Balance Wood：一种用于健康成人的双侧踝关节控制严肃游戏：两阶段横断面开发与可用性研究

文献信息

中文摘要

背景： 踝关节活动度和控制在整个成年期有助于平衡和日常活动，但通常通过重复、抽象的任务进行评估，这些任务对运动产生过程揭示甚少。严肃游戏可以使重复任务变得有趣，但大多数仅报告终点分数而非连续游戏信号，且很少建立系统可用性。在健康成人中开发和评估此类系统是必要的第一步。
目的： 本研究旨在开发Balance Wood，一种双侧踝关节控制的严肃游戏，坐姿玩家通过踝关节屈伸倾斜设备来控制屏幕上的游戏，描述该系统及其记录的信号，并评估其在健康成人中的可用性、安全性和用户体验。
方法： 在这项两阶段横断面开发与可用性研究中，无下肢损伤或影响平衡的神经或前庭疾病的健康成人完成了单次重复测量程序。在第一阶段，共40名成人——20名老年人（平均年龄73.0岁，标准差5.9岁；10名女性）和20名年轻人（平均年龄28.1岁，标准差3.2岁；4名女性）——在一次会话中完成了3个固定顺序的难度级别（探索性信号分析）。在第二阶段，共18名年轻人（平均年龄24.6岁，标准差3.9岁；5名女性）以平衡顺序完成了这些级别。可用性通过系统可用性量表（0-100）评估；使用印象和有意识使用的身体部位通过李克特量表和开放式条目评估；设备倾斜角度准确性通过与数字测角仪对比评估。
结果： 系统可用性量表平均得分为81.5（标准差11.2；95%置信区间76.0-87.1；Cronbach α=.74），高于基准68，表明感知可用性良好。安全性担忧的平均评分为2.11（标准差1.32）（95%置信区间1.45-2.77），疼痛为1.67（标准差1.03）（95%置信区间1.15-2.18）。踝关节使用最高，为4.94（标准差0.24），通过Wilcoxon符号秩检验超过膝关节2.50（标准差1.29）、髋关节2.00（标准差1.24）和躯干2.17（标准差1.15）（P<.001）。设备读数与测角仪高度一致，平均绝对误差为0.66°，组内相关系数为0.999，95%一致性界限为-0.68至1.70°。在第一阶段，所有测量对40名参与者均可计算，两组典型振幅为20.5°至27.2°，速度稳定。在第二阶段，重复测量分析（α=.05）未检测到不同难度条件或呈现位置之间的统计学显著差异（所有P>.13）。
结论： 在健康成人中，Balance Wood可用、接受度高、风险低，并提供准确的设备级倾斜测量，以踝关节控制为主，同时连续记录游戏信号。它是一种低成本、双侧、踝关节特定的控制接口，可将连续信号采集集成到一个易于使用的设备中。其贡献是一个可重复、经过可用性测试的平台，具有表征的设备准确性，以及正式定义的候选测量指标，有待验证。一旦验证，它可以支持家庭或社区记录；在短期内，它是一种研究工具。

英文摘要

BACKGROUND: Ankle mobility and control contribute to balance and everyday movement throughout adulthood, yet are usually assessed through repetitive, abstract tasks that reveal little about movement production. Serious games can make repeated tasks engaging, but most report only end point scores rather than continuous gameplay signals, and few establish system usability. Developing and evaluating such a system in healthy adults is a necessary first step.
OBJECTIVE: This study aimed to develop Balance Wood, a bilateral ankle-controlled serious game in which seated players tilt a device through ankle flexion-extension to control on-screen play, to describe the system and the signals it records, and to evaluate its usability, safety, and user experience in healthy adults.
METHODS: In this two-stage cross-sectional development and usability study, healthy adults without lower-limb injury or balance-affecting neurological or vestibular disorders completed single-session repeated-measures procedures. In stage 1, a total of 40 adults-20 older (mean age 73.0, SD 5.9 y; 10 women) and 20 younger (mean age 28.1, SD 3.2 y; 4 women) adults-completed 3 fixed-order difficulty levels in 1 session (exploratory signal analysis). In stage 2, a total of 18 younger adults (mean age 24.6, SD 3.9 y; 5 women) completed the levels in counterbalanced order. Usability was assessed with the System Usability Scale (0-100); use impressions and consciously used body parts with Likert and open-ended items; and device tilt-angle accuracy against a digital goniometer.
RESULTS: The mean System Usability Scale score was 81.5 (SD 11.2; 95% CI 76.0-87.1; Cronbach α=.74), above the benchmark of 68, indicating good perceived usability. Mean ratings were 2.11 (SD 1.32) for safety concern (95% CI 1.45-2.77) and 1.67 (SD 1.03) for pain (95% CI 1.15-2.18). Ankle use was highest at 4.94 (SD 0.24), exceeding knee 2.50 (SD 1.29), hip 2.00 (SD 1.24), and trunk 2.17 (SD 1.15) by Wilcoxon signed-rank tests (P<.001). Device readings agreed closely with the goniometer, with a mean absolute error of 0.66°, an intraclass correlation coefficient of 0.999, and 95% limits of agreement of -0.68 to 1.70°. In stage 1, all measures were computable for the 40 participants, with typical amplitudes of 20.5° to 27.2° and stable speed in both groups. In stage 2, repeated-measures analyses (α=.05) did not detect statistically significant differences across difficulty conditions or presentation positions (all P>.13).
CONCLUSIONS: In healthy adults, Balance Wood was usable, well-accepted, low-risk, and provided accurate device-level tilt measurement with predominantly ankle-based control while continuously recording gameplay signals. It is a low-cost, bilateral, ankle-specific control interface with continuous signal capture into 1 easy-to-use device. Its contribution is a reproducible, usability-tested platform with characterized device accuracy, and formally defined candidate measures awaiting validation. Once validated, it could support home- or community-based recording; in the near term, it is a research tool.