# Web-Based Serious Games and Accessibility: A Systematic Literature Review
## 5 Discussion  
In this study, we conducted a systematic review of the literature with five research questions. Excel spreadsheets can be downloaded from the Mendeley repository [69]. In this section, we summarize the main findings. 1. The current accessibility situation shows that few developers apply it to serious games that consider disabilities. This literature review found that 72% of the primary studies selected are related to visual and hearing impairment accessibility. On the other hand, 22% of studies apply accessibility guidelines to solve some cognitive and learning problems. Few studies, about 6%, are concerned with using accessibility to serious games for motor disabilities. 2. This study's statistics related to proposals to increase accessibility by type of disability in serious games reveal that 70.2% apply the accessibility guidelines. However, no guidelines are specified; we found studies that use their guidelines or modifications based on the International Game Developers Association (IGDA) [71] ideas on games' accessibility. Others apply the GA-SIG guidelines to create something like the WCAG [6]. We also find studies that involve the IBM [72] and Section 508 [73] guidelines. Of the selected primary studies, 14.9% use the WCAG 2.0, and 4.3% apply the WCAG 2.1. They apply the GA-SIG guidelines to create something like the W3C/WAI [74]. 3. The solutions to increase accessibility in serious games considering disability are few; we found that 2.1% of assistive technologies are applied, especially for cognitive disabilities. Moreover, 29.8% use external devices to make games more accessible, especially for motor and sensory disabilities. According to the studies found, we can conclude no inclusive development culture in software development companies. 4. The methods applied to the design of serious disability games show that 87.2% of the primary studies selected use the qualitative approach, relying on observation to collect non-numerical data through focus groups and observation techniques. In contrast, the quantitative method received 12.8% of the selected primary studies, based on systematic empirical research of observable phenomena using statistical, mathematical, or computer techniques. 5. The SLR results by type of disability-related documents reveal that experience-based research models received the most attention in 78.7% of the selected primary studies. This research model includes case studies, projects, and experience reports that provide lessons learned. Figure 8: Primary studies answered keywords and research questions. Besides, 10.6% of the selected primary studies rely on the author's opinion to apply accessibility in serious games. 4.3% of selected primary studies rely on evaluation research to provide solutions to practical problems and surveys. Also, 4.3% of the primary studies apply validation research by presenting researched techniques that have not yet been implemented and are novel. Finally, 2.3% of the selected primary studies use solution proposals to offer new approaches and improvements. The selected studies' quality was determined by applying the quality assessment based on five additional questions (see Table 5). This SLR process has its limitations; it is not foolproof as any other secondary research method. In this study, attention was paid to choosing the most useful query strings adapted according to each database's query structure. To mitigate this limitation, we applied the PICO criteria to our query strings [5]. The selection of the databases, the ACM Digital Library, IEEE Xplore, Scopus, and WOS, is adequate because out of 476 articles, 201 were duplicates, which means that the coverage of the four databases is high, so much so that some of them could have been excluded. The criteria emerged from discussions with the researchers involved. However, primary research search terms, such as accessibility and serious games, are traditional, well-defined, and accepted terms, which should decrease the number of ignored studies.