ExerG: adapting an exergame training solution to the needs of older adults using focus group and expert interviews

Background Exergames are playful technology-based exercise programs. They train physical and cognitive functions to preserve independence in older adults (OAs) with disabilities in daily activities and may reduce their risk of falling. This study gathered in-depth knowledge and understanding of three different user groups’ experiences in and relevant needs, worries, preferences, and expectations of technology-based training, to develop an exergame training device for OAs. Methods We conducted a qualitative study using semi-structured focus group interviews of primary (OAs in geriatric or neurological rehabilitation) and secondary (health professionals) end users, as well as expert interviews of tertiary end users (health insurance experts or similar), exploring user perspectives on adjusting an existing exergame to OAs’ needs. Voice-recorded interviews were transcribed by researchers and analyzed using thematic analysis (TA) following an inductive, data-driven, iterative approach. Results We interviewed 24 primary, 18 secondary, and 9 tertiary end users at two rehabilitation centers in Austria and Switzerland. Our TA approach identified five to six themes per user group. Themes in the primary end user group reflected aspects of safety, training goals, individuality, game environment, social interactions, and physical and technical overload. Themes in the secondary end user group comprised facets of meaningfulness, distraction through the game environment, safety, gamification elements, the availability and accessibility of the exergame. Tertiary end users’ themes addressed aspects of financial reimbursement, suitable target populations, professional training for the handling of exergame devices, training goals, and concerns about the use of exergames in geriatric rehabilitation. Conclusions In conclusion, an exergame for OAs must be safe, motivating and fully adaptable to the target group while promoting the return to or preservation of autonomy and independence in daily life. Our findings contribute to developing hard- and software extensions for the ExerG training device. Further research is needed to expand the validity of our findings to larger populations. Supplementary Information The online version contains supplementary material available at 10.1186/s12984-022-01063-x.


Item
Guide questions/description Reported (Page #)

R -Relevance of study design
Is the research question interesting? Research question explicitly stated 6 Is research question relevant to clinical practice, public health, or policy?
Research question justified and linked to the existing knowledge base (empirical research, theory, policy)

A -Appropriateness of qualitative method
Is qualitative methodology the best approach for the study aims?

Sampling
Are the participants selected the most appropriate to provide access to the type of knowledge sought by the study?
Is the sampling strategy appropriate?
Criteria for selecting the study sample justified and explained • theoretical: based on preconceived or emergent theory • purposive: diversity of opinion • volunteer: feasibility, hard-toreach groups 7-8

Recruitment
Was recruitment conducted using appropriate methods?
Details of how recruitment was conducted and by whom 8-9 Is the sampling strategy appropriate?
Could there be selection bias?
Details of who chose not to participate and why 8, Figure 4 Data collection Was collection of data systematic and comprehensive?
Method (s) outlined and examples given (e.g., interview questions) 6-11, Additional file 3, Figure 3 Are characteristics of study group and setting clear?
Study group and setting dearly described 9, Table 1 Why and when was data collection stopped, and is this reasonable?
End of data collection justified and described 7-8

Role of researchers
Is the researcher(s) appropriate?
Do the researchers occupy dual roles (clinician and researcher)?
29-30, 32-33, 35, 36 How might they bias (good and bad) the conduct of the study and results?
Are the ethics of this discussed? Do the researcher(s) critically examine their own influence on the formulation of the research question, data collection, and interpretation?

Ethics
Was informed consent sought and granted?
Informed consent process explicitly and dearly detailed 8-9, 35 Were participants'' anonymity and confidentiality ensured?
Anonymity and confidentiality discussed 10 Was approval from an appropriate ethics committee received?
Ethics approval cited 35

Analysis
Is the type of analysis appropriate for the type of study?
• Are the interpretations dearly presented and adequately supported by the evidence?
10-11, Figure 3 Are quotes used and are these appropriate and effective?
Was trustworthiness/reliability of the data and interpretations checked?
Method of reliability check described and justified e.g., was an audit trail, triangulation, or member checking employed?
Did an independent analyst review data and contest themes? How were disagreements resolved?

Discussion and presentation
Are findings sufficiently grounded in a theoretical or conceptual framework?
Findings presented with reference to existing theoretical and empirical literature, and how they contribute

29-33
Is adequate account taken of previous knowledge and how the findings add?
Are the limitations thoughtfully considered?
Strengths and limitations explicitly described and discussed

32-33
Is the manuscript well written and accessible?
Evidence following guidelines (format, word count) 7, Additional file 1, Additional file 2 Detail of methods or additional quotes, contained in appendix Additional file 4 Are red flags present?
These are common features of ill-conceived or poorly executed qualitative studies, are a cause for concern, and must be viewed critically Once you have completed this checklist, please save a copy and upload it as part of your submission. When requested to do so as part of the upload process, please select the file type: Checklist. You will NOT be able to proceed with submission unless the checklist has been uploaded. Please DO NOT include this checklist as part of the main manuscript document. It must be uploaded as a separate file.