User-Centered Demand Analysis for a Virtual Reality Pelvic Floor Rehabilitation System: Cross-Sectional Study Using...

Background: Poor adherence and monotony in home-based pelvic floor muscle training (PFMT) often lead to suboptimal rehabilitation outcomes. Serious games using virtual reality (VR) may improve training motivation and precision. This study aimed to explore user demands for a VR pelvic floor rehabilitation training system with game-based features. Methods: A Kano model-based questionnaire was developed and distributed to patients receiving PFMT. The survey assessed 20 demand items spanning five dimensions: system operation, exercise guidance, personalization, device use, and interaction. Traditional Kano categorization and an optimized mixed-method classification were used to identify core demand attributes. Satisfaction and dissatisfaction indices were also calculated. Results: A total of 112 valid questionnaires were analyzed. Using the Kano model, 20 demand items were classified as attractive (n = 7), one-dimensional (n = 5), must-be (n = 6), or indifferent (n = 2). Personalization-related demands were mainly identified as attractive attributes, whereas exercise guidance-related demands were primarily classified as must-be or one-dimensional attributes. Satisfaction Index (SI) values ranged from 0.27 to 0.64, and absolute Dissatisfaction Index (DSI) values ranged from 0.34 to 0.71. Optimized Kano analysis identified nine mixed attributes. The questionnaire demonstrated excellent internal consistency (Cronbach's α = 0.96). Conclusions: Participants demonstrated positive willingness to adopt a game-based VR system for PFMT, with diverse needs identified across functional and motivational dimensions. These findings suggest that integrating immersive, personalized, and gamified design features may hold promise for enhancing user engagement and anticipated training adherence, though direct evaluation of clinical effectiveness awaits future prototype-based studies. The identified demand priorities provide structured, evidence-informed guidance for the user-centered design of serious game-oriented VR pelvic floor rehabilitation systems.