https://www.jmir.org/issue/feed 2025-01-01T11:30:03-05:00 JMIR Publications editor@jmir.org Open Journal Systems The leading peer-reviewed journal for digital medicine and health and health care in the internet age.  https://www.jmir.org/2026/1/e89151 2026-04-20T15:30:03-04:00 Adam Suleman Zhihui Amy Liu Anna Sinaiko Anca Prica Danielle Rodin 2026-04-20T15:30:03-04:00 https://www.jmir.org/2026/1/e87542 2026-04-20T15:15:10-04:00 Riley C C Brown Megan H Ross Trevor G Russell

Background: Physical inactivity remains a global health concern, with only one in 5 adults meeting combined aerobic and muscle-strengthening guidelines. Exercise interventions delivered through immersive virtual reality (IVR) offer a novel mode of delivery. Little is known about the clinical effectiveness or feasibility of exercise via IVR across population groups. A detailed understanding of clinical effectiveness and feasibility is required for clinicians to decide whether to include IVR in exercise practice. Objective: The objective of this systematic review was to assess the clinical effectiveness of IVR interventions using aerobic or anaerobic exercise. Methods: A systematic review incorporating meta-analyses was conducted. Searches were conducted across PubMed, Embase, Web of Science, and CINAHL from inception until January 6, 2026. Randomized controlled trials including participants with an acute health condition, chronic disease, history of reconstructive or restorative surgery, and older adults implementing IVR exercise and reporting clinical effectiveness outcomes were included. Random effects meta-analyses were conducted for between-group comparisons for clinical effectiveness outcomes, grouped according to comparator group activity (exercising/nonexercising). Risk of Bias was assessed using the Cochrane Risk of Bias 2 tool and the certainty of evidence with Grading of Recommendations, Assessment, Development, and Evaluation. Results: Twenty-six trials with 846 total participants were included in this review, with 23 progressing to meta-analyses. Pooled analyses revealed a general trend for IVR, but no statistical differences with comparator intervention (exercising or nonexercising) for mobility and functional balance (exercising: standardized mean difference [SMD] −0.345, 95% CI −1.095 to 0.406; =.29; nonexercising SMD −0.322, 95% CI −0.931 to 0.288; =.22), functional leg strength (exercising: SMD −0.161, 95% CI −0.573 to 0.250; =.33; nonexercising: SMD −0.351, 95% CI −1.750 to 1.049; =.48), quality of life (exercising: SMD 0.036, 95% CI −0.444 to 0.516; =.84; nonexercising: SMD −0.053, 95% CI −0.839 to 0.728; =.80) or other outcome domains. Eighty percent of outcomes assessed were rated as “some concerns” (n=16) or at “high” (n=21) risk of overall bias. Grading of Recommendations, Assessment, Development, and Evaluation certainty grading was deemed to be “low” or “very low” for all outcomes. Conclusions: This systematic review incorporating meta-analyses provides initial evidence for the clinical effectiveness of IVR exercise interventions. This review differs from previous literature by systematically collecting and appraising evidence exclusively from IVR aerobic/anaerobic exercise interventions from across a variety of populations and settings, and including a broad range of clinical effectiveness outcomes. Initial evidence may suggest that IVR exercise does not seem to statistically differ from comparators for clinical effectiveness outcomes. However, high heterogeneity, substantial risk of bias among trials, and “low” to “very low” certainty in evidence reduce overall confidence in the findings. While these results indicate that IVR may be a viable option for the delivery of exercise, a more robust methodology in future trials is needed to properly verify findings and improve certainty. This will help to determine the real-world applicability of IVR exercise interventions for the improvement of health-related measures. Trial Registration: PROSPERO CRD420250650110; https://www.crd.york.ac.uk/PROSPERO/view/CRD420250650110

2026-04-20T15:15:10-04:00 https://www.jmir.org/2026/1/e98143 2026-04-20T15:00:17-04:00 Jenna Congdon

2026-04-20T15:00:17-04:00 https://www.jmir.org/2026/1/e87198 2026-04-17T16:30:29-04:00 Zhengbo Yuan Zhongjie Shi Zhanxiang Wang

<strong>Background:</strong> Preoperative risk communication is essential for shared decision-making (SDM) in neurosurgery; however, conveying complex neuroanatomy and surgical risks using traditional verbal explanations can limit understanding and contribute to dissatisfaction and medicolegal disputes. Augmented reality (AR) may provide patient-specific, interactive 3D visualization to support these conversations. <strong>Objective:</strong> This study evaluates whether AR-assisted preoperative risk communication improves objective understanding and other SDM-related outcomes, compared with communication supported by a conventional physical anatomical model within a standardized SEGUE-informed protocol. <strong>Methods:</strong> A prospective, single-center, randomized controlled trial was conducted with 62 neurosurgery communication recipients (patients when capable; otherwise, a legally authorized representative [LAR]). Patients were stratified by planned surgical approach (frontal, parietal, and occipital) and, within each stratum, were randomized into an experimental AR group and a control physical-model group. The primary outcome was postsession objective understanding, assessed by a multiple-choice knowledge questionnaire. Secondary outcomes were subjective understanding, communication satisfaction, pre-to-post anxiety changes, communication duration, and neurosurgeons’ communication skills from video recordings. <strong>Results:</strong> Of the 67 individuals screened, 62 communication recipients were enrolled and completed all assessments (patients, n=30; LARs, n=32; AR, n=32; and control, n=30). Objective understanding was higher with AR than with the physical model in the prespecified pooled comparison (<i>P</i>=.01). Communication satisfaction was also higher with AR (<i>P</i>&lt;.001). There were no clear between-group differences in subjective understanding (<i>P</i>=.41), anxiety changes (ΔState-Trait Anxiety Inventory [ΔSTAI] Y-1, <i>P</i>=.37; ΔSTAI Y-2, <i>P</i>=.84), in-session face-to-face communication duration (excluding any presession AR technical preparation time; <i>P</i>=.73), or SEGUE scores (<i>P</i>=.60). Exploratory stratified analyses suggested larger comprehension gains with AR in the parietal and occipital approach strata. <strong>Conclusions:</strong> In a standardized preoperative SDM conversation, an integrated visualization-support package combining AR, patient-specific modeling, and interactivity improved neurosurgical decision makers’ objective understanding and satisfaction without prolonging in-session, face-to-face communication duration. Larger multicenter trials with longer-term outcomes are warranted to confirm effectiveness and to evaluate implementation and cost considerations. <strong>Trial Registration:</strong> ISRCTN Registry ISRCTN11483487; http://www.isrctn.com/ISRCTN11483487

2026-04-17T16:30:29-04:00 https://www.jmir.org/2026/1/e80500 2026-04-17T15:45:10-04:00 Ya Li Hailong Zhang Guixiang Zhao Jiansheng Li Haoxuan Huang Longyu Wang Peilin Jia

Background: Pulmonary rehabilitation (PR) is a cornerstone of chronic obstructive pulmonary disease (COPD) management; however, access to traditional center-based PR (CBPR) remains limited. Digital and remote models, collectively termed pulmonary telerehabilitation (Tele-PR), have increasingly been used, but their heterogeneity in technology use, supervision, and interaction mode may influence effectiveness and sustainability. Objective: This systematic review and meta-analysis aimed to compare the effectiveness and adherence of Tele-PR with those of CBPR in adults with COPD while systematically evaluating the impacts of supervision intensity and delivery models on key clinical outcomes. Methods: This review followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 and PRISMA-S (Preferred Reporting Items for Systematic reviews and Meta-Analyses literature search extension) guidelines. PubMed, Embase, the Cochrane Library, and the Web of Science were searched from inception to December 10, 2025, to identify randomized controlled trials comparing Tele-PR or home-based PR (HBPR) with CBPR in adults with COPD. Random effects meta-analyses were conducted using the Hartung-Knapp-Sidik-Jonkman method. Between-study heterogeneity was assessed using τ², , and 95% prediction intervals. Risk of bias was evaluated with the Cochrane Risk of Bias 2 tool, and certainty of evidence was graded using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. Results: Seventeen randomized controlled trials involving 1658 participants were included. After intervention, Tele-PR and CBPR showed comparable average effects on exercise capacity by 6-minute walk distance (k=9; n=950, 57.3%; mean difference –5.37 m, 95% CI –15.68 to 4.95; =.26; τ²=103.97; =28.2%; 95% prediction intervals=–32.73 to 22.27). Although pooled effects were not statistically significant, substantial heterogeneity was observed across remote delivery models. Subgroup analyses linked digitally supported, synchronously supervised Tele-PR to less between-study variance across several outcomes, indicating greater consistency in treatment effects across different settings while revealing that low-technology HBPR yielded more variable outcomes, particularly in symptom burden. At long-term follow-up (≥6 mo), between-group differences in functional and symptom outcomes diminished, and short-term gains in exercise capacity did not consistently translate into increased daily physical activity. Certainty of evidence ranged from moderate to very low, mainly downgraded for performance bias, inconsistency across intervention models, and imprecision. Conclusions: Tele-PR may achieve short-term clinical outcomes comparable to CBPR. Distinct from prior reviews, we stratified remote programs by delivery models and supervision, identifying digitally supported Tele-PR and low-technology HBPR as 2 clinically distinct paradigms with differing consistency of effects. We further propose a structured “supervision gradient” to interpret model-dependent variability in effects across Tele-PR approaches, providing a context-sensitive framework for evidence-informed, model-specific implementation. Future remote rehabilitation should integrate real-time professional supervision and long-term behavioral maintenance to sustain benefits. Tele-PR may be particularly valuable for expanding PR access, while CBPR remains essential for patients requiring close in-person supervision or complex multidisciplinary care. Trial Registration: PROSPERO CRD42025633252; https://www.crd.york.ac.uk/PROSPERO/view/CRD42025633252

2026-04-17T15:45:10-04:00 https://www.jmir.org/2026/1/e82004 2026-04-17T14:30:11-04:00 Xueqin Yang Yingping Ma Yueting Wang Mengting Liu Xingyu Liu Xueping Jiao Fanghong Yan Yuxia Ma Lin Han Yanan Zhang

Background: With the widespread use of the internet and mobile devices, eHealth literacy promotion is critical for medical equity. Mobile health (mHealth) serves as a pivotal tool for enhancing eHealth literacy by providing accessible, interactive platforms for health information engagement. However, the evidence regarding the effectiveness of mHealth interventions on eHealth literacy among patients with chronic diseases remains inconclusive. Objective: This study aimed to evaluate the effectiveness of mHealth interventions on eHealth literacy among patients with chronic diseases based on randomized controlled trials (RCTs) and summarize supportive evidence from quasi-experimental and qualitative studies. Methods: A comprehensive search strategy was developed, and 8 electronic databases were systematically searched for studies published up to February 12, 2026. Patients with chronic diseases were included based on predefined inclusion criteria. The Cochrane risk of bias 2 tool for RCTs and the ROBINS-I tool for quasi-experimental studies were used to assess the risk of bias. Given the anticipated substantial heterogeneity among the studies included, we used a random-effects model based on the Hartung-Knapp-Sidik-Jonkman method to pool effect sizes. A narrative and quantitative synthesis of the findings was provided where appropriate. Results: A total of 15 studies were included in this review, including 6 RCTs, 5 quasi-experimental studies, and 4 qualitative studies, involving a total of 2884 patients with chronic diseases. Meta-analyses of RCTs suggested that mHealth interventions could improve eHealth literacy, with a pooled mean effect size of standardized mean difference (SMD)=1. 19 (95% CI 0.14-2.23; .03; =97.75%; PI [prediction interval]=−2.68 to 5.05). Subgroup analyses by intervention targets showed that interventions on targets with specific disease produced larger mean effects (SMD=1.61; 95% CI 0.16-3.06; PI=−5.40 to 8.63), while interventions targeting the population with general chronic diseases produced smaller effects (SMD=0.36; 95% CI 0-0. 73; PI=−0. 21 to 0. 94). Analysis by intervention duration subgroup showed that the combined effect of studies with intervention duration <3 months was statistically significant (SMD=0.61; 95% CI 0.09-1.13; =88.04%; PI=−5.72 to 6.95); while the combined effect of studies with intervention duration ≥3 months was not statistically significant. Taking into account bias and the risk of GRADE (Grading of Recommendations, Assessment, Development, and Evaluation), the certainty of RCT evidence was moderate, and the certainty of quasi-experimental evidence was low. Conclusions: mHealth interventions could improve eHealth literacy among patients with chronic diseases on average. By using prediction intervals, this study reveals that the effectiveness of mHealth interventions is highly context-dependent and closely linked to implementation factors. Advancing beyond prior work, this study centers on eHealth literacy as a core outcome and integrates multiple types of evidence. Meanwhile, this finding emphasizes the need for evidence-based intervention programs and more rigorous implementation of intervention designs in future research. Trial Registration: PROSPERO CRD 42024622807; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024622807

2026-04-17T14:30:11-04:00 https://www.jmir.org/2026/1/e86097 2026-04-17T14:00:18-04:00 Yiheng Zhang Haiyan He Ye Zhang Youxian Zhong Chunhong Luo Juanjuan Chen Lili Chen Ni Zhang Shihao Sun Baoyi Zhang Jia Fang Jingwen Yan Meifen Zhang

Background: Young- to middle-aged patients with breast cancer face significant psychosocial challenges. Existing interventions often lack comprehensiveness, timely initiation, and tailoring specific to this population’s unique needs. Objective: This study aimed to evaluate the impact of a peer-led, nurse-involved, blended online and offline peer support intervention program (PNO2PSP) on psychosocial adjustment in young- to middle-aged patients with breast cancer. Methods: The effectiveness of PNO2PSP was evaluated through a single-center cluster randomized controlled trial involving 70 newly diagnosed young- to middle-aged patients with breast cancer (35 in each group). The intervention group received an 8-week PNO2PSP in addition to routine care. Psychosocial adjustment, self-efficacy, social support, and coping modes were assessed presurgery and at 4, 8, and 12 weeks post surgery. Generalized estimating equations were used for intention-to-treat analyses. In-depth interviews with 9 participants explored their experiences. Results: Compared to the control group, the intervention group demonstrated significantly lower psychosocial adjustment scores at 8 weeks (T2; Wald =14.96; <.001) and 12 weeks (T3; Wald =7.49; =.006); social support was higher at 8 weeks (T2; Wald =7.65; =.006). Confrontation coping scores were higher at T2 (Wald =5.46; =.02), T3 (Wald =10.04; =.002), while avoidance coping scores were lower at T1 (Wald =8.24; =.004), T2 (Wald =7.45; =.006), and T3 (Wald =5.70; =.02). Qualitative findings supported these quantitative results, highlighting the program’s role in facilitating psychosocial adjustment, providing vital support, boosting treatment confidence, and fostering positive coping. Conclusions: The PNO2PSP effectively improved psychosocial adjustment, social support, and positive coping in young- to middle-aged patients with breast cancer. Its scientifically validated, feasible, and patient-centered design supports its recommendation for wider clinical implementation, with continued training for peer supporters and sustained delivery of peer support. Trial Registration: Chinese Clinical Trial Registry ChiCTR2300076471; https://www.chictr.org.cn/showprojEN.html?proj=198622

2026-04-17T14:00:18-04:00 https://www.jmir.org/2026/1/e97777 2026-04-17T13:45:10-04:00 Vanessa Nirode

2026-04-17T13:45:10-04:00 https://www.jmir.org/2026/1/e79928 2026-04-17T13:45:10-04:00 Nasim Badaghi Jelle Lubbers Judith Prins Saskia Kelders Anne Speckens Linda Kwakkenbos

Background: A 3-armed randomized controlled trial (RCT) demonstrated that 2 formats of online mindfulness–based cognitive therapy (eMBCT)—group-blended and individual-unguided—effectively reduced psychological distress and improved positive health outcomes in people with cancer and survivors, when compared to care as usual, up to 3 months posttreatment. However, the long-term effectiveness and possible predictors and moderators of treatment outcomes remain unknown. Objective: This study examined the long-term effects (up to 9 months posttreatment) of group-blended and individual-unguided eMBCTs on psychological distress and other mental health outcomes in people with cancer. Additionally, it explored possible predictors and moderators of treatment effects across the 2 delivery formats. Methods: The study population consisted of people with cancer who were initially randomized to group-blended or individual-unguided eMBCT within a 3-arm RCT, augmented by those who completed the waitlist condition and were subsequently randomly allocated to one of the eMBCT formats. Both groups were assessed over a 9-month follow-up period. Outcomes completed at baseline, posttreatment, and 3-, 6-, and 9-month follow-up assessments included psychological distress (primary), fear of cancer recurrence, rumination, fatigue, mindfulness skills, decentering, self-compassion, and well-being. Linear mixed-effects models examined changes over time, while linear mixed-effects models and binary logistic regression analyzed potential predictors and moderators of psychological distress and dropout. Results: Of the 186 participants enrolled in the 3-arm RCT, 161 participants were randomly assigned to either group-blended or individual-unguided eMBCTs after adding those initially assigned to the waiting condition (group-blended: n=71; individual-unguided: n=90). The majority of participants were female (n=129, 80%), diagnosed with breast cancer (n=78, 48%), and were undergoing or had completed treatment with curative intent (n=124, 77%). The mean age was 52.8 (SD 11.4) years. Both eMBCT formats resulted in significant reductions in psychological distress, fear of cancer recurrence, rumination, and fatigue, alongside improvements in mindfulness skills, decentering, and self-compassion, up to 9 months posttreatment. Higher baseline rumination, as well as lower mindfulness skills and self-compassion at baseline, predicted larger reductions in psychological distress from baseline to the 9-month follow-up period. Additionally, highly distressed participants in the group-blended eMBCT arm were more prone to dropout than those with lower distress scores, whereas psychological distress was not associated with dropout in the individual-unguided format. No other significant moderators were identified. Conclusions: Group-blended and individual-unguided eMBCTs effectively reduced psychological distress and improved well-being among people with cancer and survivors, with greater benefits for those with fewer psychological resources. However, individuals experiencing higher levels of distress were more likely to discontinue group-blended eMBCT. These findings highlight the importance of considering individual preferences and pragmatic factors in treatment decisions. Larger, fully powered RCTs are needed to confirm these results and provide more definitive guidance on treatment format selection. Trial Registration: Dutch Registry CCMO NL73117.091.20; https://onderzoekmetmensen.nl/en/trial/49163 and ClinicalTrials.gov NCT05336916; https://clinicaltrials.gov/study/NCT05336916

2026-04-17T13:45:10-04:00 https://www.jmir.org/2026/1/e89057 2026-04-17T12:00:05-04:00 Jianhui Tan Xiuzhen Deng Cuilan Wu Molin Yao Jingyi Liao Haoli Zheng Changlin Lian

<strong>Background:</strong> Parkinson disease (PD) is a progressive neurodegenerative disorder with a rapidly growing global prevalence. Current clinical assessments, such as the Unified Parkinson Disease Rating Scale, are limited by subjectivity and episodic application, creating a need for continuous, objective monitoring solutions. While previous reviews have often focused on single technologies, there is a growing trend toward integrating multiple data sources to provide a more holistic view of PD. <strong>Objective:</strong> This scoping review synthesizes progress in multimodal intelligent monitoring systems for PD, focusing on the quantification of motor and nonmotor symptoms, algorithm development, and the clinical translation of remote monitoring platforms. Furthermore, we propose a novel heuristic framework (Care-Platform Transformation in PD [CPT-PD]) that provides a forward-looking conceptual design for integrating these technologies into clinical workflows, demonstrating promising potential for future development. <strong>Methods:</strong> A targeted literature search was conducted on August 15, 2025, in PubMed, Web of Science, and China National Knowledge Infrastructure for research published between January 1, 2019, and December 31, 2024. The final search was rerun on January 22, 2026, solely to ensure completeness of coverage for this time window; no articles published after December 31, 2024, were included. <strong>Results:</strong> Wearable sensors (n=9) demonstrated high concordance with clinical scores in validation studies (eg, 99% for tremor detection), while computer vision (n=6) achieved moderate agreement with clinician ratings in controlled assessments (intraclass correlation coefficient 0.74 for bradykinesia). For nonmotor symptoms, intelligent systems (n=7) demonstrated sleep disturbance detection with up to 92.9% accuracy and autonomic dysfunction monitoring (n=7) via heart rate variability (area under the curve 0.90) and voice analysis (94.55% accuracy). Algorithm studies (n=16) explored single-modality feature extraction and cross-modal fusion, with emerging applications in federated learning. Remote platforms (n=22) improved medication adherence (172/201, 85.6%) and reduced outpatient visits (by 29% in one study). A heuristic CPT-PD framework was proposed to integrate key components of diagnosis, treatment, and management. Collectively, these advancements demonstrate the technical viability and clinical benefits of shifting from episodic, subjective assessments toward a data-driven, continuous, and multimodal approach to PD management. <strong>Conclusions:</strong> While current evidence largely reflects multisensor systems rather than deeply integrated multimodal platforms, the field holds promise for advancing toward genuine data fusion that could further improve clinical decision-making. Persistent challenges include fragmented symptom focus, algorithmic heterogeneity, and barriers to adoption among older adults. Future efforts should build on integrated frameworks such as CPT-PD to develop patient-centered ecosystems, ultimately enabling precision medicine in PD management.

2026-04-17T12:00:05-04:00