Digital Health and Innovation doi: 10.3390/dhi1010005

Authors: Aminreza Khandan Jian Sun Sofi Majidi Mohammad Dehghan Rouzi Sona Mahrokhi Khoushehmehr Helen Lavretsky Gary W. Small Linda M. Ercoli Bijan Najafi

Background: Biological aging varies substantially among individuals of the same chronological age, yet biological aging biomarkers require biospecimen collection and laboratory processing, limiting scalability for repeated monitoring. Objective: This study evaluated whether consumer smartwatch-derived digital biomarkers are associated with the pace of biological aging, quantified using DunedinPACE, a biomarker that measures biological aging rates. Methods: Baseline data were analyzed from the Healthy Minds for Life study within the Precision Aging Network. Among 1305 enrolled participants, 621 community-dwelling adults aged 50–79 years had both DunedinPACE and smartwatch data available. Smartwatch-derived biomarkers were grouped into mobility, cardiorespiratory physiology, sleep, and physiological stress domains. Associations with DunedinPACE were examined using Spearman correlations and adjusted linear regression models. Results: Significant associations were observed across all four domains. Daily step count showed the strongest mobility-domain association with DunedinPACE (r = −0.25, p < 0.01). Mean sleep peripheral oxygen saturation showed the strongest sleep-domain association (r = −0.22, p < 0.01). Resting heart rate showed the strongest physiological stress-domain association (r = 0.24, p < 0.01). Adjusted regression models supported these findings, with lower daily mobility, poorer sleep oxygenation and efficiency, greater wake after sleep onset, and higher resting heart rate showing the most consistent associations with higher DunedinPACE values. Conclusions: Smartwatch-derived biomarkers captured a multidomain profile of accelerated biological aging characterized by lower mobility, poorer sleep health, and elevated physiological stress. Consumer wearables can provide low-burden, real-world indicators of biological vulnerability, although longitudinal studies are needed before clinical use.

Digital Health and Innovation doi: 10.3390/dhi1010004

Authors: Marcello Sarini Francesco Bocci

Background/Objectives: Single-case studies represent a sophisticated and rigorous methodological framework, widely established in clinical research for providing high-resolution data on individual functional responses. This study evaluates the clinical utility of integrating immersive Virtual Reality (VR) gaming as a novel “functional ingredient” within the Video Game Therapy (VGT) protocol. Given the exploratory single-case nature of this intervention, clinical state-modulations cannot be rigorously validated using standard aggregated group statistics. Therefore, the core objective of this paper is to investigate the therapeutic potential of the VR session on psychological state-modulation, introducing the Single-Case Normative Analytics (SCNA) framework as the mandatory statistical vehicle required to validate individual longitudinal shifts against normative data. Methods: The study treats individual VR exposures as independent, short-term clinical probes embedded within a real-world clinical journey. The SCNA framework was deployed by integrating Crawford’s modified t-tests with longitudinal percentile tracking against an empirical normative reference group (n = 20). Acute state-anxiety variations (STAI-Y1), psychological well-being (PGWBI), and flow dynamics were tracked across three distinct sessions to monitor the patient’s relative repositioning within the normative distribution. Results: The inferential analysis indicates that the immersive 20-min environment facilitated reliable, statistically significant changes in acute state anxiety and flow dimensions, systematically exceeding standard measurement error boundaries and successfully moving the patient’s psychometric profile toward healthy normative ranges. Conclusions: While these findings focus on individual, idiographic reactivity, they demonstrate the utility of the SCNA framework in providing clinicians with objective, evidence-based feedback on the clinical viability of specific VR-based functional units. This approach allows for a rigorous evaluation of standalone digital tools independently of a full, holistic VGT protocol, offering a structured alternative to traditional designs focused on identifying general patterns across groups.

Digital Health and Innovation doi: 10.3390/dhi1010003

Authors: Mustafa Al-Asady Laxmi Raja Monique Shonde Claire Lovegrove Peter Thomas Swan Kang

Background: Digital exclusion remains a key barrier to equitable access to digital health services, particularly among individuals with visual impairment. Limited access to devices and digital literacy restricts participation in increasingly digital-first healthcare systems. This study aimed to evaluate the feasibility and exploratory service impact of a device recycling and digital inclusion pilot at a tertiary ophthalmic hospital. Materials and Methods: The six-month pilot at Moorfields Eye Hospital involved the refurbishment and distribution of donated electronic devices (laptops and mobile phones) alongside personalised digital literacy training delivered by trained volunteers. Twenty-two patients with visual impairment were enrolled; 18 completed the programme. Pre- and post-intervention questionnaires assessed digital engagement and confidence across key domains. Paired data were analysed using the Wilcoxon signed-rank test. Results: Across 216 item-level engagement responses, the number of responses indicating daily engagement increased from 31 to 49. Mean self-reported confidence scores improved from 3.1 to 5.1 out of 10 (Wilcoxon signed-rank test, V = 148, p = 0.0008; r = 0.81). Patients reported increased use of email, messaging, online forms, and General Practice (GP) appointment systems. Using secondary lifecycle data and modelled estimates, the reuse of refurbished laptops was associated with an indicative saving of approximately 5.3 tonnes of CO2-equivalent emissions. Conclusions: This service evaluation suggests that a multi-component intervention combining device provision with tailored support may improve digital engagement and confidence among patients with visual impairment. These findings support the feasibility of integrating digital inclusion initiatives within ophthalmology services, with potential co-benefits for environmental sustainability.

Digital Health and Innovation doi: 10.3390/dhi1010002

Authors: Niklas Kabisch John Brandes Anne Lehmann Mandy Claus Stefanie Jacobs Martin Böhmer Florian Kehrle Patrick Jahn Franziska Fink

Background: Augmented reality (AR)-based systems offer novel opportunities for digital support in physiotherapy and rehabilitation. This is especially relevant in the context of an aging population and the growing shortage of healthcare professionals. Methods: This study employed a user-centered design with iterative prototype refinement and investigated the perceived usability and user acceptance of a prototype AR-based sports therapy system (“STAR”), developed within an ongoing interdisciplinary research project, from the perspectives of patients and healthcare professionals across one iteration cycle. After an initial needs analysis (T0), participants interacted in an observer role with the system at two time points (T1, T2) using an AR headset (Microsoft HoloLens 2). They did not perform exercises but only interacted with the application by navigating through the system and viewing the exercise demonstrations. Between T1 and T2, a tutorial was integrated, exercise animations and voiceovers were revised, and voiceover controls and navigation were optimized. Usability was measured using the System Usability Scale (SUS), and user acceptance via the Technology Usage Inventory (TUI). Results: A total of 15 participants (10 patients and 5 therapists) completed both testing sessions. The average SUS score across both patients and therapists improved from 54.5 (SD = 18.8) to 71.2 (SD = 13.1), reflecting a statistically significant increase in perceived usability (p < 0.001). The usability rating improved from “ok” to “good” according to the SUS interpretation scale. The TUI subscales skepticism, immersion, accessibility and usability improved significantly, while interest, usefulness and intention-to-use only showed trend-level changes. Conclusions: The findings suggest that a user-centered development process can enhance the perceived usability and user acceptance of AR- based virtual care tools during the prototype stage by providing early-stage empirical evidence linking specific user-centered design interventions to changes in Technology Acceptance Model-related acceptance constructs.

Digital Health and Innovation doi: 10.3390/dhi1010001

Authors: Bijan Najafi

Digital health technologies—spanning wearable sensors, artificial intelligence (AI), remote patient monitoring, telehealth, and electronic health records—are reshaping how disease is prevented, detected, and managed [...]