Psychometric properties and usability of a gamified digital task system for assessing attention and hand function in stroke rehabilitation

Objective: Conventional occupational therapy for stroke rehabilitation often relies on pegboards and paper-based tasks, which lack digital, objective, and gamified assessment capabilities. To address this gap, we developed a gamified digital randomized target pressing task (RTPT) system as a user-centered digital platform for assessing attention and hand function, and evaluated its reliability, validity, and usability in patients with stroke. A previous pilot study was conducted to refine the system design and assessment protocol. Methods: A total of 33 stroke patients completed the RTPT alongside established measures, including the Box and Block Test (BBT), Loewenstein Occupational Therapy Cognitive Assessment (LOTCA), and Chu's Attention Test (CAT). Twenty-six participants repeated the RTPT to evaluate test–retest reliability. Usability and acceptance were assessed in 30 patients and 16 healthcare professionals using the System Usability Scale (SUS) and Technology Acceptance Model (TAM), capturing both user engagement and perceived system usefulness. Results: Performance with the non-paretic hand (sound side correct count (SCC)) correlated strongly with attention scores (CAT, r = .649, p < .001) and visual perception/construction (LOTCA). Paretic hand performance (affected side correct count (ACC)) correlated with manual dexterity (BBT, r = .67, p < .001) and functional abilities in self-care. Test–retest reliability was high (intraclass correlation coefficients: SCC = 0.937, ACC = 0.804). SUS scores indicated above-average usability (median 86.3), with strong internal consistency (Cronbach's α: TAM = .959) and high SUS–TAM correlations. Participants reported high engagement and satisfaction with the digital platform. Conclusion: The RTPT provides a reliable, valid, and user-friendly digital assessment of attention and hand function in stroke rehabilitation. By integrating cognitive and motor evaluation within a gamified digital platform, it demonstrates potential as a tool to support individualized therapy planning, monitor rehabilitation progress, and enhance patient engagement in clinical practice.