JMIR Publications

ABSTRACT

Background:

Novel digital technologies designed for postural control rehabilitation frequently face barriers to clinical implementation because feasibility, safety, and stakeholder acceptance are often insufficiently addressed during early development stages. Although virtual reality (VR) exergames can enhance engagement during balance training, most available systems provide limited physical perturbation and train only a subset of the postural control domains required for functional balance rehabilitation. Recent methodological frameworks, such as Co-Develop-IT, advocate iterative, user-centered validation before progression to clinical efficacy trials.

Objective:

This study aimed to evaluate the feasibility, usability, safety, and proof-of-concept functionality of a low-cost unstable platform integrated with immersive and semi-immersive VR environments for postural control training.

Methods:

This cross-sectional proof-of-concept study was positioned within Phase 5.5 (short-term testing and validation) of the Co-Develop-IT framework. Thirty-five healthy physiotherapists with experience across diverse clinical areas interacted with the platform under immersive and semi-immersive VR conditions. Safety was assessed using the Simulator Sickness Questionnaire (SSQ), usability using the System Usability Scale (SUS), and functional relevance using the Systems Framework for Postural Control (SFPC). Paired comparisons were performed using the Wilcoxon signed-rank test.

Results:

All 35 physiotherapists completed all study procedures. Mean SUS scores were 77.4 (SD 14.4) for immersive VR and 82.4 (SD 10.5) for semi-immersive VR, with the semi-immersive condition showing higher usability (P=.03). Mean SSQ scores remained low in both conditions, although were higher during immersive exposure (7.4, SD 16.8 vs 2.5, SD 5.5; P=.02). SFPC scores indicated that the platform was perceived as capable of stimulating the major domains of postural control, with no significant difference between conditions (7.7, SD 1.3 vs 7.9, SD 1.3; P=.19). No serious adverse events were reported.

Conclusions:

The proposed system demonstrated favorable usability, minimal cybersickness symptoms, and the capacity to engage multiple postural control domains. These findings support progression to longitudinal feasibility and clinical efficacy studies in neurological populations, in line with the Co-Develop-IT framework.