Abstract BackgroundTraining practitioners to implement functional communication training (FCT) is resource intensive. Emerging technologies, such as virtual reality (VR) and chatbots, may deliver training at scale. Their comparative effectiveness and whether skills taught in one modality transfer to another remain uncertain. ObjectiveThis exploratory study evaluated the effect of multicomponent training packages featuring either VR or a chatbot on (1) posttraining performance on FCT implementation probes administered in both formats and (2) changes in participants’ self-perceived knowledge, confidence, and usefulness. MethodsA convenience sample of 23 university students (mean age=24 y; 15/23, 65% female) were recruited through classroom announcements and peer referrals. Eligible participants (at least 18 years of age, available to attend trainings, and who had no history of discomfort associated with VR) were randomly assigned to either VR (n=12) or chatbot (n=11) training. Groups did not differ significantly across demographic characteristics. In-person trainings consisted of video-recorded instruction and rehearsal of steps in VR or with the chatbot during a single session. Approximate times of sessions, including tutorials and assessments, were 45 minutes (VR) and 55 minutes (chatbot). All participants’ performance on FCT procedures was measured using 2 formats: a VR-based observed mastery probe (OMP) and a text-based probe (TBP). Participants also completed a survey measuring their self-perceptions. ResultsThe number of FCT steps participants performed correctly (of 18) was analyzed using a binomial generalized linear mixed model, with random intercepts for participant and fixed effects of training group (chatbot vs VR), time (pretest vs posttest), and probe modality (OMP vs TBP); αPP
Background Social participation is a key goal of stroke rehabilitation, yet effective interventions remain limited. Existing approaches focus largely on functional training or general psychological support, rarely targeting resilience as a modifiable mechanism for enhancing social participation. Most interventions are delivered face-to-face, limiting accessibility and scalability. A theory-driven digital intervention that integrates resilience training with contextualized practice may offer a promising pathway to support social reintegration in stroke survivors. Objective This study aimed to develop a theory-driven, digital resilience-based course-game sequential intervention for improving social participation in stroke survivors and to evaluate its usability among the target population. Methods This was an intervention development and usability study. Following the first 4 steps of intervention mapping, we completed the following steps: (1) conducted a needs assessment based on prior empirical evidence identifying psychological resilience as a key determinant of social participation; (2) defined performance and change objectives grounded in the Kumpfer resilience framework, which delineates 5 protective factors (cognitive, emotional, spiritual, behavioral, and physical); (3) selected theory-based methods and practical applications; and (4) developed an intervention prototype through 4 phases: initial design integrating course learning and gamified experiential modules, expert review and refinement by an 8-member panel, development of the digital system via a WeChat mini-program, and finalization of comprehensive intervention scripts. Participants were recruited using convenience sampling from a rehabilitation hospital in Shanghai, China. Usability was evaluated with 14 stroke survivors through 5 representative tasks, the System Usability Scale (SUS), and semistructured qualitative interviews. Quantitative data were analyzed using descriptive statistics, and qualitative data were analyzed using conventional content analysis. Results The intervention comprised 2 sequential modules: a 7-session course learning module targeting 5 resilience factors, delivered weekly via narrative audio and multimodal content, and a gamified experiential module featuring a supermarket shopping scenario that enabled contextualized skill application. Each weekly course session was designed to last approximately 60 minutes. The duration of a single game session was 20 minutes. Participants had a mean age of 65.4 (SD 9.75) years, and 78.6% (11/14) had experienced an ischemic stroke. All participants completed the usability tasks successfully. The mean SUS score was 73.6 (SD 12.2, 95% CI 66.5-80.6; median 77.5, IQR 61.3-80.6), indicating good usability. Qualitative feedback revealed 3 themes: perceived ease of use and accessibility, perceived usefulness and engagement, and suggestions for improvement. Conclusions This study systematically developed a theory-driven, digital course-game sequential intervention that is innovative in targeting psychological resilience as a core mechanism for social participation, distinguishing it from conventional function-focused or generic resilience approaches. By integrating systematic course learning with contextualized gamified practice, it offers a scalable, low-burden tool that addresses key gaps in stroke rehabilitation. These findings support progression to feasibility and efficacy testing through randomized controlled trials in real-world settings.
Abstract BackgroundGamification, the integration of game elements into education and game-based learning, is increasingly applied to laparoscopic skills training. However, systematic evidence on its effectiveness and practical feasibility remains limited and fragmented. ObjectiveThis study aimed to evaluate the effectiveness and feasibility of gamified interventions and game-based learning in improving laparoscopic skills education. MethodsWe searched PubMed, Embase, Cochrane Library, Web of Science, Scopus, and ClinicalTrials from January 1, 2000, to July 1, 2026, for studies evaluating gamification and game-based learning in laparoscopic skills education. Eligible studies included interventional and observational studies involving medical students, residents, or surgeons, with measurable performance outcomes. Study quality was assessed using ROBINS-I (Risk of Bias In Non-randomized Studies-of Interventions), RoB 2 (Cochrane Risk of Bias Tool 2), and NIH quality assessment tools. Standardized mean differences (SMDs) were pooled using random-effects models; between-study heterogeneity was quantified by τI ResultsA total of 39 studies involving 2102 participants were included. Video game–based interventions served mainly as training tools or assessments, whereas gamified contexts incorporated competitive or collaborative motivational elements. Three subgroup meta-analyses were performed. Game-based learning vs no training yielded a pooled Hedges g of −0.04 (95% CI −7.14 to 7.06; III ConclusionsBoth game-based learning and gamified contexts are feasible adjuncts for basic laparoscopic skills training and may enhance motivation and deliberate practice; however, meta-analytic evidence did not demonstrate a statistically significant advantage over no training or conventional laparoscopic training, and the results were not robust to leave-one-out analysis. Generic video games showed limited efficacy for advanced, procedure-specific skills, and the evidence is constrained by heterogeneous outcome measures, small numbers of studies, moderate risk of bias, and a lack of long-term follow-up. As the first synthesis to compare video game-based and gamified context-based approaches within a unified framework, this review provides educators with guidance for integrating task-aligned gamified modules into existing curricula, while highlighting that robust efficacy and sustained operative transfer remain to be demonstrated by larger, standardized studies.
BackgroundMinimally invasive endodontics requires precise visualization to preserve tooth structure, often relying on indirect vision with a dental mirror—a challenging skill for dental students. Although virtual reality (VR) simulators provide immersive environments for dental training, most existing systems primarily focus on procedural simulation and haptic feedback, with limited capabilities for real-time mirror positioning and indirect visual guidance. ObjectiveThe aim of this study was to evaluate verbal, visual, and haptic VR-based mirror guidance for indirect vision during minimally invasive endodontic access cavity preparation. MethodsEligible fourth-year preclinical dental students were recruited through institutional email invitations and public announcements. A randomized controlled crossover trial was conducted with 30 participants, who completed all VR sessions in a simulation laboratory under direct investigator supervision to ensure standardized implementation of the training protocol. Participants performed simulated maxillary first molar access cavity preparations under 4 VR mirror guidance conditions—verbal guidance, visual guidance, haptic guidance, and no guidance—following a randomized 4 × 4 Latin square sequence with a 48-hour washout period between sessions. The primary outcome was outcome error score. Exploratory secondary outcomes included operating area visibility, operating area obstruction, operator posture error, task completion time, and Virtual Reality System Usability Questionnaire score. Outcomes were analyzed using linear mixed-effects models accounting for the crossover design. Estimated marginal mean differences (MDs) with 95% CIs and partial eta-squared (ηp2) effect sizes were reported, with Bonferroni-adjusted pairwise comparisons used to account for multiple comparisons. ResultsGuidance modality significantly affected the primary outcome, outcome error score (F3,84=20.34; P<.001; ηp2=0.421). Compared with no guidance, outcome error scores were significantly lower with verbal (MD −0.50, 95% CI −0.76 to −0.24), visual (MD −0.68, 95% CI −0.94 to −0.42), and haptic guidance (MD −0.63, 95% CI −0.89 to −0.37; all adjusted P<.001). Guidance modality also significantly affected operating area visibility (F3,84=12.31; P<.001; ηp2=0.305). Compared with no guidance, visibility duration was significantly greater with verbal (MD 37.79, 95% CI 11.15-64.43 seconds; adjusted P=.001), visual (MD 59.15, 95% CI 32.51-85.79 seconds; adjusted P<.001), and haptic guidance (MD 31.52, 95% CI 4.90-58.15 seconds; adjusted P=.01). No significant differences were detected for operating area obstruction, operator posture error, task completion time, or usability. ConclusionsVR-based mirror guidance improved the outcome error score and increased operating area visibility during minimally invasive endodontic access cavity preparation. Verbal, visual, and haptic guidance resulted in fewer outcome errors and greater operating area visibility than no guidance, while no significant differences were detected in other performance measures or usability. These findings demonstrate the potential of diverse feedback modalities to provide effective guidance for indirect vision and inform future development of adaptive VR training systems using 1 or more modalities to suit learner needs. Trial RegistrationThai Clinical Trials Registry TCTR20260126008; https://www.thaiclinicaltrials.org/show/TCTR20260126008
