Feasibility, acceptability, and functional outcomes of a home-based exergaming telerehabilitation program for adults with functional disabilities: a multi-center single-arm pilot study

BACKGROUND: Community-based rehabilitation services face significant challenges including limited access, poor exercise adherence, and resource constraints. Telerehabilitation using gamified exergaming platforms offers a promising solution to extend rehabilitation services into home settings while maintaining patient engagement. OBJECTIVE: This multi-center single-arm pilot study evaluated the feasibility, acceptability, and preliminary efficacy signals of a caregiver-supported, home-based telerehabilitation program comprising 30 days of active home use within an 18-week protocol, using the EvolvRehab gamified exergaming platform among community-dwelling adults with functional limitations who were receiving outpatient rehabilitation in Singapore. METHODS: Ten participants (mean age: 64.6 years, SD 8.5, range 48-78) were recruited from three community rehabilitation sites: Handicaps Welfare Association Day Rehabilitation Centre, Home Nursing Foundation, and Ren Ci Hospital Day Rehabilitation Centre. Participants underwent an 18-week protocol comprising onboarding, a 30-day period of active home-based telerehabilitation with therapist-prescribed daily exercises and remote monitoring, and follow-up. A primary caregiver was present during all home sessions to assist with device setup, supervise exercise, and support fall prevention. Functional outcomes were assessed at baseline (Week 0), post-intervention (Week 8), and follow-up (Week 18) using the Modified Barthel Index (MBI), Short Physical Performance Battery (SPPB), Berg Balance Scale (BBS), grip strength, and EQ-5D-5 L. System usability and patient-reported outcomes were evaluated using the System Usability Scale (SUS) and a non-validated custom questionnaire, the latter analysed as exploratory data. RESULTS: Mean exercise compliance was 80.6%, with participants exercising an average of 23.97 min daily. Within-group improvements from baseline to Week 18 follow-up were observed in MBI (75.8 to 81.2, p = 0.019), BBS (33.3 to 38.0, p = 0.037), and right-hand grip strength (15.1 to 18.0 kg, p = 0.005). SPPB improved at the post-intervention assessment (5.2 to 6.2, p = 0.015), but this change was not sustained at the Week 18 follow-up relative to baseline (6.4, p = 0.104). EQ-5D-5 L descriptive sum scores decreased (indicating reduced symptom burden) from 11.6 at baseline to 8.5 at Week 8 (p = 0.002; FDR-adjusted p = 0.048) and 8.7 at Week 18; EQ-VAS scores increased from 66.9 at baseline to 80.9 at Week 18 (p = 0.022). As an uncontrolled single-arm study, these findings represent preliminary efficacy signals rather than evidence of effectiveness, and require confirmation in controlled trials. The mean SUS score was 67.75, indicating marginal acceptability. Patient-reported outcomes showed high engagement with the gamified exercises, though concerns about cost were noted. No falls or adverse events were reported in this selected sample under caregiver-supported conditions. CONCLUSIONS: Gamified caregiver-supported telerehabilitation using the EvolvRehab platform appeared feasible and acceptable among community-dwelling adults with functional limitations, and was associated with within-group functional outcome signals. High compliance rates and the absence of adverse events under caregiver-supported conditions support the conduct of larger controlled trials, though the uncontrolled single-arm design precludes conclusions about effectiveness, and usability refinements and cost considerations require attention for scalability.