Background: Anterior cruciate ligament reconstruction surgery is one of the most common orthopedic procedures. One of the main factors that influence the outcome is regaining strength in the postoperative phase. Because anterior cruciate ligament reconstruction surgeries are often performed in young patients, we combined the concept of prehabilitation with an app-based serious gaming approach to improve maximal strength postoperatively. Objective: Our objective was to conduct a prospective randomized trial to evaluate whether an app-based active muscle training program (GenuSport Knee Trainer) can improve postoperative strength by starting rehabilitation immediately after primary anterior cruciate ligament reconstruction surgery. Methods: We designed a pilot study in which we randomly assigned patients receiving primary anterior cruciate ligament reconstruction to either the serious gaming training (intervention) group or a conventional rehabilitation (control) group. Except for the serious gaming-based training, both groups followed the same postoperative treatment protocol. Outcome parameters were absolute and relative change in maximal strength, as well as the International Knee Documentation Committee Subjective Knee evaluation form, Knee Injury and Osteoarthritis Outcome Score, and Lysholm Knee Score. Results: In total 26 patients agreed to participate (14 patients in the intervention group and 12 patients in the control group, 1 of whom was lost to follow-up). We noted a difference in absolute maximum strength between the exergaming intervention and the control groups. Mean maximum strength preoperatively was 155.1 (SD 79.2) N in the intervention group (n=14) and 157.0 (SD 40.8) N in the control group (n=11). Postoperative mean maximum strength was 212.8 (SD 78.5) N in the intervention group and 154.5 (SD 27.1) N in the control group. Mean absolute change in maximum strength was 57.7 (SD 95.2) N in the intervention group and –4.8 (22.2) N in the control group. The analysis of covariance model with absolute change as the dependent variable and treatment group and baseline maximum strength as covariates showed a relevant difference in relative change between treatment groups (intervention – control) of 59.7 N (95% CI 10.1-109.3; P=.02). Similarly to the absolute increase, the relative change in maximum strength was relevantly higher in the exergaming group. The mean relative change in maximum strength was 1.7 (SD 1.17) in the intervention group and 1 (SD 0.13) in the control group. No adverse events or problems were reported during the study period. Conclusions: Implementation of an app-based active muscle training program in the early postoperative therapy scheme was associated with an improvement in maximal strength. Therefore, we considered the use of GenuSport training after anterior cruciate ligament reconstruction to be a helpful complement to rehabilitation after anterior cruciate ligament reconstruction surgery to improve strength in the early postoperative phase. To our knowledge this was the first study to analyze immediate postoperative serious gaming-based training with the GenuSport device based on strength improvement.

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Background: Virtual reality (VR) technologies have been developed to assist education and training. Although recent research suggested that the application of VR led to effective learning and training outcomes, investigations concerning the acceptance of these VR systems are needed to better urge learners and trainees to be active adopters. Objective: This study aimed to create a theoretical model to examine how determining factors from relevant theories of technology acceptance can be used to explain the acceptance of a novel VR-assisted mental rotation (MR) training system created by our research team to better understand how to encourage learners to use VR technology to enhance their spatial ability. Methods: Stereo and interactive MR tasks based on Shepard and Metzler’s pencil and paper test for MR ability were created. The participants completed a set of MR tasks using 3D glasses and stereoscopic display and a 6-degree-of-freedom joystick controller. Following task completion, psychometric constructs from theories and previous studies (ie, perceived ease of use, perceived enjoyment, attitude, satisfaction, and behavioral intention to use the system) were used to measure relevant factors influencing behavior intentions. Results: The statistical technique of partial least squares structural equation modeling was applied to analyze the data. The model explained 47.7% of the novel, VR-assisted MR training system’s adoption intention, which suggests that the model has moderate explanatory power. Direct and indirect effects were also interpreted. Conclusions: The findings of this study have both theoretical and practical importance not only for MR training but also for other VR-assisted education. The results can extend current theories from the context of information systems to educational and training technology, specifically for the use of VR-assisted systems and devices. The empirical evidence has practical implications for educators, technology developers, and policy makers regarding MR training.

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Background: The management and comprehension of business process models are of utmost importance for almost any enterprise. To foster the comprehension of such models, this paper has incorporated the idea of a serious game called Tales of Knightly Process. Objective: This study aimed to investigate whether the serious game has a positive, immediate, and follow-up impact on process model comprehension. Methods: A total of two studies with 81 and 64 participants each were conducted. Within the two studies, participants were assigned to a game group and a control group (ie, study 1), and a follow-up game group and a follow-up control group (ie, study 2). A total of four weeks separated study 1 and study 2. In both studies, participants had to answer ten comprehension questions on five different process models. Note that, in study 1, participants in the game group played the serious game before they answered the comprehension questions to evaluate the impact of the game on process model comprehension. Results: In study 1, inferential statistics (analysis of variance) revealed that participants in the game group showed a better immediate performance compared to control group participants (P<.001). A Hedges g of 0.77 also indicated a medium to large effect size. In study 2, follow-up game group participants showed a better performance compared to participants from the follow-up control group (P=.01); here, a Hedges g of 0.82 implied a large effect size. Finally, in both studies, analyses indicated that complex process models are more difficult to comprehend (study 1: P<.001; study 2: P<.001). Conclusions: Participants who played the serious game showed better performance in the comprehension of process models when comparing both studies.

This is the abstract only. Read the full text free (open access) on the JMIR Serious Games website. JMIR is the leading ehealth publisher: fast peer-review - open access - high impact.