Currently submitted to: JMIR Serious Games
Date Submitted: Sep 5, 2026
Open Peer Review Period: Sep 7, 2026 - Nov 2, 2026
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Markerless serious games for motor–cognitive rehabilitation in Parkinson's disease (ReabNet): a non-randomized controlled pilot study of feasibility, usability and safety
ABSTRACT
Background:
Background:
Serious games may enhance Parkinson's disease (PD) rehabilitation by combining task-specific exercise with cognitive–motor engagement, but controlled evidence for markerless, camera-based systems delivered without wearable sensors remains limited.
Objective:
We primarily assessed the feasibility of a browser-based, markerless serious-games programmed (ReabNet) delivered against conventional physiotherapy in mild-to-moderate PD, and secondarily explored preliminary balance and cognitive outcomes.
Methods:
In a single-centre, non-randomized, active-comparator pilot, 25 adults with idiopathic PD (Hoehn & Yahr 1–3) were enrolled and allocated by order of arrival to ReabNet or conventional physiotherapy; 22 completed the 16-session, 8-week protocol (ReabNet n = 12; control n = 10). Feasibility (protocol completion, usability [System Usability Scale, SUS], safety) was the primary focus. Balance (Berg Balance Scale, BBS) was the prespecified primary clinical outcome, with cognition, processing speed, working memory and walking capacity as exploratory outcomes. Because groups were not randomized and differed at baseline, between-group change comparisons (Mann–Whitney) were supported by baseline- and disease-duration-adjusted ANCOVA and minimal-clinically-important-difference (MCID) responder analyses and interpreted as exploratory.
Results:
Feasibility was high: all 22 analyzed participants completed the 16 sessions, usability was good (SUS 77.5, SD 9.5), and only one transient, mild adverse event (vertigo) occurred. Groups were imbalanced at baseline (disease duration, cognition, walking). The ReabNet group showed a larger BBS change (+4.0 vs 0.0; unadjusted P = .0003) that persisted after adjustment (adjusted +3.8; P = .0009); cognitive and working-memory advantages attenuated after adjustment and remained exploratory.
Conclusions:
A markerless serious games programmed was feasible, usable and safe in mild-to-moderate PD. The balance signal is hypothesis-generating and supports an adequately powered randomized controlled trial rather than establishing efficacy. Clinical Trial: Brazilian Registry of Clinical Trials (ReBEC) RBR-32xntk4.
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