A social VR-based collaborative exergame for rehabilitation: codesign, development and user study

Abstract

Immersive virtual reality (VR)-based exercise video games (exergames) are increasingly being employed as a supportive intervention in rehabilitation programs to promote engagement in physical activity, especially for elderly users. A multifaceted and iterative codesign process is essential to develop sustainable exergaming solutions. The social aspect is considered one of the key motivating factors in exergames; however, research on the social aspect of VR exergames has been limited. Previous studies have relied on competitiveness in exergames, but research has shown that competition can lead to adverse effects on users. With the aim of motivating elderly individuals to participate in physical exercise and improving social connectedness during rehabilitation, this work presents a social VR-based collaborative exergame codesigned with elderly participants and therapists. This exergame stimulates full-body exercise and supports social collaboration among users through a collaborative game task. Furthermore, this article presents a user study based on a mixed-methods approach to gather user feedback on exergame design and the effect of social collaboration versus playing alone in a VR exergame in terms of physical exertion and motivation. This study spanned five weeks (99 exergaming sessions) with 14 elderly participants divided into two groups, one playing collaboratively and the other playing individually. Between-group comparisons were performed at baseline (first week) and in the fourth week, and within-group comparisons were performed in the fifth week, when the participants played the exergame in counterbalanced order. In contrast to the first week, the participants exergaming collaboratively in the fourth week reported significantly higher intrinsic motivation on all subscales (enjoyment: p < 0.02, effort: p < 0.002, usefulness: p < 0.01) and physical exertion (p < 0.001) than those playing alone. Thereafter, exergaming in counterbalanced order during the fifth week resulted in significant differences (medium to large effect size) within groups. The participants found the social VR gameplay enjoyable and agreed that collaboration played a vital role in their motivation. They reported various health benefits, a minimal increase in symptoms of simulator sickness, and excellent usability scores (83.75±13.3). In this work, we also identify various key design principles to support healthcare professionals, researchers and industrial experts in developing ergonomic and sustainable VR-based exergames for senior citizens.

Technological Features of Immersive Virtual Reality Systems for Upper Limb Stroke Rehabilitation: A Systematic Review

“…While the Oculus Quest is recognized for its convenience, versatility, and affordability, the HTC Vive is lauded for its power, immersion, and customization capabilities. Notably, many scholars have used the Oculus Quest in several studies focusing on shoulder, hand, balance, and arm motor rehabilitation [ 75 , 76 , 77 ].…”

Born to Run, Programmed to Play: Mapping the Extended Reality Exergames Landscape

“…We only considered studies where participants actively played at least one version of the exergame and provided feedback. For example, we would complete the form separately for a multi-session HCD process and a subsequent independent user study of the final prototype (e.g., [221]). In contrast, we excluded purely exploratory gameplay sessions of arbitrary VR games (i.e., not exergames) or domain expert interviews preceding the actual implementation phase (e.g., contextual inquiry [112]).…”

“…Seventy-six games did not necessarily require any additional hardware to be played (e.g., [161,221,276]). In contrast, haptic props (𝑛=20) were used by some exergames.…”

Leveraging Emerging Technologies to Expand Accessibility and Improve Precision in Rehabilitation and Exercise for People with Disabilities

“…Online games can overcome social barriers for people with disabilities, while also allowing people with mobility limitations to engage and compete in gamified activities that may be otherwise physically inaccessible [283][284][285]. More recently, clinicians and researchers have also started to explore how gamification of rehabilitation and exercise can be delivered using VR technologies [286][287][288]. Strategies that guide individuals through movements using gamified rehabilitation and exercise activities performed in immersive VR environments offer an approach that provides all of the benefits of gamification in addition to the enhanced user experience and psychophysiological stimuli generated by VR.…”