Based on a preliminary investigation of the home-based rehabilitation needs of survivors of colorectal cancer, we developed a Meta-Universe Multidimensional Rehabilitation Platform. This platform serves both educational and health-promotion functions. By integrating various guidelines and existing intervention practices and after expert validation, we formulated a Meta-Universe multidimensional rehabilitation program tailored to survivors of colorectal cancer. This 4-week intervention program was divided into 3 parts each week—objectives, practice, and knowledge sharing. We aimed for this 4-week intervention program to have a positive impact on health promotion. Additionally, weekly knowledge-sharing sessions serve educational purposes. Subsequently, the entire program will be implemented on the Meta-Universe platform to design and develop the Meta-Universe Multidimensional Rehabilitation Platform.

Following the design of the Meta-Universe Multidimensional Rehabilitation Platform, qualitative interviews were conducted to optimize the platform, followed by usability studies. This study primarily reports the results of the usability research.

The design of the Meta-Universe Multidimensional Rehabilitation Platform follows the steps outlined in Garrett’s user experience elements model, encompassing 5 layers—strategic, scope, structural, framework, and presentation [27].

Strategic layer: This involves defining the positioning goals of the meta-universal Multidimensional Rehabilitation platform. The platform targets survivors of colorectal cancer and their families after curative surgery. It primarily serves as a platform for survivors and their families to engage in integrated learning and communication, encompassing goal management, practice, knowledge, and interaction.

Scope layer: This layer focuses on the content design of the meta-universal Multidimensional Rehabilitation platform. The main content areas included physical rehabilitation, dietary and nutritional interventions, mental health education, and behavior management.

Structural layer: This step primarily involves an information framework. Within the Meta-Universe, a virtual environment is created to allow users to access rehabilitation resources, participate in activities, and interact with other participants. The structural framework is as follows.

Main lobby: Serving as the primary entrance and reception area of the platform, a central area was designated for project introductions and access points to various rehabilitation learning rooms. The lobby’s background music comprises gentle, soothing tunes to calm users’ minds, alleviate anxiety, tension, and negative emotions, and foster a sense of warmth and hope for the future.

Presentation layer: This involves perceptual design, including page layout, color schemes, and sensory experiences, to create high-fidelity prototypes. Additionally, incorporating audio, video, and other multisensory design methods enhances the user experience (providing voice reading functions for both text and graphics). These measures deliver a sleek and engaging interface design for users.

The overall layout of the platform is depicted in Multimedia Appendix 1.

Before using the Meta-Universe Multidimensional Rehabilitation Platform, users will receive an instructional video explaining how to use it. When using the platform, users were required to follow a predetermined timeline for learning. Users must enter the corresponding room for each week’s learning; once the tasks for a week are completed, the room for the next week will unlock, gradually revealing the content for the third and fourth weeks. Completed rooms remain accessible for continuous learning. The ideal outcome of using the platform is for users to acquire knowledge of dietary habits, exercise routines, behavior management, and emotional regulation in daily life, develop self-management skills, and apply these practices effectively.

After the Meta-Universe Multidimensional Rehabilitation Platform was designed, we assembled a platform optimization team comprising health care professionals, survivors of colorectal cancer, and volunteer family members. This team was primarily responsible for ensuring the platform’s internal usability. External usability research was conducted once internal feedback had been provided. External usability research involved inviting survivors of colorectal cancer and their family members to use the meta-universal Multidimensional Rehabilitation platform. The duration of use was personalized based on each participant’s circumstances, allowing them to use the platform until they felt that they had fully understood and mastered its functionalities. Subsequently, the usability of the platform was assessed using relevant metrics, and user experience suggestions and feedback were collected.

After users were confirmed to participate, they were instructed and demonstrated by the researchers on how to operate the platform, following which the users commenced the trial. The trial was entirely self-directed, with no researcher involvement during the process; however, users could contact the researchers at any time if they had any questions. Considering the portability during the trial and the platform’s potential for future scalability, AR headphones were not used. This ensured that users could access the platform anytime and anywhere.

The study was conducted from February 1, 2024, to April 1, 2024. Participants were recruited offline. Patients from the Department of Colorectal Surgery and Oncology at the Xiamen University Affiliated Hospital and Hunan Xiangya Hospital were selected. Those who met the inclusion criteria among survivors of colorectal cancer were contacted through face-to-face interviews or phone calls to confirm their willingness to participate in the study. Once the patients and their family members agreed to participate, the study participants met the inclusion and exclusion criteria.

Patients who underwent curative surgery for colorectal cancer and received adjuvant therapy, aged 18 years or older but younger than 75 years, not pregnant, willing to participate in the study, and able to use a mobile phone were included. Exclusion criteria included patients with multiple cancers, those with special dietary requirements, and individuals with cognitive impairments that could affect the use of the multidimensional rehabilitation platform.

Inclusion criteria for family members were family members of patients who underwent curative surgery for colorectal cancer and received adjuvant therapy, aged 18 years or older but younger than 75 years, willing to participate in the study, and able to use a mobile phone. Individuals with cognitive impairments that could affect the use of multidimensional rehabilitation platforms were excluded.

Purposeful sampling was implemented, with a small sample size (n<14) sufficient to reflect usability [28]. A total of 18 survivors of colorectal cancer and their family members were included. According to the relationship curve between the number of participants and the percentage of identified issues, 10 patients could identify 80% of usability issues, and 15 participants were adequate to identify 100% of usability issues [29]. Therefore, the minimum sample size for this study ranged from 10 to 15 individuals.

The Methods section primarily involved questionnaire assessments, including basic information, a usability questionnaire, and 5 open-ended questions. The general information collected included name, age, level of education, role (patient or caregiver), and other relevant details.

The usability questionnaire assessment used 2 tools—the Post-Study System Usability Questionnaire (PSSUQ; version 3) and the System Usability Scale (SUS). The PSSUQ questionnaire consists of 3 dimensions (usefulness, information quality, and interface quality) and 1 overall evaluation item, totaling 16 items [30]. Each item was rated on a scale of “strongly disagree” to “strongly agree” with a range of 1‐5 points. To facilitate comparisons across dimensions, scores for each dimension were converted to a percentage scale, with higher scores indicating greater user satisfaction. The SUS was used to evaluate user experience using a Likert 5-point scale method with 10 questions. Among these questions, 1, 3, 5, 7, and 9 were positively phrased, whereas 2, 4, 6, 8, and 10 were negatively phrased. The validity of this scale is 0.85 [31]. SUS scores were calculated on a percentage scale, where a score above 70 indicated a “good” level, and above 50 indicated an “okay” level.

Additionally, the questionnaire included 5 open-ended questions, with the researchers responsible for recording the participants’ responses. The questions were as follows:

1. What is your overall impression of using this platform?

2. How beneficial is this platform for self-management and symptom management, and what are its advantages?

3. Which features of this platform are easier to use?

4. What shortcomings do you think exist in this platform?

5. How beneficial is this platform for self-management and symptom management, and what are its advantages?

After patients or their family members have tried the platform, both parties will agree on a time and location for a face-to-face or remote assessment. The collection of intervention data will be the responsibility of the researcher. Participants can choose to fill out the questionnaire themselves or opt for one-on-one questioning by the researcher. Throughout the process, if participants have any questions about any item, the researcher will provide answers promptly to ensure the accuracy of the responses.

Following the completion of questionnaire data collection, interview data collection will commence. The interviews will be fully recorded, and the researcher will ask questions one by one according to the interview outline. If participants do not have clear answers to certain questions, the researcher will provide appropriate neutral guidance to elicit the participants’ true feelings. If participants are unable or unwilling to participate in oral interviews, they can also fill out the answers themselves based on the interview outline.

Quantitative data analysis: Continuous data will be presented as mean (SD) along with the range of values (minimum and maximum), while categorical data will be expressed as percentages. The Mann-Whitney U test and ANOVA will be used to investigate differences in the total and dimension scores of the SUS and PSSUQ scales based on gender, age, and educational level distributions. For data visualization, a violin plot will be used to display all data, while radar charts will visually represent the scores of each dimension and the total score of the usability scale.

Interview data analysis: Within 24 hours of the completion of the interviews, the interview content will be transcribed verbatim into text format. The content of the interviews will be carefully read, important information will be extracted and analyzed, and keywords and phrases that repeatedly appear will be recorded. All content and viewpoints will be summarized; similar viewpoints will be identified and organized into different themes.

Ethical approval was obtained from the Xiamen University School of Medical Research Ethics Board (approval XDYX202308K52). All methods were performed in accordance with relevant guidelines and regulations. The study adhered to the principles outlined in the Declaration of Helsinki and was conducted under continuous supervision of the ethics committee. Informed consent was obtained from all the participants. The researchers provided a written explanation of the study’s purpose and methods to the participants, emphasizing their voluntary participation and freedom to withdraw from the study at any time, without facing any consequences. Furthermore, it was clarified that the information provided would be used solely for research purposes and not for any other purpose. To protect participant privacy and confidentiality, all personal identifiers were removed or anonymized in the data collection, storage, and analysis processes. All confidential information and research data were securely stored and only accessible to authorized researchers involved in this study. No financial or other forms of compensation were provided to the participants in this study.

Recruitment involved 21 patients and their family members, with 3 individuals excluded (1 did not provide informed consent, 1 was older than 75 years old, and 1 selected the same option on the SUS scale). Ultimately, 18 participants were included in this analysis. Refer to Table 1 for detailed information about the participants.

The SUS and PSSUQ scores were converted to a percentage scale, with the specific scores presented in Table 2. The overall average and average scores for each dimension of both the scales exceeded 50. There were no significant differences (P>.05) in the overall scores and dimension scores of the SUS and PSSUQ based on gender, age, and educational level distributions. For detailed information, please refer to Tables 3 and 4.

In this study, we used the average and median values of each dimension of the SUS and PSSUQ (using the mean for normally distributed data and the median for nonnormally distributed data) to create radar charts and compare the relationships and trends between different variables. These variables include Learnability, Effectiveness, Satisfaction, System Quality (SysQual), Information Quality (InfoQual), and Interaction Quality (IntQual), which represent the 6 characteristics of the metaverse platform. Each variable is represented on a different axis, forming a closed polygonal area. The scale on each axis represents the range of the values for each variable.

From the radar chart, it is evident that the learnability score for the metaverse platform was the lowest (mean 61.11, SD 5.09, 95% CI 50.38-71.84), whereas the IntQual score was the highest (median 86.67, IQR 73.3-100). Refer to Figure 1 for more detailed information.

Violin plots were used to display the distribution of scores. From the results of the violin plots, it can be observed that the distribution of the SUS total scores is relatively concentrated in the range of 50‐60, showing distinct peaks. The distribution of the SUS total scores ranged from 40 to 100. In the various dimensions of the SUS, the maximum value for effectiveness was 100, and the minimum value was 31. For learnability, the maximum value was 100 and the minimum was 33. The maximum satisfaction score was 100, with a minimum of 33. The distribution of learnability was concentrated below 50, whereas the scores for the other 2 dimensions were concentrated above 50. The scores for satisfaction and usability were concentrated between 50 and 75, above the OK line. Refer to Figure 2 for more detailed information.

The distribution of the total PSSUQ scores ranged from 60 to 100. In the various dimensions of the PSSUQ, the maximum value for InfoQual was 100 and the minimum value was 53. For IntQual, the maximum and minimum values are 100 and 60, respectively. SusQual had a maximum value of 100 and a minimum of 63. There are 2 concentration areas for the PSSUQ total scores, at 100 and 75‐87.5 points; InfoQual scores are concentrated around 100 and 75 points; IntQual scores are relatively concentrated between 95 and 100; and SysQual scores are mostly concentrated between 75 and 87.5, with another concentration area at 100 points. Refer to Figure 3 for more detailed information.

Interview data from 16 participants were collected, and the interview data for each participant is numbered from N1 to N16. A total of 4 main themes were identified based on the interview titles and content, and keywords were extracted for analysis.

Metaverse technology has been widely applied in various fields, such as telemedicine, clinical care, education, mental health, and physical well-being [32]. It supports remote health care, overcomes geographical limitations, and brings new and challenging opportunities to the health care sector [14]. An increasing number of medical institutions are beginning to adopt virtual reality technology for adjunct therapy and remote rehabilitation services [17]. The Metaverse multidimensional rehabilitation platform developed in this study for survivors of colorectal cancer covers exercise training, dietary guidance, psychological health education, and behavior management. It also includes a 4-week self-management intervention program aimed at helping survivors of colorectal cancer adopt healthy lifestyles, promote healthy behaviors, and ultimately improve their quality of life. Additionally, the platform serves as a remote communication platform for survivors of colorectal cancer and their families, as well as an educational platform for hospitals. The usability test results indicate that the platform performs well in terms of clinical usability, with excellent system quality, interface quality, and information quality. Learnability, usability, and satisfaction all reached a “good” level. Furthermore, the study found that the scores of usability dimensions were not related to gender, age, or educational level, suggesting that the middle-aged and older adult population (younger than 75 y old) may have potential in learning to use new platforms. Due to the limited sample size, the statistical power to detect and confidently estimate the effects of factors influencing usability is reduced, thereby potentially limiting the robustness and generalizability of the conclusions. Results from the unstructured interviews show that most users had a positive evaluation of the platform, noting its comprehensive and professional content, practical multimedia functions, ease of operation, and interesting and innovative features. However, issues with slow loading and complex operation were identified in terms of platform usability.

Our study represents the first application of metaverse technology, specifically in the family rehabilitation of survivors of colorectal cancer, offering new research perspectives in this field and providing insights for other cancer studies. We obtained a series of meaningful results with important implications for future medical practice and research.

The scores for system quality, information quality, and interaction quality are relatively high, indicating a strong correlation between these performance aspects and the quality of content provided by the platform, including convenience, clarity, and interactivity. This suggests that the platform’s content design is relatively excellent. However, the score for learnability is the lowest, implying that users may find it challenging to grasp the platform’s functions and operations during initial use, resulting in a higher learning cost and time investment. Effectiveness is above the passing line, indicating that the platform may not effectively assist users in achieving their goals quickly and accurately, requiring additional effort. Satisfaction is at a moderate level, possibly influenced by software operations.

Violin plot analysis reveals that while the learnability score is concentrated around the passing line (50 points), scores for other dimensions exhibit 2 concentrated distribution areas, both above the passing line. The high-score concentration area reflects that most users perceive the platform’s performance as good (except for learnability), further confirming the platform’s excellent performance in terms of usability. However, attention should still be paid to the platform’s learnability.

This study observed that patient groups rated platform usability lower than family members. Usability fundamentally reflects the degree of human-machine adaptation in user interaction interfaces. It is worth noting that this evaluation difference may be closely related to the physiological and psychological characteristics of the evaluators. Most patients are in the treatment period (chemotherapy and ostomy), with certain physiological and psychological issues, which may have multiple impacts on evaluation results. First, treatment-related complications (such as neuropathic pain and cancer-related fatigue) may affect patients’ cognitive function and technical operational abilities, thereby reducing their acceptance of technology. Second, the anxiety and depression commonly found in patients during the treatment period may influence the objectivity of evaluations, leading to a negative evaluation bias. Additionally, treatment-related physical limitations (such as peripheral neuropathy and decreased visual acuity) may directly impact the platform’s utility, lowering patients’ acceptance of the technology. When promoting clinical application in the future, a simple assessment of patients’ physical conditions should be conducted, and based on the patients’ situation, the platform’s target users could be patients or family members, with family members learning the platform content and then supervising patients to complete intervention tasks, which could be a better choice.

There were no significant differences in scores between genders across dimensions. Differences in scores across dimensions were observed by age, with the 18‐ to 44-year age group generally scoring higher than those aged 45 years and older in software operation–related ratings (learnability and effectiveness), and those with a college education or higher scoring higher than those with other educational levels. In terms of software quality, the older than 60 age group scored the lowest, while the junior high school and below education group scored lower compared with the relatively higher educated group. This may be related to the characteristics of these 2 groups, as individuals with lower education levels and older individuals may prefer a simple, visually engaging, and easy-to-understand platform compared with other groups. Radar chart analysis shows that the scores across platform dimensions are uneven, especially with weaknesses in learnability and effectiveness, indicating the need for improvement.

Although there are score differences in age and educational level distributions, they have not reached statistical significance. This finding may suggest that the rehabilitation platform may be universal for individuals aged 18‐75 years, providing similar levels of service and support to different user groups. Particularly noteworthy is that age has not become a limiting factor in learning new platforms, providing more possibilities for older adults to embrace new technologies. This result differs from common perceptions. While some older adult individuals may encounter operational issues during actual use, there are also older adult individuals, especially those with higher education levels, who can easily use the Metaverse platform.

Technical experience may influence users’ attitudes toward the Metaverse platform [33]. During the experiment, it was found that some young people also encountered difficulties in using the platform. These young people are usually more educated but may lack experience with online games and are predominantly female. On the other hand, some users, despite having lower levels of education, were able to use the Metaverse platform smoothly and showed higher satisfaction. These users typically have more experience with online games.

Dependence on network speed also affects the usability of the Metaverse platform. In areas with slow network speeds, users may encounter issues, such as slow loading and lagging. Additionally, the mobile phone system can also affect the user experience of the Metaverse, as older versions of mobile phone systems may not fully support Metaverse apps. Through communication with the technical team, these issues can be resolved. This is also one of the reasons for user dissatisfaction. However, with the continuous advancement of technology, issues resulting from low network speeds and operating system configurations will gradually be resolved, leading to a continuous improvement in user satisfaction with the Metaverse platform.

During the experiment, it was observed that users’ initial impressions and attitudes toward the Metaverse platform also influence their enthusiasm and effectiveness in learning to operate the platform. The more positive the attitude, the easier the learning process, and users are more likely to master the platform. For those who initially believe they cannot grasp the Metaverse platform, they often encounter difficulties in practical operation. As long as they maintain a curiosity for learning, many older adult individuals can also easily get started. Therefore, the focus should be on “technological resistance.” When facing “technology,” do not be intimidated by it; instead, embrace it and believe in your ability to handle technology. Technology exists to serve humanity, making life more convenient and enjoyable. If a technology makes users feel difficult, it will eventually be eliminated because it does not align with the original intention of technological development. When faced with a new technological platform, maintain an open mindset and bravely try it out. Therefore, it is important to value users’ initial feelings and attitudes toward the platform, as this will directly impact the degree of user acceptance and the effectiveness of use of the Metaverse platform. It is recommended that when promoting the Metaverse platform, particular attention should be given to users’ psychological attitudes and emotional feedback, and through active guidance and training, help users develop a positive perception of the platform, thereby enhancing their learning and operational effectiveness, and ultimately improving the overall user experience and satisfaction.

Due to the limited research sample and insufficient demographic variables, this study has not fully explored the factors influencing the use of the Metaverse platform, which may involve cultural levels, gender, familiarity with online games, self-efficacy, and so on. In conclusion, although the Metaverse platform holds great potential in the field of rehabilitation services, there are still some limiting factors that need to be addressed, such as the impact of user group characteristics on platform use, network speed, and mobile system compatibility issues. With technological advancements and continuous platform optimization, it is believed that these limiting factors will gradually be resolved, leading to a continuous improvement in user satisfaction and popularity of the Metaverse platform, providing a better rehabilitation service experience for more users.

The metaverse platform, as an emerging rehabilitation tool, has demonstrated unique advantages and potential in the field of remote rehabilitation. Answers to open-ended questions indicate that users generally give positive feedback on the platform content, considering it practical, interesting, comprehensive, instructive, clear, and easy to understand. The diversity and instructiveness of the rehabilitation content enable users to better understand and absorb information, thereby enhancing the effectiveness of rehabilitation. However, issues such as the complexity of platform operation, potential lag during operation, and lack of interactivity affect user experience and platform learnability. Overall, while the platform content can adequately meet clinical needs and is well-structured, there are still some areas in operational aspects that require improvement.

The diverse intervention content and methods provided by the metaverse platform offer users a comprehensive rehabilitation service experience. First, the platform offers a wealth of graphic and video resources, providing users with multiple sensory input pathways that aid in information comprehension and absorption. Compared with plain text, videos and graphics are more vivid and intuitive, conveying information more effectively, making it easier for users to understand and remember, thus enhancing intervention effectiveness and sustainability. Second, the metaverse platform incorporates questionnaire functions to help survivors assess whether they have achieved their set goals. This personalized assessment method allows users to gain a clearer understanding of their rehabilitation progress, helping them adjust their rehabilitation plans and improve rehabilitation outcomes. Additionally, the platform introduces gamification mechanisms, including setting tasks and providing rewards, which motivate survivors during the rehabilitation process, enhancing their motivation and sense of involvement. Furthermore, the metaverse platform provides auxiliary design features to help users better receive information, such as the function of automatically reading text on images by clicking on them, digital human navigation services, and signposts, greatly facilitating the acceptance of intervention information by different age groups, enhancing intervention universality and operability. These advantages collectively make the metaverse platform the preferred choice in the field of remote rehabilitation.

Moreover, the metaverse multidimensional rehabilitation platform also offers social interaction and support systems, allowing users to interact and communicate in real time with other survivors or health experts. This social support can increase users’ motivation for rehabilitation and self-management capabilities, promote information sharing and experience exchange, and build a supportive rehabilitation community [34]. Additionally, the platform has cross-platform and cross-device compatibility, allowing users to access the platform anytime, anywhere through different devices, achieving seamless connection of the rehabilitation process from the hospital to the home, providing users with a convenient and smooth rehabilitation experience.

Research results indicate that the metaverse platform has been successful in meeting user needs, providing effective information, and offering a good user experience, demonstrating the potential to provide excellent rehabilitation support for survivors of colorectal cancer and their families. Research on the effectiveness of metaverse rehabilitation therapy for cerebral palsy has shown significant improvements in various health parameters compared with traditional physical rehabilitation treatments [35]. Experts have pointed out that metaverse rehabilitation exercises can help patients with stroke improve cognitive function, attention, muscle endurance, cardiorespiratory function, maintain appropriate weight, and prevent stroke recurrence [36]. Floreo, a company in the United States, created the first behavioral therapy metaverse, teaching social, behavioral, communication, and life skills to patients with autism spectrum disorders, attention-deficit/hyperactivity disorder, anxiety disorders, and other neurodiversity disorders. Additionally, the metaverse is used to build communication platforms for patients with cancer and their families, assisting patients in improving the discomfort caused by illness and enhancing their social adaptability [19]. These applications emphasize the potential advantages of incorporating metaverse-based approaches into patient rehabilitation interventions and disease management. The metaverse holds promise for bringing new opportunities to rehabilitation medicine, improving the quality of life of survivors of colorectal cancer, and reducing the incidence of complications.

The metaverse has the potential to shorten social distances, facilitate simultaneous online learning for multiple users, and stimulate participants’ rehabilitation motivation. Competitive incentives and mutual encouragement among participants can help in task completion. The research team of Mizuta et al [37] reported that compared with simply posting exercise videos on YouTube (Google), providing exercise videos through the metaverse platform can increase physical activity among young individuals with similar exercise motivations, while reducing feelings of isolation during exercise. Despite similar video content, the viewing experience provided by the metaverse is more engaging and immersive, adding challenge and enjoyment. The metaverse also offers additional benefits, such as avoiding the embarrassment of visiting clinics and increasing the acceptance among patients who find it inconvenient to seek treatment at hospitals due to psychological barriers. Participants tend to label metaverse-based therapeutic content as entertaining, enjoyable, or convenient [33].

The metaverse holds great potential in the health care field. Simulation programs for early-onset schizophrenia care based on the metaverse can serve as an alternative for high-quality care education, replacing clinical psychiatric practice without spatial constraints [38]. The application of the metaverse in medical training programs has shown significant effects. Using the metaverse in onboarding training and nurse and resident training programs has led to improvements in participants’ knowledge, skills, and confidence [39]. The application of the metaverse in clinical handover nurse training has significantly improved nurses’ self-efficacy, handover skills, and satisfaction [40]. Overall, the metaverse has shown good effectiveness in the education and training fields, indirectly confirming its clinical feasibility, given that the metaverse multidimensional rehabilitation platform mainly focuses on health education. While the application of the metaverse in the rehabilitation field is limited, existing clinical experiences demonstrate significant potential, such as virtual physical therapy to guide rehabilitation patients in exercises and movements [41].

Although the metaverse brings many benefits, the current multidimensional rehabilitation platform still has some limitations, including insufficient content, complexity of operation, lack of interactivity, inadequate professional services, lack of prompts, unclear information, and difficulty in screening. To address these issues, the team has further optimized the metaverse platform, including enlarging operation buttons and changing the taskbar to prominent patterns. Additionally, content directories have been added at the entrance of each room to help users find the desired content. Outstanding issues include professional services and interactivity, mainly because the platform has not been formally deployed in clinical practice, team members have not fully engaged with the platform, and professional services and interactive content have not been fully explored. This limitation is expected to be partially addressed in formal clinical studies.

In conclusion, the metaverse platform, as an innovative rehabilitation tool, has shown tremendous potential and advantages, providing innovative solutions for the rehabilitation of survivors of colorectal cancer. Its diverse intervention content and social support system offer users a comprehensive and effective rehabilitation service experience, with the potential to enhance survivors’ quality of life. However, operational aspects still require optimization, with simplification being a key focus for future improvements. Through continuous optimization and enhancement, the metaverse platform is poised to become a leading choice in the field of rehabilitation, enhancing survivors’ quality of life and rehabilitation outcomes.

This study has the following limitations. First, the sample size is small, with only 18 participants, which limits our ability to conduct detailed analyses of different participant groups and prevents an in-depth exploration of multiple potential factors affecting satisfaction with the metaverse. This also limits the statistical testing power of the results and the generalizability of the conclusions, especially when facing diverse user needs, where the representativeness of the results may be affected. Although the sample size in this study exceeds the minimum sample size recommended by the US Clinical Trial Registration Platform for usability studies (fewer than 10 people), it is still difficult to completely exclude the risk of bias caused by insufficient samples. Second, the assessment tools used in this study are mainly self-report scales, which are subjective to a certain extent. Participants’ responses may be influenced by social desirability bias, memory bias, or personal emotional states, thereby introducing response bias or measurement errors that affect the objectivity and accuracy of the data. Third, there are significant individual differences in users’ preferences for platform content. For example, some patients are more concerned with mental health education content, while others place more emphasis on content related to physical activities. This heterogeneity in content preferences may lead to large variations in evaluations of usability indicators, affecting the internal consistency and generalizability of the results. In addition, the data in this study are mainly based on short-term usage feedback, lacking longitudinal observation of the platform’s long-term usability and long-term user satisfaction, making it difficult to reflect the dynamic changes in user experience and long-term effects. Finally, the study lacks objective behavioral data support (such as usage duration and interaction frequency) and mainly relies on subjective evaluations. Future research should combine more objective indicators to comprehensively and multidimensionally assess the platform’s usability and user experience. In summary, future studies should expand sample sizes, cover a broader range of population characteristics, adopt mixed research methods that combine subjective evaluations with objective data, and conduct long-term follow-up observations to comprehensively and in-depth investigate factors influencing the usability of metaverse platforms, thereby enhancing the scientific rigor and practical guidance value of the research.

This study demonstrates the potential and prospects of metaverse technology in colorectal cancer rehabilitation, providing personalized and convenient rehabilitation services for patients and their families with the aim of improving patient quality of life and rehabilitation outcomes. However, integrating metaverse technology into clinical practice still presents challenges. In the future, exploring the combination of virtual reality, augmented reality, and other technologies to provide comprehensive, personalized rehabilitation platforms and integrating AI to achieve more intelligent and precise medical services could be beneficial. Emphasis should be placed on safety and privacy protection to ensure compliance with regulations and to safeguard patient privacy and data security. Additionally, integrating metaverse technology with traditional medical models to achieve complementary advantages and to build a more complete medical ecosystem can provide patients with comprehensive and continuous medical services. Importantly, this study is the first to apply metaverse technology to the family rehabilitation of survivors of colorectal cancer, bringing new ideas and opportunities to related research and practices. Our findings not only offer innovative rehabilitation support for survivors of colorectal cancer and their families but also provide insights and inspiration for other cancer rehabilitation research. This metaverse-based rehabilitation platform has the potential to improve the quality of life of patients and their families and may offer medical institutions more effective rehabilitation services and educational outreach avenues.

Although the application prospects of metaverse technology in the medical field are broad, continuous exploration and improvement in clinical practice are necessary to achieve better medical outcomes and service quality. Through ongoing innovation and collaboration, metaverse technology has the potential to bring breakthroughs and advancements to the medical field, benefiting more patients and their families.