Ruben Debeuf

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. CLINICALTRIAL Clinicaltrials.gov NCT07460778

BACKGROUND People aged 60 years and over represent the fastest growing population segment worldwide. Aging is associated with complex health and social challenges, and quality of life is influenced by multiple factors, including access to healthcare services, caregiver support, social participation, and community engagement. In this context, digital health interventions (DHIs), such as mobile applications and wearables, may meet these needs in older adults. However, their adoption among older adults remains low, partly due to limited usability, inadequate accessibility, and a lack of inclusive design principles. OBJECTIVE This study aimed to validate a novel set of inclusive design guidelines for DHIs targeting older adults. To achieve this objective, we convened an expert panel in digital health, user experience, design, and geriatrics. METHODS The initial version of the guidelines was created using a multi-method approach in previous work and comprised 13 guideline elements. A three-round eDelphi study was conducted with experts from academia, industry, and public and private health sectors. Participants rated each guideline item in terms of utility, clarity, and ease of use on a 7-point Likert scale, which was transformed into a fuzzy scale for analysis. The eDelphi process and reporting followed the Guidance on Conducting and Reporting Delphi Studies (CREDES) guidelines. Consensus criteria were predefined. After the eDelphi rounds, experts also contributed practical examples to support guideline implementation. RESULTS A total of 28 experts from a range of disciplines participated in round 1, 20 in round 2, and 19 in round 3. Consensus was reached on more than 75% of the evaluated items related to the guidelines’ utility, clarity, and ease of use (33/42 items). All guideline items achieved consensus regarding their utility and clarity. However, approximately 65% of guideline items (9/14 guideline items) did not reach consensus with respect to their ease of use. According to the panel, this was primarily due to the lack of concrete examples supporting the practical implementation of the guidelines. Therefore, such examples were subsequently added to the final version of the guideline. CONCLUSIONS The eDelphi panel confirmed that inclusive design of DHIs for older adults should address not only user interface elements but also broader healthcare, organizational, and contextual factors. The validated guideline provide evidence-based support for the development of DHIs intended for older adults. The findings highlight the importance of complementing theoretical guidelines with practical examples to enhance the ease of use for designers and developers.

Assistive lower-limb exoskeletons (LLEs) have been recognized as promising tools for enhancing physical capacity in stroke survivors. Involving end-users in the early development stages is essential to ensure these technologies meet user needs. Co-design approaches, which actively engage end-users, support this goal. This study aims to (1) evaluate the impact of fatigue on daily living, (2) identify activities that could benefit from LLE assistance, (3) outline design and usability requirements for home-based LLEs, and (4) define physical parameters LLEs should monitor and assess. Discussions were structured using the PERCEPT co-design methodology and thematically analyzed. Four chronic stroke survivors participated in three focus group sessions, each lasting approximately 2 hours. Fatigue was identified as a significant factor in daily life, underscoring the importance of assistive technologies, such as LLEs, to help mitigate exhaustion. Participants recognized LLEs as valuable tools for enhancing physical performance, with benefits for muscle strength, balance, fatigue management, coordination, and general mobility. Design considerations included system modularity, battery efficiency, ease of donning and doffing, and practical needs for daily use. Our findings offer valuable insights into stroke survivors' design and usability concerns regarding LLEs and provide a foundation for advancing the development and adoption of new assistive technologies.

Background: Hospitalized older adults often spend prolonged periods of time bedridden, leading to decreased muscle strength and function. To tackle this, rehabilitation aims to keep patients active and train affected muscles. Exergames have proven to be effective in the rehabilitation of different patient populations and offer a motivating solution to combat inactivity associated with hospitalization. Furthermore, blood flow restriction (BFR) is effective in therapy for weakened patients, so combining BFR and exergames might be promising. Objective: As part of an iterative process of user-centered development, this mixed method study investigates the acceptability and feasibility of the Ghostly game as a stand-alone added therapy or combined with BFR in strength training of hospitalized older adults. Methods: A mixed methods study was conducted on 15 hospitalized older adults. Participants were randomized into 3 groups and received daily interventions from the moment they were included in the geriatric ward, until discharge from the hospital. The Ghostly group received daily conventional therapy with the Ghostly game as added therapy, the Ghostly + BFR group received daily conventional therapy with Ghostly in combination with BFR as added therapy and last, the control group received daily conventional therapy with dose-matched isometric exercises as added therapy. The primary outcome, user experience, was assessed before discharge from the hospital using the Usefulness, Satisfaction, and Ease of Use questionnaire and through expert observations. Clinical outcomes such as muscle strength, muscle architecture, and segmental body composition were assessed at baseline and before discharge from the hospital to test the feasibility of the research protocol in preparation for future randomized controlled trials. Results: A total of 15 hospitalized older adults (11 female participants, 73.33%) were included in this study with an average age of 84.53 (range: 78‐94) years. Participants received an average of 3.47 (range: 3‐5) intervention sessions after transferring to the geriatric ward of the hospital. Results on user experience revealed high scores on all subcategories of the Usefulness, Satisfaction, and Ease of Use questionnaire (usefulness: 78.93%, ease of use: 82.99%, ease of learning: 85.36%, and satisfaction: 87.55%). Furthermore, expert observations identified issues with color contrast, reaction time speed, and the need to tailor the game to accommodate the diverse requirements of different patient populations. All outcomes and procedures were found feasible for a future randomized controlled trial. Conclusions: This mixed methods study combines the innovative aspects of an electromyography-driven exergame with strength training principles of BFR and reveals the acceptability and feasibility of the Ghostly game as a stand-alone added therapy modality for strength training in hospitalized older adults and in combination with BFR. Future improvements of the exergame could focus on addressing expert-identified issues, including optimizing color contrast, adjusting reaction time speeds, and tailoring the game to meet the needs of different patient populations.

「福祉科技與服務管理學刊」創辦於2012年12月，由中華福祉科技與服務管理學會發行，旨在提供老人福祉科技(gerontechnology)及高齡者照護服務與管理之相關學者、產業界和從業人員，以中文發表研發成果或實務經驗之平台，期能促進跨領域知識交流與傳播，提升整體研究水平與相關產業發展，進而為高齡化社會衍生之各種問題提出具體解決方案，提升高齡者之生活品質。

Stroke is a global healthcare problem that represents the primary cause of acquired, long-term disability in the adult population [1]. It is recognized that hemiparesis, defined as an alteration in...

The implementation of technology in healthcare shows promising results and provides new opportunities in rehabilitation. However, the adoption of technology into daily care is largely dependent on the acceptance rate of end-users. This study aims to gather information from healthcare professionals on the development of new assistive technology that match users’ needs using the Comprehensive Assistive Technology model. In total 27 healthcare professionals (12 occupational therapists, 8 physiotherapists, 3 nurses, 2 allied health directors, a physician and a speech therapist) attended one of four online focus group discussions. These focus group discussions were structured using a question guide based on three predefined scenarios. Recordings were transcribed and data was analyzed using a thematic analysis (NVivo). Major themes identified in this study were safety, price and usability. Healthcare professionals focused on both functional capabilities of the user, as well as behavioral aspects of usability and attitude toward technology. Furthermore, the need for assistive technology that were catered toward the limitations in activity and user experience, was highlighted extensively. Based on information gathered from healthcare professionals a user-centered approach in development of safe, low-cost devices that maximize both functional outcomes and user acceptance, could potentially increase the adoption of new technology in rehabilitation.