## 4 Discussion
With respect to usability, the participants using the SmartWalk tool indicated a mean SUS score of 86.84 \(\pm\) 9.97 [23], which is higher than those obtained in our study from both the patients (72.3 \(\pm\) 17.2) and healthcare professionals (68.9 \(\pm\) 12.2). Thus, future improvements in the robustness of the technology to improve usability must be made to enhance the patient's experience. In a 6-month single-blind randomized controlled trial among 150 community-dwelling older adults with subjective and/or objective cognitive impairment who used the Standing-Tall program, a digital exercise program designed to improve mobility delivered via a tablet, a nonsignificant difference in gait speed of 0.04 m/s (\(p\) = 0.09) was observed. Thus, this finding reinforces the fact that even longer periods of training still have limitations in terms of effectiveness (in this case, mobility). Finally, the average SUS score was slightly higher than that of our healthcare professionals sample (76.7 \(\pm\) 15.3 vs. 68.9 \(\pm\) 12.2), although it was similar to that of the patients in our study (72.3 \(\pm\) 17.2). In addition, 89.1% of patients reported a subjective benefit from the StandingTall program [24]. In comparison, in our study, 91.7% of the participants stated that they had an overall positive experience with COGNIVITRA, which was higher than that reported in the StandingTall study. Tele-FootXTM is a motion sensor module equipped with a custom application that is designed to improve balance and cognition during distractive conditioning through gamified balance tasks and explicit augmented visual feedback, while a telemedicine interface remotely supervises the exercise [25]. A clinical trial involving 14 patients with mild cognitive impairment reported good acceptability, perceived benefits, and positive attitudes toward the use of the system. The Technology Acceptance Model (TAM) scores were significantly lower for exergaming adherence and increased for the participants' level of interest while performing in-home exergaming exercises. In our study, it is noteworthy that overall adherence was high, with participants completing more weeks than needed, which was particularly evident among those in the home setting compared with those in the clinical setting. In fact, as mentioned above, some participants exceeded the prescribed number of sessions, exclusively among those in the home study. On the other hand, values significantly increased for the questions that indicated that participants benefitted from performing in-home exergaming exercises to improve their physical and mental functions and quality of work. In terms of cognition and anxiety, an improvement in the average MoCA score of 9.7% and a decrease in the average Beck Anxiety Inventory (BAI) score of 27.6% were observed [25]. In our study, a nonsignificant improvement in the MoCA score was also observed, although only in the overall study (from 24.6 \(\pm\) 3.2 to 25.0 \(\pm\) 3.8) and clinical setting study samples (from 23.2 \(\pm\) 3.8 to 24.3 \(\pm\) 4.8), with a slight decline observed in the home study sample (from 25.9 \(\pm\) 2.1 to 25.6 \(\pm\) 2.9). These results might be explained by the different patient populations, study lengths, and numbers of sessions per week. With respect to the willingness to pay for the device, user satisfaction often correlates with the perceived value of a medical device, as well as its quality, performance, and user-friendly interfaces. This satisfaction can positively influence users' willingness to pay for the device, as they see it as worth the investment. In our study, most of the participants (75.0%) were willing to pay to use COGNIVITRA, which was positively correlated with the overall high satisfaction scores reported among the users. Interestingly, this scenario is not always observed; as in other devices, user satisfaction and willingness to pay do not always correlate [26].