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The target dose was consistent with a previous large telerehabilitation study that showed significant improvements in upper-limb impairment (42 h [29]). In contrast, training in this program was not limited to one body area [30-32] and could be achieved with multiple effectors (ie, upper-limb, hand, trunk, and lower-limb).
Training dose was delivered via synchronous telerehabilitation and asynchronous training (Table 2).
JMIR Serious Games 2025;13:e69335
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Participants received the HWC e Health program (as detailed in item 1) and participated in 3 remotely facilitated group meetings via video (each lasting 2 h). Due to the COVID-19 pandemic, these meetings were held remotely and included brief introductions to topics, such as goal setting, stress management, and self-compassion, followed by small-group discussions (Table S2 in Multimedia Appendix 1). Group meetings were held at 1, 6, and 10 months during the 12-month treatment period.
JMIR Ment Health 2025;12:e66518
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Chou [30] developed the Octalysis framework, combining game design, motivational psychology, and behavioral economics into 8 core drives. Although it is widely used in education and marketing [31-34], its application in health care remains limited, representing an area for further exploration. A systematic review by Xu et al [35] analyzed 50 studies on gamified health apps and reported mixed findings in terms of engagement and effectiveness.
JMIR Serious Games 2025;13:e66262
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