scale. Findings have been presented in tabular and narrative formats. Twenty-six studies met the inclusion criteria, and these were mainly clinical trials involving patients with neurological conditions, particularly poststroke status (n=6) and spinal cord injury (n=2). Several studies provided physiological data, including electroencephalography (n=12), electromyography (n=2), magnetic resonance imaging (n=1), galvanic skin response (n=1), electrodermal activity (n=1), and motor-evoked potential data (n=1). Two studies used noninvasive brain stimulation, and another two used eye tracking. Most studies (n=17) used built-in motion sensors; however, some (n=8) analyzed the data quantitatively. Unity 3D was the most frequently used development platform (n=8). First-person (n=20) and third-person (n=2) perspectives were used, and 4 studies combined both perspectives. Interventions mainly targeted sensorimotor deficits, with improvements in motor and cognitive performance. Sixteen studies addressed body perception, focusing on limb embodiment. Questionnaires were the most frequently used evaluation tools (n=18), and 3 studies used standardized tests. Some studies (n=7) investigated body ownership under visuomotor inconsistencies with or without visuotactile stimulation. XR was primarily applied to enhance sensorimotor recovery and assess device feasibility. Few studies directly measured embodiment (n=4), ownership (n=2), or self-location (n=2). The ability of XR platforms to deliver multisensory feedback appears to facilitate sensorimotor learning and support a more accurate body schema. Evidence from the studies supports the usefulness of XR in enhancing reinforcement learning and facilitating recovery in neurorehabilitation. Tailored XR approaches, which are grounded in embodiment principles and patient-specific needs, show promise for improving outcomes in neurological rehabilitation programs. The AR paradigm, which could offer several advantages, was not explored in depth, perhaps due to its difficult implementation during the period considered.

Learning and applying anatomy are essential but are studied and done through 2D tools and imaging techniques. This study aims to verify the usefulness of an additional 3D technique and ensure an improvement in the visualization of anatomical structures and pathological findings. The study aims to examine the usefulness of virtual reality (VR) technology as an additional tool in medical diagnostics. Groups of students, residents, and specialists in surgery, radiology, and internal medicine evaluated magnetic resonance imaging (MRI) by answering a multiple-choice questionnaire. Subsequently, a virtual 3D display was used for processing. The questionnaire focused on topographical conditions and the transfer of academic knowledge into clinical application. The main objective was to determine anatomical understanding in a comparison between sectional image (2D) presentation and additional VR (3D) presentation, measured through correctly answered questions and processing time. The system usability scale (SUS) was integrated as another criterion for VR usability. The cross-over study assessed 63 participants regarding their knowledge of liver anatomy and pathologies based on an interindividual comparison. Group formation according to the respective level of medical training was as follows: students (n=35), residents (n=15), and specialists (n=13). Participants answered 25 multiple-choice questions first using sectional imaging (MRI) in a 2D environment (computer screen) and afterward with the respective segmented 3D model visualized in a VR simulation. The main criteria for the analyses were the number of correctly answered questions and processing time. A customized SUS was used to analyze VR usability. Missing data analysis showed that there were no accounted missing data. The rate of correct answers improved significantly with the additional use of VR (F 1,59=314.376; P<.001). Using MRI, a significant difference was observed between students and residents (P=.04) and between students and specialists (P<.001). In the VR condition, no significant differences between groups were found. In the MRI condition, significant differences in processing time were observed between students and specialists (P=.02) and between residents and specialists (P=.04). No differences existed between students and residents. With VR, processing time decreased significantly in all groups (F 1,59=280.700; P<.001). Significant differences between students and specialists (P=.02) and between students and residents (P=.004) remained. No notable differences between residents and specialists (P=.72) were found. The SUS showed a subjectively simplified answerability of the questions with additional use of VR. The usefulness and benefits for an additional use of VR were stated. The additional use of VR suggests statistically significant improvements across all groups. VR seems to enable students and residents to participate in diagnostics and create treatment plans at an early stage. Transferred to clinical practice, this may lead to improvement in diagnostics and interventions. The lack of randomization and a potential learning effect are the main limitations to be addressed in future studies.

Physical activity interventions for people with dementia have shown promising effects in improving cognition and physical function or slowing disease-related decline. Immersive virtual reality (iVR), using head-mounted displays, facilitates realistic experiences by blurring the boundaries between VR and the real world. The use of iVR for people with dementia offers the potential to increase active time and improve dementia therapy and care through exercise interventions. However, the feasibility of using VR use in people with dementia, considering changes in motor, cognitive, psychological, and physiological parameters, remains insufficiently investigated. This study aims to investigate the feasibility of using iVR in people with dementia or mild cognitive impairment in nursing homes. Specifically, we examined changes in motor performance (balance and mobility), cognitive performance (global cognition and executive functions), emotional responses, and fear of falling using iVR. Utilizing a pre-post design, this study recruited 35 participants with mild-to-moderate dementia, assessed by the Mini-Mental State Examination (MMSE). Participants underwent a single session involving iVR exposure, with pre- and postexposure assessments and a feedback form, to exclude negative effects on cognitive and motor functions, mood, anxiety levels, and balance performance. The use of iVR involved 4 scenes, with a total length of 8 minutes. These scenes depicted a park with short and rather passive impressions presented as a 360&#xb0; video in a head-mounted display. Before and after using the iVR, cognitive parameters were assessed using the Trail-Making Test A (TMT-A), motor parameters were assessed using the FICSIT-4 (Frailty and Injuries: Cooperative Studies of Intervention Techniques-4) and Timed-Up-and-Go (TUG) tests, and psychological parameters were assessed using the Dementia Mood Picture Test, State-Trait Anxiety Inventory, and Short Falls Efficacy Scale-International (Short FES-I). The Emotion Rating Scale and the duration of use were recorded during use, and a feedback questionnaire was completed afterward in addition to the posttests. Paired t tests and Wilcoxon tests were used to examine pre-post differences. Of the 35 initial participants, 33 completed the study, which corresponds to a dropout rate of 6%. All 33 participants, who had a mean of 83.71 (SD 5.01) years, had dementia. They showed no statistically significant difference in cognitive and motor performance before and after iVR use. Thus, no negative effects on cognitive and motor functions, mood, anxiety levels, and balance performance were observed. The emotion rating scale also showed that 72% (n=24) felt joy and fun during iVR use, 100% (n=33) showed no emotions such as fear, sadness, or anger, and 93% (n=31) were attentive during iVR use. The feasibility of using iVR for people with dementia can be rated positively. There were no changes in motor, cognitive, or emotional parameters that would increase the risk of falls or other negative emotional reactions during or after iVR use. Further studies are needed to investigate prolonged use in a more stimulating computer-generated environment and possible physical and cognitive tasks for people with dementia in nursing homes. German Clinical Trials Register DRKS00030616; https://drks.de/search/de/trial/DRKS00030616.

The perception-action cycle enables humans to adapt their behaviors by integrating sensory feedback into motor actions. Functional neurological disorder (FND) disrupts this cycle, leading to maladaptive motor responses and a diminished sense of agency. FND includes functional seizures, movement disorders, and cognitive impairments, significantly affecting quality of life. Recent advancements in extended reality (XR) neurotechnologies provide opportunities for novel rehabilitation approaches, leveraging visual and haptic feedback to retrain motor control and restore agency in individuals with functional limb weakness. This study aimed to co-design and evaluate an XR-based biofeedback platform for upper-limb rehabilitation in FND, incorporating multisensory feedback (visual and haptic) to enhance motor retraining. A mixed methods design was used. In phase 1, a Delphi survey (N=20, patients with FND) identified key user requirements, emphasizing customizability, real-time feedback, accessibility, and comfort. These insights guided the codevelopment of an XR biofeedback platform. In phase 2, a co-design workshop with 6 participants (3 FND patient representatives and 3 health care professionals) evaluated the usability of 3 XR training tasks: virtual reality (VR) relaxation task, a guided meditation in a VR calming environment; XR position feedback task ("Hoop Hustle"), a VR-based motion task requiring arm movements to interact with virtual objects, providing real-time positional biofeedback; and XR force feedback task, a haptic robot-assisted exercise using the Human Robotix System (HRX-1) haptic device, applying resistive forces to guide upper limb movements. Participants completed system usability scale (SUS) questionnaires and provided qualitative feedback, which was analyzed using NVivo (QSR International) thematic analysis. The XR position feedback task achieved the highest usability ratings, with 4 out of 6 participants scoring it above 85, indicating "excellent" usability. The VR relaxation task received polarized scores: 2 participants rated it highly (90 and 87.5), while 3 scored it poorly (mid-40s), citing motion discomfort and disengagement. The XR force feedback task had mixed usability outcomes (SUS range: 27.5-95.0), with 1 participant with functional dystonia struggling significantly (SUS 27.5), while others rated it between 62.5 and 95.0. Qualitative feedback emphasized comfort (lighter headsets and better ergonomic design), immersion and content quality (clearer visuals and reduced distracting audio prompts), personalization (adjustable settings for speed, difficulty, and force resistance), and accessibility (cost concerns and home usability considerations). Overall, participants viewed the XR biofeedback platform as highly promising but in need of fine-tuning. This study demonstrates the feasibility and usability of an XR neurotechnology platform for FND rehabilitation, with strong acceptance of XR position feedback, mixed reactions to VR relaxation, and individual-specific usability outcomes for the force feedback task. Findings underscore the need for personalization features and hardware refinement. Future work will focus on enhancing usability, improving accessibility, and evaluating effectiveness in larger clinical trials.

Mindfulness has been shown to enhance emotional well-being and cognitive performance, yet much of this evidence stems from interventions requiring prolonged practice, making them time-consuming and less accessible. Recent studies suggest that brief mindfulness sessions may also yield positive outcomes, but the effectiveness of such interventions in virtual reality (VR) and mixed reality (MR) remains underexplored. This study investigates the effects of brief mindfulness breathing exercises delivered through VR and MR on attentional and emotional restoration and self-control capacity. Using a within-subjects experimental design, 102 undergraduate participants (n=83, 81.4% female; mean age 20.87, SD 1.89 ) completed a brief (approximately 15 min) VR and MR mindfulness breathing intervention delivered via a head-mounted display and a duration-matched mind-wandering audio control condition. Participants were undergraduates recruited via convenience sampling from psychology courses in a local university in Singapore. These conditions were separated by a 1-week washout period. Emotional well-being and self-control capacity were measured at baseline and post treatment, using self-report measures, whereas working memory capacity was measured at both time points, using operation span at baseline and rotation span post treatment. Repeated-measures ANOVAs (&#x3b1;=.05) indicated that VR and MR mindfulness breathing conditions significantly enhanced positive affect (P<.001, &#x3b7;p &#xb2;=0.366), reduced negative affect (P<.001, &#x3b7;p &#xb2;=0.279), and improved self-control capacity (P<.001, &#x3b7;p &#xb2;=0.219), compared with the mind-wandering control condition. In contrast, no significant differences were observed for working memory, and Bayesian analyses provided moderate evidence in support of the null hypothesis for both the main effect of condition and the time&#xd7;condition interaction (BF01=7.42 and BF01=5.55, respectively). Participants reported significantly greater absorption in the VR and MR conditions than in the control condition (Cohen's d=-1.61, 95% CI -1.91 to -1.32). These findings suggest that a brief VR and MR mindfulness breathing exercise improves emotional well-being and self-control capacity relative to a mind-wandering control but does not yield short-term benefits for working memory. In contrast to existing studies that typically emphasize stress reduction or rely on multisession digital interventions, this study highlights that a single brief VR or MR session can enhance key emotional and self-regulatory outcomes. As such, these results underscore the potential of VR and MR mindfulness interventions as scalable and accessible tools for promoting mental well-being, while also pointing to the need for further research to optimize their cognitive impact.

Virtual reality-based mindfulness interventions (VRbMIs) increasingly populate studies as scalable tools for stress and emotion regulation. However, findings across psychological outcomes are heterogeneous, and methodological variation in intervention design, outcome measurement, and reporting practices limits cross-study comparability and cumulative synthesis. A PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020-compliant systematic review and meta-analysis was conducted to evaluate the psychological effects of VRbMIs published between 2023 and 2025, examining methodological quality and outcome consistency across diverse study designs. A PRISMA 2020-compliant systematic search was conducted across PubMed, PsycINFO, Scopus, Semantic Scholar, and CORE from January 2023 to April 2025. Eligible studies included quantitative VRbMIs reporting psychological outcomes. We assessed risk of bias using the Mixed Methods Appraisal Tool and conducted random-effects meta-analyses using Hedges g where data were sufficient. VRbMIs were associated with a large, statistically significant reduction in negative affect and a statistically significant increase in state mindfulness, while effects on depression, stress, and anxiety were small to moderate and nonsignificant. Trait mindfulness was described narratively rather than meta-analyzed and showed limited, inconsistent change across studies. For anxiety, we included 13 studies contributing 27 effect size estimates in the quantitative synthesis. A random-effects model indicated a small-to-moderate, nonsignificant pooled effect (g=0.44, 95% CI -0.08 to 0.96; t 26=1.74; P=.09), with substantial between-study heterogeneity (Q 26=381.60; P<.001; &#x3c4;2=0.96). Physiological outcomes were reported across a subset of studies and generally aligned with self-reported psychological findings; however, inconsistent measurement and incomplete reporting precluded quantitative synthesis. This analysis represents 35 studies with a combined sample of approximately 1550 participants (1 study did not report sample size). VRbMIs demonstrate statistically significant short-term benefits for negative affect and state mindfulness, with consistently positive but nonsignificant trends toward improvement in stress, anxiety, and depression. Effects on positive affect and trait mindfulness were small and less consistent. Physiological findings were promising but limited by inconsistent reporting. These results support the use of VRbMIs as accessible tools for emotional regulation across diverse populations, while highlighting the need for larger trials, standardized outcome reporting, and more rigorous control conditions to strengthen the evidentiary foundation of this rapidly evolving field.

Immersive virtual reality (VR) technology presents digital simulations that create the sense of an actual experience. VR simulations are persuasive enough to elicit physiological reactions that mirror real-world responses. Prior research suggests that fear responses and sensation seeking are inversely correlated, but that work largely relies on self-reported outcomes and hypothetical scenarios. To more closely model real-world phenomena, we tested for inverse associations using an experiential height exposure simulation and a behavioral task for sensation seeking. We tested these associations comprehensively by using multiple methods for convergent evidence. A total of 57 healthy undergraduates participated in an interventional study that included an anxiety-inducing VR simulation, behavioral tasks, and personality inventories. The VR paradigm (Richie's Plank) prompted users to walk across and step off a plank at the top of a skyscraper. This simulation of extreme height exposure and falling was intended to evoke fear. Physiological recordings and self-reported state anxiety were collected prior to and during the experience. Behavioral sensation seeking was quantified using an olfactory choice task offering a "boring" or "exciting" (risky) option varying in intensity and pleasantness. Evoked fear was calculated as the difference between the calm (pre-plank) and provoked fear state (standing on the plank), with correlations performed between evoked fear and personality and behavioral measures. The false discovery rate was set to q<.05, with analyses conducted in SPSS. The VR experience evoked self-reported fear (P<.001) and physiological arousal (P<.006 for heart rate and P<.017 for respiration). Acrophobia correlated with self-reported fear in men and women (P<.01). Behavioral sensation seeking negatively correlated with both self-reported fear (P=.02) and increased heart rate in men (P=.02). Behavioral and self-reported sensation seeking were uncorrelated (P=.89). Self-reported fear was uncorrelated with physiological fear responses (P>.46). VR simulations can produce lifelike responses to scenarios that are impractical to test in reality. Our demonstration of an experiential manipulation negatively correlating with sensation seeking behavior in men increases confidence in other findings from studies using more traditional methods. Our use of VR along with objective measures, for example, behavioral tasks, and subjective measures, for example, self-report, confirm the effectiveness of these tools to investigate behavioral health topics. Our findings further suggest that sex is an important intervening factor for fear and sensation seeking and that additional study is warranted. This study highlights the potential of VR to expand convergent validity more broadly with other traits and paradigms. Finally, VR technology permits presenting highly abstract or improbable scenarios, thus expanding the range of topics for behavioral investigations. Given the ever-wider adoption of immersive therapeutics in the clinic, VR research will continue to facilitate the study of biobehavioral outcomes and interactions with personality factors and advance actionable knowledge for clinical applications.

Virtual reality (VR) is a type of extended reality (XR) technology that is seeing increasing adoption in health care. There is robust evidence articulating how consumer-grade VR presents significant cybersecurity and privacy risks due to the often ubiquitous and wide range of data collection and user monitoring, as well as the unique user impact of attacks due to the immersive nature of the technology. However, little is known about how these risks translate in the use of VR systems in health care settings. The objective of this scoping review is to identify potential cybersecurity risks associated with clinical XR systems, with a focus on VR, and potential mitigations for them. The scoping review followed the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews), and publications were reviewed using Covidence software. The Google Scholar database was searched using the predefined search terms. The inclusion criteria of the articles were restricted to relevant primary studies published from 2017 to 2024. Furthermore, reviews, abstracts, viewpoints, opinion pieces, and low-quality studies were excluded. Additionally, data on publication statistics, topic, technology, cyber threats, and risk mitigation were extracted. These data were synthesized and analyzed using the STRIDE (spoofing, tampering, repudiation, information disclosure, denial of service, and elevation of privilege) framework, enterprise risk management framework, and National Institute of Standards and Technology Cybersecurity Framework, as well as developing threat taxonomies. Google Scholar returned 482 articles that matched the search criteria. After title and abstract screening, 53 studies were extracted for a full-text review, of which 29 were included for analysis. Of these, the majority were published in the last 4 years and had a focus on VR. The greatest cyber threat identified to XR components was information disclosure followed by tampering when mapped against the STRIDE framework. The majority of risk mitigation strategies provide confidentiality and integrity and can potentially address these threats. Only 3 of 29 papers mention XR in the context of health care and none of the identified threats or mitigations have been studied in a clinical setting. This scoping review identified privacy threats where personal and health-related data may be inferred from VR usage data, potentially breaching confidentiality, as the most significant threat posited for health care VR systems. Additionally, immersive manipulation threats were highlighted, which could potentially risk user safety when launched from a compromised VR system. Many potential mitigations were identified for these threats, but these mitigations must first be assessed for their effectiveness and suitability for health care services. Furthermore, health care services should consider the usage and governance of XR for each individual application based on risk threshold and perceived benefits. Finally, it is also important to note that this scoping review was limited by the quality and scope of the studies returned by Google Scholar.

Vaping among youth and young adults has become a significant public health issue, with increasing prevalence and associated health risks. Despite awareness of these risks, many youth and young adults struggle to quit due to complex social pressures, stress, and a lack of tailored interventions. Digital tools, including augmented reality (AR), offer an opportunity to address these challenges by creating engaging and personalized support systems. The aim of this study was to determine what can be learned from youth and young adult vapers who are motivated to quit vaping to inform the design of mobile app-based AR intervention strategies. This qualitative study applied an interpretive description (ID) approach to explore youth and young adults' perspectives on vaping cessation and their preferences for digital intervention features. Semistructured interviews were conducted with participants (N=12) who shared their experiences with vaping, quitting attempts, and ideas for app-based AR support. Reflexive thematic analysis and ID were used to code the data and identify patterns, resulting in the generation of themes that reflected the individualized and contextual nature of vaping cessation. The findings collectively yielded four major themes: (1) social and cultural context play a role in youth and young adults' experiences of cessation, (2) quitting vaping is an individual endeavor that does not always mean success, (3) digital support as a bridge between individual and social needs, and (4) AR as a catalyst for personalized support. These themes address the motivations, challenges, and opportunities identified by participants in their cessation journeys, as well as their perspectives on integrating AR technology as a supportive tool. Our findings reveal that vaping cessation is a deeply personal process influenced by internal motivations (eg, health improvement and personal milestones) and external factors (eg, social context). Participants identified AR as a promising app-based tool for cessation support, with interest in potential AR-integrated features such as gamified rewards, health visualizations, and anonymous support. Youth and young adults emphasized the need for sensitive design to avoid negative or punitive content. This study provides actionable insights for designing youth and young adult-centered digital health tools that leverage app-based AR to support vaping cessation. By addressing the unique sociocultural and behavioral needs of youth and young adults, app-based AR interventions can bridge gaps in traditional cessation strategies. These findings contribute to the development of innovative public health approaches aimed at reducing vaping prevalence in vulnerable populations.

Cardiac arrest is a critical medical emergency that requires strict adherence to clinical guidelines to achieve optimal outcomes. Deviations from these guidelines, often due to task complexity, can adversely affect patient outcomes. Augmented reality (AR) offers a way to deliver role-specific, in-view guidance, but evidence on its perceived usability, user experience, and acceptability in cardiac arrest resuscitation remains limited. This study aimed to design, develop, and evaluate a role-specific AR decision support system for resuscitation team leaders and medication nurses. In this observational study, we assessed clinicians' perceived usability, user experience, and technology acceptance of the new AR system in a high-fidelity simulated cardiac arrest scenario. We conducted a prospective observational pilot study using a high-fidelity simulated pediatric cardiac arrest scenario. A total of 10 clinicians were recruited from Alberta Children's Hospital, including 5 (50%) of 10 pediatric emergency physicians serving as team leaders (men: 3/5, 60%, and women: 2/5, 40%; median age 41, IQR: 40-42 y) and 5 (50%) of 10 emergency nurses serving as medication nurses (men: 1/5, 20%, and women: 4/5, 80%; median age 45, IQR: 42-46 y). Participants used role-specific AR decision support interfaces deployed on HoloLens 2 head-mounted displays. Following the simulation, perceived usability, user experience, and technology acceptance were assessed using validated questionnaires: the System Usability Scale, User Experience Questionnaire, and Technology Acceptance Model. Data were collected via postsimulation surveys and analyzed descriptively. Descriptive analyses were performed without inferential statistical testing. The mean System Usability Scale scores were 75.5 (SD 9.25, 95% CI 64.0-87.0) for team leaders and 82.0 (SD 11.20, 95% CI 68.0-96.0) for medication nurses. User experience was positive across roles, with mean User Experience Questionnaire scores indicating favorable attractiveness (team leaders: 1.87, SD 1.14, 95% CI 0.45-3.28; medication nurses: 2.43, SD 0.52, 95% CI 1.79-3.08), pragmatic quality (team leaders: 1.88, SD 0.87, 95% CI 0.80-2.97; medication nurses: 1.80, SD 0.69, 95% CI 0.94-2.66), and hedonic quality (team leaders: 2.40, SD 0.89, 95% CI 1.30-3.50; medication nurses: 2.28, SD 0.69, 95% CI 1.42-3.13). Technology acceptance was high, with mean combined Technology Acceptance Model scores of 5.92 (SD 0.46, 95% CI 5.35-6.49) for team leaders and 6.02 (SD 0.56, 95% CI 5.32-6.71) for medication nurses. This study introduces a novel role-specific AR decision support system that delivers tailored, in-view guidance to resuscitation team leaders and medication nurses during cardiac arrest. Unlike prior cognitive aids that present uniform or device-agnostic information, this system explicitly adapts interface content and structure to distinct clinical roles and workflows. The findings contribute early empirical evidence on the perceived usability, user experience, and acceptability of role-tailored AR support in high-acuity team settings and yield transferable design principles for developing role-aware AR interfaces. In real-world contexts, such systems may support protocol adherence and team coordination during resuscitation training and early-stage clinical deployment, informing future evaluations that incorporate objective performance and workflow outcomes.

The growing global mental health (MH) burden, especially in underresourced communities, calls for innovative, scalable, and culturally responsive training approaches to expand care access and improve outcomes. Task-sharing has shown promise in addressing workforce shortages but is limited by training and supervision challenges. Traditional methods, such as role-playing and standardized patients, are resource-intensive and less scalable. Virtual simulations, including augmented reality (AR), present novel opportunities for immersive and interactive training. An AR-assisted training tool can enable culturally sensitive training while fostering empathy, communication skills, and confidence in handling nuanced MH scenarios. However, AR's usability and effectiveness for MH task-sharing training remain underexplored. This study aimed to assess the usability of an AR-assisted MH task-sharing training tool that uses virtual patient (VP) simulation and evaluate its potential to enhance training. Additionally, we developed design recommendations for future related XR-assisted clinical training tools. We conducted a formative, explorative sequential mixed-methods usability study. A convenience sample of 5 MH trainees or workers (ages 18-60 years; female: n=3, male: n=2; identifying as African American, Asian, and Hispanic) participated. Participants were recruited through a university-affiliated MH training program. The usability testing protocol included a semistructured prestudy interview, orientation to the AR headset (Magic Leap 2), a think-aloud user testing session, and a poststudy quantitative questionnaire and qualitative interview. Usability was assessed using a modified Post-Study System Usability Questionnaire (PSSUQ), which measures system usefulness, information quality, and interface quality. Data were analyzed using descriptive statistics and thematic analysis. The AR simulation was positively received by participants, demonstrating above-average usability. The overall mean PSSUQ score was 3.46 (SD 1.71), with subscale scores for system usefulness (mean 3.46, SD 1.77), information quality (mean 3.76, SD 1.73), and interface quality (mean 2.83, SD 1.59). Thematic analysis highlighted high realism fostered trainees' empathy toward the VP, while increasing immersion and interaction quality. Despite some hardware limitations and user discomfort that broke immersion, participants recognized the tool's potential and usefulness for training in various MH scenarios. Based on these findings, we proposed design recommendations across environmental context, training structure, VP behavioral realism (body language, voice, eye movement, and technical hardware considerations). This pilot study is among the first to evaluate AR-based VP simulation for training lay MH task-sharers, filling the technology and population gaps of prior VR- and desktop-focused simulation research. Preliminary empirical usability evidence from a validated instrument (PSSUQ) demonstrates above-average usability, and findings informed design recommendations for future research. These findings suggest AR-based training could provide a less resource-intensive solution for realistic MH training practice in underresourced settings. Further research includes larger sample sizes for inferential analysis, comparison studies with traditional methods, and generalizing to other MH conditions.

Anxiety-related symptoms are prevalent and can negatively affect concentration, motivation, and overall well-being. Traditional treatments such as cognitive behavioral therapy and medication work well for clinical anxiety disorders. However, individuals with anxiety often struggle with access, adherence, and staying engaged in treatment. Emerging technologies such as virtual reality (VR) and gamification offer new opportunities to enhance user engagement and motivational processes within digital mental health applications. This study introduces Cleanify, a gamified VR cleaning simulation designed using the Octalysis framework and the persuasive system design model. The objective was to evaluate whether gamification elements improve user engagement, focus, and satisfaction compared to a nongamified version among individuals experiencing anxiety symptoms. We hypothesized that the gamified version would outperform the nongamified version in enhancing user engagement, immersion, and overall user experience. A pilot experimental study was conducted with 50 participants aged 18 to 39 years recruited from the general population in northern Sweden. Participants were randomly assigned to either a gamified or nongamified version of the Cleanify VR application and completed a single 15-minute VR session using the Oculus Quest headset. Baseline anxiety symptoms were assessed using the Generalized Anxiety Disorder-7 scale for descriptive purposes only. Postintervention outcomes included focus and immersion measured using the Flow State Scale and user experience measured using the short version of the User Experience Questionnaire. Group differences were analyzed using 2-tailed independent-sample t tests. Participants using the gamified VR version demonstrated higher engagement and immersion than those using the nongamified version. The gamified group reached higher in-game levels overall, with a greater proportion of participants reaching level 3 (17/25, 68% vs 8/25, 32%), and reported higher recommendation scores (mean 4.20, SD 0.76 vs 3.36, SD 0.86). Significant group differences were observed for overall flow (t 48=3.87; P<.001), fluency (t 48=4.36; P<.001), and absorption (t 48=2.80; P=.008). User Experience Questionnaire results indicated higher pragmatic quality, hedonic quality, and overall user experience in the gamified condition. Integrating gamification into a VR environment significantly enhanced user engagement, focus, and immersion in this pilot sample. These findings provide preliminary evidence that gamified VR design elements can positively influence user experience outcomes. Further research incorporating longitudinal designs and clinical outcome measures is needed to determine potential relevance.

Health care professionals globally face increasing levels of burnout characterized by emotional exhaustion, depersonalization, and a reduced sense of accomplishment, and it has been notably exacerbated during the COVID-19 pandemic. This condition not only impacts the well-being of health care workers but also affects patient care and contributes to significant economic burden. Traditional approaches to mitigating burnout have included various psychosocial interventions, with mindfulness being recognized for its effectiveness in enhancing mental health and stress management. The emergence of virtual reality (VR) technology offers a novel immersive platform for delivering mindfulness and emotional management training. This study aimed to evaluate the immediate impact of an 8-week VR educational program on burnout and work engagement among health care professionals. This nonrandomized pre-post intervention study enrolled 90 health care professionals, including nurses, physicians, and allied health staff, from 3 different centers. Of these 90 professionals, 83 (92%) completed the program. The intervention consisted of 8 weekly VR sessions of 10-13 minutes each, using Meta Quest 2 headsets. The sessions focused on mindfulness and emotional management. The Maslach Burnout Inventory (MBI) and Utrecht Work Engagement Scale (UWES) were used for assessments. Data analysis involved inferential statistical techniques for evaluating the impact on the scales, including paired t tests for normally distributed variables and Wilcoxon signed rank tests for nonnormally distributed variables. The significance of changes was indicated by P values <.05, with effect sizes measured using Cohen d for t tests and Cohen r for Wilcoxon tests for quantifying the magnitude of the intervention's effect. The statistical analysis revealed significant improvements in the MBI and UWES indices after the intervention (P<.05). Specifically, the MBI showed reductions in emotional exhaustion (t 82=5.58; P<.001; Cohen d=0.61) and depersonalization (t 82=4.67; P<.001; Cohen d=0.51), and an increase in personal accomplishment (t 82=-3.62; P<.001; Cohen d=0.4). The UWES revealed enhancements in vigor (t 82=-3.77; P<.001; Cohen d=0.41), dedication (Z=-3.63; P<.001; Cohen r=0.41), and absorption (Z=-3.52; P<.001; Cohen r=0.4). The study provides initial data supporting the effectiveness of VR-based educational programs for reducing burnout and enhancing work engagement among health care professionals. While limitations, such as the absence of a control group, are acknowledged, the significant improvements in burnout and engagement indices coupled with high participant adherence and minimal VR discomfort underline the potential of VR interventions in health care settings. These encouraging findings pave the way for more comprehensive studies, including randomized controlled trials, to further validate and expand upon these results.

Self-care plays an important role in improving health symptoms in patients diagnosed with chronic illnesses such as diabetes. Gamification is among the most effective methods for enhancing health monitoring by applying principles of behavioral economics and motivation. This study aimed to develop an innovative self-care system using a virtual reality (VR)-gamified intervention and to evaluate its effects on patients diagnosed with diabetes metabolic symptoms and health-related behaviors compared to other standard interventions. This study was a randomized controlled trial with a parallel-group design, conducted between December 2024 and February 2025. A total number of 78 patients diagnosed with diabetes were recruited from The Children's Medical Center clinic in a closed, offline setting. Briefing, tutorials, and interventions were partly face-to-face. Eligible participants (n=68) were randomly assigned to the 4 groups using stratified block randomization based on age and sex, with allocation concealment ensured through a sequentially numbered process. Each group received a different type of self-care intervention for 6 weeks, which was health care provider-assisted. One group received the VR gamified intervention, while the other 3 groups received comparator interventions, including the MySugr (mySugr GmbH) monitoring app, traditional counseling, and medication only, respectively. The primary outcomes were fasting blood sugar and health-related behaviors, including physical activity and food intake, while secondary outcomes were long-term metabolic indicators, including hemoglobin A1c (HbA1c) and BMI. All outcomes were measured by self-assessed questionnaires. No blinding was implemented for participants or care providers. However, data analysis was conducted using anonymized group labels. Eight participants were lost to follow-up. Minor missing daily entries were handled by weekly data aggregation. Data from 60 participants were included in the final analysis (VR-gamified group n=16, application group n=14, counseling group n=15, and control group n=15). Linear mixed model showed significant time&#xd7;group interaction effects for fasting blood sugar (F 15,280=2.046; P=.01; partial &#x3b7;&#xb2;=.099), physical activity (F 15,280.61=2.544; P=.001; partial &#x3b7;&#xb2;=.120), and food intake (F 15,336 =2.794; P<.001; partial &#x3b7;2=.111), indicating greater improvement over time in the VR gamification group compared with the other parallel groups. No statistically significant differences were observed for BMI or glycated hemoglobin. No serious adverse events related to the VR intervention were reported. VR gamified self-care interventions may potentially contribute to better management of diabetes-related symptoms and behaviors compared with conventional self-care approaches. Such gamified VR systems show promise as alternative or complementary tools for enhancing health outcomes among children and adolescents diagnosed with diabetes.

Virtual reality (VR)-based goal-oriented games for cognitive assessment are rapidly emerging and progressively being used in neuropsychological settings. These games have been validated quantitatively, but minimal qualitative insights from users currently exist. Such insights on user experience are essential to answering critical questions linked to the games' large-scale usability, adoption in hospital settings, and game design refinement. Current qualitative studies on these games have used general questionnaires or web-based reviews to answer these questions, but direct observation from primary settings is missing. We believe that direct observation of participants playing these games and subsequent interaction with them is critical to developing a more objective, clear, and unbiased view of the games' efficacy, usability, and acceptability. In this study, we aimed to extract constructive and relevant insights directly from the participants who played VR-based goal-oriented games. We used these insights to answer vital questions linked to the practical utility of VR-based cognitive assessment. On the basis of these results, we also aimed to provide actionable insights to key stakeholders in the field, such as researchers, game developers, business personnel, and neuropsychology and allied professionals. Interview data from 82 younger (aged 18-28 years) and 42 older adult (aged >60 years) participants were used. The interview data were obtained from the 2 pilot studies we conducted on VR games for cognitive assessment. Inductive thematic analysis was conducted on the interview data, and later, the findings were carefully interpreted to develop implications for the key stakeholders. We identified 5 themes: ergonomic issues, learning and training, postgame effects, game feedback, and system purpose. Regarding hardware, headset weight, adjustment straps, and controllers need to be improved to promote easy use of the device. Regarding software, graphics quality, immersion experience, and game mechanics are the primary deciding factors for a positive user experience. The younger group prioritized purpose and utility for long-term use, whereas the older participants cherished the entertainment aspect. Researchers and game developers must conceptualize and develop games that can provide maximum insights into real-world abilities. Manufacturing businesses need to improve the headset and accessories to make them more user-friendly. Finally, neuropsychology and allied practitioners must identify strategies to engage and train the participants to try VR-based cognitive assessment games. VR-based games for cognitive assessment are promising tools to improve the current practices of neuropsychological evaluations; however, a few changes are required to make the overall user experience enjoyable, purposeful, and sustainable. In addition, all the key stakeholders need to focus on meaning and purpose over the hype of VR and are advised to work in synergy.

Chronic pain management in public health services often struggles with limited engagement, emotional burden, and medication use. XR shows promise in specialized settings, but evidence for codesign and integration into primary care remains limited. This study aimed to examine the feasibility, usability, and real-world implementation of REDOCVR, an XR-supported psychoeducational program, and to explore preliminary clinical outcomes during its integration into chronic pain groups in public primary care centers. This was a nonrandomized, hybrid type 2 phased implementation study conducted in 3 primary care centers in Catalonia, Spain. The intervention built on existing multidisciplinary psychoeducational chronic pain groups led by psychologists and physiotherapists. In collaboration with patients, XR modules were codesigned and incorporated to enhance mindfulness, cognitive reframing, and motor activation activities already established in routine care. Eight weekly sessions included 15-20 minutes of this content, with a supervised medication tapering protocol included in later groups. Primary outcomes were implementation measures (adherence, tolerability, System Usability Scale, and satisfaction). Secondary outcomes included patient-reported clinical measures (Warwick-Edinburgh Mental Well-being Scale [WEMWBS], Hospital Anxiety and Depression Scale [HADS], Central Sensitization Inventory, and EQ-5D-5L) and medication changes, assessed at baseline, post-intervention, and 5-month follow-up. In total, 42 participants were enrolled, and 36 (85.7%) completed the intervention and all assessments. Adherence was high, and no serious adverse events occurred, with minimal cybersickness reported (5.6%). Patient usability was strong (mean 81.4, 95% CI 75.6-87.1), and overall satisfaction was high (mean 82.4, 95% CI 78.5-86.4). Professional usability was moderate (mean 59.1, 95% CI 51.6-66.5). Statistically significant improvements were observed in emotional well-being (Warwick-Edinburgh Mental Well-being Scale mean change 4.8, 95% CI 2.9-6.7; Cohen d=0.86), anxiety (HADS-A -2.5, 95% CI -3.8 to -1.2; Cohen d=0.66), and depression (HADS-D -1.6, 95% CI -2.5 to -0.7; Cohen d=0.62) (all P<.001). Mobility improved significantly (median change -1.0, 95% CI -1.0 to 0.0, P=.09), while Pain/Discomfort showed a nonsignificant trend (P=.08). Among tapering participants (n=22), mean use of benzodiazepines decreased by 71.7% and opioids by 41.8% at 5 months. This study suggests that an XR-enhanced psychoeducational program can be incorporated into group-based chronic pain care within the public primary health care system. Exploratory improvements in emotional well-being, anxiety, depression, and reduced use of high-risk medications during supervised tapering indicate potential benefits, although causal inferences cannot be drawn given the feasibility design. These findings provide practical insights to inform refinement and progression to larger controlled studies evaluating scalability and long-term effects in routine primary care.

Youth mental health is a global public health priority, with rising rates of anxiety and depression, particularly after the COVID-19 pandemic. Despite the early onset and substantial burden of mental disorders in this age group, young people are less likely than adults to seek professional help and face barriers such as workforce shortages, stigma, and low mental health literacy. Although efforts such as outreach initiatives and school-based programs have been implemented, innovative and scalable solutions remain limited. Digital technologies, including the metaverse, may offer flexible and stigma-reducing approaches to mental health care; however, evidence regarding their real-world feasibility and acceptability is scarce. This study investigated the feasibility and user experience of metaverse-based psychiatric consultations for young people with mental health conditions. We conducted a qualitative descriptive feasibility study at a single academic institution in Yokohama, Japan, between July and November 2023. A total of 26 participants aged 16 to 25 years (mean age 19.9, SD 2.4; 15 male, 7 female, 3 nonbinary, 1 no response) who self-identified as having mental health concerns were recruited from local psychiatric clinics, schools, universities, and social media. Reported concerns included anxiety, depressive symptoms, and autism spectrum disorder traits. Participants completed a 30- to 40-minute one-on-one metaverse-based consultation with a psychiatrist using avatars in a virtual reality environment, followed by semistructured interviews exploring feasibility, usability, and user perceptions. Data were analyzed using thematic analysis, and data collection continued until no substantially new themes emerged. Reporting followed the APA Journal Article Reporting Standards for qualitative research. All participants completed the study without any adverse psychological events. Five participants experienced minor, transient physical discomfort (eg, headaches and virtual reality-related sickness), which resolved without medical intervention. Thematic analysis identified 3 primary domains: perceived psychological safety through avatar-mediated interaction, enhanced spatial presence facilitating rapport, and increased autonomy within the virtual environment. Metaverse consultations were perceived as particularly beneficial for individuals experiencing interpersonal anxiety, sensory sensitivities (including autism spectrum disorder traits), difficulty leaving home due to psychiatric conditions, psychological resistance to traditional psychiatric settings, or discomfort with physical self-presentation. This qualitative descriptive feasibility study provides preliminary evidence that metaverse-based psychiatric consultations are a feasible and acceptable approach for supporting young people with mental health conditions. Unlike conventional telepsychiatry based on videoconferencing, the use of avatar-mediated interaction and immersive virtual environments may reduce psychological barriers related to self-presentation, stigma, and interpersonal anxiety for specific subgroups of youth. These findings suggest that metaverse-based consultations can be effectively integrated into clinical pathways as a complementary, "low-threshold" access point within stepped or hybrid care models, ultimately bridging the gap between initial help-seeking and formal psychiatric treatment.