Validity, safety, usability, and user experience of virtual reality gamified home-based exercises in stroke

 

Hatem Lazem+ 7 authorsHelen Dawes
2025, Clinical Rehabilitation
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Objective: This study adopted a novel approach to exploring the content validity, safety, usability, and user experiences of different games for telerehabilitation purposes from the perspective of physiotherapists and stroke survivors. Design A cross-sectional content validity and usability study. Setting Lab and online. Participants: 23 participants were recruited: 11 neuro-physiotherapists and 12 chronic stroke survivors. Outcomes Content validity and safety were assessed using a bespoke state evaluation questionnaire. Usability was evaluated using the System Usability Scale (SUS) and the User Experience Questionnaire (UEQ). House of Quality analysis was conducted to identify the priority aspects for improvement. Results: Physiotherapists perceived the usability of the games as good to excellent for three games (median SUS = 80%) and poor for two games (SUS < 68%). Three games had a mean content validity index (CVI) > 0.8, and all games were safe to administer at home; mean CVI-safety item = 0.90. Stroke survivors with Fugl-Meyer Assessment of Upper Extremity function mean (SD) = 41(19.4), and mild to moderate spasticity perceived usability as very good to excellent for four games (median SUS = 85%). The UEQ scale showed good to excellent acceptance across most games. House of Quality analysis revealed that clear instructions, avatar quality, motivational exercise scenarios, and clinical assessment tools are essential criteria to consider throughout development. Conclusion: This study demonstrated the value of exploring patient and physiotherapist perspectives for better co-development of rehabilitation interventions. Clinical trials should be conducted after further refinement of the games to investigate their feasibility and potential efficacy as a telerehabilitation tool for arm and balance training.

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