A Preliminary Multi-Criteria Decision-Support Framework for Selecting Immersive Virtual Reality Applications for Usability Evaluation in Upper-Limb Stroke Rehabilitation

Upper-limb motor impairment after stroke often limits independence and quality of life, while immersive virtual reality (IVR) offers a promising technology-assisted rehabilitation approach. However, the growing availability of rehabilitation-specific systems and commercial VR games complicates application selection for usability research involving individuals with motor, cognitive, and perceptual impairments. This study aimed to develop a preliminary, literature-informed multi-criteria framework to guide IVR application selection for usability evaluation in upper-limb stroke rehabilitation. Using a narrative synthesis approach, 22 peer-reviewed studies were identified through PubMed, Scopus, IEEE Xplore, and ACM Digital Library, supplemented by reference-list screening and continuing literature tracking, and were included in the framework synthesis. Rehabilitation-oriented applications and commercial IVR games were examined, resulting in six evaluation domains: usability, safety and tolerability, engagement and motivation, cognitive load, feasibility, and clinical relevance. A worked demonstration applied the framework to eight representative applications, comprising four rehabilitation-oriented and four commercial applications. Domain scores ranged from 0 to 3, with application-level domain profiles demonstrating distinct trade-offs. Overall, the findings support multi-criteria application selection rather than selection based solely on therapeutic purpose or entertainment value. The framework is preliminary and requires validation of its content validity, reliability, and relationship with user outcomes.