Elisa Pedroli

Background: Evidence suggests that older adults can improve dual-task (DT) performance through specific motor-cognitive training programs. Recent technological advancements have facilitated the development of novel rehabilitative DT methodologies. In particular, the DUAL-REHAB project exploits 360° technology to develop ecological, cost-effective DT exercises for clinical and home settings. Objective: This study aimed to comprehensively understand the DUAL-REHAB project’s end users (older adults with subjective memory complaints [SMC] and mild cognitive impairment [MCI]) and obtain feedback on an initial DUAL-REHAB mobile app prototype using a user-centered design approach. Methods: The study used a 2-phase procedure. In the first phase (user requirements), we investigated end users’ lifestyles, habits, perceived well-being, technology adoption, and cognitive and cognitive-motor DT training expectations. In the second phase (prototype evaluation), we developed and tested a DUAL-REHAB mobile app prototype to assess its functionality with end users. Results: Overall, 14 participants were initially recruited for the study. The sample included 7 women with a mean age of 79 (SD 3.79) years and 7 men with a mean age of 82.43 (SD 5.65) years. One female participant was excluded for not meeting the criteria for either group; accordingly, the final sample study included 13 participants, with 8 categorized as MCI and 5 categorized as SMC. Participants reported structured daily routines with high autonomy, although some faced challenges with social connections. Perceived well-being was moderate across physical (mean 2.79, SD 0.97), psychological (mean 3.14, SD 0.86), and cognitive (mean 3.14, SD 0.53) domains. The perceived technology skills were low (mean 2.57, SD 0.94), with low digital literacy (mean 2.21, SD 0.89). Interest in cognitive training was high, with 92.31% (12/13) participants aware of its benefits and demonstrating strong interest (mean 4.15, SD 1.34) and perceived use (mean 4.15, SD 1.28). While only 46.15% (6/13) were aware of the possibility of DT training with technology, 92.31% (12/13) were willing to participate, and 84.61% (11/13) were open to home-based training. The preferred frequency was 2-3 days per week (63.64%, 7/11), with 10-20 minute sessions (8/11, 72.72%). Prototype evaluation revealed specific usability issues related to icon identification, device interaction, and navigation between training days. Conclusions: We obtained valuable insights into the lifestyles, habits, and technological needs of older adults with MCI and SMC, which will guide DUAL-REHAB training development to align with user needs and capabilities. Our findings emphasize the importance of simplified technological processes with intuitive interfaces. Additionally, structured interaction opportunities during clinical and at-home training could enhance motivation, facilitate timely problem resolution, and address participants’ social needs.

Virtual reality applications in healthcare settings require robust evaluation methods to ensure optimal user experience, particularly when targeting specialized populations such as older adults. Despite the proliferation of virtual reality-based interventions, current assessment instruments often present several limitations, as they typically focus on isolated aspects or were originally designed for conventional interfaces. This paper presents the development of the User Experience questionnaire for Virtual Reality application in Healthcare (UXVR-H), a novel questionnaire specifically designed to evaluate user experience when users interact with virtual reality applications in clinical settings. The multi-phase development process combined literature analysis, user-centered design approach, and expert consultation. We first conducted a comprehensive review of existing assessment tools, identifying eight crucial dimensions of virtual experiences in healthcare: usability and functionality, aesthetics of design, engagement, emotional state, motivation and intention of use, side effects, realism of environments, and presence. An initial pool of 271 items was systematically refined through two key phases: (i) a reformulation technique involving older adults to ensure item clarity and comprehension, and (ii) content validation by eight independent user experience and methodology experts. This rigorous process resulted in a final 24-item instrument with a 5-point Likert scale. This work represents the first critical step toward a fully validated assessment tool to establish reliability and construct validity. The UXVR-H addresses a significant gap in the field by providing a specialized assessment instrument that can enhance the design and implementation of virtual reality-based interventions in healthcare settings once fully validated.

The exponential growth and integration of virtual reality technology in clinical environments necessitates a comprehensive user experience evaluation. This assessment is critical for clinical populations and geriatric cohorts presenting peculiar needs and expectations. Despite the longstanding conceptual framework of user experience, a consensus regarding its definition and optimal evaluation methodologies remains elusive, especially within healthcare contexts. This systematic scoping review examines state-of-the-art questionnaire-based instruments for assessing user experience in healthcare virtual reality applications, synthesizing current evaluation approaches and identifying key user experience dimensions. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Review guidelines, we analyzed articles employing questionnaires to evaluate user experience in virtual reality-based health applications for adults. Following a meticulous screening process of 325 papers across PubMed, Web of Science, and Embase databases, 17 studies met our inclusion criteria. Studies predominantly used multiple and diverse questionnaires exploring several dimensions. Eight key user experience dimensions emerged: usability and functionality, aesthetics of design, engagement, emotional state, presence, realism of environments, side effects, and motivation and intention of use. Current evaluation lacks standardization and theoretical consistency. We propose a comprehensive eight-domain framework and recommend integrating multidisciplinary expertise, implementing longitudinal evaluation approaches, and developing psychometrically validated instruments. These findings provide essential guidance for improving patient outcomes and healthcare delivery efficacy through optimized virtual reality-based implementation.

Background: Current research on Alzheimer’s Disease has progressively focused on Mild Cognitive Impairment (MCI) as a pre-dementia state, as well as on Subjective Memory Complaint (SMC), as a potential early indicator of cognitive change. Consequently, timely interventions to prevent cognitive decline are essential and are most effective when combined with motor training. Nevertheless, motor-cognitive dual-task training often employs non-ecological tasks and is confined to clinical contexts lacking generalizability to daily life. The integration of 360° media could overcome these limitations. Therefore, the aim of the current work is twofold: (a) to present a dual-task training using 360° technology for its interactivity, versatility, and ecological validity, and (b) to propose a protocol to test its efficacy through a randomized clinical trial. Methods: This study will recruit 90 older adults (MCI and SMC). Participants will follow two phases of training: in-hospital rehabilitation and at-home rehabilitation. The experimental design will follow a 2 × 3 × 2 structure with 3 factors: type of treatment (360° training vs. traditional rehabilitation), time (baseline, post in-hospital training, and post at-home training), and group (SMC vs. MCI). Results: The expected outcome is an improvement in cognitive and motor functioning after the experimental training. Conclusion: This study will advance the literature on non-pharmacological interventions and innovative technological tools for cognitive trainings in the early stages of cognitive decline.