Background:Commercial wearable devices allow for continuous heart rate (HR) monitoring in daily life. Their accuracy under ecologically valid conditions, however, remains insufficiently independently tested, especially during irregular activity, cognitive stress, and variable climates. Objective:This study evaluated the HR accuracy of 10 commercially available wearables under controlled variations in physical activity, cognitive stress, and temperature. We hypothesized that physical activity irregularity, cognitive stress, and thermal climate conditions would affect measurement accuracy. Methods:Forty-five healthy adults (21-68, mean 34, SD 12 y) completed a standardized protocol in climate-controlled chambers simulating neutral (23 °C), hot (36 °C), and cold (10 °C) conditions. Tasks included rest, cognitive stress (Montreal Imaging Stress Task), steady walking, and intermittent walking. Each of the 10 devices (Fitbit Charge 6, Fitbit Inspire 3, Garmin Vivosmart 5, Garmin Vivoactive 5, Apple Watch SE, Google Pixel Watch 2, Polar Ignite 3, Polar Pacer, Xiaomi Watch 2, and Oura Ring Gen 3) was compared against electrocardiogram-derived HR from a Zephyr BioHarness chest strap. Accuracy was assessed using mean absolute error (MAE), mean absolute percentage error (MAPE), repeated-measures concordance correlation coefficient (CCC), and Bland-Altman analysis. Results:Significant variability across the devices was observed. Fitbit Charge 6 (MAE 4.5 bpm, MAPE 5.5%, CCC 0.93) and Google Pixel Watch 2 (MAE 4.9 bpm, MAPE 6.7%, CCC 0.87) showed strong agreement with the gold standard. In contrast, Fitbit Inspire 3, Polar Ignite 3, Polar Pacer, and Oura Ring displayed larger errors (MAE 9-14 bpm, MAPE 11%-16%) and lower CCC values (0.45-0.66). The climate conditions did not significantly affect the measurement accuracy of the test devices. The activity type, however, did have a significant effect: intermittent walking increased errors for multiple devices. Conclusions:Wearable HR measurement accuracy is device-specific and context-dependent. Moderate climates did not impair performance, but irregular movement reduced accuracy. Fitbit Charge 6 and Google Pixel Watch 2 demonstrated the highest reliability, supporting their use in health and sports monitoring. Careful device selection and context-aware interpretation remain critical for applied and clinical applications.

Stress increased markedly in recent years, highlighting the need for effective and accessible relaxation strategies. Virtual Reality (VR) has emerged as a promising intervention. While most prior VR studies were conducted under controlled conditions, the present study explored the acceptability and feasibility of VR as a relaxation tool in naturalistic settings. Additionally, it explored the effects on the perceived level of relaxation and mood, and whether heart rate (HR) data obtained from consumer-grade wearables correlated with changes in psychological state.The study involved 160 participants, including healthcare and research professionals, patients, and attendants in healthcare organizations. VR relaxation was tested using both smartphone-based and standalone VR applications in clinical and non-clinical studies. Changes in mood and relaxation were explored using validated instruments, while acceptability and feasibility were assessed through open-ended questions.Qualitative feedback was predominantly positive, with participants willing to reuse and recommend the VR application. VR relaxation was perceived as an effective means of environmental escape, offering immersive natural settings complemented by guided exercises, ambient sounds, and voice instructions. Wearable devices generally recorded HR reductions during VR sessions; however, these exploratory physiological changes did not significantly correlate with subjective relaxation levels.Participants reported increased relaxation (VAS scores), reduced muscle tension, fewer cardiovascular symptoms of stress (slower breathing and HR), and greater overall physical calmness. Regarding mood, most participants experienced fewer negative emotions (e.g., anxiety, guilt, sadness) following VR exposure, although positive affect (e.g., enthusiasm, confidence) remained unchanged according to PANAS. POMS scores indicated reductions in tension after VR sessions.

Background Accumulating evidence supports the use of virtual reality (VR) in mental health care, with one potential application being its use to assist individuals with relaxation exercises. Despite studies finding support for the potential of VR to effectively aid in relaxation, its implementation remains limited outside of specialized clinics. Known barriers are insufficient knowledge regarding VR operation, lack of availability of VR relaxation apps tailored to local health care systems, and cost concerns. Unfortunately, many VR relaxation apps are designed exclusively for stand-alone headsets, limiting accessibility for a broad audience. Objective We aimed to design an accessible, smartphone-based VR relaxation app based on user preferences. This paper describes the assessment of 2 stand-alone VR relaxation apps and the resulting smartphone-based VR relaxation app design. Methods Overall, 30 participants (n=23, 77% women; n=7, 23% men) took part in 2 separate VR sessions, assessing 1 of the 2 VR relaxation apps (Flowborne and Calm Place) in each session. After each session, participants were presented with open-ended questions to assess their experiences via a web-based survey tool. These questions explored positive and negative features, shortcomings, and suggestions for improvements while also allowing space for additional remarks concerning the 2 VR relaxation apps. Three of the authors analyzed the responses using inductive thematic analysis, a process comprising 6 phases. Results Across both the apps, 5 recurring themes and 13 recurring subthemes were identified in the participants’ answers: audio (music and sounds, guidance), visuals (content, realism, variation and dynamics in the environment), features (language, options, feedback and instructions, duration, exercise), implementation (technical aspects, cybersickness, acceptability and usability), and experience. We analyzed the participants’ findings and conducted a literature review, which served as the basis for developing the app. The resulting app is a Dutch-language, smartphone-based VR relaxation app, with customization options including 3 types of relaxation exercises, 2 guiding voices, and 3 different environments. Efforts have been made to ensure maximum variation and dynamism in the environments. Calming music and nature sounds accompany the exercises. The efficacy and effectiveness of the resulting app design were not assessed. Conclusions This study provides insights into key features of VR relaxation apps, which were subsequently used for the development of a novel smartphone-based VR relaxation app. Further research concerning the effectiveness of this app, along with a broader evaluation of the efficacy and user feedback for smartphone-based VR relaxation apps, is needed. More generally, there is a clear need for more research on the impact of interactivity, biofeedback, and type of environment in VR relaxation.

Hemineglect is a neurological condition in which individuals experience difficulty attending to stimuli on one side of their environment, typically due to brain trauma. This study aimed to develop a first mixed reality (MR) proof-of-concept (PoC) application for the rehabilitation of individuals with hemineglect, using the Design Thinking methodology. The proposed application involves an activity to practice visual scanning and to stimulate the lower limbs through interaction with virtual objects alternately generated on both sides of the individual. As MR devices do not natively support interaction via the lower limbs, we evaluated two methods for integrating this functionality: 1. MR device's controllers and 2. Third party trackers, both attached to the feet. Consequently, an in-depth comparison was conducted between the Meta Quest 3 controllers and the HTC VIVE Ultimate Trackers. In addition, for more accurate exercise evaluation and monitoring, a specific module was programmed to collect limb angle data using a digital goniometer via Bluetooth. This data source, combined with live visualization of the activity, provides healthcare professionals with a valuable tool for assessing the individual’s progress in the rehabilitation process. The MR application was presented to occupational therapists to assess its usefulness, usability, and therapeutic potential. Their feedback provided valuable insights for future improvements and iterations of the system.

Rationale Although the study of emotions can look back to over 100 years of research, it is unclear which information the brain uses to construct the subjective experience of an emotion. Objective In the current study, we assess the role of the peripheral and central adrenergic system in this respect. Methods Healthy volunteers underwent a double inhalation of 35% CO 2 , which is a well-validated procedure to induce an intense emotion, namely panic. In a randomized, cross-over design, 34 participants received either a β 1 -blocker acting selectively in the peripheral nervous system (atenolol), a β 1 -blocker acting in the peripheral and central nervous system (metoprolol), or a placebo before the CO 2 inhalation. Results Heart rate and systolic blood pressure were reduced in both β-blocker conditions compared to placebo, showing effective inhibition of the adrenergic tone. Nevertheless, the subjective experience of the induced panic was the same in all conditions, as measured by self-reported fear, discomfort, and panic symptom ratings. Conclusions These results indicate that information from the peripheral and central adrenergic system does not play a major role in the construction of the subjective emotion.

Access to inclusive and qualitative education on an equal basis is a clear right of every child, even from the very beginning in Early Childhood Education and Care (ECEC). However, inclusive education is often not possible without access to appropriate (assistive) technologies. Notwithstanding the opportunities of technology to enhance inclusion of all children, it is still limitedly integrated by educators and teachers into their curriculum. Therefore, the SKATE project aims in gearing innovative technology as resource for inclusive education. This study describes and evaluates the preparation, the design, the implementation, and the effects of technology-based classroom activities in inclusive ECEC. The classroom activities are developed and implemented by school teams of 14 preschools spread over four European (EU) countries. A total of 50 school team members participated in a SKATE Learning Programme. This resulted in more than 20 technology-based inclusive class activities, created by school teams together with technology experts. Across the four countries, approximately 330 pre-schoolers, with and without special educational needs (SEN), participated. At this moment, 13 school team members from four EU countries and 45 parents from two EU countries evaluated the technology-based inclusive classroom activities. Nearly all teachers agreed that the activity promoted the inclusion of all children. Teachers reported that most of the children enjoyed the activity. This was confirmed in the evaluation by the parents. Most parents had the impression that the activity was meaningful, joyful and inclusive for all children.

BACKGROUND:Living labs in the health and well-being domain have become increasingly common over the past decade but vary in available infrastructure, implemented study designs, and outcome measures. The Horizon 2020 Project Virtual Health and Wellbeing Living Lab Infrastructure aims to harmonize living lab procedures and open living lab infrastructures to facilitate and promote research activities in the health and well-being domain in Europe and beyond. This protocol will describe the design of a joint research activity, focusing on the use of innovative technology for both rehabilitation interventions and data collection in a rehabilitation context. OBJECTIVE:With this joint research activity, this study primarily aims to gain insight into each living lab's infrastructure and procedures to harmonize health and well-being living lab procedures and infrastructures in Europe and beyond, particularly in the context of rehabilitation. Secondarily, this study aims to investigate the potential of innovative technologies for rehabilitation through living lab methodologies. METHODS:This study has a mixed methods design comprising multiple phases. There are two main phases of data collection: cocreation (phase 1) and small-scale pilot studies (phase 2), which are preceded by a preliminary harmonization of procedures among the different international living labs. An intermediate phase further allows the implementation of minor adjustments to the intervention or protocol depending on the input that was obtained in the cocreation phase. A total of 6 small-scale pilot studies using innovative technologies for intervention or data collection will be performed across 4 countries. The target study sample comprises patients with stroke and older adults with mild cognitive impairment. The third and final phases involve Delphi procedures to reach a consensus on harmonized procedures and protocols. RESULTS:Phase 1 data collection will begin in March 2022, and phase 2 data collection will begin in June 2022. Results will include the output of the cocreation sessions, small-scale pilot studies, and advice on harmonizing procedures and protocols for health and well-being living labs focusing on rehabilitation. CONCLUSIONS:The knowledge gained by the execution of this research will lead to harmonized procedures and protocols in a rehabilitation context for health and well-being living labs in Europe and beyond. In addition to the harmonized procedures and protocols in rehabilitation, we will also be able to provide new insights for improving the implementation of innovative technologies in rehabilitation. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID):PRR1-10.2196/34537.

Background There is a great evidence base today for the effectiveness of e-mental health, or the use of technology in mental healthcare. However, large-scale implementation in mental healthcare organisations is lacking, especially in inpatient specialized mental healthcare settings. Aim The current study aimed to gain insights into the factors that promote or hinder the implementation of e-mental health applications on organisational, professional and patient levels in Belgium. Methods Four Belgian psychiatric hospitals and psychiatric departments of general hospitals invited their professionals and patients to use Moodbuster, which is a modular web-based platform with a connected smartphone application for monitoring. The platform was used in addition to treatment as usual for three to four months. The professionals and patients completed pre- and post-implementation questionnaires on their reasons to participate or to decline participation and experiences with the Moodbuster platform. Results Main reasons for the organisations to participate in the implementation study were a general interest in e-mental health and seeing it is a helpful add-on to regular treatment. The actual use of Moodbuster by professionals and patients proved to be challenging with only 10 professionals and 24 patients participating. Implementation was hindered by technical difficulties and inpatient care specific factors such as lack of structural facilities to use e-mental health and patient-specific factors. Professionals saw value in using e-mental health applications for bridging the transition from inpatient to outpatient care. Twenty-two professionals and 31 patients completed the questionnaire on reasons not to participate. For the patients, lack of motivation because of too severe depressive symptoms was the most important reason not to participate. For professionals, it was lack of time and high workload. Conclusions The current implementation study reveals several important barriers to overcome in order to successfully implement e-mental health in inpatient psychiatric care.

Exposure therapy is an effective treatment for specific phobia that could be further enhanced through Augmented Reality, a novel technology that can facilitate implementation of gradual exposure and promote treatment acceptability. Effective exposure interventions require stimuli evoking high levels of anxiety. Therefore, it is important to ascertain whether animals can induce anxiety in distinct Augmented Reality modalities, such as Head-Mounted Displays and smartphones, which can differ in user experience and technological embodiment. This study compared the anxiety inducing potential and experienced realism of a spider within the HoloLens 2 Augmented Reality headset and an Augmented Reality smartphone application. Sixty-five participants were exposed to a virtual spider in a 5-step Behavioral Approach Task through both the HoloLens 2 head-mounted display and the PHOBOS Augmented Reality smartphone application. Participants reported Subjective Units of Distress at each step and physiological arousal was measured using heart rate and Skin Conductance. Results show that both technological modalities induced self-reported anxiety for spiders in a Behavioral Approach Task task in a non-clinical sample. The Hololens 2 modality was also related to an skin conductance (SC) increase. Perceived realism did not differ between modalities but was associated with increased anxiety in the HoloLens 2 modality. Findings demonstrate that both implemented modalities have potential for enabling Augmented Reality Exposure Therapy, although the role of experienced realism merits additional investigation. Future research should assess the effectiveness of Augmented Reality Exposure Therapy in clinical samples and assess whether new extended reality modalities, such as passthrough virtual reality, could accommodate observed limitations and improve Augmented Reality Exposure Therapy experiences and outcomes.

Accumulating evidence supports the use of virtual reality (VR) as an effective pain and anxiety management tool for pediatric patients during specific medical procedures in dedicated patient groups. However, VR is still not widely adopted in everyday clinical practice. Feasibility and acceptability measures of clinicians' experiences are often missing in studies, thereby omitting an important stakeholder in VR use in a clinical setting. Therefore, the aim of this mixed-methods study was to investigate the feasibility, acceptability, tolerability (primary outcomes), and preliminary effectiveness (secondary outcome) of Relaxation-VR in both pediatric patients aged 4–16 years and clinicians. Relaxation-VR is a VR application prototype aimed to provide distraction and relaxation for a variety of patient populations and procedures and is used to reduce anxiety, stress (tension) and pain for children in hospital. Multiple measures of acceptability, feasibility and tolerability, and pre-to-post changes in measures of pain, anxiety, stress and happiness were assessed in pediatric patients. At the end of the study, acceptability and feasibility of VR use was assessed in clinicians. Results indicate that VR use (in particular, the Relaxation-VR prototype) for both distraction and relaxation is acceptable, feasible and tolerable for a variety of pediatric patients aged 4–16 years, as assessed in both patients and clinicians, and can reduce anxiety, pain and tension (stress), and increase happiness in a hospital setting.

Background: Arousal may be important for learning to restructure ones' negative cognitions, a core technique in depression treatment. In virtual reality (VR), situations may be experienced more vividly than, e.g., in an imaginative approach, potentially aiding the emotional activation of negative cognitions. However, it is unclear whether such activation and subsequent cognitive restructuring in VR elicits more physiological, e.g. changes in skin conductance (SC), heart rate (HR), and self-reported arousal. Method: In a cross-over experiment, 41 healthy students experienced two sets, one in VR, one face-to-face (F2F), of three situations aimed at activating negative cognitions. Order of the sets and mode of delivery were randomised. A wristband wearable monitored SC and HR; self-reported arousal was registered verbally. Results: Repeated measures analyses of variance revealed significantly more SC peaks per minute, F (1, 40) = 13.89, p = .001, higher mean SC, F (1,40) = 7.47, p = .001, and higher mean HR, F (1, 40) = 75.84, p < .001 in VR compared to F2F. No differences emerged on the paired-samples t-test for self-reported arousal, t (40) = - 1.35, p = .18. Discussion: To the best of our knowledge, this is the first study indicating that emotional activation and subsequent cognitive restructuring in VR can lead to significantly more physiological arousal compared to an imaginative approach. These findings need to be replicated before they can be extended to patient populations.

E-mental health (eMH) encompasses the use of digital technologies to deliver, support, or enhance mental health services. Despite the growing evidence for the effectiveness of eMH interventions, the process of implementation of eMH solutions in healthcare remains slow throughout Europe. To address this issue, the e-Mental Health Innovation and Transnational Implementation Platform North-West Europe (eMEN) project was initiated to increase the dissemination and quality of eMH services in Europe. In this project, status analyses regarding eMH in the six participating countries (i.e., Belgium, France, Germany, Ireland, The Netherlands, and the UK) were conducted and eight recommendations for eMH were developed. Expert teams from the six participating countries conducted status analyses regarding the uptake of eMH based on a narrative literature review and stakeholder interviews. Based on these status analyses, the eMEN consortium developed eight policy recommendations to further support the implementation of eMH in Europe. The status analyses showed that the participating countries are in different stages of implementing eMH into mental healthcare. Some barriers to implementing eMH were common among countries (e.g., a limited legal and regulatory framework), while others were country-specific (e.g., fragmented, federal policies). The policy recommendations included fostering awareness, creating strong political commitment, and setting reliable standards related to ethics and data security. The eMEN project has provided the initial recommendations to guide political and regulatory processes regarding eMH. Further research is needed to establish well-tailored implementation strategies and to assess the generalizability of the recommendations beyond the countries involved in the eMEN project.

Over the past years, mobile health (mHealth) applications and specifically wearables have become able and available to collect data of increasing quality of relevance for mental health. Despite the large potential of wearable technology, mental healthcare professionals are currently lacking tools and knowledge to properly implement and make use of this technology in practice. The Carewear project is aimed at developing and evaluating an online platform, allowing healthcare professionals to use data from wearables in their clinical practice. Carewear implements data collection through self-tracking, which is aimed at helping people in their behavioral change process, as a component of a broader intervention or therapy guided by a mental healthcare professional. The Empatica E4 wearables are used to collect accelerometer data, electrodermal activity (EDA), and blood volume pulse (BVP) in real life. This data is uploaded to the Carewear platform where algorithms calculate moments of acute stress, average resting heart rate (HR), HR variability (HRV), step count, active periods, and total active minutes. The detected moments of acute stress can be annotated to indicate whether they are associated with a negative feeling of stress. Also, the mood of the day can be elaborated on. The online platform presents this information in a structured way to both the client and their mental healthcare professional. The goal of the current study was a first assessment of the accuracy of the algorithms in real life through comparisons with comprehensive annotated data in a small sample of five healthy participants without known stress-related complaints. Additionally, we assessed the usability of the application through user reports concerning their experiences with the wearable and online platform. While the current study shows that a substantial amount of false positives are detected in a healthy sample and that usability could be improved, the concept of a user-friendly platform to combine physiological data with self-report to inform on stress and mental health is viewed positively in our pilots.

We investigate the application of feature selection methods and their influence on distinguishing nocturnal motor seizures in epileptic children from normal nocturnal movements using accelerometry signals. We studied two feature selection methods applied one after the other to reduce the complexity and computation costs of least-squares support vector machine (LS-SVM) models. Simultaneous feature selection analyses were performed for each seizure type individually and jointly. Starting from 140 features, a filter method based on mutual information was applied to remove irrelevant and redundant features. The obtained subset was further reduced through a wrapper feature selection strategy using an LS-SVM classifier with both forward search and backward elimination. The discriminative power of each feature subset was evaluated on the test data in terms of the area under the receiver operating characteristic curve, sensitivity, and false detection rate per hour. We showed that, by using only a filter method for feature selection, it was possible to obtain classification results of comparable or slightly reduced performance with respect to the complete feature set. The attained results could facilitate further development of accelerometry-based seizure detection and alarm systems.