Effect of a gamification-based application on upper limb self-training in patients with chronic stroke: a non-randomized controlled trial

Background: Stroke is a major cause of persistent disability worldwide. Chronic stroke survivors frequently contend with upper limb impairments that erode quality of life. While sustained arm use can foster neuroplastic changes, adherence to repetitive exercises remains challenging. Gamification—integrating game-like elements and sensor technology—may enhance motivation and performance frequency, offering a promising avenue for chronic stroke rehabilitation.Objective: To determine whether a sensor-based gamification application improves upper limb motor function and promotes real-world arm use in chronic stroke survivors more effectively than conventional self-training.Methods: In this non-randomized controlled trial with partial allocation based on participant attitudes, 40 participants (≥ 1 year post stroke onset) were divided into a gamification group and a control group. Both groups completed 4 weeks of self-training (20 min, twice weekly). The gamification group used the sensor-based “Digireha” application, and the control group performed repetitive grasp-and-release exercises. Primary outcomes were the Fugl-Meyer Assessment (FMA) and Action Research Arm Test (ARAT). The Motor Activity Log (MAL) measured real-world upper limb use.Results: The gamification group exhibited significant improvement in FMA scores, with gains comparable to the minimal clinically important difference (MCID) commonly reported for individuals with chronic stroke. Although ARAT changes did not significantly differ between groups, the gamification group achieved greater gains in MAL subscales, indicating more frequent and higher-quality use of the paretic arm in daily activities. The control group exhibited no substantial changes.Conclusions: Sensor-based gamification led to meaningful upper limb function gains and increased real-world arm use, highlighting its potential to boost motivation, reduce learned non-use, and support lasting functional recovery in chronic stroke.