Home-Based Multimodal Exergame Prototype for Patients With Chronic Stroke: Cross-Sectional Content Validation and Prospective Single-Arm Feasibility Study.

Background: Patients with chronic stroke commonly experience motor and cognitive impairments, with diminished quality of life. Their participation in rehabilitation is often limited by long travel distances and low motivation. Given the health benefits of multimodal exercise, with the accessibility and engagement offered by interactive exergames, delivering such interventions in a remote format may help overcome common barriers, and enhance health outcomes. Objective: This study aimed to assess the content validity and feasibility of a prototype home-based multimodal exergame for patients with chronic stroke. Methods: This study comprised a cross-sectional study for content validity and preliminary usability evaluation (part 1), and a prospective single-arm feasibility study with blinded assessors (part 2). In part 1, the content validity of a prototype home-based multimodal exergame was evaluated by 5 experts. Moreover, 5 patients with chronic stroke were enrolled to evaluate the preliminary usage of the game prototype. Enjoyment, rating of perceived exertion, user feedback, satisfaction, and safety were assessed. In part 2, 9 patients with chronic stroke were enrolled to evaluate the feasibility of home-based multimodal exergame (mean age 53.67, SD 11.70 years, and mean time post stroke onset 75.00, SD 101.99 months). Participants performed the intervention for 60 min/day, 3 days/week, for 6 weeks. Feasibility outcomes, including adherence, adverse events, motor function, cognitive function, and enjoyment of the program, were determined. Results: In part 1, the content validity index for the overall program was 0.82. The average total enjoyment score was 47.80 out of 56 (SD 7.50), the rating of perceived exertion was 13.40 out of 20 (SD 0.55), the satisfaction score was 8.60 out of 10 (SD 1.34), and no adverse events were reported. In part 2, after the 6-week intervention, positive changes were observed in global cognition (mean difference=-3.44, 95% CI -5.66 to -1.23; P=.007) and executive function (mean difference=38.43, 95% CI 3.78-73.08; P=.03) compared with baseline. Participants reported a consistently high level of exercise enjoyment throughout the training period. The average exercise adherence rate was 85.19%, and no adverse events were reported throughout the training. Conclusions: These findings suggest that the prototype home-based multimodal exergame was a valid, enjoyable, accessible, and user-friendly rehabilitation approach. Unlike conventional home exercise programs, this multimodal exergame integrates physical and cognitive training into an interactive remote rehabilitation platform for individuals with chronic stroke. The intervention showed potential benefits for cognitive outcomes, maintained enjoyment, and promoted exercise adherence, and reported no adverse events throughout the intervention period. These findings provide preliminary evidence that home-based multimodal exergame may support long-term rehabilitation participation. Importantly, the program may address barriers to stroke rehabilitation, including transportation limitations, restricted access to rehabilitation services, and low long-term adherence, particularly among individuals living in underserved or remote areas.