Exergame-Based Upper-Limb Rehabilitation in Adults With Chronic Stroke

The ARAT assesses upper-limb functionality through 19 tasks categorized into grasp, grip, pinch, and gross movement. It provides a standardized, performance-based measure of upper-limb motor ability in individuals with stroke.

Health-related quality of life will be assessed using the EuroQol EQ-5D-5L questionnaire, which provides both a utility index score and a Visual Analogue Scale (VAS; 0-100). Higher VAS scores indicate better perceived health status.

Upper-limb functional performance will be evaluated using the Wolf Motor Function Test (WMFT), which measures motor ability through timed functional tasks, strength-based assessments, and quality-of-movement ratings. Scores range from 0 to 75, with higher scores indicating better motor performance and less impairment.

Upper-limb motor recovery will be assessed using the Fugl-Meyer Assessment for Upper Extremity (FMA-UE), which evaluates motor function, sensation, passive joint range of motion, and joint pain in individuals after stroke. Scores range from 0 to 66, with higher scores reflecting better motor function.

Perceived manual ability will be measured using the ABILHAND questionnaire, which evaluates the self-reported ease or difficulty of performing bimanual activities of daily living. Responses follow an ordinal scale (impossible, difficult, easy), with higher scores indicating greater perceived manual ability.

Outcome Type: Ordinal qualitative variable.

Percentage of completed sessions out of the total prescribed 40 sessions. Adherence will be considered adequate when ≥80% of sessions are completed.

Total time (minutes) of active execution of motor or cognitive tasks during sessions, recorded directly by the physiotherapist using manual timing.

Movement accuracy will be quantified as the number of correctly performed task executions recorded by the digital platform during each training session. Higher values indicate better task performance and motor control.

Perceived exertion will be measured at the end of each session using the Modified Borg Scale (0-10). Higher scores indicate greater perceived effort.

Total time (minutes) spent by the physiotherapist preparing, supervising, and documenting each session.

Usability will be assessed using the System Usability Scale (SUS; score 0-100). Higher scores indicate better usability.

Efficiency will be assessed by calculating cost-effectiveness ratios, expressed as cost per unit of clinical improvement. Direct participant-level costs (including professional time, material resources, and technical support) will be related to improvements in functional autonomy and quality of life, as measured by validated clinical outcomes such as EQ-5D-5L and ABILHAND-CS. Lower cost per unit of improvement indicates greater efficiency of the intervention.

Postural control will be evaluated as the number of compensatory postural movements detected by the digital platform during each training session. Higher values indicate poorer postural control.

Patient satisfaction will be assessed using a 5-point Likert scale, ranging from 1 (very dissatisfied) to 5 (very satisfied). Higher scores indicate greater satisfaction with the intervention. The variable will be analyzed as an ordinal outcome.

Social value will be evaluated through the estimation of avoided healthcare costs attributable to the intervention. This will include reductions in expected healthcare resource use (e.g., unplanned visits, additional rehabilitation, or medical consultations). Higher estimated avoided costs indicate greater social value generated by the program.