## 4 Discussion  
As seen in the introduction, there are different approaches to the design of a tool based on virtual reality games to be used in health treatments. We have proposed a method for which the objective is to facilitate this entire design process. It is not only intended to make the process simpler but also to integrate the use of validated tools that increase the credibility and robustness of the process and allow greater guarantees that the developed tool will effectively meet its health objectives. \begin{table}
\begin{tabular}{c c} \hline \hline  & **Mean (SD)** \\ \hline Stress & 36.48 (5.73) \\ \hline Engagement & 48.05 (16.18) \\ \hline Interest & 54.86 (5.73) \\ \hline Excitement & 42.90 (5.50) \\ \hline Focus & 34.52 (6.46) \\ \hline Relaxation & 34.52 (12.56) \\ \hline \hline \end{tabular}
\end{table} 
Table 4: Emotive reactions and user experience while the video game is developed, mean and standard deviations (SD). \begin{table}
\begin{tabular}{c c c} \hline \hline
**User Experience** & **Scale** & **Proportion (\(n\))** \\ \hline \multirow{4}{*}{Enough instructions} & Always & 57.1\% (12) \\ \cline{2-3}  & Almost Always & 28.6\% (6) \\ \cline{2-3}  & Sometimes & 14.3\% (3) \\ \cline{2-3}  & Almost never & 0\% (0) \\ \hline \multirow{4}{*}{Clarity} & Always & 4.8\% (1) \\ \cline{2-3}  & Almost Always & 42.9\% (9) \\ \cline{2-3}  & Sometimes & 38.1\% (8) \\ \cline{2-3}  & Almost never & 14.3\% (3) \\ \hline \multirow{4}{*}{Interface Exp} & Always & 4.8\% (1) \\ \cline{2-3}  & Almost Always & 28.6\% (6) \\ \cline{2-3}  & Sometimes & 61.9\% (13) \\ \cline{2-3}  & Almost never & 4.8\% (1) \\ \hline \multirow{4}{*}{Health Target} & Always & 9.5\% (2) \\ \cline{2-3}  & Almost always & 66.7\% (14) \\ \cline{2-3}  & Sometimes & 14.3\% (3) \\ \cline{2-3}  & Almost never & 9.5\% (2) \\ \hline \multirow{2}{*}{Difficulties} & No & 90.5\% (19) \\ \cline{2-3}  & Yes & 9.5\% (2) \\ \hline \hline \end{tabular}
\end{table} 
Table 5: Outcomes of user experience in proportions according to the Likert scale. By relying on these clinical tests, the development process of the tool can be linked to evidence-based medicine [30]. For example, in the case study presented, the development process is supported by tests from the field of rehabilitation. Among the existing approaches that can be considered similar to our work, the most remarkable is that of [PERSON] et al. [19]. Our proposal goes further than [PERSON]'s and includes, among the most important design elements, an interaction element where patients are informed before starting of how to follow game instructions, how to be physically prepared according to their own health requirements, and how and when to record their vital signs. As seen in the results (Table 5); this integration is highly valued by users. The results of this work show that the proposed method improves usability and user experience. Results were also obtained with respect to the \"emotional reactions\" of the users, showing that focus and engagement promotes the patient's motivation to do the activities and therefore achieve the goal of treating physical activity in patients with T2 DM. The results of the study have shown that people who applied this case have had a remarkable improvement in following the re-habilitation activities promoted by the videogame. Additionally, to the results presented, they were asked, in a private form, whether they would recommend using video games for their rehabilitation and most of them agreed with that statement. It was not the purpose of this work to demonstrate the clinical effectiveness of the tool presented as an example. A possible evaluation, with a randomized clinical trial, of the effectiveness of the tool remains a future goal. An additional consideration when developing a health care virtual reality solution is the scope of the proposal. The features included in a proposal are based on the needs of the patients. However, due to the complexity of the disease, there are different approaches that depending on time, could not be included in the design.