Table 5.
Engagement, satisfaction, and usability characteristics of gamified interventions.
| Study | Engagement | Satisfaction | Cultural adaptation | Technical adaptation | Challenges |
| Tabak et al [8], 2014 | Web portal use: 86.4% of d; exercise adherence: 21%; activity coach used for 299 d (132 d monitoring and 167 d feedback) | Satisfaction (CSQ-8a): telehealth group—26.4, CGb—30.4 (out of 32) | NRc | Wearable and web-based portal; no adaptation for other platforms | Technical issues with activity coach (eg, cycling accuracy); low exercise adherence (21%) |
| Mazzoleni et al [14], 2014 | 7 additional Wii Fit sessions for EGd; all completed | Satisfaction: EG—42.4, CG—43.9 (out of 49) | NR | None beyond Wii Fit system | Initial difficulty with balance board; exclusion of patients with motor limitations |
| Kotrach et al [15], 2015 | All participants adhered to the VGSe training | NR | NR | None beyond training sessions | Language barriers and patient ability to use VGS |
| Hoaas et al [12], 2016 | On average, 3 diary entries per wk and 1.7 training sessions per wk | Increased self-efficacy and emotional safety; participants experienced health benefits | NRNR | iPad and treadmill used to adapt exercise training to home settings | Some technical difficulties with videoconferencing |
| LeGear et al [16], 2016 | 90% enjoyed Wii intervention, and 80% agreed that it could be used at home | NR | NR | None beyond standard Wii setup | Some participants required supervision for safe use |
| Liu et al [17], 2016 | 75% of patients with COPDf and 90% of healthy older adults improved in second GRAILg test | NR | NR | No major technical adaptation beyond GRAIL VRh setup | Complex setup required; difficulty for patients using self-paced treadmill |
| Bamidis et al [18], 2017 | Various engagement tools: achievements and self-reported progress via mobile apps | NR | Tailored to socioeconomic and cultural contexts of various countries | Use of ICTi, mobile apps, SMS text messaging, and gamification across different platforms | Interoperability and customization for different health care systems; potential digital divide |
| Burkow et al [19], 2018 | Peer monitoring and virtual group updates drove engagement | High acceptance; improved adherence to exercise routines; group motivation | NR | Tablet optimized with all other apps disabled | Minor technical issues (weather widget and activity sensor) |
| De Las Heras et al [20], 2018 | High engagement; 12 out of 13 patients appreciated the ARj glasses | Suggestions for improvement: adjustable screen, brightness, and head fixation | NR | Adjustments to AR glasses design and usability proposed by patients | Issues with head fixation during movement; brightness control |
| Parent et al [21], 2018 | 91% of the participants reached high-intensity levels in squatting exercises | Reported enjoyment, motivation for home use, and exercise tolerance | NR | None beyond Kinect customization | Participants experienced some discomfort in using new technology |
| Rutkowski et al [22], 2019 | High adherence to both standard and virtual rehabilitation programs | Significant improvement in exercise tolerance | NR | Basic Kinect setup for stationary use; no advanced technical customizations | Minor technical issues with Kinect system |
| Sutanto et al [23], 2019 | High adherence to the Wii Fit program | NR | Conducted in an Indonesian context but no specific cultural adaptations noted | Wii Fit program customized to the local setting; no major technical challenges | Limited intensity tracking, high cost of the Wii Fit program |
| Jung et al [13], 2020 | High engagement due to enjoyment and immersive aspects | Improved QoLk, patient satisfaction, and engagement | NR | Feedback on improving headset weight and app functionality | Minor technical glitches; request for more customizable exercise levels |
| Rutkowski et al [11], 2020 | High adherence (95% participation rate) | NR | NR | None beyond basic setup with Kinect | None significant; minor technical adjustments needed |
| Tu et al [24], 2020 | High engagement in demonstration sessions; real-time feedback kept users on track | User feedback on usability, engagement, and real-time performance improvements | NR | Used lightweight algorithms and readily available devices for home use | Some technical refinements (eg, headset comfort and sound effects) suggested by users |
| Rutkowski et al [9], 2021 | High engagement in VR group with full participation over the 2 wk | NR | NR | Use of VR TierOne device; simple immersion setup | NR |
| Simmich et al [25], 2021 | Participants’ interest in wearables increased with social interaction and family involvement; challenges in long-term adherence were noted | Barriers and motivators for using wearables and AVGsl | NR | NR | Participants struggled with technological complexity and preferred more straightforward options |
| Simmich et al [26], 2021 | High adherence to Fitbit (84.3% of d); moderate GEQm score of 30.4 | Engagement metrics (IMIn and GEQ); adherence to Fitbit | NR | No notifications, limiting engagement | Bluetooth synchronization issues with Fitbit |
| Baxter et al [27], 2022 | High satisfaction with visual rewards; 75% found the timer motivating | User satisfaction with app’s usability, responsiveness, and animations | NR | Distance measurement for inspiratory detection needed improvement | App required further technical refinement to improve microphone sensitivity |
| Oberschmidt et al [28], 2022 | Exergames promoted challenge and seeing results, motivating participants | NR | NR | Issues with camera accuracy during exercise detection | Technical errors with exercise detection and loud notifications disrupted patient comfort |
| Finkelstein et al [29], 2023 | Positive feedback for visual feedback, ease of navigation, and VR app structure | NR | NR | Simplified controls and interface for older adults with limited computer skills | Minor difficulties in finding and starting the app initially |
| Gabriel et al [30], 2023 | NR | High satisfaction with visual feedback and educational content (mean posttask scores: 4.74-4.89 [out of 5]) | NR | Simplified interface and navigation for older adults with limited technological experience | Minor difficulties in initial navigation and setup |
| Gabriel et al [31], 2023 | High engagement; increased focus during exercises; minimal distractions | Improved motivation, focus on exercise content, and engagement | NR | Simplified interface for older adults with limited technological skills | Difficulty with headset weight, loading screens, and initial app navigation |
| Pancini et al [32], 2023 | High engagement anticipated due to immersive VR and personalized savoring exercises | Enhanced positive emotions and psychological well-being | NR | Simplified interface to ensure ease of use for older adult patients | NR |
| Pardos et al [33], 2023 | Scoring system with credits aimed at enhancing patient engagement | NR | NR | Data from smartwatches and Bluetooth devices integrated for monitoring | Further development required to expand recommendation domains |
| Colombo et al [34], 2024 | 86.85% attendance rate | High user engagement (mean Short Flow State Scale score 4.40, SD 0.36); fatigue and dyspnea improvements | Focused on older Italian patients with COPD | Use of semi-immersive VR to suit hospital settings | Issues with scaling workload increments |
| Jin et al [35], 2024 | 82.5% adherence in the intervention group | NR | Tailored to older Chinese patients with COPD | Visual feedback and game variety catered to balance and respiratory issues | Unclear measurement of exercise intensity |
| Kizmaz et al [36], 2024 | VR+PRo group had significantly longer pedaling time (508.44 s vs 357.56 s; P=.007) | NR | NR | Real-world footage of cycling in a forest used to enhance ecological realism | One patient could not continue due to dizziness related to VR use |
| McAnirlin et al [10], 2024 | Participants cocreated their own VR experiences, leading to high engagement and satisfaction | NR | Customized to individual preferences and memories | Personalized VR experiences were created using 360-degree videos | Customization required multiple visits and effort to personalize scenes |
aCSQ-8: Client Satisfaction Questionnaire-8.
bCG: control group.
cNR: not reported.
dEG: experimental group.
eVGS: virtual game systems.
fCOPD: chronic obstructive pulmonary disease.
gGRAIL: Gait Real-time Analysis Interactive Lab.
hVR: virtual reality.
iICT: information and communication technology.
jAR: augmented reality.
kQoL: quality of life.
lAVG: active video game.
mGEQ: Game Engagement Questionnaire.
nIMI: Intrinsic Motivation Inventory.
oPR: pulmonary rehabilitation.