# Probe: A Framework for Serious Games in Telecrabilitation
## 4 Discussion  
We then tested the process of game customization by therapists and analyzed the levels of experience, involvement, and suitability for both therapists and end users. Data from the different components of the User Satisfaction Evaluation Proteo Questionnaire assessed the impact that the two game experiences had on participant engagement. Overall and irrespective of the game mode, participants reported low feelings of boredom and tiredness, i.e., low levels negative affect and highs level of positive affect (involvement and enjoyment). Irrespective of previous experience level, the suitability with the conditions of successfulness, ability to control, clarity, and helpfulness were also reported as high.  
More in depth, with reference to the therapists, before starting the study, we wanted to refer to a sample of therapists who were not very experienced in the use of the PC or in the use of the different apps; the results concerning the therapists' previous knowledge confirmed these data, as the therapists show an intermediate level of knowledge and, as we expected, their experience in creating a serious game was very low. With reference to the therapists' level of involvement, the condition of positive feeling was reported as high while the condition of negative feeling was reported as low. With reference to users' previous knowledge, the sample we contacted to participate in the research had a high level of knowledge, and their level of involvement was also very high. We believe that this positive impact of the system on the subjects' feelings was mainly due the easiness and the fun of the system. This was confirmed by the data related to the level of suitability described by the therapists. As we underlined, the therapists were able to finish the assigned task, and they reported a strong feeling of being in control of the process and that the Proteo app was clear and helpful.  
Figure 12: Boxplots of the components of the end user’s level of engagement.  
In clinical practice, frameworks such as Proteo can enable simultaneous training of physical, cognitive, and psychological aspects and show great potential to improve patient motivation and adherence, mainly due to the possibility of gamification and personalizing the feedback from TR modalities that can be customized by the therapist across subgroups of patients. In order to analyze the suitability of the system, our results are promising; in order to analyze the safety of Proteo app, we have no data because nobody replied in an affirmative way to the question: \"Did you feel discomfort during your experience with the system?\" For this reason and because no therapist reported problems during the task, we believe that Proteo is safe. However, in order to systematically adopt Proteo in routine clinical practice, the ease with which the therapists completed the assigned task and the pleasure of creating new tasks are not sufficient for the success of the therapy. It is necessary that the therapists are well-trained. They must be competent when determining what feedback to give and at what moment, they and must be aware of the hierarchy of learning objectives, the transfer of them, and all of the factors that can lead to the autonomy the patient. The therapists also need to be careful not to give patients more help than necessary.  
This study has some limitations that should be acknowledged. Regarding the data analysis, our sample size is relatively small for some of the statistical analyses performed, and the results should be considered with caution. However, sample size calculations determined that the sample size was sufficient to evaluate the study objectives.