Accepted for/Published in: JMIR Serious Games
Date Submitted: Jul 16, 2025
Date Accepted: Feb 23, 2026
Balance Assessment Using Gamified Digital Technology in Community-Dwelling Older Adults: A Mixed Methods Validation Study and Randomized Controlled Trial
ABSTRACT
Background:
Falls are a leading cause of injury and mortality among older adults, underscoring the need for reliable, scalable, and engaging balance assessment tools that can be used in community settings. Traditional clinician-administered assessments like the Brief-BESTest are limited by subjectivity and accessibility constraints.
Objective:
This study aimed to develop and evaluate a Gamified Digital Balance Assessment (GDBA) based on the traditional clinician-administered Brief-BESTest to develop a valid and engaging balance assessment tool for older adults in China.
Methods:
two-phase mixed methods study was conducted. In phase 1, a computer vision–based digitalized Brief-BESTest was developed and evaluated for concurrent validity in 10 older adults (mean age 64.9, SD 2.76 years) against the traditional clinician-administered version. In phase 2, a randomized controlled trial involving 30 older adults (mean age 66.7, SD 3.93 years) compared the digitalized Brief-BESTest and the GDBA. Quantitative outcomes included perceived exertion, enjoyment, competence, pressure, and intention to continue use. Qualitative interviews explored user experience.
Results:
In phase 1, the digitalized Brief-BESTest demonstrated excellent intra-session reliability (ICC = 0.89–0.92) and strong concurrent validity with the clinician-administered version (ρ = 0.91, P < .01). In phase 2, participants using the GDBA reported significantly lower perceived exertion (P = 0.01, d = –1.09) and higher enjoyment (P = 0.01, d = 1.17), perceived competence (P = 0.02, d = 0.89), and intention to continue use (P < 0.01, d = 1.25), compared to those using the digitalized Brief-BESTest. Perceived pressure did not differ significantly between groups (P = 0.09, d = 0.63).
Conclusions:
The digitalized Brief-BESTest demonstrated both strong reliability and validity, while the GDBA enhanced user engagement and motivation through gamification. These findings support the potential of GDBA as a valid, engaging, and scalable tool for fall risk screening in community-dwelling older adults. Clinical Trial: This trail was registered in ClinicalTrials.gov (NCT06958653).
Citation
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Copyright
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