User Perspectives on Exergames Designed to Explore the Hemineglected Space for Stroke Patients With Visuospatial Neglect: Usability Study
Open accessAbstract
BACKGROUND: Visuospatial neglect due to stroke is characterized by the inability to perceive stimuli emerging in the area opposite to the side of brain damage. Besides adopting conventional rehabilitation methods to treat neglect symptoms, the use of virtual reality (VR) is becoming increasingly popular. We designed a series of 9 exergames aimed to improve exploration of the neglected side of space. When new VR interventions are designed, it is important to assess the usability aspects of such management strategies within the target population. To date, most studies used questionnaires to assess user satisfaction with the intervention or product being tested. However, only a combination of both quantitative and qualitative data allows a full picture of user perspective. OBJECTIVE: The purpose of this study was to quantitatively and qualitatively assess patient and therapist perspectives of a VR intervention based on the series of 9 exergames designed to explore hemineglected space. Specifically, we wanted to evaluate (1) perceived-user friendliness of the exergames, (2) attitude towards using the exergames, and (3) intention to use the exergames in the future. METHODS: A total of 19 participants (7 patients, 12 therapists) evaluated the exergames they had used 5 times a week during 3 weeks. The Technology Acceptance Model (TAM) questionnaire was filled out after the intervention. Based on those responses, we conducted focus group interviews (with therapists) and individual interviews (with patients). To analyze the TAM questionnaires, we used descriptive statistics. We adopted content and comparative analysis to analyze the interviews and drew illustration maps to analyze the focus group interviews. RESULTS: The therapists took a more critical stance with a mean TAM questionnaire total score of 48.6 (SD 4.5) compared to the patients who had a mean total score of 56.1 (SD 12.3). The perceived user-friendliness score was 5.6 (SD 1.4) for patients and 4.9 (SD 1.4) for therapists. The attitude towards using the exergames was rated 4.8 (SD 1.9) by patients and 3.6 (SD 1.4) by therapists, respectively. The intention to use the exergames in the future was rated 3.9 (SD 2.1) by patients and 3.7 (SD 1.8) by therapists. We gained information on how to improve the exergames in the interviews. CONCLUSIONS: Patients and therapists perceived the exergames as user-friendly; however, using the games further with the actual test version was not perceived as conceivable. The therapists were generally more critical towards future use than the patients. Therefore, involving both users to achieve acceptable and user-friendly versions of game-based rehabilitation for the future is deemed crucial and warranted. TRIAL REGISTRATION: Clinicaltrials.gov NCT02353962; https://clinicaltrials.gov/ct2/show/NCT02353962 (Archived by WebCite at http://www.webcitation.org/6soxIJlAZ).
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Qualitative research has shown gamification elements are perceived as attractive features by users.
“qualitative research has shown gamification elements are indeed perceived as attractive features by users”
From Better, Virtually: the Past, Present, and Future of Virtual Reality Cognitive Behavior Therapy (2021) · cites this paper as Tobler-Ammann et al. 2017
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- Authors
- Tobler-Ammann, B. C., Surer, E., Knols, R. H., Borghese, N. A., & de Bruin, E. D.
- Affiliations
- Maastricht University (NL)
- University Hospital Zurich (CH)
- University of Milan (IT)
- Corresponding author
- Tobler-Ammann, Bernadette C
- Venue
- JMIR Serious Games
- Publisher
- JMIR Publications Inc.
- Published
- 2017-08-25
- Volume
- 5
- Issue
- 3
- Pages
- e18
- ISSN
- 2291-9279 (ISSN-L)
- PMC
- PMC5591406
- OpenAlex
- W2746964134
- Cited by
- 29
- References
- 46
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 3 · 2023: 6 · 2022: 3 · 2021: 5 · 2020: 5 · 2019: 1 · 2018: 4
- FWCI
- 1.57
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- JMIR Serious Games (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Archivio Istituzionale della Ricerca (Universita Degli Studi Di Milano) (submittedVersion, cc-by)
- Research Publications (Maastricht University) (submittedVersion, cc-by)
- OpenMETU (Middle East Technical University) (submittedVersion, cc-by-nc-nd)
- Repository for Publications and Research Data (ETH Zurich) (submittedVersion, cc-by)
- Research Publications (Maastricht University) (submittedVersion, other-oa)
- ETH Zürich Research Collection (cc-by)
- Funders
- European Commission (287713)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Spatial Neglect and Hemispheric Dysfunction
- Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
- Physical Sciences › Computer Science › Human-Computer Interaction › Virtual Reality Applications and Impacts
- Keywords
- visuospatial neglect, stroke rehabilitation, exergames, virtual reality, usability, user acceptance, technology acceptance model, patient perspectives, therapist perspectives, intention to use, ease of use, attitudes toward technology, focus groups, user-centered design
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