Currently submitted to: JMIR Serious Games
Date Submitted: Sep 30, 2026
Open Peer Review Period: Sep 30, 2026 - Nov 25, 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Warning: This is an author submission that is not peer-reviewed or edited.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.
Expert consensus on development of exergames, a modified Delphi Study
ABSTRACT
Background:
The rise of exergames offers promising opportunities for rehabilitation but also faces an abundance of challenges. Exergames have proven to increase functional outcomes across a range of clinical populations, but adoption into routine rehabilitation remains limited.
Objective:
Building on existing implementation guidelines, this study gathered insights into exergames development to promote good functional outcomes and strong adoption into clinical care. This study drew on expert insights to inform a consensus-based design blueprint for exergames designed to support functional outcomes and adoption in rehabilitation practice.
Methods:
Insights from an expert panel regarding key design requirements throughout the development of exergames were collected using a three-phase, modified Delphi study. Experts in the field of rehabilitation and rehabilitation technology were recruited through purposive sampling. The first phase consisted of an online survey collecting initial input from the expert panel in preparation of phase two. In the second phase, four focus group discussions were organized expanding on the recommendations and methodologies mentioned in the first phase. Finally, the last phase consisted of three consecutive rounds of an online survey aimed at ranking the findings of the previous two phases based on relative priority for development.
Results:
In total 34 experts from 16 countries participated in this Delphi study. The results highlight the importance of iterative co-design approaches and early involvement of healthcare organizations, as well as methods for user experience testing, stakeholder mapping and clinical effectiveness assessments relevant during the different stages of development.
Conclusions:
The findings emphasize the importance of a user-centered and implementation-based focus throughout the entire developmental process, through early and continuous involvement of relevant stakeholders and healthcare organizations, iterative codesign approaches and user experience testing. This Delphi study builds on the existing body of evidence on implementation frameworks and provide effective methods to operationalize these guidelines. Clinical Trial: Clinicaltrials.gov NCT07460778
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Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.