The use of games as interventions in the domain of health care is often paired with evaluating the effects in randomized clinical trials. The iterative design and development process of games usually also involves an evaluation phase, aimed at identifying improvements for subsequent iterations. Since game design theory and theories from associated fields provide no unified framework for designing successful interventions, interpreting evaluation results and formulating improvements is complicated. This case study explores an approach of monitoring design decisions and corresponding theories throughout the design and development cycle, allowing evaluation results to be attributed to design decisions. Such an approach may allow the game design and development process to iterate the game more efficiently towards use in practice.Acknowledgements. The authors would like to thank ComPlay and Smith Fysiotherapie Praktijk for their participation and support in conducting this study.

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