Development of Serious Games for Rehabilitation, a Delphi Study

The third and final phase consists of consecutive online surveys in which the experts are asked to rank the different items that were mentioned in the previous phases based on priority. Similar to the focus group discussions, the answers from these phases will be anonymized, aggregated and reported to the experts after each ranking phase. Experts will have the opportunity to revise their answers across multiple rounds. This ranking process is repeated until consensus is reached for all items. Consensus will be defined using the Kendall's W coefficient of concordance. Kendall's W is a value between 0 and 1 assessing agreement, with a W value of 0.5 indicating moderate agreement and 0.7 indicating strong agreement. A cut-off of 0.5 will be used to determine consensus.

The first phase consists of an online survey aimed at identifying important tools and methodologies for each stage of development, as well as across all stages of development. To structure this survey the TRL model will be used as a conceptual framework (appendix 1). The different levels of the model will be used as stages of development to base the questions on. However, the aim is not to strictly adhere to this model, but to gather input on what methods should be used and what can be adjusted from existing models such as the TRL model to maximize adoption of serious games into care. Furthermore, the survey will try to identify key principles that should be taken into account across the entire developmental process of serious games for rehabilitation. These key principles, such as a user-centered approach, working evidence-based, maximizing engagement of end-users, etc., are the foundation for the developmental process and should be adhered to throughout the entire process.

The second phase consists of focus groups that will be organized to discuss the results of the online survey and add missing data if needed. The focus group discussions will also be structured based on the TRL model used during the survey and will expand on the results mentioned by the experts (appendix 2 and 3). After all focus group discussion are completed the results will be anonymized, aggregated and reported to the experts. This will provide them with the opportunity to further revise their answers based on all the results.