Quantitative and Qualitative Insights into Telerehabilitation for Parkinson’s Disease: A Data-Driven Study of Game Metrics, Patient Feedback, and UPDRS Scores.

Due to the progressive aging of the population and the resulting rise in individuals with neurological diseases and chronic disabilities, such as Parkinson's Disease (PD), there is a growing need for personalized care solutions that promote patient autonomy while maintaining the sustainability of healthcare services. Telemedicine, including remote monitoring and rehabilitation, represents an Information and Communication Technology (ICT)-based approach aimed at complementing traditional care and alleviating pressure on healthcare systems. Exergames—video games that utilize motion sensors, cameras or other input devices to translate player movements into gameplay—are a promising application within telemedicine. They promote physical activity by integrating exercise into an engaging game-based experience. Five exergames with adjustable difficulty levels, developed by Synarea Consultants and the National Research Council of Italy – Institute of Electronics, Computer and Telecommunication Engineering (CNR-IEIIT) using Unity and Google’s Mediapipe, were tested in a clinical study involving 14 PD patients from the Associazione Amici Parkinsoniani Piemonte (AAPP-AIP). Data was collected in 5 to 10 one-hour sessions per participant. During each session, patients repeated the games when possible, with difficulty levels increased after maximum scores. Following gameplay, participants completed a 5-star-based survey capturing data on medication timing (Levodopa-based), self-assessment, satisfaction, willingness to repeat, perceived difficulty and fatigue. Additionally, clinical evaluations were conducted using the Unified Parkinson’s Disease Rating Scale (UPDRS), provided by an expert neurologist from Department of Neuroscience of University of Turin. The primary objective of this study was to conduct both qualitative and quantitative analyses of the collected data, aiming to track the evolution of patient performance over sessions and assess the alignment between game metrics and survey responses. Furthermore, a correlation analysis was performed to identify relationships between gameplay performance, UPDRS scores, and survey responses—globally, per game, per session and per patient. The results indicated a strong correlation between UPDRS motor scores and in-game performance metrics, suggesting that patients’ responses over time to the exercises were influenced by their clinical condition, which also appeared to affect their self-reported experience in the surveys. Promising usability outcomes emerged both from the analysis of the maximum levels reached in each exergame and from the participants’ questionnaire responses.