Investigating the "Flow" Experience: Key Conceptual and Operational Issues

A Psychometric Development and Evaluation of the Flow State Scale for Caregiving Tasks Among Clinical Nurses

BACKGROUND

The extensive research already conducted in numerous non-healthcare disciplines has consistently demonstrated the effectiveness of flow in alleviating work-related stress and boosting employee engagement in the workplace. Despite the potential benefits to nursing of improving flow, no valid instrument is currently available to measure the work-related flow experience of clinical nurses.

PURPOSE

This study was designed to develop the Flow State Scale for Caregiving Tasks (FSS-CT) and to evaluate its psychometric properties in the context of clinical nurses.

METHODS

This study, guided by the flow theory of Mihaly Csikszentmihalyi (1975), employed a three-phase approach to developing and evaluating the psychometric properties of the FSS-CT. Five hundred thirty-six full-time clinical nurses working in hospitals of various levels in Taiwan were recruited via cluster random sampling to participate in an anonymous online survey. The content validity of the developed scale was established through expert panel verification, criterion-related validity was assessed by correlating the scale with the Work-related Flow Inventory, and construct validity was evaluated via explanatory and confirmatory factor analyses. Scale reliability was determined using Cronbach's α coefficient.

RESULTS

The FSS-CT, a 12-item Likert scale comprising four domains, was developed. These domains capture the elements of nurses' work-related flow, including professional confidence, merging of action and awareness, balance between skill and challenge, and autotelic experience. The FSS-CT demonstrated high content validity (content validity index > .90) and satisfactory criterion-related validity (coefficient = .55, p < .001). Furthermore, the scale was found to have excellent internal consistency (Cronbach's α = .91). Factor analyses yielded a four-factor structure accounting for 69.34% of the total variance, indicating a good fit for the final model based on recommended goodness-of-fit indices.

CONCLUSIONS

The FSS-CT is a viable and dependable instrument for assessing the work-related flow experiences of nurses, with the measured outcomes offering to nursing administrators valuable insights into or directions for personnel development and work allocation initiatives.

Forgetting ourselves in flow: an active inference account of flow states and how we experience ourselves within them

Flow has been described as a state of optimal performance, experienced universally across a broad range of domains: from art to athletics, gaming to writing. However, its phenomenal characteristics can, at first glance, be puzzling. Firstly, individuals in flow supposedly report a loss of self-awareness, even though they perform in a manner which seems to evince their agency and skill. Secondly, flow states are felt to be effortless, despite the prerequisite complexity of the tasks that engender them. In this paper, we unpick these features of flow, as well as others, through the active inference framework, which posits that action and perception are forms of active Bayesian inference directed at sustained self-organisation; i.e., the minimisation of variational free energy. We propose that the phenomenology of flow is rooted in the deployment of high precision weight over (i) the expected sensory consequences of action and (ii) beliefs about how action will sequentially unfold. This computational mechanism thus draws the embodied cognitive system to minimise the ensuing (i.e., expected) free energy through the exploitation of the pragmatic affordances at hand. Furthermore, given the challenging dynamics the flow-inducing situation presents, attention must be wholly focussed on the unfolding task whilst counterfactual planning is restricted, leading to the attested loss of the sense of self-as-object. This involves the inhibition of both the sense of self as a temporally extended object and higher-order, meta-cognitive forms of self-conceptualisation. Nevertheless, we stress that self-awareness is not entirely lost in flow. Rather, it is pre-reflective and bodily. Our approach to bodily-action-centred phenomenology can be applied to similar facets of seemingly agentive experience beyond canonical flow states, providing insights into the mechanisms of so-called selfless experiences, embodied expertise and wellbeing.

Creative flow as optimized processing: Evidence from brain oscillations during jazz improvisations by expert and non-expert musicians

Using a creative production task, jazz improvisation, we tested alternative hypotheses about the flow experience: (A) that it is a state of domain-specific processing optimized by experience and characterized by minimal interference from task-negative default-mode network (DMN) activity versus (B) that it recruits domain-general task-positive DMN activity supervised by the fronto-parietal control network (FPCN) to support ideation. We recorded jazz guitarists' electroencephalograms (EEGs) while they improvised to provided chord sequences. Their flow-states were measured with the Core Flow State Scale. Flow-related neural sources were reconstructed using SPM12. Over all musicians, high-flow (relative to low-flow) improvisations were associated with transient hypofrontality. High-experience musicians' high-flow improvisations showed reduced activity in posterior DMN nodes. Low-experience musicians showed no flow-related DMN or FPCN modulation. High-experience musicians also showed modality-specific left-hemisphere flow-related activity while low-experience musicians showed modality-specific right-hemisphere flow-related deactivations. These results are consistent with the idea that creative flow represents optimized domain-specific processing enabled by extensive practice paired with reduced cognitive control.

Using caffeine as a chemical means to induce flow states

Flow is an intrinsically rewarding state characterised by positive affect and total task absorption. Because cognitive and physical performance are optimal in flow, chemical means to facilitate this state are appealing. Caffeine, a non-selective adenosine receptor antagonist, has been emphasized as a potential flow-inducer. Thus, we review the psychological and biological effects of caffeine that, conceptually, enhance flow. Caffeine may facilitate flow through various effects, including: i) upregulation of dopamine D1/D2 receptor affinity in reward-associated brain areas, leading to greater energetic arousal and 'wanting'; ii) protection of dopaminergic neurons; iii) increases in norepinephrine release and alertness, which offset sleep-deprivation and hypoarousal; iv) heightening of parasympathetic high frequency heart rate variability, resulting in improved cortical stress appraisal, v) modification of striatal endocannabinoid-CB1 receptor-signalling, leading to enhanced stress tolerance; and vi) changes in brain network activity in favour of executive function and flow. We also discuss the application of caffeine to treat attention deficit hyperactivity disorder and caveats. We hope to inspire studies assessing the use of caffeine to induce flow.

The Flow State Scale for Rehabilitation Tasks: A New Flow Experience Questionnaire for Stroke Patients

IMPORTANCE

Flow can be described as a subjective state that people report when they fully engage in an activity and experience pleasure, satisfaction, and enjoyment. Flow experiences are measured to determine the extent to which patients engage in therapy activities. Several flow questionnaires are used in neurorehabilitation. However, none have been validated for patients with (sub)acute stroke.

OBJECTIVE

To develop and validate a new flow questionnaire for patients with (sub)acute stroke.

DESIGN

Single-center prospective cohort study.

SETTING

Neurorehabilitation unit of the Neurocenter of the Luzerner Kantonsspital in Lucerne, Switzerland.

PARTICIPANTS

Fifty patients with (sub)acute stroke.

OUTCOMES AND MEASURES

Development of the Flow State Scale for Rehabilitation Tasks (FSSRT) and determination of the psychometric properties of the FSSRT (internal consistency, test-retest reliability, structural and construct validity) in (sub)acute stroke patients.

RESULTS

The FSSRT showed good internal consistency and excellent test-retest reliability. Composed of four components-concentration, pleasure, movement control, and absorption-the FSSRT correlated significantly negatively with the Hospital Anxiety and Depression Scale, indicating good divergent validity.

CONCLUSIONS AND RELEVANCE

The FSSRT is a reliable and valid questionnaire measuring flow experience in patients with (sub)acute stroke. This questionnaire can be easily used in occupational therapy as well as in physical therapy and gives therapists important information about the flow experience of patients during therapy to adjust the therapy accordingly. Plain-Language Summary: Measuring flow experience, or the extent to which patients engage in therapy activities, in the context of occupational therapy and physical therapy is a new approach. This study confirmed that the Flow State Scale for Rehabilitation Tasks questionnaire is reliable and valid for measuring the flow experience of patients after (sub)acute stroke. Occupational therapists and physical therapists can use the FSSRT to optimally adjust the therapy program and increase patient engagement during therapy.

The impact of self-directed learning experience and course experience on learning satisfaction of university students in blended learning environments: the mediating role of deep and surface learning approach

Introduction

With the rapid development of technology and the evolution of educational ideas, the blended learning model has become the new norm in higher education. Therefore, based on Biggs' learning process theory, this study aims to investigate the relationships between learning experience, learning approaches, and learning satisfaction of university students within the Chinese blended learning context to explore the dynamic process and mechanism of blended learning.

Methods

The Chinese modified versions of the Self-Rating Scale of Self-Directed Learning, the Course Experience Questionnaire, and the Revised Study Process Questionnaire were administered to 939 Chinese university first-grade students (444 men, 495 women). The data were analyzed by using the covariance-based structural equation modeling (CB-SEM) technique.

Results

The results demonstrated that, among Chinese university students, there were significant correlations between the self-directed learning experience, the course experience, the deep learning approach, the surface learning approach, and learning satisfaction. Additionally, the learning approaches mediated the association between the self-directed learning experience and learning satisfaction and between the course experience and learning satisfaction.

Conclusion

This study provides insight into the facilitative effect of university students' self-directed learning experience and course experience on their learning satisfaction and how this effect is triggered through the mediating role of different learning approaches with the blended learning context. This study shows the learning behaviors and psychology in a blended learning environment, thus revealing the new learning characteristics of university students by integrating the self-learning characteristics of blended learning into the framework of learning process theory. The findings contribute to assisting blended learning providers in delivering targeted interventions to enhance students' learning satisfaction.

Exploring the relationships between psychological variables and loot box engagement, part 2: exploratory analyses of complex relationships

In a pre-registered survey linked to this paper (Exploring the relationships between psychological variables and loot box engagement, part 1: pre-registered hypotheses), we confirmed bivariate associations between engagement with loot boxes (purchasable randomized rewards in video games) and measures of problem gambling, problem video gaming, impulsivity, gambling cognitions, experiences of game-related 'flow', psychological distress and reduced wellbeing. However, these variables have complex relationships, so to gain further insights, we analysed the dataset (1495 gamers who purchase loot boxes and 1223 purchasers of non-randomized content) in a series of Bayesian mixed-effects multiple regressions with a zero-inflation component. The results challenge some well-established results in the literature, including associations between loot box engagement and problematic gambling measures, instead suggesting that this relationship might be underpinned by shared variance with problem video gaming and gambling-related cognitions. An entirely novel discovery revealed a complex interaction between experiences of flow and loot box engagement. Distress and wellbeing are both (somewhat contradictorily) predictive of participants engaging with loot boxes, but neither correlate with increasing loot box risky engagement/spend (among those who engage). Our findings unravel some of the nuances underpinning loot box engagement, yet remain consistent with narratives that policy action on loot boxes will have benefits for harm minimization.

Exploring the relationships between psychological variables and loot box engagement, part 1: pre-registered hypotheses

Loot boxes are purchasable randomized rewards in video games that share structural and psychological similarities with gambling. Systematic review evidence has established reproducible associations between loot box purchasing and both problem gambling and problem video gaming, perhaps driven by a range of overlapping psychological processes (e.g. impulsivity, gambling-related cognitions, etc.) It has also been argued that loot box engagement may have negative influences on player financial and psychological wellbeing. We conducted a pre-registered survey of 1495 loot box purchasing gamers (LB cohort) and 1223 gamers who purchase other, non-randomized game content (nLB cohort). Our survey confirms 15 of our 23 pre-registered hypotheses against our primary outcome (risky loot box engagement), establishing associations with problem gambling, problem gaming, impulsivity, gambling cognitions, experiences of game-related 'flow' and specific 'distraction and compulsion' motivations for purchase. Results with hypotheses concerning potential harms established that risky loot box engagement was negatively correlated with wellbeing and positively correlated with distress. Overall, results indicate that any risks from loot boxes are liable to disproportionately affect various 'at risk' cohorts (e.g. those experiencing problem gambling or video gaming), thereby reiterating calls for policy action on loot boxes.

Emotional labor mediates the associations between self-consciousness and flow in dancers

Emotional labor has been a focal point in occupational well-being literature, but studies have long overlooked an important group of emotional laborers: performers. This research represents a pioneering effort to examine dancers' adoption of emotional labor strategies, their antecedent of self-consciousness, and the outcome of flow experience. We explored these elements both in the traditional setting of stage dancing and in the novel context of online dance classes without on-site spectators during the COVID-19 pandemic. The results revealed that dancers employed all three common emotional labor strategies: surface acting, deep acting, and expression of naturally felt emotions, with deep acting being the most frequent. In the traditional setting, only the expression of naturally felt emotions mediated the positive effect of private self-consciousness and the negative effect of public self-consciousness on flow experience. In contrast, in the online setting, only private self-consciousness impacted flow through the mediation of deep acting and expression of naturally felt emotions. This exploratory study bridges dramaturgy-originated theories of emotional labor with empirical performing arts research, preliminarily advancing knowledge in the relevant fields of dance education, self-presentation, and flow studies.

Chinese college students collaborative mobile-assisted language learning experience and flow as a key factor for further adoption

Introduction

In recent years, the widespread shift toward online learning in higher education has led to a notable increase in the utilization of collaborative mobile-assisted language learning (MALL). However, the efficacy and implementation of MALL in college settings remain subjects of ongoing scholarly debate. To gain deeper insights into the experiences of Chinese college students with collaborative MALL and investigate factors that may influence their intentions for further adoption, this study proposed a comprehensive model that integrates the updated Unified Theory of Acceptance and Use of Technology (UTAUT) and flow theory.

Methods

The model aimed to assess the relationship between flow and various antecedents, including perceived cost, social influences, perceived mobility, collaboration, and knowledge sharing, which shape students' intentions to adopt collaborative MALL. A survey was conducted among a sample of 831 students from 32 provinces and autonomous regions.

Results

The data analysis revealed that while 73% of participants reported having experienced collaborative MALL, overall adoption levels among Chinese college students are still in its initiative stage of adoption. Furthermore, variations were observed in the experiences of students from different majors and level of education. Importantly, the assessment of the proposed Mobile Collaborative Language Learning (MCLL) Model demonstrated the significant role of flow in predicting the adoption of collaborative MALL among Chinese college students.

Discussion

The study concludes with suggestions for future research opportunities based on the research findings, aiming to enhance our understanding and application of collaborative MALL in higher education contexts.

The Effects of Emotional Labor on Work Strain and Nonwork Strain Among Dancers: A Person-Centered Approach

Introduction

Emotional labor is an important research area, but four key gaps remain regarding outcomes of nonwork strains, explanatory frameworks beyond the conservation of resources theory, adoption of person-centered approaches, and subjects of performers.

Methods

By surveying 183 Chinese dance students, we employed cluster analysis to examine the adoption of emotional labor strategies (ie, surface acting, deep acting, and expression of naturally felt emotions) and to explore the outcomes on work strain (ie, emotional exhaustion and reduced flow experience) and nonwork strain (ie, depression and anxiety) with introducing the allostatic load theory as an analytical basis.

Results

Four types of emotional workers were identified, namely, flexible regulators (33.33%), authentic regulators (15.85%), display rules compliers (39.34%), and non-regulators (11.48%). Authentic regulators had the lowest emotional exhaustion. Non-regulators had the lowest flow. No differences emerged in depression or anxiety across clusters.

Discussion

Findings partially align with past research showing risks of surface acting in terms of emotional exhaustion. However, all three strategies enhanced flow states. Moreover, dancers' work strains did not extend to psychological problems, unlike other professions. Possible explanations include training in emotional regulation and flow states in performing. Practical implications exist for training emotional regulation and fostering flow at work.

Fostering flow experiences at work: a framework and research agenda for developing flow interventions

Flow, the holistic experience of intrinsic motivation and effortless attention, is positively associated with job performance, work engagement, and well-being. As many individuals struggle to enter and maintain flow states, interventions that foster flow at work represent valuable catalysts for organizational and individual improvement. Since the literature on work-related flow interventions is still sparse, this article aims to provide a foundation for the systematic development of these interventions. Through a narrative review of the empirical and theoretical field, we develop a comprehensive framework with three dimensions, (1) the intervention aim (entering, boosting, or maintaining flow), (2) the target (context, individual, or group), and (3) the executor (top-down or bottom-up), for systematically classifying flow interventions at work. We complement the framework with guiding questions and concrete starting points for designing novel interventions. In addition, we explain how to build on these dimensions when operationalizing flow as the outcome variable in evaluating intervention effectiveness. By acknowledging individual and situational variability in flow states and the contingent limitations of flow interventions, we offer a broad perspective on the potential for fostering flow at work by using adaptive interventions.

Psychometric analysis of the flow short scale translated to Finnish

Flow is a well-known construct describing the experience of deep absorption in a task, typically demanding but intrinsically motivating, and conducted with high skill. Flow is operationalized by self-report, and various instruments have been developed for this, but none have been made available in the Finnish language in thoroughly validated form. We present a psychometric scale-validation study for the Finnish translation of the Flow Short Scale (FSS). We collected data from 201 Finnish speaking participants using the Prolific Academic platform. We assessed the scale's factorial structure using Mokken scale analysis, Parallel Analysis, Very Simple Structures analysis and a standard Confirmatory Factor Analysis. We then evaluated how correlated was the FSS with the Flow State Scale and Flow Core Scale. Finally, we evaluated how well the FSS distinguished Flow-inducing experiences from boring (non-Flow-inducing) experiences. Taken together, our results show that an 8-item, two-factor version of the scale was a justified instrument with good psychometric properties.

A moderated mediation mechanism underlying the impact of website telepresence on purchase intention - Evidence from Chinese female college student customers

Telepresence in e-commerce, the feeling of resembling shopping in a physical store, plays a critical role in determining online purchase intention. However, the cognitive mechanism and boundary conditions about its effect still need further investigation. The current study construed flow experience and socioeconomic status as important variables and developed a moderated mediation model for their roles in the effect of telepresence. The model was supported by our study where a group of Chinese female college students participated in simulated online apparel shopping and completes relevant questionnaire surveys. The results show that: (1) website telepresence predicts positively the purchase intention of females, (2) flow experience mediates the impact of website telepresence on purchase intention, and (3) the relationship between website telepresence and flow experience could be moderated by socioeconomic status, namely, females with higher socioeconomic status demonstrate stronger mediation of flow experience. These findings can help researchers and online retailers understand the flow concept in e-commerce and formulate marketing strategies to retain consumers with different socioeconomic statuses.

Flow Experience and Emotional Well-Being among Italian Adolescents during the COVID-19 Pandemic

Research highlighted the negative consequences of the COVID-19 pandemic on adolescents' emotional well-being worldwide. In the attempt to identify resources which could facilitate adolescents' adjustment, this study examined the occurrence of flow experience and related activities, and the association between flow and emotional well-being among Italian teenagers. In Spring 2021, 150 students (40.7% girls) aged 15-19 completed instruments assessing flow and related activities before and during the pandemic, and current positive and negative affect. Findings revealed that only 24.7% of the participants currently reported flow; over half of those reporting flow before the pandemic did not experience it subsequently, and only 6.5% of those not reporting flow before the pandemic currently experienced it. Participants with flow both before and during the pandemic reported higher positive affect than teens who never experienced flow (p = .011), or lost it (p = .006). No group differences were detected for negative affect. Learning, structured leisure, and interpersonal relations were the domains most frequently associated with flow before and during the pandemic, but after the pandemic onset a reduction in the variety of flow activities and limited identification of new flow domains were observed. The association of flow with higher emotional well-being even in pandemic times suggests the potential usefulness of interventions promoting flow retrieval under adverse circumstances.

Development of Flow State Self-Regulation Skills and Coping With Musical Performance Anxiety: Design and Evaluation of an Electronically Implemented Psychological Program

Positive Psychology has turned its attention to the study of emotions in a scientific and rigorous way. Particularly, to how emotions influence people's health, performance, or their overall life satisfaction. Within this trend, Flow theory has established a theoretical framework that helps to promote the Flow experience. Flow state, or optimal experience, is a mental state of high concentration and enjoyment that, due to its characteristics, has been considered desirable for the development of the performing activity of performing musicians. Musicians are a population prone to health problems, both psychological and physical, owing to different stressors of their training and professional activity. One of the most common problems is Musical Performance Anxiety. In this investigation, an electronic intervention program was carried out for the development of psychological self-regulation skills whose main objective was to trigger the Flow response in performing musicians and the coping mechanism for Musical Performance Anxiety. A quasi-experimental design was used with a control group in which pre- and post-measures of Flow State, Musical Performance Anxiety and, also, Social Skills were taken. Sixty-two performing musicians from different music colleges in Spain participated in the program. Results indicated that the intervention significantly improved Flow State (t = -2.41, p = 0.02, d = 0.36), and Sense of Control (t = -2.48, p = 0.02, d = 0.47), and decreased Music Performance Anxiety (t = 2.64, p = 0.01, d = 0.24), and self-consciousness (t = -3.66, p = 0.00, d = 0.70) of the participants in the EG but not CG. The changes in the EG after the program showed the inverse relationship between Flow and Anxiety. Two important theoretical factors of both variables (especially in situations of performance and public exposure), such as worry and the feeling of lack of control, could be involved. The results are under discussion and future lines of research are proposed.

Do you Feel it? The Relationship Between the Perceived Team Climate for Innovations and the Experience of Flow and Worry

This paper examines the relationship between the perceived team climate for innovations and the experience of flow and worry and the moderating effect of team size. The research contains a multi-organization dataset with 323 software product development team members. The results show that the perceived climate for innovation is significantly positively related to the experience of flow and worry. However, the findings did not support the moderation with no differences in working in smaller or larger teams. This study indicates that the perceived climate for innovations positively relates to positive and negative individual effects without the importance of team size.

Positive Psychology and Philosophy-as-Usual: An Unhappy Match?

The present article critiques standard attempts to make philosophy appear relevant to the scientific study of well-being, drawing examples in particular from works that argue for fundamental differences between different forms of wellbeing (by Besser-Jones, Kristjánsson, and Kraut, for example), and claims concerning the supposedly inherent normativity of wellbeing research (e.g., Prinzing, Alexandrova, and Nussbaum). Specifically, it is argued that philosophers in at least some relevant cases fail to apply what is often claimed to be among their core competences: conceptual rigor—not only in dealing with the psychological construct of flow, but also in relation to apparently philosophical concepts such as normativity, objectivity, or eudaimonia. Furthermore, the uncritical use of so-called thought experiments in philosophy is shown to be inappropriate for the scientific study of wellbeing. As an alternative to such philosophy-as-usual, proper attention to other philosophical traditions is argued to be promising. In particular, the philosophy of ZhuangZi (a contemporary of Aristotle and one of the most important figures in Chinese intellectual history) appears to concord well with today’s psychological knowledge, and to contain valuable ideas for the future development of positive psychology.

Being at work improves stress, craving, and mood for people with opioid use disorder: Ecological momentary assessment during a randomized trial of experimental employment in a contingency-management-based therapeutic workplace

Employment problems are common among people with substance use disorders (SUDs), and improving vocational functioning is an important aspect of SUD treatment. More detailed understanding of the psychosocial benefits of employment may help refine vocational interventions for people with SUDs. Here, we used ecological momentary assessment to measure possible affective improvements associated with work. Participants (n = 161) with opioid use disorder were randomized to work (job-skills training) in a contingency-management-based Therapeutic Workplace either immediately or after a waitlist delay. Throughout, participants responded via smartphone to randomly scheduled questionnaires. In linear mixed models comparing responses made at work vs. all other locations, being at work was associated with: less stress, less craving for opioids and cocaine, less negative mood, more positive mood, and more flow-like states. Some of these differences were also observed on workdays vs. non-workdays outside of work hours. These results indicate that benefits associated with work may not be restricted to being actually in the workplace; however, randomization did not reveal clear changes coinciding with the onset of work access. Overall, in contrast to work-associated negative moods measured by experience-sampling in the general population, Therapeutic Workplace participants experienced several types of affective improvements associated with work.

Live Music Performance: The Relationship Between Flow and Music Performance Anxiety

Most studies exploring the relation between flow and Music Performance Anxiety (MPA) have focused on the disposition of generally experiencing flow and the occurrence of MPA. Little is known about the connection between experiencing flow and MPA as it relates to a specific performance. In this study, flow and MPA have been investigated in 363 orchestral musicians in relation to a particular live music performance. The musicians were asked to fill out a questionnaire immediately after a concert. Flow experience during the performance was measured using the Flow Short Scale. The Performance-specific Questionnaire on MPA (PQM) was used for MPA. The PQM addresses particular aspects of MPA and refers retrospectively to the time before and during the performance as well as to the moment of filling out the questionnaire after the performance. Using three scales, the functional coping, the perceived symptoms of MPA and self-efficacy were determined for each time point of the performance. The results showed that experiencing flow was on average higher among orchestral musicians compared to a sample of the general population. However, there were differences between the professional and non-professional musicians. All PQM scales showed significant correlations with the global flow scale. Regression analysis on the global flow score found that regarding the time before the performance the PQM scale symptoms of MPA were diametrically connected with the flow experience. The PQM scale functional coping was shown to be positively related to the flow during the performance. Moreover, high self-efficacy was found to be closely related with stronger flow experience. Furthermore, flow seems to have positive effects on functionally coping with MPA and the self-efficacy after the performance. These findings confirm the negative relationship between flow and symptoms of MPA, offering further approaches in understanding the relationship especially for live music performances.

Getting into a "Flow" state: a systematic review of flow experience in neurological diseases

BACKGROUND

Flow is a subjective psychological state that people report when they are fully involved in an activity to the point of forgetting time and their surrounding except the activity itself. Being in flow during physical/cognitive rehabilitation may have a considerable impact on functional outcome, especially when patients with neurological diseases engage in exercises using robotics, virtual/augmented reality, or serious games on tablets/computer. When developing new therapy games, measuring flow experience can indicate whether the game motivates one to train. The purpose of this study was to identify and systematically review current literature on flow experience assessed in patients with stroke, traumatic brain injury, multiple sclerosis and Parkinson's disease. Additionally, we critically appraised, compared and summarized the measurement properties of self-reported flow questionnaires used in neurorehabilitation setting.

DESIGN

A systematic review using PRISMA and COSMIN guidelines.

METHODS

MEDLINE Ovid, EMBASE Ovid, CINAHL EBSCO, SCOPUS were searched. Inclusion criteria were (1) peer-reviewed studies that (2) focused on the investigation of flow experience in (3) patients with neurological diseases (i.e., stroke, traumatic brain injury, multiple sclerosis and/or Parkinson's disease). A qualitative data synthesis was performed to present the measurement properties of the used flow questionnaires.

RESULTS

Ten studies out of 911 records met the inclusion criteria. Seven studies measured flow in the context of serious games in patients with stroke, traumatic brain injury, multiple sclerosis and Parkinson's disease. Three studies assessed flow in other activities than gaming (song-writing intervention and activities of daily living). Six different flow questionnaires were used, all of which were originally validated in healthy people. None of the studies presented psychometric data in their respective research population.

CONCLUSION

The present review indicates that flow experience is increasingly measured in the physical/cognitive rehabilitation setting in patients with neurological diseases. However, psychometric properties of used flow questionnaires are lacking. For exergame developers working in the field of physical/cognitive rehabilitation in patients with neurological diseases, a valid flow questionnaire can help to further optimize the content of the games so that optimal engagement can occur during the gameplay. Whether flow experiences can ultimately have positive effects on physical/cognitive parameters needs further study.

Expanding Social, Psychological, and Physical Indicators of Urbanites' Life Satisfaction toward Residential Community: A Structural Equation Modeling Analysis

Attention on, and interest in, life satisfaction has increased worldwide. However, research on life satisfaction focused toward the urban dwellers' residential community is mainly from western countries, and the limited research from China is solely focused on the geriatric population via a narrowly constrained research perspective. This study, therefore, aimed to investigate urbanites' life satisfaction toward their community, combining the psychological (behavioral community engagement, mental state of flow, and cognitive community identity), physical (PREQIs-perceived residential environment quality indicators: e.g., green area), and social perspectives (social capital). The proposed conceptual model was tested on a regionally representative sample of 508 urban community residents in the city of Chengdu, Sichuan province, China. Data were analyzed via a structure equation modelling approach in AMOS software. Findings suggested that all of the psychological, physical and social factors contributed to a prediction of life satisfaction. Specifically, social capital mediated the path from community engagement and flow to life satisfaction, and community identity mediated the path from flow experience and green area to life satisfaction. Additionally, social capital contributed to predict life satisfaction through its influence on community identity. Findings provide suggestions for urban designers and policymakers to focus on creating an urban community equipped with green area, which helps to promote physical activities that are flow-productive, to enhance residents' identification to their residential community and, therefore, increase life satisfaction.

Toward Evaluation of the Subjective Experience of a General Class of User-Controlled, Robot-Mediated Rehabilitation Technologies for Children with Neuromotor Disability

Technological advances in game-mediated robotics provide an opportunity to engage children with cerebral palsy (CP) and other neuromotor disabilities in more frequent and intensive therapy by making personalized, programmed interventions available 24/7 in children's homes. Though shown to be clinically effective and feasible to produce, little is known of the subjective factors impacting acceptance of what we term assistive/rehabilitative (A/R) gamebots by their target populations. This research describes the conceptualization phase of an effort to develop a valid and reliable instrument to guide the design of A/R gamebots. We conducted in-depth interviews with 8 children with CP and their families who had trialed an exemplar A/R gamebot, PedBotHome, for 28 days in their homes. The goal was to understand how existing theories and instruments were either appropriate or inappropriate for measuring the subjective experience of A/R gamebots. Key findings were the importance of differentiating the use case of therapy from that of assistance in rehabilitative technology assessment, the need to incorporate the differing perspectives of children with CP and those of their parents into A/R gamebot evaluation, and the potential conflict between the goals of preserving the quality of the experience of game play for the child while also optimizing the intensity and duration of therapy provided during play.