Home-Based Exergame Rehabilitation for Upper Limb Function in People With Multiple Sclerosis

The ARAT assesses upper-limb functionality across four domains: grasp, grip, pinch, and gross movement. Scores range from 0 to 57, with higher scores indicating better upper-limb function and less impairment.

The EuroQol 5-Dimension 5-Level Questionnaire (EQ-5D-5L) is a standardized measure of health-related quality of life. It provides (1) a utility index score, ranging from -0.281 to 1.000, where higher scores indicate better health status, and (2) a Visual Analog Scale (VAS) ranging from 0 to 100, where 0 represents the worst imaginable health and 100 represents the best imaginable health.

Assesses upper-limb motor performance through timed tasks and strength measures. Scores range from 0 to 75, with higher scores indicating better motor function.

Evaluates motor function, sensation, passive joint mobility, and joint pain. Total scores range from 0 to 66, with higher scores indicating better motor recovery.

The ABILHAND Questionnaire is a patient-reported measure of perceived manual ability during bimanual activities of daily living. Each item is rated using three response categories: "impossible," "difficult," and "easy." Responses are converted through Rasch analysis into a linear measure of manual ability. The official scoring system provides Rasch-transformed results that can be expressed on a 0-100 scale, where 0 represents the lowest manual ability and 100 represents the highest manual ability.Higher scores indicate better perceived manual ability.

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.

Percentage of completed sessions out of the prescribed 40 sessions. Adherence ≥80% is considered adequate.

Total minutes of active motor or cognitive task execution, recorded by the physiotherapist.

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 effort will be assessed using the Modified Borg Scale, a validated measure of perceived exertion that ranges from 0 ("nothing at all") to 10 ("maximal").Higher scores indicate greater perceived exertion. Participants will report their perceived effort immediately after each training session.

Total number of minutes the physiotherapist dedicates to preparing, supervising, and documenting each session.

Assesses usability of the exergame system. Scores range from 0 to 100. Higher scores indicate better usability.

Social value will be assessed by estimating the healthcare resource use avoided due to the intervention (e.g., reduced need for follow-up visits, unscheduled care, or additional rehabilitation). Results will be reported as the estimated number of avoided healthcare contacts during the study period. Higher values indicate greater social value generated by the intervention.

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.

Cost-effectiveness will be evaluated by calculating the Incremental Cost-Effectiveness Ratio (ICER), expressed as cost per quality-adjusted life year (€/QALY) gained. The ICER will be derived by comparing the total direct costs of the intervention (including professional time, materials, and technical support) with the health utility outcomes measured through the EQ-5D-5L. Higher ICER values indicate lower cost-effectiveness.