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Balance Assessment Using Gamified Digital Technology in Community-Dwelling Older Adults: Mixed Methods Validation
Jianan Zhao1, Yaqin Xia1, Yahui Zhang2
1College of Fashion and Design, Donghua University, Yanan Road #1448, Shanghai, 200240, China.
JMIR Serious Games
|July 21, 2026
Summary
A new gamified digital balance assessment tool for older adults shows high reliability and validity. This system enhances user experience by improving motivation and perceived competence without compromising assessment performance.
Area of Science:
- Geriatric Medicine
- Biomedical Engineering
- Human-Computer Interaction
Background:
- Falls are a major cause of injury and mortality in older adults, highlighting the need for accessible balance assessment tools.
- Traditional balance tests like the Brief Balance Evaluation Systems Test (Brief-BESTest) face limitations in subjectivity and accessibility.
- Computer vision and gamification offer potential solutions to improve balance assessment scalability and engagement.
Purpose of the Study:
- To digitalize and validate a computer vision-based Brief-BESTest against clinician scoring.
- To evaluate if a gamified interface enhances user experience in older adults during balance assessment.
- To determine if gamification impacts assessment performance in older adults.
Main Methods:
- A mixed-methods approach combining a validity substudy (n=10) and a randomized controlled trial (RCT; n=30) with community-dwelling older adults (≥60 years).
- Concurrent validity was assessed using OpenPose skeletal tracking against the clinician-administered Brief-BESTest.
- The RCT compared a Gamified Digital Balance Assessment (GDBA) interface against a non-gamified version, measuring perceived exertion, motivation, and intention to continue use.
Main Results:
- The digitalized Brief-BESTest demonstrated excellent intrasession reliability (ICC=0.89-0.92) and strong concurrent validity (ρ=0.91, P<.01).
- Gamified Digital Balance Assessment (GDBA) users reported significantly lower perceived exertion, higher enjoyment, perceived competence, and intention to continue use.
- Thematic analysis revealed that motivational rewards (real-time feedback) and perceived usability (avatar demonstrations) were key engagement factors.
Conclusions:
- A computer vision-based digital Brief-BESTest was successfully validated, showing high reliability and accuracy.
- A gamified interface (GDBA) significantly improved older adults' user experience, motivation, and perceived competence during balance assessment.
- This gamified digital approach offers a scalable, engaging, and potentially low-cost tool for fall-risk screening and intervention in community settings.
