Design and Evaluation of User-Centered Exergames for Patients With Multiple Sclerosis: Multilevel Usability and Feasibility Studies

BackgroundMultiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system. Patients with MS experience a wide range of physical and cognitive dysfunctions that affect their quality of life. A promising training approach that concurrently trains physica...

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Main Authors: Schättin, Alexandra, Häfliger, Stephan, Meyer, Alain, Früh, Barbara, Böckler, Sonja, Hungerbühler, Yannic, de Bruin, Eling D, Frese, Sebastian, Steinlin Egli, Regula, Götz, Ulrich, Bauer, René, Martin-Niedecken, Anna Lisa
Format: Article
Language:English
Published: JMIR Publications 2021-05-01
Series:JMIR Serious Games
Online Access:https://games.jmir.org/2021/2/e22826
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spelling doaj-91c68980df9c4d6f9470f545e2f77c0c2021-05-07T12:31:05ZengJMIR PublicationsJMIR Serious Games2291-92792021-05-0192e2282610.2196/22826Design and Evaluation of User-Centered Exergames for Patients With Multiple Sclerosis: Multilevel Usability and Feasibility StudiesSchättin, AlexandraHäfliger, StephanMeyer, AlainFrüh, BarbaraBöckler, SonjaHungerbühler, Yannicde Bruin, Eling DFrese, SebastianSteinlin Egli, RegulaGötz, UlrichBauer, RenéMartin-Niedecken, Anna Lisa BackgroundMultiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system. Patients with MS experience a wide range of physical and cognitive dysfunctions that affect their quality of life. A promising training approach that concurrently trains physical and cognitive functions is video game–based physical exercising (ie, exergaming). Previous studies have indicated that exergames have positive effects on balance and cognitive functions in patients with MS. However, there is still a need for specific, user-centered exergames that function as a motivating and effective therapy tool for patients with MS and studies investigating their usability and feasibility. ObjectiveThe aim of this interdisciplinary research project is to develop usable and feasible user-centered exergames for the pressure-sensitive plate Dividat Senso by incorporating theoretical backgrounds from movement sciences, neuropsychology, and game research as well as participatory design processes. MethodsFocus groups (patients and therapists) were set up to define the user-centered design process. This was followed by the field testing of newly developed exergame concepts. Two sequential usability and feasibility studies were conducted on patients with MS. The first study included a single exergaming session followed by measurements. Between the first and second studies, prototypes were iterated based on the findings. The second study ran for 4 weeks (1-2 trainings per week), and measurements were taken before and after the intervention. For each study, participants answered the System Usability Scale (SUS; 10 items; 5-point Likert Scale; score range 0-100) and interview questions. In the second study, participants answered game experience–related questionnaires (Flow Short Scale [FSS]: 13 items; 7-point Likert Scale; score range 1-7; Game Flow questionnaire: 17 items; 6-point Likert Scale; score range 1-6). Mixed methods were used to analyze the quantitative and qualitative data. ResultsIn the first study (N=16), usability was acceptable, with a median SUS score of 71.3 (IQR 58.8-80.0). In the second study (N=25), the median SUS scores were 89.7 (IQR 78.8-95.0; before) and 82.5 (IQR 77.5-90.0; after), and thus, a significant decrease was observed after training (z=−2.077; P=.04; r=0.42). Moreover, high values were observed for the overall FSS (pre: median 5.9, IQR 4.6-6.4; post: median 5.8, IQR 5.4-6.2) and overall Game Flow Questionnaire (pre: median 5.0, IQR 4.7-5.3; post: median 5.1, IQR 4.9-5.3). A significant decrease was observed in the item perceived importance (FSS: z=−2.118; P=.03; r=0.42). Interviews revealed that user-centered exergames were usable, well accepted, and enjoyable. Points of reference were identified for future research and development. ConclusionsThe project revealed that the newly developed, user-centered exergames were usable and feasible for patients with MS. Furthermore, exergame elements should be considered in the development phase of user-centered exergames (for patients with MS). Future studies are needed to provide indications about the efficacy of user-centered exergames for patients with MS.https://games.jmir.org/2021/2/e22826
collection DOAJ
language English
format Article
sources DOAJ
author Schättin, Alexandra
Häfliger, Stephan
Meyer, Alain
Früh, Barbara
Böckler, Sonja
Hungerbühler, Yannic
de Bruin, Eling D
Frese, Sebastian
Steinlin Egli, Regula
Götz, Ulrich
Bauer, René
Martin-Niedecken, Anna Lisa
spellingShingle Schättin, Alexandra
Häfliger, Stephan
Meyer, Alain
Früh, Barbara
Böckler, Sonja
Hungerbühler, Yannic
de Bruin, Eling D
Frese, Sebastian
Steinlin Egli, Regula
Götz, Ulrich
Bauer, René
Martin-Niedecken, Anna Lisa
Design and Evaluation of User-Centered Exergames for Patients With Multiple Sclerosis: Multilevel Usability and Feasibility Studies
JMIR Serious Games
author_facet Schättin, Alexandra
Häfliger, Stephan
Meyer, Alain
Früh, Barbara
Böckler, Sonja
Hungerbühler, Yannic
de Bruin, Eling D
Frese, Sebastian
Steinlin Egli, Regula
Götz, Ulrich
Bauer, René
Martin-Niedecken, Anna Lisa
author_sort Schättin, Alexandra
title Design and Evaluation of User-Centered Exergames for Patients With Multiple Sclerosis: Multilevel Usability and Feasibility Studies
title_short Design and Evaluation of User-Centered Exergames for Patients With Multiple Sclerosis: Multilevel Usability and Feasibility Studies
title_full Design and Evaluation of User-Centered Exergames for Patients With Multiple Sclerosis: Multilevel Usability and Feasibility Studies
title_fullStr Design and Evaluation of User-Centered Exergames for Patients With Multiple Sclerosis: Multilevel Usability and Feasibility Studies
title_full_unstemmed Design and Evaluation of User-Centered Exergames for Patients With Multiple Sclerosis: Multilevel Usability and Feasibility Studies
title_sort design and evaluation of user-centered exergames for patients with multiple sclerosis: multilevel usability and feasibility studies
publisher JMIR Publications
series JMIR Serious Games
issn 2291-9279
publishDate 2021-05-01
description BackgroundMultiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system. Patients with MS experience a wide range of physical and cognitive dysfunctions that affect their quality of life. A promising training approach that concurrently trains physical and cognitive functions is video game–based physical exercising (ie, exergaming). Previous studies have indicated that exergames have positive effects on balance and cognitive functions in patients with MS. However, there is still a need for specific, user-centered exergames that function as a motivating and effective therapy tool for patients with MS and studies investigating their usability and feasibility. ObjectiveThe aim of this interdisciplinary research project is to develop usable and feasible user-centered exergames for the pressure-sensitive plate Dividat Senso by incorporating theoretical backgrounds from movement sciences, neuropsychology, and game research as well as participatory design processes. MethodsFocus groups (patients and therapists) were set up to define the user-centered design process. This was followed by the field testing of newly developed exergame concepts. Two sequential usability and feasibility studies were conducted on patients with MS. The first study included a single exergaming session followed by measurements. Between the first and second studies, prototypes were iterated based on the findings. The second study ran for 4 weeks (1-2 trainings per week), and measurements were taken before and after the intervention. For each study, participants answered the System Usability Scale (SUS; 10 items; 5-point Likert Scale; score range 0-100) and interview questions. In the second study, participants answered game experience–related questionnaires (Flow Short Scale [FSS]: 13 items; 7-point Likert Scale; score range 1-7; Game Flow questionnaire: 17 items; 6-point Likert Scale; score range 1-6). Mixed methods were used to analyze the quantitative and qualitative data. ResultsIn the first study (N=16), usability was acceptable, with a median SUS score of 71.3 (IQR 58.8-80.0). In the second study (N=25), the median SUS scores were 89.7 (IQR 78.8-95.0; before) and 82.5 (IQR 77.5-90.0; after), and thus, a significant decrease was observed after training (z=−2.077; P=.04; r=0.42). Moreover, high values were observed for the overall FSS (pre: median 5.9, IQR 4.6-6.4; post: median 5.8, IQR 5.4-6.2) and overall Game Flow Questionnaire (pre: median 5.0, IQR 4.7-5.3; post: median 5.1, IQR 4.9-5.3). A significant decrease was observed in the item perceived importance (FSS: z=−2.118; P=.03; r=0.42). Interviews revealed that user-centered exergames were usable, well accepted, and enjoyable. Points of reference were identified for future research and development. ConclusionsThe project revealed that the newly developed, user-centered exergames were usable and feasible for patients with MS. Furthermore, exergame elements should be considered in the development phase of user-centered exergames (for patients with MS). Future studies are needed to provide indications about the efficacy of user-centered exergames for patients with MS.
url https://games.jmir.org/2021/2/e22826
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