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Application and Evaluation of Extended Reality Games in Healthcare
Blekinge Institute of Technology, Faculty of Computing, Department of Computer Science.ORCID iD: 0000-0003-3520-3302
2024 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Since the term ’human-computer interaction’ was first used in the 1970s, the way humans interact with computers has become diverse. Immersive technologies provide an interactive way to merge the physical and digital worlds. Among immersive technologies collectively referred to as extended reality (XR), virtual reality (VR) is one of the main types. In the industrial market, most of the investment in immersive technology was concentrated in the gaming industry, and healthcare-related applications were also at the forefront. Lack of consumer demand and user experience issues were among the main challenges of popularisation. With this background, this dissertation used the literature review and survey to understand the development status, opportunities, challenges, and evaluation of XR games in healthcare from academic and consumer perspectives. Based on these results, this dissertation designed and implemented an indoor VR rowing game for physical exercise aimed at the elderly and conducted a questionnaire-based test on this game. This small-scale test is a pilot study to test the experimental environment, equipment and methods, as well as collect feedback on the game and research. Based on this feedback and the problems found in the pilot study, this dissertation improved the experimental design and the game settings and conducted a large-scale formal experiment. This experiment tested the subjective evaluation method based on standardised scales and the objective evaluation based on biosensors in VR rowing games. This dissertation explored user preferences on real devices, postures, and game tasks and studied the impact of age on them. This dissertation provides a reference value for researchers and developers in related work: 1) the current status and trends of XR game applications and evaluation in the health fields from academic and industrial perspectives, 2) attempting to provide solutions to the lack of VR games for elderly users, and 3) trying to provide subjective and objective evaluation methods for user experience evaluation as well as exploration of user preferences.

Place, publisher, year, edition, pages
Karlskrona: Blekinge Tekniska Högskola, 2024. , p. 193
Series
Blekinge Institute of Technology Doctoral Dissertation Series, ISSN 1653-2090 ; 2024:12
Keywords [en]
extended reality, augmented reality, virtual reality, mixed reality, game, gamification, healthcare, biofeedback evaluation, eye tracking, galvanic skin response, heart rate
National Category
Computer Sciences
Research subject
Computer Science
Identifiers
URN: urn:nbn:se:bth-27036ISBN: 978-91-7295-485-4 (print)OAI: oai:DiVA.org:bth-27036DiVA, id: diva2:1921232
Public defence
2025-01-28, J1630, BTH, Valhallavägen 1, Karlskrona, 09:00 (English)
Opponent
Supervisors
Available from: 2024-12-16 Created: 2024-12-13 Last updated: 2024-12-18Bibliographically approved
List of papers
1. A Systematic Literature Review of Virtual, Augmented, and Mixed Reality Game Applications in Healthcare
Open this publication in new window or tab >>A Systematic Literature Review of Virtual, Augmented, and Mixed Reality Game Applications in Healthcare
2022 (English)In: ACM Transactions on Computing for Healthcare, ISSN 2691-1957, Vol. 3, no 2, article id 22Article, review/survey (Refereed) Published
Abstract [en]

Virtual reality, augmented reality, and mixed reality (VR/AR/MR) as information and communication technologies have been recognised and implemented in healthcare in recent years. One of the popular application ways is games, due to the potential benefits of providing an engaging and immersive experience in a virtual environment. This study presents a systematic literature review that evaluates the state-of-the-art on VR/AR/MR game applications in healthcare by collecting and analysing related journal and conference papers published from 2014 through to the first half of 2020. After retrieving more than 3,000 papers from six databases, 88 articles, from both computer science and medicine, were selected and analysed in the review. The articles are classified and summarised based on their (1) publication information, (2) design, implementation, and evaluation, and (3) application. The presented review is beneficial for both researchers and developers interested in exploring current research and future trends in VR/AR/MR in healthcare. © 2022 Association for Computing Machinery.

Place, publisher, year, edition, pages
ACM Publications, 2022
Keywords
Augmented reality, Health care, Game, Gamification, Immersive, Information and Communication Technologies, Journal paper, Mixed reality, Mixed reality game, Potential benefits, State of the art, Systematic literature review, healthcare, Virtual reality
National Category
Human Computer Interaction
Identifiers
urn:nbn:se:bth-22826 (URN)10.1145/3472303 (DOI)001373194500006 ()2-s2.0-85126731767 (Scopus ID)
Available from: 2022-04-08 Created: 2022-04-08 Last updated: 2025-01-02Bibliographically approved
2. A Systematic Literature Review of Extended Reality Exercise Games for the Elderly
Open this publication in new window or tab >>A Systematic Literature Review of Extended Reality Exercise Games for the Elderly
2023 (English)In: Biomedical Engineering Systems and Technologies: 15th International Joint Conference, BIOSTEC 2022, Virtual Event, February 9–11, 2022, Revised Selected Papers / [ed] Ana Cecília A. Roque, Denis Gracanin, Ronny Lorenz, Athanasios Tsanas, Nathalie Bier, Ana Fred, Hugo Gamboa, Springer Science+Business Media B.V., 2023, p. 333-352Conference paper, Published paper (Refereed)
Abstract [en]

In recent years, with the rise of the ageing population worldwide, the health of the elderly has attracted increasing attention. This study explored existing extended reality (XR) game applications aiming at physical exercise for the elderly. Through the review of 1847 papers from the Scopus database, 17 articles were included. Based on these papers, we explored the existing contributions of exercise XR games for the elderly, the development opportunities and challenges of such games, and their special considerations in adapting to the characteristics and requirements of the target user. The results were organized into several perspectives: publication information and keywords, immersive technologies and game concepts, teamwork and social games, evaluation, opportunities and challenges, and adapting designs. We found the elderly interested in and accepted using XR games. The reported research results proved positive effects on such games’ physical and mental health. XR exercise games for the elderly should considerately adapt to the elder’s cognition, behaviour, and demand. Although problems existed, such as simulator sickness, safety risks, device problems, and cost, there were opportunities and space for research and future developments. Researchers and developers could refer to this paper for XR exercise games for the elderly and create or enhance future XR applications by learning from existing work. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Place, publisher, year, edition, pages
Springer Science+Business Media B.V., 2023
Series
Communications in Computer and Information Science, ISSN 18650929 ; 1814
Keywords
Augmented reality, Elderly, Exercise, Extended reality, Game, Health, Mixed reality, Old people, Physical training, Virtual reality, E-learning, Aging population, Older People, Physical exercise, Systematic literature review
National Category
Human Computer Interaction
Identifiers
urn:nbn:se:bth-25447 (URN)10.1007/978-3-031-38854-5_17 (DOI)2-s2.0-85172189765 (Scopus ID)9783031388538 (ISBN)
Conference
15th International Conference on Biomedical Engineering Systems and Technologies, BIOSTEC 2022. Online, February 9-11, 2022.
Funder
Knowledge Foundation, 20220068
Available from: 2023-10-10 Created: 2023-10-10 Last updated: 2024-12-13Bibliographically approved
3. A Survey of Possibilities and Challenges with AR/VR/MR and Gamification Usage in Healthcare
Open this publication in new window or tab >>A Survey of Possibilities and Challenges with AR/VR/MR and Gamification Usage in Healthcare
2021 (English)In: PROCEEDINGS OF THE 14TH INTERNATIONAL JOINT CONFERENCE ON BIOMEDICAL ENGINEERING SYSTEMS AND TECHNOLOGIES - VOL. 5: HEALTHINF / [ed] Pesquita, C (Pesquita, C) Fred, A (Fred, A) Gamboa, H (Gamboa, H, SCITEPRESS , 2021, p. 733-740Conference paper, Published paper (Refereed)
Abstract [en]

Software and applications of augmented reality (AR), virtual reality (VR), and mixed reality (MR) technology combined with game/gamification techniques in healthcare have increasingly been studied in academia. However, there is a need to explore the usage, challenges and opportunities of AR/VR/MR game/gamification software/applications in the healthcare system. To explore this, we present an online survey conducted in the healthcare-relevant system (including hospital-based system, homecare-based system, institute and university, and industry). Based on the answers, we found examples of digital games and AR/VR/MR applications used in healthcare, as well as some general information (name and feature, purpose, target user, and use occasion), usage situation, and user experience. This presented survey is beneficial for both researchers and developers in computer science and medical science. It can familiarise them with existing products and their current use, advantages and potential issues of AR/VR/MR and game applications in healthcare. In future work, the survey would be extended to obtain other user experiences and feedback of AR/VR/MR techniques and game/gamification technology applied to healthcare, as well as to study how to overcome the challenges, and develop the opportunities further.

Place, publisher, year, edition, pages
SCITEPRESS, 2021
Keywords
Virtual Reality; Augmented Reality; Mixed Reality; Healthcare; Game; Gamification
National Category
Human Computer Interaction Computer Sciences
Identifiers
urn:nbn:se:bth-22076 (URN)10.5220/0010386207330740 (DOI)000664063000083 ()
Conference
14th International Joint Conference on Biomedical Engineering Systems and Technologies (BIOSTEC) / 14th Int Conf on Bio-inspired Systems and Signal Processing (BIOSIGNALS) / 14th Int Conf on Biomedical Electronics and Devices (BIODEVICES)
Note

14th International Joint Conference on Biomedical Engineering Systems and Technologies (BIOSTEC) / 14th Int Conf on Bio-inspired Systems and Signal Processing (BIOSIGNALS) / 14th Int Conf on Biomedical Electronics and Devices (BIODEVICES), ELECTR NETWORK, FEB 11-13, 2021

Available from: 2021-09-02 Created: 2021-09-02 Last updated: 2024-12-13Bibliographically approved
4. A Survey on AR/VR Games for Mental and Physical Public Health
Open this publication in new window or tab >>A Survey on AR/VR Games for Mental and Physical Public Health
2021 (English)In: Proceedings of the eTELEMED, 2021, p. 50-58Conference paper, Published paper (Other academic)
Abstract [en]

The use of augmented and virtual reality (AR/VR) has recently been increased in various people’s work and life. The combination of technology with digital games have recently received much attention. The 2020 Augmented and Virtual Reality Survey Results report by Perkins Coie, XR Association, and Boost VC, pointed out that immersive techniques are leaving from laboratory research and theoretical applications and growing upas fully mature and income-generating marketplaces. Except forgames and entertainment, the most common area reported was healthcare and medical devices from immersive technologies, followed by education. The survey presented in this paper explores the usage, perceived benefits and problems of AR/VR games for mental or physical health. It also highlights future features that users would see as relevant in these applications. Through an online questionnaire, we found examples of used AR/VR games and their usage frequency, the user’s perception of their mental or physical health benefits and problems, and the prospects to physical and mental health for AR/VR games. This study is helpful for researchers and developers both in computer science and medical science. It provides people with examples of existing consumer-level products, their advantages and disadvantages, and AR/VR games’ requirements relevant to mental and physical health. In future work, the survey sample size would be extended to collect additional user experience data and further explore the challenges and opportunities of such techniques for public health.

Series
International Conference on eHealth, Telemedicine, and Social Medicine (eTELEMED), ISSN 2308-4359
Keywords
Virtual reality, augmented reality, public health, games, survey
National Category
Computer Sciences
Identifiers
urn:nbn:se:bth-27245 (URN)978-1-61208-872-3 (ISBN)
Conference
The Thirteenth International Conference on eHealth, Telemedicine, and Social Medicine, 18-22 July 2021, Nice.
Available from: 2024-12-13 Created: 2024-12-13 Last updated: 2024-12-13
5. Conceptual Design of an Extended Reality Exercise Game for the Elderly
Open this publication in new window or tab >>Conceptual Design of an Extended Reality Exercise Game for the Elderly
2022 (English)In: Applied Sciences, E-ISSN 2076-3417, Vol. 12, no 13, article id 6436Article in journal (Refereed) Published
Abstract [en]

Facing the increasingly serious ageing problem, IT technology is being applied more and more to alleviate the increasing health demands of the elderly. Virtual reality (VR) games, in particular, have been shown to benefit the physical and mental health of the elderly. However, almost all consumer-level VR games address the general user, not considering the characteristics of the elderly, such as their particular needs regarding cognitive aspects and safety. In addition, the existing VR rowing games’ research typically focuses on athlete training or is based on a rowing machine. Extending on previous research, this paper proposes a conceptual design of a VR rowing game, VRrowing to provide a home exercise game for the elderly which benefits both physical and mental health. This research first analysed the relevant literature and existing VR exercise games for the elderly to find characteristics and their particular needs. Then, following design principles (in exercise games, human–computer interaction, and user interfaces (UIs)) for the elderly, this study proposed a conceptual design of VRrowing through the MDA framework (standing for mechanics, dynamics, and aesthetics). The results cover the system architecture, activities and tasks, patterns and roles, mechanics and structures, and UI examples. Based on comprehensive consideration of the results from relevant research and fostering strengths and circumventing weaknesses, VRrowing was designed as a sports game, aimed at the elderly according to their characteristics and needs, which fills the void of home VR rowing games for seniors’ exercise. This research has reference value for scientific research or development personnel in VR game applications and evaluations, especially for such games targeting the elderly. © 2022 by the authors. Licensee MDPI, Basel, Switzerland.

Place, publisher, year, edition, pages
MDPI, 2022
Keywords
elderly, exercise, extended reality, game, rowing, virtual reality
National Category
Computer Sciences
Identifiers
urn:nbn:se:bth-23514 (URN)10.3390/app12136436 (DOI)000824081500001 ()2-s2.0-85133251130 (Scopus ID)
Note

Open access.

Available from: 2022-08-11 Created: 2022-08-11 Last updated: 2024-12-13Bibliographically approved
6. A Pilot Study of User Preferences of Posture and Display Technologies in Virtual Reality Exercise Games
Open this publication in new window or tab >>A Pilot Study of User Preferences of Posture and Display Technologies in Virtual Reality Exercise Games
2024 (English)In: Proceedings of 2024 International Conference on Virtual and Augmented Reality Simulations, ICVARS 2024, Association for Computing Machinery (ACM), 2024, p. 22-27Conference paper, Published paper (Refereed)
Abstract [en]

With the continuous development of extended reality (XR), encompassing augmented reality (AR), virtual reality (VR), and mixed reality (MR), the increasing application of VR, especially combined with game technology in the health area, is trending. Due to this development, academia and industry have rising research and practices focusing on VR exercise game applications and their evaluation. This paper presented a pilot study addressing the comparison of user preferences in using VR exercise games. Eight volunteering participants with VR or rowing experience were involved in the pilot study. Their responses on using different postures (standing or sitting), display devices (VR or a large screen), and game tasks (collect coins vs distance travelled) were explored, as well as feedback suggestions for the study and VR games. The pilot study revealed the opportunities and challenges to enhance the VR exercise games, user experience, and performance. It tested the feasibility and duration of each session and potential improvements that could be made for the main experiment, including the instructions, game environments, process, devices, data gathering, and analysis methods. © 2024 Copyright held by the owner/author(s).

Place, publisher, year, edition, pages
Association for Computing Machinery (ACM), 2024
Keywords
exercise game, head-mounted display, large screen, posture, user preference, virtual reality, Helmet mounted displays, Mixed reality, Continuous development, Display technologies, Game technologies, Head-mounted-displays, Pilot studies, User's preferences, Augmented reality
National Category
Human Computer Interaction
Identifiers
urn:nbn:se:bth-26769 (URN)10.1145/3657547.3657562 (DOI)001263811200004 ()2-s2.0-85198032665 (Scopus ID)9798400709012 (ISBN)
Conference
8th International Conference on Virtual and Augmented Reality Simulations, ICVARS 2024, Melbourne, March 14-16 2024
Funder
Knowledge Foundation, 20220068
Available from: 2024-08-08 Created: 2024-08-08 Last updated: 2024-12-13Bibliographically approved
7. User Experience and Biofeedback Evaluation of Virtual Reality vs. Large Screen Rowing Games
Open this publication in new window or tab >>User Experience and Biofeedback Evaluation of Virtual Reality vs. Large Screen Rowing Games
(English)Manuscript (preprint) (Other academic)
National Category
Computer Sciences
Identifiers
urn:nbn:se:bth-27246 (URN)
Available from: 2024-12-13 Created: 2024-12-13 Last updated: 2024-12-16Bibliographically approved

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