Table 1.
Summary of the studies included.
| References | Sample(s) | Aims | VR technology | VR training | Design framework | Usability assessment tools | Primary outcomes | Clinical field |
|---|---|---|---|---|---|---|---|---|
| Brox et al. (2017) | 10 OA (age range= 66–90, MMSE > 25) with strength/balance impairments and recent illness/surgery | Recording UX and usability of exergame for physical training in OA | Semi-immersive VR with Kinect | Every second week for 3 years to play exergames and participate in the UCD protocol | Senior UCD | UCD-based questionnaire, semi-structured and structured interviews, observation, group discussions | Results show that VR features (e.g., realism, interaction), usability assessment, and physical impairments are critical factors to be taken into account in the older people | R |
| Valladares-Rodriguez et al. (2019) | 64 older people (16 MCI, mean age = 76.87, SD = 9.33; 20 AD, mean age = 79.15, SD = 4.91; 28 HC, mean age = 75.57, SD = 7.14) | Evaluate UX and PX of game-based battery Panoramix | Non-immersive: Samsung Galaxy Note Pro (SM-P900) | Patients played each game twice during two different sessions (45 min) | TAM, playability model and EMOLVE guidelines | Videogame, technology and TAM questionnaires, PSSUQ and PSSUQ-playability-based to administrators | The Panoramix battery is usable and playable by patients, regardless of their socio-cultural level and their technological dexterity | A |
| Tsai et al. (2012) | 52 OA (age range = 64–91) | Exploring the usability of Sharetouch system to encourage social integration for senior users | Semi-immersive VR with infrared LED | One 10 min session | TAM and architecture design | TAM questionnaire | Sharetouch can enrich the users' social network experience through its hardware and software architecture | R |
| Nikitina et al. (2018) | 60 OA (age range = 59–83) with non-to-mild frailty | Exploring the usability of home-based online group training for home physical training (high vs. low social cohesion and interaction vs. individual group) | Non-immersive VR: PC or tablet app (Gymcentral) | 8 weeks at least two sessions (30–40 min) per week | SCAIS | SUS, acceptance questionnaire, VR data (e.g., ratio of copresence sessions, time), MOS, PACES | Group exercise app has a high usability and future use. Copresence was found to be related to social cohesion factor | R |
| Sáenz-de-Urturi et al. (2015) | 14 OA (mean age = 81.28, SD = 8.94 MMSE = 20–26) with mixed age-related disabilities | Assessing usability of Kinect-based training for physical exercises | Semi-immersive VR with Kinect | Three 9 min sessions | Playability model and architecture design | Heuristic evaluation, videotaping, written observation, think aloud, CEGEQ, modified SUS, physical exercise questionnaire | Results from CEGEQ and SUS suggest a high game playability and usability. End-users and experts are critical during the design phase | R |
| Pedroli et al. (2018) | 5 OA (mean age = 70, SD = 11.70; MMSE > 20) | Evaluating usability, characteristics and experience of the Positive Bike for cognitive and physical therapy in frailty | Immersive VR; CAVE with Cosmed Eurobike 320, Vicon motion tracking system and controller | 15 min ride in virtual park with a dual interference task (cognitive vs. physical) | ToF | SUS, flow state scale, semi-structured interview | The Positive Bike was evaluated as usable and provided a positive flow experience | R |
| Cook and Winkler (2016) | 11 OA (mean age = 71.2) who completed the training and 8 OA (mean age = 71.2) non-completers | Exploring usability and engagement of VE for health care | Non-immersive SL environments | Four educational sessions on SL | TAM | TAM-based questionnaire | VE are evaluated as adequate and applicable for health care uses after proper training | R |
| Castilla et al. (2013) | 8 OA (age range = 60–72) with no cognitive deterioration and proper vision and audition level | Development and assessment of Butler, a VR telemedicine system for older people | Non-immersive VR | Conceptual design | Not reported | Group enquiry method, cognitive walkthrough method, and heuristic evaluation method | Older people mental model require accurate user interface design in order to facilitate usability | R |
| Corno et al. (2014) | 10 OA (age ≥ 60. MMSE range: 27–30) | Evaluate the usability of V-MT for executive functions assessment in older people | Immersive VR: HMD with wand | One session with eight tasks of the V-MT | Not reported | Familiarity with technology questionnaire, SSQ, think aloud, SUS, semi-structured usability interview | Usability was found to be crucial for detecting issues of immersive VR (instructions, movements, and realism) | A |
| Morán et al. (2015) | 32 OA (M = 64,96; SD = 6,31) with no apparent cognitive and functional problems were divided according to their experience of technology | The aim of the study is to discuss usability aspects of Gesture Therapy for stroke rehabilitation according to technology experience | Non-immersive VR with hand sensor | Three games (15 min) in one session | TAM2 | TAM-based questionnaire, indirect observation (verbal and non-verbal language) | The study shows that expert and non-expert older people differ in terms of anxiety and enjoyment. Two strategies approach were found for the users (score and compete vs. explore and learn). Based on these factors, authors provided feedback guidelines for VR trainings | R |
| Vanbellingen et al. (2017) | 13 OA (mean age = 68.2, SD = 17.5) | Evaluating the usability, compliance and efficacy of VBT using the LMC to train fine manual dexterity rehabilitation of stroke patients | Non-immersive VR with LMC | Nine training sessions of 30 min, spread out over 3 weeks | Not reported | SUS, VR data (e.g., time), PRPS, interview. | VBT using LMC is a usable rehabilitation tool to train dexterity in stroke patients | R |
| Trombetta et al. (2017) | 10 OA (age range = 61–75) | The aim of the study is to offer a tool (i.e., Motion Rehabe AVE 3D) to improve upper limb motor and balance rehabilitation for stroke patients | Immersive VR with HMD and Kinect and semi-immersive with Smart TV 3D | Motion Rehab AVE 3D contemplates six physical activities | Not reported | Device preference questionnaire and physical training interview | Regarding this pilot study, all participants classified the experience as interesting and excellent for older people. For stroke patients authors suggest semi-immersive apparatus | R |
| Im et al. (2015) | 18 OA (mean age = 64.7, SD = 7.27, mean MMSE = 29.06, SD = 1) | The aim of the study is to assess a novel 3D ARS balance program | Semi-immersive with Kinect | Ten sessions (30 min, three games) over the course of 4 weeks | Not reported | PRPS, side effects interview (e.g., dizziness, headache, falling and joint pain) | Participants were engaged in the training across the sessions without any adverse effects. 3D ARS is a safe, well-tolerated, motivating and efficacious method | R |
| Wüest et al. (2014) | 16 OA (age > 64, MMSE ≥ 22) | Assessing the usability of a stroke rehabilitation program (REWIRE project) for motor training | Non-immersive VR with force platform | 36, 30-min sessions over 12 weeks (five exergames) | Abridged TAM | TAM questionnaire, think aloud, number of drop-outs and completed sessions | The findings revealed high level of acceptance, positive attitude, future use toward the program | R |
| Rebsamen et al. (2019) | 12 OA (mean age = 72.3, SD = 4.44, MoCA range = 26–30) | Investigating the feasibility and efficacy of a physical exergame on cardiovascular fitness | Semi-immersive VR: Senso system | 4 weeks training with three sessions per week (eight exergames; 30 min circa) | TAM | Think aloud, SUS, TAM questionnaire, enjoyment scale, computer use, VR data | Senso has excellent usability, is fun and well-accepted | R |
| Plechatá et al. (2019) | 36 OA (mean age = 69.47, SD = 7.39) vs. 25 YA (mean age = 25.4, SD = 5.13) | Assessing age-related differences on immersive vs. non-immersive version of the vSST for episodic memory evaluation | Non-immersive vs. immersive VR: desktop PC and HTC Vive | One session (4–10 min) | Not reported | Ad-hoc usability questionnaire | OA memory was worst in the immersive compared to desktop-based VR. YA prefer HMD and generally reported more usability of VR systems. OA did not show a specific preference | A |
| Money et al. (2019) | 15 participants (age range = 50–70) | Exploring and evaluating usability of Falls Sensei 3D for fall prevention | Non-immersive VR | One exergame session (~17 min) | UTAUTM and architecture design | Think aloud, post-experience interview, SUS | Fall Sensei was rated as engaging and feasible serious game for fall prevention | R |
| Kiselev et al. (2015) | 4 participants with fall risk (1 = control group; 3 = intervention group, age > 55) | The aim of the study is to investigate the usability and user acceptance of VR home-based training (i.e., Interactive Trainer) for fall prevention | Semi-immersive VR with Kinect and sensors | 6 weeks training (balance exercises) | UCD | Semi-structured interviews, focus group and VR data | Participants stated that the Interactive Trainer was easy to use and exercises challenging but some technical and interaction problems were reported | R |
| Shubert et al. (2015) | 21 OA (mean age = 69.2, SD = 5.8) with mixed chronic diseases (no neurodegenerative) | Exploring usability of ST as a possible platform to provide a fall prevention program | Non-immersive VR; VERA software, Kinect and laptop | 90 min session of system navigation and physical exercise | Not reported | Debrief survey, think aloud, SUS, interview | OA well-accepted this system and show the potential of ST to provide OEP | R |
| Schwenk et al. (2014) | 33 OA with risk fall. Intervention (mean age = 84.3, SD = 7.3) Control (mean age = 84.9, SD = 6.6; MMSE > 23). | Evaluating the effectiveness and UX of a balance-training program. | Semi-immersive VR with sensors | Training session of 45 min twice a week for 4 weeks | Not reported | GEQ | Training was rated as fun, well-designed and adequate | R |
| van Beek et al. (2019) | 10 PD (mean age = 65.4, SD =7.01, Hoehn and Yahr range = 2–4, MoCA range = 22–29) | Evaluating the usability of a dexterity exergame in PD | Non-immersive VR with LMC | Eight 30 min sessions (5 games) for 4 weeks | Not reported | VR data (i.e., time/planned time × 100), PRPS, interview, SUS | Patients showed high adherence, motivation, enjoyment and good usability | R |
| Desteghe et al. (2017) | 15 AF patients (mean age = 69.2, SD = 3.7). | The aim of this pilot study was to assess the feasibility and usability of the Health Buddies app in AF patient | Non-immersive (PC, tablet or mobile) | Training lasted every day for 3 months | Not reported | Focus group, UEQ, MMAS-8, MEMS, Helping Hand, VR data | The app was positively rated by its users; nevertheless adherence to medication was low and need user-friendly interface | A |
| Epelde et al. (2014) | 13 medical professionals and 19 orthopedic patients (mean age = 69.31, SD = 7.38) | Assessing the acceptance of a universal remote rehabilitation leaded by avatar | Semi-immersive VR with inertial sensors | One session | URC | Ad -hoc usability questionnaire, focus group | Medical professionals were positive regarding the virtual therapists and patients showed good acceptance of the system | R |
| Fordell et al. (2011) | 31 stroke patients (mean age = 74.1, SD = 11) with no severe comorbidity and with (N = 9) or without (N = 22) neglect | Assesses effectiveness and usability of VR-DiSTRO compared to gold-standard neglect assessment | Immersive VR 3D glasses and interaction pen | One sessione (VR 15 min “paper and pencil” 50 min) | Not reported | Ad -hoc usability | Patients felt focused, amazed and comfortable with the VR assessment. Any severe side effects were reported. | A |
| Kizony et al. (2006) | 12 OA (mean age = 70.6, SD = 4.4) 4 OA patients (3 stroke and 1 spinal stenosis) | Assess usability of TheraGame for neurorehabilitation | Non-immersive VR | One session (30 min) and 2 weeks and half for one stroke patient | Not reported | SUS, SFQ, Borg scale | Both groups showed good level of usability and enjoyment during the session. Also the caregiver who followed the patient during the 2 weeks confirmed the usability. | R |
A, assessment; AD, Alzheimer's disease; AF, atrial fibrillation; ARS, augmented reality system; CAVE, cave automatic virtual environment; CEGEQ, core elements of the gaming experience questionnaire; EMOVLE, emotive virtual learning environment; GEQ, game experience questionnaire; HMD, head-mounted display; HC, healthy controls; LMC, leap motion controller; MOS, medical outcome survey; MEMS, medication event monitoring system; MCI, mild cognitive impairment; MMSE, mini-mental state examination; MoCA, Montreal cognitive assessment; MMAS-8, Morisky medication adherence scale; OA, older adults; OEP, Otago exercise program; PD, Parkinson's disease; PACES, physical activity enjoyment scale; PRPS, Pittsburgh rehabilitation participation scale; PX, player experience; PSSUQ, post-study system usability questionnaire; R, rehabilitation; SL, second life; SCAIS, senior citizens' acceptance of information systems; SFQ, short feedback questionnaire; SSQ, simulator sickness questionnaire; ST, stand tall; SUS, system usability scale; TAM, technology acceptance model; ToF, transformation of flow; UTAUTM, unified theory of acceptance and use of technology model; UX, user experience; UEQ, user experience questionnaire; UCD, user-centered design; URC, user remote console; VBT, videogame-based training; VE, virtual environment; V-MT, virtual multitasking test; VR, virtual reality; vSST, virtual supermarket shopping task; YA, young adults.