JMIR Publications

ABSTRACT

Background:

Background:

Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system and the commonest cause of neurological disabilities in young adults. MS patients suffer from 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, so-called exergaming. Previous studies have indicated that exergames have positive effects on balance and on specific cognitive functions in MS patients. However, there is still a need both for specific user-centered exergames providing a long-term motivating and effective therapy tool for MS patients and for studies investigating their usability and feasibility.

Objective:

Objective:

The aim of the interdisciplinary research project was to develop usable and feasible user-centered exergames for the pressure-sensitive plate Dividat Senso (©Dividat) by incorporating theoretical background from movement sciences, neuropsychology and game research, as well participatory design processes.

Methods:

Methods:

First, focus groups (patients & therapists) were set up to define the user-centered design process, followed by field-testing with the newly developed exergame concepts. Two sequential usability and feasibility studies were conducted with MS patients. The first study included a single exergaming session followed by measurements. Between the first and the second study, prototypes were iterated based on the findings. The second study ran over a period of 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) and pre-defined interview questions. In the second study, participants also answered game-flow questionnaires (Flow Short Scale (FSS) and Game Flow (GF)). Mixed methods were used to analyze the quantitative and qualitative data.

Results:

Results:

In the first study, the SUS was 71.3 [58.8; 80.0] (median [interquartile range]). In the second study, the SUS was 89.7 [78.8; 95.0] (before) and 82.5 [77.5; 90.0] (after) and, thus, a significant decrease was measured (z = –2.077, p = 0.038, r = 0.42). Moreover, high values were assessed for overall FSS (5.9 [4.6; 6.4] (pre) & 5.8 [5.4; 6.2] (post)) and overall GF (5.0 [4.7; 5.3] (pre) & 5.1 [4.9; 5.3] (post). A significant decrease was observed in the item “perceived importance” (FSS) (z = –2.118, p = 0.034, r = 0.42). Interviews revealed that the user-centered exergames were usable, well accepted and enjoyable. Points of reference were identified for future research and development work.

Conclusions:

The project revealed that the newly developed user-centered exergames were usable (SUS score above 70) and feasible in MS patients. Furthermore, exergame elements were specified that should be considered in the development phase of user-centered exergames (for MS patients). Future studies are needed that provide some early indications about the efficacy of user-centered exergames in MS patients.