This Scoping Review is registered at the Open Science Framework database (OSF.IO/tx3d9). This review followed the Joanna Briggs Institute methodology for scoping reviews [30] and also adhered to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) to ensure quality, transparency and reproducibility [31].

The objective of this study is to explore the use of technological devices integrating gamification in the rehabilitation of motor symptoms for individuals with PD. Specifically, it aims to identify the gamification elements and technological devices used in this context, classify the gamification elements based on the core motivational drives they target and the devices according to the motor symptoms they address, and describe the rationale behind their application in enhancing motor symptom rehabilitation for people with PD.

All peer-reviewed articles and peer-reviewed conference papers published in English or Spanish were included. Gray literature sources were excluded to maintain methodological consistency, ensuring all included studies underwent formal peer evaluation and were fully accessible. To guide the eligibility criteria, the Population, Concept, and Context framework was used, in which population, concept, and context are defined to guide study selection [30]. Population refers to people with PD, with no restrictions applied regarding specific subpopulations, gender, disease stage, or geographical location. The Concept covered intervention studies that described motor rehabilitation through technological solutions incorporating clearly identifiable gamification elements. Studies that used commercial video games originally developed for entertainment were also included. While Deterding’s [17] definition of gamification refers to the use of game elements in nongame contexts, implying the exclusion of full video games aimed at entertainment, the therapeutic application of these games in rehabilitation effectively shifts their context. As a result, built-in motivational features such as points, progression systems, and feedback mechanics can be considered relevant gamification elements when used for rehabilitation in PD. In situations where not enough details were given regarding the intervention to chart its gamification elements, the studies were excluded. No restrictions regarding Context or year of publication were established. Articles that met the selection criteria were incorporated without assessing their quality, as the objective of scoping reviews is to chart the pertinent works in a particular area and pinpoint areas lacking research [30].

The search strategy was developed and conducted by a librarian on November 23, 2023, across 7 electronic databases: MEDLINE, EMBASE, Scopus, Cochrane, Web of Science, PsycINFO, and Epistemonikos. A combination of controlled vocabulary and free-text keywords was used to ensure retrieval of all potentially relevant studies. The search focused on terms related to PD, gamification, rehabilitation, motor symptoms, and various technological rehabilitation strategies, such as VR, videogames, and exergames. Boolean operators were applied to refine the search, and search strings were adapted to match the indexing structures of each database. The search strategy used for each database is detailed in Multimedia Appendix 1. No systematic or scoping reviews on the specified topic were identified in the Joanna Briggs Institute Systematic Review Register, PROSPERO, or biomedical and nursing databases.

All articles extracted from databases were imported to Covidence [32] and checked for duplicates by using its duplicate detection system. Given the large volume of references obtained, the initial title and abstract screening were independently conducted by 3 reviewers (PBB, OMN, and MMA) rather than 2, as initially proposed in the registered protocol. Any disagreements during this screening stage were resolved through consensus discussions involving all 3 reviewers. In the next step, full-text screening was independently performed by the same 3 reviewers, and inconsistencies were again resolved by consensus. Data extraction of all included articles was conducted by PBB.

A total of 4451 articles were retrieved from all databases. After duplicates were removed, both by Covidence and manually, 48.48% (2158/4451) of all articles underwent title and abstract reviewing. After this first title and abstract screening, 87.62% (1891/2158) of articles were excluded. A total of 267 articles were left for full-text screening, 69.66% (186/267) of which were excluded.

General study information such as location, sample size, age, disease duration, gender, year, and study design were collected. Specific data pertinent to the review’s objectives was also collected.

In order to identify and name the gamification elements found in each study, the Marczewski 52 Gamification Mechanics [22] nomenclature was used due to its clear terminology and ease of use. All gamification elements identified were then classified using the Kai Octalysis Framework [21] due to its focus on motivation and end user interaction with the system. The Octalysis framework delineates human motivation into 8 different core drives: epic meaning and calling, development and accomplishment, empowerment of creativity and feedback, ownership and possession, social influence and relatedness, scarcity and impatience, unpredictability and curiosity, and loss and avoidance. All gamification elements identified using Marczewski’s framework [22] were classified with the core drive they most effectively addressed.

Technological devices integrating gamification were classified based on the type of platform they were used with and also based on which symptoms they intended to address.

Finally, a qualitative content analysis using an inductive approach was conducted to identify the justifications used by each study for the inclusion of gamification elements and technological devices for motor rehabilitation in PD [33]. Data from all included studies were coded and organized into categories, which were then clustered into broader themes with the support of a hierarchical tree diagram. Definitions were developed for each code, category, and subcategory. Two reviewers (PBB and HFL) carried out the analysis independently using Excel, and then discussed how to group codes, align interpretations, and resolve discrepancies. Final themes were reviewed and refined through team-based triangulation to ensure consistency and credibility.

Altogether 81 studies were included in the final review (Multimedia Appendix 2) [34-114]. The PRISMA flow diagram (Figure 1) [115] details the steps followed during the screening process and data on number of excluded studies as well as reasons for exclusion in the full-text step. Of the 81 articles included, over 50% (41/81) were published in the year 2019 or later. Italy and Brazil were the 2 countries where most research was produced, with 18.5% (14/81) and 17.3% (13/81), respectively. The most frequent study design consisted of randomized controlled trials, which accounted for 49% (40/81) of all studies, followed by quasi-experimental studies, which accounted for 46% (37/81) of all studies. Sample sizes from the studies included ranged from 2 to 302 participants, with an average sample size of 32.2 participants. The mean age for participants was 66.64 (SD 5.05) years, with a mean of 2.29 (SD 0.57) on the Hoehn and Yahr [116] scale for disease severity and a mean disease duration of 7.35 (SD 2.70) years. A total of 39.39% of all participants were female. Most studies (62/81, 77%) implemented their interventions in an in-person format, while 23% (19/81) used telerehabilitation. Additionally, 1% (1/81) of studies used a hybrid approach, combining both in-person and remote intervention formats.

This scoping review aimed to identify and classify the technological devices integrating gamification used in motor rehabilitation for PD, as well as to describe the rationale behind their application. This review is particularly relevant as it addresses a growing interest in leveraging innovative, technology-driven approaches to manage PD’s motor symptoms, a field where gamification has been suggested to enhance patient engagement and therapeutic outcomes [20]. Despite this potential, the integration of gamification into PD rehabilitation interventions remains underexplored, with a limited understanding of how these elements are being applied in practice or their theoretical justifications.

Findings reveal that while technological devices integrating rehabilitation are widely used, the range of gamification mechanics is narrow, with a strong focus on the development and accomplishment core drive. This result aligns with statements by Kai [21], according to which the core drive of development and accomplishment is the easiest to design and the one drawing the most focus from developers. Commonly used elements like feedback mechanisms, points, and progression systems dominate interventions, reflecting an emphasis on monitoring and improving performance. This aligns closely with the most targeted motor symptoms—balance, gait, and functional mobility—which significantly benefit from feedback-driven adjustments offered by motion-sensing technologies, aiding postural control in individuals with PD [117]. Gamification mechanics such as time pressure and consequences from the loss and avoidance core drive are used less frequently with the goal of instilling urgency and accountability, improving speed and efficiency. Elements from this core drive should be carefully considered in designing future interventions, since different motor phenotypes of PD appear to respond differently to reward or punishment-based systems [118]. Similarly, competition mechanics foster motivation and social interaction, aiding long-term engagement. However, more intrinsic motivational pathways, such as those tied to unpredictability and curiosity or ownership and possession, remain underused. Notably absent are complex gamification features like narratives or exploratory elements, highlighting a gap in current approaches.

Out of all the studies included in this review, only 2 [45,47] explicitly refer to the concept or use of gamification when describing their interventions, and none used a theoretical framework to justify their use. Additionally, 37 out of the 81 included studies used technological devices originally designed for entertainment in healthy populations rather than as rehabilitation tools tailored to individuals with health conditions. These findings underline clear research gaps in applying gamification to its full potential in the rehabilitation of people with PD, as well as highlighting an overreliance on video game consoles and other devices designed for entertainment purposes (ie, Nintendo Wii and Microsoft Kinect) rather than rehabilitation-specific technologies. The high presence of interventions based on commercial video consoles and video games for rehabilitation presents an intriguing landscape within this context. On the one hand, leveraging refined, off-the-shelf commercial software offers distinct advantages, eliminating the need for costly development efforts and providing products inherently designed for entertainment, which may enhance participant engagement. However, it is essential to recognize that these interventions lack tailored considerations for populations affected by neurodegenerative conditions, such as PD. Furthermore, the feedback mechanisms embedded in these software options are geared toward game performance rather than exercise and motor learning, potentially rendering them less relevant for the rehabilitation of individuals with PD. As a result, gamification elements, digital environments, and gameplay patterns may not align optimally with the requirements and objectives of this specific population [119]. User-centered design would be an essential part of development in this context, incorporating the needs and preferences of individuals with PD into the interventions [120]. Notably, people with PD exhibit distinct differences from the younger populations typically targeted by commercial video games, which could lead to unintended outcomes when using them to apply rehabilitation interventions [121].

The delivery format of interventions varied by technology type. Video game consoles and computer-based systems were primarily used in in-person settings (85% [28/33] and 78% [25/32], respectively), while tablet-based systems were predominantly used in telerehabilitation (7/9, 78%). Despite most devices being designed for at-home use, researchers tended to implement interventions in supervised settings, likely to ensure safety, adherence, and standardized assessments. This preference aligns with findings suggesting that motion-sensing and immersive rehabilitation technologies often require clinical oversight for effective implementation, particularly in neurodegenerative conditions such as PD [122].

This review identified 4 distinct categories through content analysis of the justifications provided by studies for using technological devices integrating gamification for rehabilitation. Collectively, these categories underscore expectations of such solutions as being safe, motivational, and engaging tools for addressing diverse conditions. They are bolstered by extensive evidence of potential and proven effectiveness and offer innovative training opportunities, including telerehabilitation, dual-task integration, and advanced biofeedback. Despite these well-defined expectations, articles give minimal or no attention to the gamification elements that significantly contribute to their interventions. Current evidence of gaming interventions is unclear, with no studies isolating the effects of gamification used in interventions on people with PD [123]. These findings suggest that while technological solutions show great promise for advancing rehabilitation for individuals with PD, greater emphasis on thoughtfully integrating gamification elements could enhance outcomes by providing more tailored and effective interventions for this population [24].

Many of the interventions in this review relied on commercial entertainment video games, which are not inherently designed for rehabilitation. Their built-in feedback systems and progression mechanics are primarily meant to enhance gameplay rather than support motor learning or therapeutic outcomes for individuals with PD. However, these games remain widely used because they are engaging, cost-effective, and easily accessible. Rather than focusing solely on developing new rehabilitation-specific games, a practical approach could involve evaluating existing commercial games to determine their suitability for therapy. Establishing clear assessment criteria, such as a standardized checklist, could help clinicians identify which games align best with rehabilitation goals and patient needs.

Future research should also explore how well these technologies adapt to the specific challenges faced by individuals with PD, particularly in terms of usability and accessibility. Additionally, a deeper understanding of how different gamification elements influence engagement and adherence, especially when grounded in motivational theories, could help refine rehabilitation strategies. Identifying the most effective elements for sustaining participation and improving outcomes would allow clinicians to make better-informed choices and develop interventions that truly meet the needs of people with PD. To advance this field, research should also prioritize a structured, evidence-based approach to gamification, ensuring that technological solutions are designed with both therapeutic effectiveness and user experience in mind. Integrating User-Centered Design principles with established motivational frameworks could help create interventions that are both engaging and clinically relevant, thus optimizing their impact in neurorehabilitation settings.

This scoping review adhered to the PRISMA-ScR [31] recommendations to ensure methodological rigor. However, several limitations warrant acknowledgment:

Due to the substantial volume of retrieved studies, an initial screening was conducted using only titles and abstracts. This step involved 3 different reviewers who reached a consensus in cases of disagreement. Despite this method, there remains a risk of inadvertently excluding relevant papers.

Another limitation consists of the review’s scope being bound by the search date at which it was performed. Consequently, any studies published after this date were not considered. There is also a limitation in that gray literature, which may contain valuable insights, was not included in the search. As a result, some relevant research might have been overlooked. Articles published in languages other than English and Spanish were also not included, which may also omit relevant information from this review.

This review did not systematically analyze the usability, accessibility, or adaptability of the interventions, as these factors were not part of the predefined data extraction criteria. While these aspects are important for the success of rehabilitation technologies, more research is needed to understand how well gamified interventions address the unique motor and cognitive challenges of individuals with PD.

Finally, there is also a limitation in how the selection of gamification elements for this study was performed. While efforts were made to identify gamification elements in all included studies based on manuscript information and web-based sources, certain custom-made software options and commercial games were inaccessible or had limited available information. Consequently, some gamification elements may not have been fully accounted for.

This scoping review sheds light on the widespread adoption of technologies integrating gamification elements for motor symptom rehabilitation in individuals with PD. However, it also reveals a notable gap in understanding and acknowledging gamification mechanics among researchers and developers. The current landscape of gamification elements within the reviewed interventions predominantly emphasizes performance-based experiences, focusing on straightforward elements like scoring and feedback. Expectations of technological devices integrating gamification applied in rehabilitation contexts are clear, but there is a notable absence of justification for the specific inclusion of gamification through the application of relevant theories or frameworks, indicating a lack of standardization or rationale for the design of these interventions. Further studies in this field should focus on the importance of user-centered design for the inclusion of gamification mechanics that could modify the experience of users, so as to optimize the development efforts to optimally reach the needs of people with PD. There is also a clear need for the development of studies that report on the effects of gamification itself, which would allow developers to precisely deploy elements according to the expected role of these mechanics within their interventions.