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

No control group, and all ten participants continued their usual outpatient rehabilitation during the study. The authors call this a major uncontrolled confounder: the gains could reflect natural recovery, that concurrent therapy, or regression to the mean, and cannot be separated from the games. Small sample. Thirteen enrolled, three withdrew, ten analysed, and no power calculation was done. The target of 20 participants was set by funding and expected dropouts, not by a sample size estimate. The group mixed neurological (40%) and musculoskeletal (40%) diagnoses, plus 20% with deconditioning or cardiopulmonary conditions. These were pooled without splitting by diagnosis, and the study was far too small to look at diagnosis-specific effects. The acceptability questionnaire was written by the study team, has never been validated, and the authors report its results as exploratory only. They rest their acceptability claim on the compliance, retention and usability data instead. Ten comparisons were made. A correction for multiple testing was applied, but in a sample this size the risk of a chance finding remains. Selection bias: everyone needed a willing, capable caregiver and adequate space at home, and people over 90, with cognitive impairment, or needing a lot of assistance were excluded. Those are often the patients who most need a home programme. Follow-up stopped 10 weeks after the device was taken away, so nothing is known about whether any gains last longer than that. The safety record applies only to supervised use. Higher-risk participants without an adequate caregiver were excluded, and a competency-checked caregiver was present at every session. The support model was resource-intensive per participant: onboarding sessions, caregiver training, device installation and retrieval, individualised prescription, weekly video calls, remote monitoring and troubleshooting. The authors say it may not scale without dedicated staff, reimbursement and reliable technical support.

The study was funded by the Ng Teng Fong Healthcare Innovation Programme. No competing-interest declaration appears in the text supplied. The exergaming platform tested (EvolvRehab) is a commercial product developed by Evolv, and the authors report no involvement of that company in the study.

Do not conclude that home exergaming is safe for this population in general. Every session had a competency-checked caregiver present, exercises were prescribed and progressed by a therapist, tolerance was reviewed weekly, and higher-risk patients without an adequate caregiver were excluded, so the absence of falls and adverse events applies only to these supported conditions.