Design and Evaluation of an IMU-Driven Virtual Reality Serious Game for Postoperative ACL Rehabilitation: An Iterative User-Centered Study
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Serious games and exergaming have shown promise in enhancing motivation for rehabilitation, yet applications for anterior cruciate ligament (ACL) rehabilitation remain limited, particularly in supporting proprioceptive recovery and sensorimotor control. This study proposes an immersive virtual reality (VR) rehabilitation framework integrating IMU-based motion capture with adaptive multimodal biofeedback. A multi-stage, user-centered process was conducted, involving 18 healthy participants, one patient, and 8 rehabilitation physicians, with evaluation through semi-structured interviews, the System Usability Scale (SUS), and the Intrinsic Motivation Inventory (IMI). The system demonstrated feasibility and user acceptance, with immersive feedback supporting proprioceptive recalibration, movement symmetry, and motivation. IMI results indicated high interest and perceived competence with low pressure, while usability approached an acceptable level (SUS = 67.5). Qualitative findings informed iterative refinements, suggesting the approach supports engaging, personalized rehabilitation and contributes to next-generation interactive rehabilitation systems.