Requirements of health professionals and affected persons for an App based Dual Task training for hearing impaired older adults - a Delphi survey

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Recent studies have highlighted potential benefits of cognitive-motor training but lack specificity regarding the unique needs of this population. This study aimed to determine the exercise preferences and specific needs of older adults with hearing impairments to develop tailored cognitive-motor training programs. Methods: A Delphi survey was conducted to gather expert opinions and user preferences to inform the development of an app. The survey engaged 220 health and exercise professionals and 30 older adults with hearing impairments across three rounds, using a combination of open and closed questions. Data collection lasted from December 2023 to July 2024 and resulted in 10 to 14 complete responses per group and round. Statistical analyses included frequency analysis, mean, standard deviation and one-way ANOVA to identify significant differences between expert and user responses. Results: The study gathered a lot of opinions and perspectives regarding the aspects of a training app. All 570 responses were clustered in 148 items and only 35 were removed due to low relevance. While revealing a high level of consensus, the data showed significant differences between the groups. For example, in the preference for training types, health professionals differed from hearing-impaired participants. While professionals emphasised the integration of sensory challenges and dual-task exercises, participants preferred less demanding physical activities and those incorporating music or ambient sounds. Strength exercises and prescribed frequent sessions were deemed less feasible, indicating a preference for more adaptable and enjoyable training regimes. Conclusions: Tailored cognitive-motor training programs that incorporate the individual preferences and sensory capabilities of hearing-impaired older adults promise high adherence and effectiveness. Frequent training sessions stimulate neuroplasticity, enhancing both cognitive and motor functions, which is crucial for older adults facing sensory deficits. The intensity of the exercises should match the individual's abilities, gradually increasing to ensure engagement without overwhelming participants. These programs should emphasise ease of use, flexibility and autonomy to enhance the enjoyment while sensory accommodation helps to enhance physical and cognitive functions, supporting greater independence and quality of life for this vulnerable population. hearing impairments older adults digital intervention cognitive-motor training Delphi study exercise preferences user-centered design Figures Figure 1 Introduction Age-related hearing impairment affects approximately 50% of adults over the age of 65 [ 1 ] and is expected to affect 8% of the global population by 2050 [ 2 ]. Hearing impairment adversely impacts social and emotional well-being [ 3 ] and restricts daily activities and physical function [4; 5; 6; 7], thereby increasing the public health burden worldwide. Hearing impairment has been associated with declines in both cognitive [8; 9; 10] and physical function [11; 6], affecting gait and balance. This is evident during dual-task activities, which combine walking with a cognitive task [12; 13], potentially increasing the cognitive load and increasing the risk of falls [14; 15] - a leading cause of injury and loss of independence among older adults [ 16 ]. Cognitive-motor interventions - often referred to as dual-task training - have been recommended to mitigate these risks [ 17 ]. A systematic review and meta-analysis suggested that cognitive-motor interventions can strengthen executive function, including inhibitory control, working memory, and cognitive flexibility, as well as improve static and dynamic balance in older adults [17; 18]. These benefits are particularly relevant for those with age-related hearing impairment, as dual-task training addresses unique sensory and functional challenges by enhancing sensory integration alongside balance and cognitive function [19; 20]. Despite these benefits, existing research on dual-task training tailored for older adults with hearing impairments is limited. This population requires targeted strategies, such as auditory-based exercises that involve responding to tones while maintaining balance, rather than traditional balance training approaches. Furthermore, to date there is no consensus regarding the optimal design, intensity and progression of such interventions, as well as a lack of diagnostic tools needed to assess their efficacy. Amidst the growing relevance of digital interventions in health promotion, mHealth programs provide an excellent opportunity for delivering such tailored interventions without the constraints of locations or time [ 21 ], reaching individuals who may not have access to gyms or physiotherapy services. Furthermore, the integration of motivating features such as progress tracking and gamification within mHealth applications have potential to maintain engagement and encourage long-term use. However, the effectiveness of these interventions relies on a user-centered design (UCD). UCD ensures that the program is easy to use, motivating [ 22 ], and accessible for those with cognitive or motor impairments. Less is known about the specific requirements of older adults with hearing impairments to design a tailored mHealth intervention. Therefore, this study aims to address these gaps through a Delphi survey engaging both health professionals and participants with hearing or balance impairments. This research aims to identify and prioritise key training components, diagnostic tools and delivery methods. Based on this process we can establish a framework for evidence-based, user-centered mHealth training programs that enhance mobility, balance and cognitive function in older adults with hearing impairments. As a part of the “xx” project, the results contribute directly to the successful development of an innovative dual-task training App system that integrates auditory and motor exercises tailored to older adults with hearing impairment. Methods Study design The Delphi survey consisted of three rounds. There were open-ended questions in the first and second round and closed-ended questions in the second and third round following the guidelines provided by Trevelyan and Robinson [22]. This study integrated insights from health professional experts and older adults with hearing and/or balance impairment. The first survey round involved separate surveys for each participant group to address specific perspectives and complexities. Subsequent rounds integrated responses from both participant groups to refine and validate the findings. The respective surveys were provided in German or English. Each survey round adhered to ethical standards outlined in the Declaration of Helsinki [23]. Data collection was conducted online between December 2023 and July 2024. Participants Sample size The study aimed to incorporate a broad range of expertise, inviting 220 international health and exercise science professionals and 30 adults with hearing impairments following the recommendations in the literature [22; 24]. Inclusion criteria Participants included professionals with expertise in medical and therapeutic support relevant to older adults with hearing and/or balance impairments, exercise delivery in older adults with or without hearing impairment, and digital solutions for older adults. Older adults were required to be at least 50 years old, and either experiencing mild to moderately severe hearing loss or balance issues. Identification of participants The participants were identified through the broader network of the authors including colleagues and participants of former studies, or based on their authorship of published research articles in this area of interest. We also asked all recruited participants to indicate people they believed were suitable and who could be approached for participation in the study. Study flow The initial recruitment and ongoing engagement were managed through personalised email communication and reminders to encourage complete participation across all survey rounds. Participant contributions were acknowledged in the study outputs, with all participants given the option to be listed in the acknowledgments section. This inclusive approach aimed to enhance the validity and applicability of the research findings to real-world settings. Survey process The surveys were administered using LimeSurvey software (LimeSurvey GmbH, Hamburg, Germany), ensuring data anonymity and security. The design and content of the surveys were pre-tested by volunteers, including hearing-impaired older adults, to ensure clarity and accessibility. The process involved initial email contact for recruitment, followed by electronic informed consent in a separate survey that, in a nested way only after agreement, led to an independent survey with the respective questions. This way, it was possible to keep all personal information (names, email addresses, consent) totally separate from the responses. Each survey phase was open for 2-3 weeks, with intervals of 2-4 weeks between rounds for data analysis and preparation of subsequent surveys. Each Delphi round featured a structured online survey, accommodating both open and closed response formats. Round 1 focused on gathering a broad range of opinions through open-ended questions covering training intervention characteristics, App functionality and barriers to implementation. Participants responded to questions across four blocks: training characteristics (n=7), program functionality (n=5), barriers and safety aspects (n=4) and additional comments and demographics (n=3). Hearing-impaired participants were specifically asked to outline their requirements and wishes, where applicable, ensuring tailored feedback directly from the target user group. More information is available in the supplemental materials. Round 2 used a mixed format. First participants rated the relevance of each of the synthesised items from the first round on a 10-point Likert scale (10 points equals highest relevance). A following free-text response option allowed for participants to provide additional qualitative feedback, elaborate on their ratings, or highlight missing aspects. All items that were rated by at least 70% of the participants with a rating higher than 7.0 were summarised for final consensus in the third round. Round 3 used closed-ended questions and aimed to reach a consensus by all participants, enabling us to define final recommendations for the App’s development. Participants were asked to specifically assess the features critical for the target user group of older hearing and/or balance impaired adults. Participants rated their agreement to all relevant items from round two on a 10-point scale from 'totally disagree' to 'totally agree'. This group agreement represents the consensus on the recommended features and training elements for the App. To highlight the importance of direct user input in the development of health-related technologies, the ratings provided by hearing-impaired participants were given particular emphasis. Items with an average rating of M = 7.0 or higher from this group were prioritised and listed in the final consensus tables. Data analysis Qualitative data from the first and second rounds were analysed using thematic analysis to categorise responses following the inductive approach recommended by Mayring (2010). Quantitative analysis of the ratings in Rounds 2 and 3 involved calculating frequencies, means and standard deviations. Statistical differences between the responses of health professionals and hearing-impaired participants in round 3 were analysed by using one-way ANOVAs in SPSS (IBM SPSS Statistics, Armonk, NY, USA). Results Sample Characteristics The response rate for the first round was 14.4 %, and the rate of complete answers from total participation was 75%. The distribution of incomplete and complete answers are displayed next to the total participation per round and the distribution of professions among the participants are presented in Table 1. Out of a total of 250 participants, 36 confirmed the privacy policy in the first round. In the first round, the experts were a group of 10 females, 2 males, and 1 person who did not prefer to state their gender with an average age of 48.1 years ranging from 35 to 70 years. The group of older adults consisted of 8 females, 1 diverse person, and 4 males with an average age of 67.1 years ranging from 55 to 87 years. All responses from all three stages were included in the analysis. Table 1 Overview of the participants of the Delphi surveys round 1-3 Participation people affected Impairment Round Incomplete Complete Total Hearing impaired Balance impaired Both Unknown 1 4 14 18 9 1 2 6 2 2 12 14 8 0 4 2 3 3 12 15 7 0 2 6 Participation health professional experts Profession Round Incomplete Complete Total Scientist Physio- therapist Physicist Unknown 1 5 13 18 6 4 1 7 2 2 10 12 5 3 2 2 3 1 10 11 6 3 1 1 Results from Round 1 The qualitative analysis from the first round led to 148 different aspects regarding the training characteristics as well as the App’s design and functionality, as detailed in Table 2. Health professionals provided more feedback on training content, while hearing-impaired adults offered more insights on training characteristics and specific requirements for the App. Questions related to App features and functions elicited more qualitative responses from health professionals, whereas hearing-impaired participants commented more on issues about monitoring motor and hearing functions. Table 2 Overview of qualitative items related to the initial questions No Question Number of responses health professionals n (%) Number of responses hearing affected n (%) Total 1 What features of physical training or exercise would you recommend for the target group of older hearing-impaired and/or balance-impaired adults? Please explain your answer. 43 (66.2) 22 (33.8) 65 2 What hearing exercise would you recommend for this target group of older hearing-impaired and/or balance-impaired adults? Please explain your answer. 11 (73.3) 4 (26.7) 15 3 What exercises are clinically relevant for this target group? Please explain your answer. 43 (100) // (0) 43 4 What recommendations would you give to combine physical and hearing exercises, e.g., as a Dual-task training? Please explain your answer. 36 (90) 4 (10) 40 5 Please outline the training type, intensity, frequency and training duration you recommend for this target group. Please explain your answer. 10 (30.3) 23 (69.7) 33 6 Please outline the training type, intensity, frequency and training duration you recommend for this target group. Please explain your answer. 12 (50) 12 (50) 24 7 Please outline any training control parameters you would integrate into your treatment for this target group. Please explain your answer. 15 (100) // (0) 15 8 How should the instructions for the training tasks be presented to the target group? What feedback would you integrate into the App? Please explain your answer. 20 (40.8) 29 (59.2) 49 9 How should the instructions for the training tasks be presented to the target group? What feedback content would you integrate into the App? Please explain your answer. 8 (40) 20 (60) 28 10 How should the instructions for the training tasks be presented to the target group? How would you present feedback in the App? Please explain your answer. // (0) 23, 100 23 11 What other function(s), e.g., gamification or reminders would you like to see included in an App? Please explain your answer. 31 (75.6) 10 (24.4) 41 12 What specific requirements do we have to consider if we design an App or digital intervention to improve motor functioning and hearing for older people with hearing and/or balance impairments? Please explain your answer. 26 (72.2) 10 (27.8) 36 13 What specific tests to measure motor function would you recommend integrating into the App? Please explain your answer. 14 (40) 21 (60) 35 14 What specific tests to measure hearing performance would you recommend integrating into the App? Please explain your answer. 3 (11.5) 23 (88.5) 26 15 Can you identify any barriers preventing people from following the recommendations provided in a training App that combines auditory training with movement exercises? Please explain your answer. 30 (85.7) 5 (14.3) 35 16 What concerns do you have regarding the safety and privacy of the target group when using a training and therapy App? If so, do you have ideas on how those concerns can be addressed? Please consider the target group in your answer. 21 (63.6) 12 (36.4) 33 17 What kind of data would you want to see in the back end of the App? How should this data be presented, interpreted, displayed? Please explain your answer. 29 (100) // (0) 29 Sum 352(61.8) 218(38,2) 570 Legend: //= this question was not provided to the group in round 1 Results Round 2 After clustering the answers of Round 1, all 148 items were reviewed by both groups in Round 2. Participants rated the relevance of these items using a 10-point Likert scale (10 points equals highest relevance), and the 113 items that were rated by 70% of all responders with at least a rating of 7.0 are presented in Table 3. That only 35 items were removed after Round 2 showed a high consensus among all responders. Table 3 Items per category transferred from round 2 into round 3 Category Round 2 Round 3 Physical training or exercises 12 items 11 items Hearing training or exercises 12 items 9 items Dual-task training 12 items 7 items Training frequency 8 items 3 items Training duration 5 items 1 items Training control measures 8 items 7 items Instruction presentation 6 items 4 items Feedback content 7 items 6 items Feedback presentation 6 items 5 items App functions 17 items 11 items App usability 15 items 15 items Motor function to monitor 6 items 6 items Hearing function to monitor 9 items 9 items Barriers of an App 16 items 10 items Safety aspects 4 items 4 items Interface to professionals 5 items 5 items Summary of Items 148 113 Results Round 3 A total of 113 items were included in Round 3 for final consensus voting. Tables 4-7 present the final results for the ratings from both groups, organised across four categories: (1) training content, (2) feedback and monitoring, (3) App features and barriers, and (4) data protection and safety. Only seven items did not reach the consensus level of 7.0. Table 4 Agreement on the potential training contents of the DT training App Question Item Rating affected persons Mean + SD Rating Health professionals Mean + SD Content to improve motor performance Flexibility exercises (e.g., gymnastics; specific exercises for foot flexibility) 8.3 ± 1.45 7.3 ± 1.6 Movement combined with visual tasks (e.g., walking and observing something) 8.2 ± 1.8 8.7 ± 2 Movement combined with coordination tasks (e.g., combining walking with arm movements) 8.0 ± 1.9 8.5 ± 2 Combined training exercises with strength, endurance, flexibility, and balance 7.9 ± 2 8.5 ± 1 Endurance exercises (e.g., walking) 7.7 ± 2.3 8.0 ± 2.2 Combined strength and balance exercises for fall prevention 7.8 ± 1.9 9.3 ± 1 Balance exercises (e.g., longer one-legged stance or shifting positions from right to left leg) 7.8 ± 2 9.5 ± 0.7 Everyday training tasks (e.g., getting up from a chair), functional training 7.5 ± 2.7 9.1 ± 2.1 Exergames (computer-based games that promote movement, especially balance and strength) 7.5 ± 2.1 7.7 ± 2.6 Exercises with closed eyes 7.5 ± 2 8.3 ± 1.2 Content to improve hearing performance Exercises for distinguishing multiple voices 7.8 ± 2.1 8.8 ± 1 Listening exercises with background noise 7.7 ± 2.2 10 Everyday exercises (e.g., understanding content from a phone call) 7.7 ± 2 9.7 ± 1 Combination of multiple concurrent listening tasks (e.g., tracking different sound sequences) 7.7 ± 2 9.2 ± 1 Exercises that involve both brain hemispheres (e.g., recognizing direction of a sound) 7.4 ± 2.8 9.8 ± 0.5 Exercises with and without hearing aids 7.2 ± 2.7 9.5 ± 1 Exercises for recognizing sound patterns or noises 7.2 ± 2 9 ± 1 Exercises for recognizing consonants 7.1 ± 2.3 8.7 ± 1 Exercises for distinguishing pitch 7 ± 2 9.3 ± 1 Content for DT exercises Navigating complex environments (e.g., crossing a street) 8.6 ± 2 9.1 ± 2.1 Performing exercises with music or background noise 8.4 ± 2 8.1 ± 2 Exercises in combination with self-efficacy training (gradually building confidence in one's abilities) 7.6 ± 2.7 8.7 ± 2.1 Having conversations while walking 7.6 ± 2.2 8.9 ± 1 Listening tasks during balance exercises (static, e.g., standing on one leg for an extended period, and dynamic, e.g., switching from right to left leg) 7.3 ± 2.6 9.1 ± 1 Exergames: computer-based games that promote movement (e.g., combining balance and hearing abilities) 7.3 ± 2.6 8.1 ± 2.2 Everyday exercises (e.g., walking and using the phone) 7 ± 2.6 9.6 ± 1 Content for training design (training characteristics; principles) Adjustment of training intensity (e.g., complexity of tasks) based on individual physical performance and hearing ability 8.6 ± 1.8 9.4 ± 0.8 Increase in training difficulty based on individual improvements 8.2 ± 2 9.1 ± 1.4 Adjustment of training volume (e.g., duration of training sessions) based on recommendations for fall prevention 8.3 ± 1.6 8.7 ± 2.4 Adjustment of training volume (e.g., duration of training sessions) based on individual physical and cognitive performance 8.0 ± 2.4 8.8 ± 2.5 Recording of training participation 7.8 ± 2.4 8.7 ± 1 4-5 times per week 7.7 ± 2.6 8.4 ± 2.8 Regular tests to assess individual physical fitness and hearing ability 7.5 ± 2 7.3 ± 2.5 Training cycle of at least 20 weeks 7.3 ±2.1 7.5 ± 2 Training contents. The analysis revealed notable differences in how health professional experts and hearing-impaired older adults rated training components. Health professionals typically rated motor-related items, such as “Combined strength and balance exercises for fall prevention” (F(1,22)= 5.307; p=0.031) and “Exercises with closed eyes” (F(1,22)= 8.208; p=0.009), significantly higher than hearing-impaired participants (cf. Table 4). Similar trends were observed for hearing-related items “Listening exercises with background noise” (F(1,17)= 6.243; p=0.025), “Exercises with and without hearing aids” (F(1,17)= 5.676; p=0.031) and “Exercises for distinguishing pitch” (F(1,16)= 6.427; p=0.023). The dual-task (DT) training items, such as “Listening tasks during balance exercises (static, e.g., standing on one leg for an extended period, and dynamic, e.g., switching from right to left leg)” (F(1,20)= 4.675; p=0.044) and “Everyday exercises” (e.g., walking and using the phone) (F(1,20)= 4.675; p=0.044), ratings from health professionals were also higher. Conversely, “Flexibility exercises (e.g., gymnastics; specific exercises for foot flexibility)” and “Performing exercises with music or background noise” received higher ratings from hearing-impaired older adults compared to the health professional experts, but this difference was not significant. Items that did not meet the threshold of a 7.0 rating, such as “Strength exercises (e.g., squats)” were excluded from the final recommendations. Table 5 Agreement on training instruction, feedback and monitoring Question Item Rating Hearing affected person Mean + SD Rating Health professionals Mean + SD Instruction Combination of short videos and explanatory text 8.5 ± 2 9.6 ± 0.7 Combination of images and text 8 ± 2.2 8.7 ± 2.5 Short videos 7.7 ±2.6 8.6 ± 0.8 Images 7.2 ± 2 7.6 ± 2.2 Feedback Available at any time 8.4 ± 1.8 7.9 ± 2.7 Feedback on current performance compared to the goal 8.1 ± 1.9 8.6 ± 2.1 Presentation format: Visual (e.g., pop up of points gained) 8 ± 3 7.6 ± 2.5 Feedback on current performance 7.8 ± 1.8 8.8 ± 0.7 Correction during the execution of exercises 7.6 ± 2.7 8.9 ± 1 Feedback on current exercise progress (e.g., number of exercises completed) 7.5 ± 2 8.4 ± 1.5 Feedback Timing: Weekly 7.3 ± 2.9 7.6 ± 2.5 Feedback after each session 7.1 ± 3 7.6 ± 3 Feedback on the difficulty level of the exercise 7.1 ± 1.9 8 ± 2 Monitoring Hearing everyday sounds despite various background noises 8.9 ± 1.7 9.5 ± 1 Hearing everyday sounds, hearing threshold (e.g., PTA) 8.8 ±1.7 9.5 ± 1 Speech discrimination 8.7 ± 1.8 9.8 ± 0.5 Word recognition in background noise 8.7 ± 1.7 10 Risk of falls 8.6 ± 2 9.4 ± 0.8 Number of steps per day 8.1 ± 2.8 8.1 ±1.1 Sound localization 8.2 ± 1.7 9.8 ± 0.0 Recognition of the content of spoken words 8.1 ± 3.1 10 Leg mobility 8 ± 2.1 7.3 ± 1.7 Postural stability/balance 8 ± 2.6 9.2 ± 0.8 Reaction speed to signals 7.8 ± 2.6 8.6 ± 0.9 Combination of strength, balance, and gait (e.g., SPPB or TUG) 7.7 ± 2.8 9.3 ± 0.7 Sensitivity to tone discrimination 7.7 ± 3 9.3 ± 1 Auditory memory 7.6 ± 2.4 9.3 ± 1 Gait analysis (e.g., speed, posture, safety) 7.4 ± 2.7 8.2 ± 0.8 Feedback and monitoring. The item “Feedback Available at any time” was the only item that was rated higher by the hearing-impaired older adults compared to the health professional experts, although this difference was not statistically significant (cf. Table 5). The item “Presentation of performance curves” received an average rating of 5.8 ± 2.6 points from the hearing impaired and 8.0 ± 1.0 points by the health professional experts (F(1,20)= 5.970; p=0.027). Similarly, the item “Feedback after each exercise” was also excluded, because the score was <7 in both groups. Within the section for Monitoring, the item “Leg Mobility“ was rated higher by the hearing-impaired older adults but did not reach significance. Table 6 App requirements, user barriers and features Question Item Rating Hearing affected person Mean + SD Rating Health professionals Mean + SD Requirements of the App design and its functionalities Options for integrating personal hearing aids 9.1 ± 1.7 8.7 ±1.9 Ease of use 9.1 ±1.7 9.3 ± 1.4 User manual 9 ± 1.7 7.1 ±2.5 Compatibility with existing devices 9 ± 1.7 9 ± 1.4 Easily understandable instructions 8.9 ± 1.6 10 Support for learning how to use the App upon initial use 8.8 ± 1.7 9.2 ± 1 Exercises that are enjoyable 8.7 ± 1.7 8.9 ± 1.5 Option to receive technical support 8.7 ± 1.7 9.1 ± 1.5 Simple graphics for monitoring progress 8.4 ± 1.6 9.3 ± 1 Simple tests to assess hearing ability 8.4 ± 1.5 8.8 ± 1.2 Instructions for creating a safe training environment 8.3 ±2 9.4 ± 0.7 Simple tests to assess physical fitness 8.1 ±1.9 9.1 ±0.8 Simple barrier-free design (e.g., large letters and input buttons) 8 ± 2 9.4 ± 0.7 Movement tracking 8 ± 1.8 7.7 ± 1 Option for training without additional functions 7.4 ± 2.8 9.1 ± 1.2 Barriers for users Low self-efficacy 8.3 ± 2.2 8.4 ± 1.5 Poor user-friendliness 7.6 ± 2.4 9.8 ± 0.7 Lack of clear or absent rationale for recommendations 8 ± 2 8 ± 2 Feeling overwhelmed/Frustration 7.8 ± 2.1 9.2 ± 1.3 Too high complexity of the App and its operation 7.3 ± 2.8 9.8 ± 0.7 Time and opportunity 7 ± 2.9 7.9 ± 2.2 Functionalities and features Opportunities for networking with medical care (e.g., personal counseling) 8.3 ± 2 8.8 ±1 Buttons for repeating instructions 8.3 ± 2.4 9.6 ± 0.8 Option to select the format (verbal, video, or written) for exercise instructions 7.9 ± 2.3 9.8 ± 0.7 Reminder function 7.8 ± 1.9 8.3 ± 2.3 Display of current heart rate and calorie expenditure 7.9 ± 3.1 6.1 ± 2.8 Information on techniques for behavior change 7.4 ±2.4 7 ±2 Information material on hearing impairment and balance difficulties 7.6 ± 2.3 6.8 ±2 Information on how training adjustments are made 7.6 ±1.7 8.4 ± 2 Specific elements to enhance motivation (e.g., positive messages) 7.4 ± 2.8 8.8 ±1.3 Option to select the format (verbal, video, or written) for exercise feedback 7.3 ± 3.2 9.3 ± 1.3 App features and barriers . The following items, identified under barriers to using a training App, had significant differences: “Poor user-friendliness” (F(1,20)= 7.143; p=0.017) and “Too high complexity of the App and its operation” (F(1,20)= 6.368; p=0.022) and showed lower ratings by hearing-impaired adults (cf. Table 6). “Too high complexity of the App and its operation”, along with “incompatibility with older smartphone models”, “Lack of technology/equipment”, “Low willingness to use smartphones” and “Visual impairment” were excluded due to ratings <7 by the hearing-impaired adults. The feature “Option to select the format (verbal, video, or written) for exercise instructions” differed between the two groups (F(1,20)= 5.985; p=0.027), with higher ratings from the health professionals. The items “Gamification elements (e.g., high scores, rewards for participation and achievements, etc.)” and “Competitions with other users” were excluded due to scores <7 by the hearing-impaired older adults. Table 7 Data protection and safety Question Item Rating Hearing affected person Mean + SD Rating Health professionals Mean + SD Safety instructions for use 8.6 ± 1.6 8.9 ± 1.3 Safety instructions during training, warnings 8.1 ± 2 8.9 ± 1 Voluntary submission of data to professionals Physical fitness 8.2 ± 2 8.6 ± 1 Training results/success 8.1 ± 2 8.7 ± 2 Training participation/duration 8 ± 2 9.4 ± 1 Thresholds for clinically relevant changes 7.7 ± 3 9.3 ± 1 User satisfaction feedback 7 ± 2 8.1 ± 2 Data protection and safety . All data protection items were rated higher by the health professionals. However, the item “Legal data protection including information about the collection and use of personal data” was removed due to an overall rating <7, reflecting possible concerns or differing priorities between the groups regarding data security measures. Discussion This study used a Delphi process to explore the design needs for an mHealth App aimed at cognitive-motor training for older adults with hearing impairments. By involving both health professionals and the target demographic, this research sought to create a robust, evidence-based framework that addresses the unique challenges this group faces in maintaining mobility, balance and cognitive function. The results from the third round of the Delphi process highlighted critical insights into the consensus and discrepancies between health professional experts and hearing-impaired older adults. Notably, there were significant differences in the perceived importance of various training components, particularly those related to motor functions, hearing capabilities and DT training. Training components and characteristics Consensus across both participant groups underscored the inclusion of traditional falls prevention exercises (including walking, strength and balance exercises), confirming their evidence-based role in physical health [e.g., 25; 26]. Moreover, DT training was rated to be highly relevant, which helps to increase cognitive and motor performance [27; 28; 17]. Distinct preferences became apparent in the assessment of specific exercises. Health professionals frequently rated complex exercises like "Combined strength and balance exercises for fall prevention" and "Exercises with closed eyes" higher than the hearing-impaired participants. This disparity suggests a professional inclination towards comprehensive, sensory-challenging protocols that may not resonate as strongly with hearing-impaired individuals, who might view these exercises as overly demanding or inaccessible without additional support [e.g., 29; 30]. For the hearing-related aspects, items such as "Listening exercises with background noise", "Exercises with and without hearing aids", and "Exercises for distinguishing pitch" received higher ratings from health professionals, reflecting a recognition of the importance of practicing in varied auditory environments to enhance real-world functional hearing [31; 32]. However, hearing-impaired participants often rated these tasks lower, possibly indicating perceived difficulties or lesser relevance, highlighting a gap between expert recommendations and user preferences [ 33 ]. For the DT component, the items "Listening tasks during balance exercises” and "Everyday exercises" (e.g., walking and using the phone) also exhibited significant differences. Health professionals rated these dual-task exercises higher, emphasizing the integration of cognitive and physical tasks more than the hearing-impaired participants, who might prioritise immediate auditory comfort over potential cognitive benefits [ 34 ]. On the other hand, hearing-impaired participants may have been less inclined to view these exercises as necessary, especially if they perceive balance and cognitive training to be secondary to their hearing needs [ 33 ]. The exclusion of "Strength exercises (e.g., squats)" from the program due to low ratings underscores a consensus that these may not be essential for the targeted training goals of hearing-impaired older adults. Similarly, the omission of specified frequent training sessions reflects practical concerns about the feasibility of intensive regimens for this group, highlighting the need for adaptable training schedules that accommodate individual capabilities and lifestyle needs [35; 36]. However, the results indicate, that more knowledge on exercise physiology might benefit future applications. Frequent training sessions stimulate neuroplasticity, enhancing both cognitive and motor functions, which is crucial for older adults facing sensory deficits. The intensity of the exercises should match the individual's abilities, gradually increasing to ensure engagement without overwhelming participants. For those with hearing impairments, exercises should challenge their cognitive abilities, especially since auditory deficits may require additional focus on visual or tactile cues [ 37 ]. The duration of sessions and total training time must be balanced to avoid fatigue while still providing adequate stimulation for cognitive and physical benefits. The types of exercises should be varied, incorporating cognitive and motor tasks tailored to each individual's needs, particularly considering hearing loss. Moreover, individualisation ensures that training programs are personalised to the participant's specific cognitive and physical abilities, increasing engagement and effectiveness [eg., 38]. Moreover, personalised approaches might reduce frustration and improve long-term adherence to training. These aspects might also align with feedback and training instruction. Training Instruction, Feedback and Monitoring Feedback preferences within the study revealed a significant trend: hearing-impaired participants particularly valued the option for "Feedback available at any time". This preference underscores the importance of adaptable feedback mechanisms that can be accessed on-demand, aligning with the fluctuating needs and capacities of hearing-impaired older adults. Such flexibility not only enhances user autonomy but also accommodates the variable nature of hearing impairments, which may affect a person’s ability to engage with the training program consistently [ 39 ]. Conversely, the relatively low interest in "Presentation of performance curves" and "Feedback after each exercise" suggests a nuanced approach to feedback is necessary, especially as the variability in the response behavior was rather high. These findings indicate a preference for less frequent feedback that does not overwhelm or disrupt the training experience. This could be particularly relevant for hearing-impaired users who might find continuous feedback too intrusive or distracting, especially if it relies on auditory cues that are less accessible to them. Developers might consider implementing customisable feedback options that allow users to select how and when they receive updates about their progress, thus tailoring the experience to individual preferences and needs. Requirements and Barriers to App Use The study highlighted the critical importance of ease of use and accessibility in App design, with both hearing-impaired participants and health professionals prioritising these aspects. Simple, intuitive App interfaces are essential, particularly for older adults who may not be as technologically savvy or who might face additional challenges due to hearing impairments. This is reflected by the hearing-impaired older adults rating the item “low self-efficacy” as the greatest barrier. Apps for this target group need to enable and empower their users to keep the motivation high. The significant differences in ratings regarding "Poor user-friendliness" and "High complexity of the App operation" suggest that while hearing-impaired users may find certain technological interfaces manageable, these factors still represent significant barriers that can hinder the effective use of mHealth solutions [e.g., 40; 41]. Developers must focus on reducing the complexity of the App’s operation, ensuring that features are straightforward and that help and support resources are readily available. Simplifying navigation and minimising the need for frequent adjustments or settings changes can make Apps more accessible and less intimidating for users with sensory impairments. Furthermore, ensuring that Apps are compatible with assistive technologies, such as screen readers or enhanced visual aids, can help bridge the gap between functional design and user needs. Data protection and safety Data protection and safety emerged as a unanimous concern among all study participants, underscoring the universal importance of securing sensitive personal information and ensuring safe use of the App and personal data. This emphasis is crucial not only for building trust but also for complying with legal standards concerning data security and privacy. Participants indicated a strong preference for features that ensure the confidentiality and integrity of data, such as secure login processes, encrypted data storage, and clear privacy policies that outline how data is collected, used, and shared. Additionally, safety features within the App, such as emergency contacts, alert systems for abnormal health readings, and easy access to support in case of difficulties during exercises, are vital. These features can provide users with the confidence to engage fully with the training program, knowing that safeguards are in place to protect them during use. This aspect is particularly critical for older adults who may be at increased risk of falls or other injuries during physical activities. Developers should incorporate robust safety protocols and consider integrating features that monitor user engagement and provide alerts or guidance when potentially risky situations are detected. Limitations This Delphi study has several limitations that could influence its outcomes and generalisability. Firstly, the diversity and size of the panel may limit the findings, comprising a specific group of health professionals and hearing-impaired older adults, therefore may not represent wider perspectives. Additionally, the response rates, particularly the low completion rate for the first round, might have skewed the consensus, affecting the reliability of the results. This also resulted in the problems to gain answers for the second round leading to a delay for the final round. Geographical limitations are notable since the participant pool was international with regards to the experts but located in Germany only for affected persons, possibly not reflecting the needs and conditions of broader, diverse populations in lower to middle income countries. Lastly, the study’s reliance on technology for conducting surveys might have excluded those with limited access to digital resources or less familiarity with such tools, further affecting the inclusiveness and breadth of the data collected. Study implications The study fills critical knowledge gaps by providing a better understanding on exercise preferences and needs of older adults with hearing impairments, highlighted the need of tailoring interventions to accommodate both the physical and sensory limitations. The findings provide an empirical basis for developing tailored, user-centered cognitive-motor training programs. Exercise professionals can use this information to refine their training protocols, incorporating preferred activities such as exercises involving music and adjustable intensity into their routines, which have been identified as less demanding and more enjoyable by hearing-impaired participants. Furthermore, technology represents a potential avenue for personalising training experiences. Future research should focus on developing and testing advanced assistive technologies that improve the accessibility and efficacy of these training programs. It is essential for developers to implement robust safety protocols and to include features that alert users to potential risks during exercises. Conducting clinical trials to explore the long-term impacts of these tailored programs on health outcomes, self-efficacy and quality of life are needed to evaluate their effectiveness. Conclusions Cognitive-motor training represents a holistic approach to addressing the complex challenges faced by older adults with hearing impairment. The personalised nature of the recommended exercises ensures that the training adheres to the specific sensory and physical needs of this population. This type of training not only aims to improve cognitive and physical function but also significantly improve overall quality of life. By integrating feedback from this population into the design of training programs, it is possible to support the wellbeing and independence of older adults with hearing impairment effectively. Abbreviations UCD User-centered design DT Dual-task Declarations Human Ethics and Consent to Participate Each survey round adhered to ethical standards outlined in the Declaration of Helsinki from 2018. The study was approved by the local ethics committee of the xx with the approval number: 2023_022. Funding Declaration This study was part of the project “xx” funded by the German Federal Ministry for Economic Affairs and Climate Protection in the central innovation program (BMW-ZIM) with the grant number xx. Clinical Trial Number As this study was not a clinical trial, a clinical trial number is not applicable. Consent to Publish declaration This study does not provide any details, images, or videos relating to an individual person so that a declaration is not required. Author Contribution BW and AW wrote the main mauscript with the help of MA and KD. The methodology was conducted by BW and AWE supervised by KD. Tabels and figures were conducted by BW and AW. All authors reviewed the manuscript. AW and KD serve as shared senior authors.Availability of data and materialsThe dataset(s) supporting the conclusions of this article is(are) included within the article (and its additional file(s)).Human Ethics and Consent to ParticipateEach survey round adhered to ethical standards outlined in the Declaration of Helsinki from 2018. The study was approved by the local ethics committee of the Universität Hamburg with the approval number: 2023_022.Funding DeclarationThis study was part of the project “GeHörBalance” funded by the German Federal Ministry for Economic Affairs and Climate Protection in the central innovation program (BMW-ZIM) with the grant number 16KN084649. Clinical Trial NumberAs this study was not a clinical trial, a clinical trial number is not applicable.Consent to Publish declarationThis study does not provide any details, images, or videos relating to an individual person so that a declaration is not required. Acknowledgement AcknowledgmentsWe are especially grateful for the support by Andrei Calin Berbec and the input of our project partners in the GehHörBalance project, Ralph Warnke and René Schüler. We thank all participants that want to remain anonymous and some of our experts in alphabetical order: Vera Belkin, Jacqueline Close, Catherine Dean, Eleftheria Giannouli, Hanin Karawani, Berit K. Labott, Antoine Langeard, Oron Levin, Stephen Lord, Daniela Meinrath, Jasmine Menant, Yael Netz, Carsten Passiel, Claudia Rodríguez-Aranda, Daniel Schoene, Daina Sturnieks, Morag Taylor. References Goman AM, Lin FR. Prevalence of hearing loss by severity in the United States. Am J Public Health. 2016;106(10):1820–2. World Health Organization. Deafness and hearing loss. [Internet]. 2024 [cited 2025 Mar 8]. Available from: https://www.who.int/news-room/fact-sheets/detail/deafness-and-hearing-loss Davis AC, Hoffman HJ. Hearing loss: rising prevalence and impact. Bull World Health Organ. 2019;97(10):646. Chang HP, Ho CY, Chou P. The factors associated with a self-perceived hearing handicap in elderly people with hearing impairment—results from a community-based study. 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Differences in auditory perception between young and older adults when controlling for differences in hearing loss and cognition. Trends Hear. 2022;26:23312165211066180. Chen DS, Genther DJ, Betz J, Lin FR. Association between hearing impairment and self-reported difficulty in physical functioning. J Am Geriatr Soc. 2014;62(5):850–6. Wollesen B, Scrivener K, Soles K, Billy Y, Leung A, Martin F, et al. Dual-task walking performance in older persons with hearing impairment: implications for interventions from a preliminary observational study. Ear Hear. 2018;39(2):337–43. Wunderlich A, Wollesen B, Asamoah J, Delbaere K, Li K. The impact of cognitive-motor interference on balance and gait in hearing-impaired older adults: a systematic review. Eur Rev Aging Phys Act. 2024;21(1):17. Lin FR, Ferrucci L. Hearing loss and falls among older adults in the United States. Arch Intern Med. 2012;172(4):369–71. Jiam NTL, Li C, Agrawal Y. Hearing loss and falls: a systematic review and meta-analysis. 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Fleming T, Dewhirst M, Haenga-O'Brien A, Chinn V, Ormerod F, Andreae H, et al. Digital tools for mental health and wellbeing: opportunities & impact. JMIR mHealth UHealth. 2024;12:1–10. Trevelyan EG, Robinson N. Delphi methodology in health research: how to do it? Eur J Integr Med. 2015;7(4):423–8. World Medical Association. WMA Declaration of Helsinki – Ethical principles for medical research involving human subjects. [Internet]. 2018 [cited 2025 Mar 8]. Available from: https://www.wma.net/policies-post/wma-declaration-of-helsinki/ Skulmoski GJ, Hartman FT, Krahn J. The Delphi method for graduate research. J Inf Technol Educ Res. 2007;6(1):1–21. Sibley KM, Thomas SM, Veroniki AA, Rodrigues M, Hamid JS, Lachance CC, et al. Comparative effectiveness of exercise interventions for preventing falls in older adults: a secondary analysis of a systematic review with network meta-analysis. Exp Gerontol. 2021;143:111151. Montero-Odasso M, Van Der Velde N, Martin FC, Petrovic M, Tan MP, Ryg J, et al. World guidelines for falls prevention and management for older adults: a global initiative. Age Ageing. 2022;51(9):afac205. Agmon M, Belza B, Nguyen HQ, Logsdon RG, Kelly VE. A systematic review of interventions conducted in clinical or community settings to improve dual-task postural control in older adults. Clin Interv Aging. 2014;9:477–92. Wollesen B, Wildbredt A, van Schooten KS, Lim ML, Delbaere K. The effects of cognitive-motor training interventions on executive functions in older people: a systematic review and meta-analysis. Eur Rev Aging Phys Act. 2020;17:1–22. Westlake KP, Culham EG. Sensory-specific balance training in older adults: effect on proprioceptive reintegration and cognitive demands. Phys Ther. 2007;87(10):1274–83. Zhang SL, Liu D, Yu DZ, Zhu YT, Xu WC, Tian E, et al. Multisensory exercise improves balance in people with balance disorders: a systematic review. Curr Med Sci. 2021;41:635–48. Van Wilderode M, Vermaete E, Francart T, Wouters J, van Wieringen A. Effectiveness of auditory training in experienced hearing-aid users, and an exploration of their health-related quality of life and coping strategies. Trends Hear. 2023;27:23312165231198380. Lelic D, Nielsen J, Parker D, Marchman Rønne F. Critical hearing experiences manifest differently across individuals: insights from hearing aid data captured in real-life moments. Int J Audiol. 2022;61(5):428–36. Meyer C, Hickson L. What factors influence help-seeking for hearing impairment and hearing aid adoption in older adults? Int J Audiol. 2012;51(2):66–74. Rieker JA, Reales JM, Muiños M, Ballesteros S. The effects of combined cognitive-physical interventions on cognitive functioning in healthy older adults: a systematic review and multilevel meta-analysis. Front Hum Neurosci. 2022;16:838968. Power V, Clifford AM. Characteristics of optimum falls prevention exercise programmes for community-dwelling older adults using the FITT principle. Eur Rev Aging Phys Act. 2013;10:95–106. Izquierdo M, Merchant RA, Morley JE, Anker SD, Aprahamian I, Arai H, et al. International exercise recommendations in older adults (ICFSR): expert consensus guidelines. J Nutr Health Aging. 2021;25(7):824–53. Fletcher MD. Using haptic stimulation to enhance auditory perception in hearing-impaired listeners. Expert Rev Med Devices. 2021;18(1):63–74. Netz Y, Yekutieli Z, Arnon M, Argov E, Tchelet K, Benmoha E, et al. Personalized exercise programs based upon remote assessment of motor fitness: a pilot study among healthy people aged 65 years and older. Gerontology. 2022;68(4):465–79. Pichora-Fuller MK, Singh G. Effects of age on auditory and cognitive processing: implications for hearing aid fitting and audiologic rehabilitation. Trends Amplif. 2006;10(1):29–59. Scheerens C, Gilissen J, Volow AM, Powell JL, Ferguson CM, Farrell D, et al. Developing eHealth tools for diverse older adults: lessons learned from the PREPARE for Your Care Program. J Am Geriatr Soc. 2021;69(10):2939–49. Liu N, Yin J, Tan SSL, Ngiam KY, Teo HH. Mobile health applications for older adults: a systematic review of interface and persuasive feature design. J Am Med Inform Assoc. 2021;28(11):2483–501. Additional Declarations No competing interests reported. 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Hearing impairment adversely impacts social and emotional well-being [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] and restricts daily activities and physical function [4; 5; 6; 7], thereby increasing the public health burden worldwide. Hearing impairment has been associated with declines in both cognitive [8; 9; 10] and physical function [11; 6], affecting gait and balance. This is evident during dual-task activities, which combine walking with a cognitive task [12; 13], potentially increasing the cognitive load and increasing the risk of falls [14; 15] - a leading cause of injury and loss of independence among older adults [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCognitive-motor interventions - often referred to as dual-task training - have been recommended to mitigate these risks [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. A systematic review and meta-analysis suggested that cognitive-motor interventions can strengthen executive function, including inhibitory control, working memory, and cognitive flexibility, as well as improve static and dynamic balance in older adults [17; 18]. These benefits are particularly relevant for those with age-related hearing impairment, as dual-task training addresses unique sensory and functional challenges by enhancing sensory integration alongside balance and cognitive function [19; 20].\u003c/p\u003e \u003cp\u003eDespite these benefits, existing research on dual-task training tailored for older adults with hearing impairments is limited. This population requires targeted strategies, such as auditory-based exercises that involve responding to tones while maintaining balance, rather than traditional balance training approaches. Furthermore, to date there is no consensus regarding the optimal design, intensity and progression of such interventions, as well as a lack of diagnostic tools needed to assess their efficacy.\u003c/p\u003e \u003cp\u003eAmidst the growing relevance of digital interventions in health promotion, mHealth programs provide an excellent opportunity for delivering such tailored interventions without the constraints of locations or time [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], reaching individuals who may not have access to gyms or physiotherapy services. Furthermore, the integration of motivating features such as progress tracking and gamification within mHealth applications have potential to maintain engagement and encourage long-term use. However, the effectiveness of these interventions relies on a user-centered design (UCD). UCD ensures that the program is easy to use, motivating [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], and accessible for those with cognitive or motor impairments.\u003c/p\u003e \u003cp\u003eLess is known about the specific requirements of older adults with hearing impairments to design a tailored mHealth intervention. Therefore, this study aims to address these gaps through a Delphi survey engaging both health professionals and participants with hearing or balance impairments. This research aims to identify and prioritise key training components, diagnostic tools and delivery methods. Based on this process we can establish a framework for evidence-based, user-centered mHealth training programs that enhance mobility, balance and cognitive function in older adults with hearing impairments.\u003c/p\u003e \u003cp\u003eAs a part of the \u0026ldquo;xx\u0026rdquo; project, the results contribute directly to the successful development of an innovative dual-task training App system that integrates auditory and motor exercises tailored to older adults with hearing impairment.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Delphi survey consisted of three rounds. There were open-ended questions in the first and second round and closed-ended questions in the second and third round following the guidelines provided by Trevelyan and Robinson [22]. This study integrated insights from health professional experts and older adults with hearing and/or balance impairment. The first survey round involved separate surveys for each participant group to address specific perspectives and complexities. Subsequent rounds integrated responses from both participant groups to refine and validate the findings. The respective surveys were provided in German or English. Each survey round adhered to ethical standards outlined in the Declaration of Helsinki [23]. Data collection was conducted online between December 2023 and July 2024.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSample size\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe study aimed to incorporate a broad range of expertise, inviting 220 international health and exercise science professionals and 30 adults with hearing impairments following the recommendations in the literature [22; 24].\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eInclusion criteria\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eParticipants included professionals with expertise in medical and therapeutic support relevant to older adults with hearing and/or balance impairments, exercise delivery in older adults with or without hearing impairment, and digital solutions for older adults. Older adults were required to be\u003cem\u003e\u0026nbsp;\u003c/em\u003eat least 50 years old, and either experiencing mild to moderately severe hearing loss or balance issues.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eIdentification of participants\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe participants\u003cem\u003e\u0026nbsp;\u003c/em\u003ewere identified through the broader network of the authors including colleagues and participants of former studies, or based on their authorship of published research articles in this area of interest. We also asked all recruited participants to indicate people they believed were suitable and who could be approached for participation in the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eStudy flow\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe initial recruitment and ongoing engagement were managed through personalised email communication and reminders to encourage complete participation across all survey rounds. Participant contributions were acknowledged in the study outputs, with all participants given the option to be listed in the acknowledgments section. This inclusive approach aimed to enhance the validity and applicability of the research findings to real-world settings.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSurvey process\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe surveys were administered using LimeSurvey software (LimeSurvey GmbH, Hamburg, Germany), ensuring data anonymity and security. The design and content of the surveys were pre-tested by volunteers, including hearing-impaired older adults, to ensure clarity and accessibility. The process involved initial email contact for recruitment, followed by electronic informed consent in a separate survey that, in a nested way only after agreement, led to an independent survey with the respective questions. This way, it was possible to keep all personal information (names, email addresses, consent) totally separate from the responses. Each survey phase was open for 2-3 weeks, with intervals of 2-4 weeks between rounds for data analysis and preparation of subsequent surveys.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEach Delphi round featured a structured online survey, accommodating both open and closed response formats.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRound 1 focused on gathering a broad range of opinions through open-ended questions covering training intervention characteristics, App functionality and barriers to implementation. Participants responded to questions across four blocks: training characteristics (n=7), program functionality (n=5), barriers and safety aspects (n=4) and additional comments and demographics (n=3). Hearing-impaired participants were specifically asked to outline their requirements and wishes, where applicable, ensuring tailored feedback directly from the target user group. More information is available in the supplemental materials.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRound 2 used a mixed format. First participants rated the relevance of each of the synthesised items from the first round on a 10-point Likert scale (10 points equals highest relevance). A following free-text response option allowed for participants to provide additional qualitative feedback, elaborate on their ratings, or highlight missing aspects. All items that were rated by at least 70% of the participants with a rating higher than 7.0 were summarised for final consensus in the third round. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRound 3 used closed-ended questions and aimed to reach a consensus by all participants, enabling us to define final recommendations for the App\u0026rsquo;s development. Participants were asked to specifically assess the features critical for the target user group of older hearing and/or balance impaired adults. Participants rated their agreement to all relevant items from round two on a 10-point scale from \u0026apos;totally disagree\u0026apos; to \u0026apos;totally agree\u0026apos;. This group agreement represents the consensus on the recommended features and training elements for the App. To highlight the importance of direct user input in the development of health-related technologies, the ratings provided by hearing-impaired participants were given particular emphasis. Items with an average rating of M = 7.0 or higher from this group were prioritised and listed in the final consensus tables. \u0026nbsp;\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eData analysis\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eQualitative data from the first and second rounds were analysed using thematic analysis to categorise responses following the inductive approach recommended by Mayring (2010). Quantitative analysis of the ratings in Rounds 2 and 3 involved calculating frequencies, means and standard deviations. Statistical differences between the responses of health professionals and hearing-impaired participants in round 3 were analysed by using one-way ANOVAs in SPSS (IBM SPSS Statistics, Armonk, NY, USA).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSample Characteristics\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe response rate for the first round was 14.4 %, and the rate of complete answers from total participation was 75%. The distribution of incomplete and complete answers are displayed next to the total participation per round and the distribution of professions among the participants are presented in Table 1. Out of a total of 250 participants, 36 confirmed the privacy policy in the first round. In the first round, the experts were a group of 10 females, 2 males, and 1 person who did not prefer to state their gender with an average age of 48.1 years ranging from 35 to 70 years. The group of older adults consisted of 8 females, 1 diverse person, and 4 males with an average age of 67.1 years ranging from 55 to 87 years. All responses from all three stages were included in the analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1 Overview of the participants of the Delphi surveys round 1-3\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"604\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 230px;\"\u003e\n \u003cp\u003eParticipation people affected\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003eImpairment\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eRound\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003eIncomplete\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003eComplete\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003eHearing impaired\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003eBalance impaired\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003eBoth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003eUnknown\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e2\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"604\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 225px;\"\u003e\n \u003cp\u003eParticipation health professional experts\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eProfession\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003eRound\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003eIncomplete\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003eComplete\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003eScientist\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003ePhysio- therapist\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003ePhysicist\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003eUnknown\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eResults from Round 1\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe qualitative analysis from the first round led to 148 different aspects regarding the training characteristics as well as the App\u0026rsquo;s design and functionality, as detailed in Table 2. Health professionals provided more feedback on training content, while hearing-impaired adults offered more insights on training characteristics and specific requirements for the App. Questions related to App features and functions elicited more qualitative responses from health professionals, whereas hearing-impaired participants commented more on issues about monitoring motor and hearing functions.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2 Overview of qualitative items related to the initial questions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"605\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 304px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eQuestion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of responses health professionals\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en (%) \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of responses hearing affected\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 304px;\"\u003e\n \u003cp\u003eWhat features of physical training or exercise would you recommend for the target group of older hearing-impaired and/or balance-impaired adults? Please explain your answer.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e43 (66.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e22 (33.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e65\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 304px;\"\u003e\n \u003cp\u003eWhat hearing exercise would you recommend for this target group of older hearing-impaired and/or balance-impaired adults? Please explain your answer.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e11 (73.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e4 (26.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e15\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 304px;\"\u003e\n \u003cp\u003eWhat exercises are clinically relevant for this target group? Please explain your answer.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e43 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e// (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e43\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 304px;\"\u003e\n \u003cp\u003eWhat recommendations would you give to combine physical and hearing exercises, e.g., as a Dual-task training? Please explain your answer.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e36 (90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e4 (10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e40\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 304px;\"\u003e\n \u003cp\u003ePlease outline the training type, intensity, \u003cstrong\u003efrequency\u003c/strong\u003e and training duration you recommend for this target group. Please explain your answer.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e10 (30.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e23 (69.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e33\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e6\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 304px;\"\u003e\n \u003cp\u003ePlease outline the training type, intensity, frequency and training\u003cstrong\u003e\u0026nbsp;duration\u003c/strong\u003e you recommend for this target group. Please explain your answer.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e12 (50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e12 (50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e24\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e7\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 304px;\"\u003e\n \u003cp\u003ePlease outline any training control parameters you would integrate into your treatment for this target group. Please explain your answer.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e15 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e// (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e15\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e8\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 304px;\"\u003e\n \u003cp\u003eHow should the\u003cstrong\u003e\u0026nbsp;instructions\u003c/strong\u003e for the training tasks be presented to the target group? What feedback would you integrate into the App? Please explain your answer.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e20 (40.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e29 (59.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e49\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e9\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 304px;\"\u003e\n \u003cp\u003eHow should the instructions for the training tasks be presented to the target group? What \u003cstrong\u003efeedback\u0026nbsp;\u003c/strong\u003econtent would you integrate into the App? Please explain your answer.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e8 (40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e20 (60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e28\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e10\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 304px;\"\u003e\n \u003cp\u003eHow should the instructions for the training tasks be presented to the target group? How would you present feedback in the App? Please explain your answer.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e// (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e23, 100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e23\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e11\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 304px;\"\u003e\n \u003cp\u003eWhat other function(s), e.g., gamification or reminders would you like to see included in an App? Please explain your answer.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e31 (75.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e10 (24.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e41\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e12\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 304px;\"\u003e\n \u003cp\u003eWhat specific requirements do we have to consider if we design an App or digital intervention to improve motor functioning and hearing for older people with hearing and/or balance impairments? Please explain your answer.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e26 (72.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e10 (27.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e36\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e13\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 304px;\"\u003e\n \u003cp\u003eWhat specific tests to measure motor function would you recommend integrating into the App? Please explain your answer.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e14 (40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e21 (60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e35\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e14\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 304px;\"\u003e\n \u003cp\u003eWhat specific tests to measure hearing performance would you recommend integrating into the App? Please explain your answer.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e3 (11.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e23 (88.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e26\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e15\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 304px;\"\u003e\n \u003cp\u003eCan you identify any barriers preventing people from following the recommendations provided in a training App that combines auditory training with movement exercises? Please explain your answer.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e30 (85.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e5 (14.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e35\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e16\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 304px;\"\u003e\n \u003cp\u003eWhat concerns do you have regarding the safety and privacy of the target group when using a training and therapy App? If so, do you have ideas on how those concerns can be addressed? Please consider the target group in your answer.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e21 (63.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e12 (36.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e33\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e17\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 304px;\"\u003e\n \u003cp\u003eWhat kind of data would you want to see in the back end of the App? How should this data be presented, interpreted, displayed? Please explain your answer.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e29 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e// (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e29\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSum\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 304px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e352(61.8)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e218(38,2)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e570\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eLegend: //= this question was not provided to the group in round 1\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults Round 2\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAfter clustering the answers of Round 1, all 148 items were reviewed by both groups in Round 2. Participants rated the relevance of these items using a 10-point Likert scale (10 points equals highest relevance), and the 113 items that were rated by 70% of all responders with at least a rating of 7.0 are presented in Table 3. That only 35 items were removed after Round 2 showed a high consensus among all responders. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3 Items per category transferred from round 2 into round 3\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"604\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 241px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 231px;\"\u003e\n \u003cp\u003eRound 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eRound 3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 241px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePhysical training or exercises\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 231px;\"\u003e\n \u003cp\u003e12 items\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e11 items\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 241px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHearing training or exercises\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 231px;\"\u003e\n \u003cp\u003e12 items\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e9 items\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 241px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDual-task training\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 231px;\"\u003e\n \u003cp\u003e12 items\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e7 items\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 241px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTraining frequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 231px;\"\u003e\n \u003cp\u003e8 items\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3 items\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 241px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTraining duration\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 231px;\"\u003e\n \u003cp\u003e5 items\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1 items\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 241px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTraining control measures\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 231px;\"\u003e\n \u003cp\u003e8 items\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e7 items\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 241px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInstruction presentation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 231px;\"\u003e\n \u003cp\u003e6 items\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e4 items\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 241px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFeedback content\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 231px;\"\u003e\n \u003cp\u003e7 items\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e6 items\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 241px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFeedback presentation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 231px;\"\u003e\n \u003cp\u003e6 items\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e5 items\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 241px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eApp functions\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 231px;\"\u003e\n \u003cp\u003e17 items\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e11 items\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 241px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eApp usability\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 231px;\"\u003e\n \u003cp\u003e15 items\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e15 items\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 241px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMotor function to monitor\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 231px;\"\u003e\n \u003cp\u003e6 items\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e6 items\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 241px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHearing function to monitor\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 231px;\"\u003e\n \u003cp\u003e9 items\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e9 items\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 241px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBarriers of an App\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 231px;\"\u003e\n \u003cp\u003e16 items\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e10 items\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 241px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSafety aspects\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 231px;\"\u003e\n \u003cp\u003e4 items\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e4 items\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 241px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInterface to professionals\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 231px;\"\u003e\n \u003cp\u003e5 items\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e5 items\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 241px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSummary of Items\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 231px;\"\u003e\n \u003cp\u003e148\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e113\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eResults Round 3\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 113 items were included in Round 3 for final consensus voting. Tables 4-7 present the final results for the ratings from both groups, organised across four categories: (1) training content, (2) feedback and monitoring, (3) App features and barriers, and (4) data protection and safety. Only seven items did not reach the consensus level of 7.0.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4 Agreement on the potential training contents of the DT training App\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"604\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 372px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eQuestion Item\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRating affected persons\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMean + SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRating Health professionals\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMean + SD\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 604px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eContent to improve motor performance\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 372px;\"\u003e\n \u003cp\u003eFlexibility exercises (e.g., gymnastics; specific exercises for foot flexibility)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e8.3 \u0026plusmn; 1.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e7.3 \u0026plusmn; 1.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 372px;\"\u003e\n \u003cp\u003eMovement combined with visual tasks (e.g., walking and observing something)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e8.2 \u0026plusmn; 1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e8.7 \u0026plusmn; 2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 372px;\"\u003e\n \u003cp\u003eMovement combined with coordination tasks (e.g., combining walking with arm movements)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e8.0 \u0026plusmn; 1.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e8.5 \u0026plusmn; 2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 372px;\"\u003e\n \u003cp\u003eCombined training exercises with strength, endurance, flexibility, and balance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e7.9 \u0026plusmn; 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e8.5 \u0026plusmn; 1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 372px;\"\u003e\n \u003cp\u003eEndurance exercises (e.g., walking)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e7.7 \u0026plusmn; 2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e8.0 \u0026plusmn; 2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 372px;\"\u003e\n \u003cp\u003eCombined strength and balance exercises for fall prevention\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e7.8 \u0026plusmn; 1.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e9.3 \u0026plusmn; 1\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 372px;\"\u003e\n \u003cp\u003eBalance exercises (e.g., longer one-legged stance or shifting positions from right to left leg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e7.8 \u0026plusmn; 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e9.5 \u0026plusmn; 0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 372px;\"\u003e\n \u003cp\u003eEveryday training tasks (e.g., getting up from a chair), functional training\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e7.5 \u0026plusmn; 2.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e9.1 \u0026plusmn; 2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 372px;\"\u003e\n \u003cp\u003eExergames (computer-based games that promote movement, especially balance and strength)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e7.5 \u0026plusmn; 2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e7.7 \u0026plusmn; 2.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 372px;\"\u003e\n \u003cp\u003eExercises with closed eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e7.5 \u0026plusmn; 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e8.3 \u0026plusmn; 1.2\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 604px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eContent to improve hearing performance\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 372px;\"\u003e\n \u003cp\u003eExercises for distinguishing multiple voices\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e7.8 \u0026plusmn; 2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e8.8 \u0026plusmn; 1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 372px;\"\u003e\n \u003cp\u003eListening exercises with background noise\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e7.7 \u0026plusmn; 2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 372px;\"\u003e\n \u003cp\u003eEveryday exercises (e.g., understanding content from a phone call)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e7.7 \u0026plusmn; 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e9.7 \u0026plusmn; 1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 372px;\"\u003e\n \u003cp\u003eCombination of multiple concurrent listening tasks (e.g., tracking different sound sequences)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e7.7 \u0026plusmn; 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e9.2 \u0026plusmn; 1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 372px;\"\u003e\n \u003cp\u003eExercises that involve both brain hemispheres (e.g., recognizing direction of a sound)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e7.4 \u0026plusmn; 2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e9.8 \u0026plusmn; 0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 372px;\"\u003e\n \u003cp\u003eExercises with and without hearing aids\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e7.2 \u0026plusmn; 2.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e9.5 \u0026plusmn; 1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 372px;\"\u003e\n \u003cp\u003eExercises for recognizing sound patterns or noises\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e7.2 \u0026plusmn; 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e9 \u0026plusmn; 1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 372px;\"\u003e\n \u003cp\u003eExercises for recognizing consonants\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e7.1 \u0026plusmn; 2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e8.7 \u0026plusmn; 1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 372px;\"\u003e\n \u003cp\u003eExercises for distinguishing pitch\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e7 \u0026plusmn; 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e9.3 \u0026plusmn; 1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 604px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eContent for DT exercises\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 372px;\"\u003e\n \u003cp\u003eNavigating complex environments (e.g., crossing a street)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e8.6 \u0026plusmn; 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e9.1 \u0026plusmn; 2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 372px;\"\u003e\n \u003cp\u003ePerforming exercises with music or background noise\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e8.4 \u0026plusmn; 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e8.1 \u0026plusmn; 2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 372px;\"\u003e\n \u003cp\u003eExercises in combination with self-efficacy training (gradually building confidence in one\u0026apos;s abilities)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e7.6 \u0026plusmn; 2.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e8.7 \u0026plusmn; 2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 372px;\"\u003e\n \u003cp\u003eHaving conversations while walking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e7.6 \u0026plusmn; 2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e8.9 \u0026plusmn; 1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 372px;\"\u003e\n \u003cp\u003eListening tasks during balance exercises (static, e.g., standing on one leg for an extended period, and dynamic, e.g., switching from right to left leg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e7.3 \u0026plusmn; 2.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e9.1 \u0026plusmn; 1\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 372px;\"\u003e\n \u003cp\u003eExergames: computer-based games that promote movement (e.g., combining balance and hearing abilities)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e7.3 \u0026plusmn; 2.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e8.1 \u0026plusmn; 2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 372px;\"\u003e\n \u003cp\u003eEveryday exercises (e.g., walking and using the phone)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e7 \u0026plusmn; 2.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e9.6 \u0026plusmn; 1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 604px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eContent for training design (training characteristics; principles)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 372px;\"\u003e\n \u003cp\u003eAdjustment of training intensity (e.g., complexity of tasks) based on individual physical performance and hearing ability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e8.6 \u0026plusmn; 1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e9.4 \u0026plusmn; 0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 372px;\"\u003e\n \u003cp\u003eIncrease in training difficulty based on individual improvements\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e8.2 \u0026plusmn; 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e9.1 \u0026plusmn; 1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 372px;\"\u003e\n \u003cp\u003eAdjustment of training volume (e.g., duration of training sessions) based on recommendations for fall prevention\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e8.3 \u0026plusmn; 1.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e8.7 \u0026plusmn; 2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 372px;\"\u003e\n \u003cp\u003eAdjustment of training volume (e.g., duration of training sessions) based on individual physical and cognitive performance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e8.0 \u0026plusmn; 2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e8.8 \u0026plusmn; 2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 372px;\"\u003e\n \u003cp\u003eRecording of training participation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e7.8 \u0026plusmn; 2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e8.7 \u0026plusmn; 1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 372px;\"\u003e\n \u003cp\u003e4-5 times per week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e7.7 \u0026plusmn; 2.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e8.4 \u0026plusmn; 2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 372px;\"\u003e\n \u003cp\u003eRegular tests to assess individual physical fitness and hearing ability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e7.5 \u0026plusmn; 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e7.3 \u0026plusmn; 2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 372px;\"\u003e\n \u003cp\u003eTraining cycle of at least 20 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e7.3 \u0026plusmn;2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e7.5 \u0026plusmn; 2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eTraining contents.\u003c/em\u003e The analysis revealed notable differences in how health professional experts and hearing-impaired older adults rated training components. Health professionals typically rated motor-related items, such as \u0026ldquo;Combined strength and balance exercises for fall prevention\u0026rdquo; (F(1,22)= 5.307; p=0.031) and \u0026ldquo;Exercises with closed eyes\u0026rdquo; (F(1,22)= 8.208; p=0.009), significantly higher than hearing-impaired participants (cf. Table 4). Similar trends were observed for hearing-related items \u0026ldquo;Listening exercises with background noise\u0026rdquo; (F(1,17)= 6.243; p=0.025), \u0026ldquo;Exercises with and without hearing aids\u0026rdquo; (F(1,17)= 5.676; p=0.031) and \u0026ldquo;Exercises for distinguishing pitch\u0026rdquo; (F(1,16)= 6.427; p=0.023). The dual-task (DT) training items, such as \u0026ldquo;Listening tasks during balance exercises (static, e.g., standing on one leg for an extended period, and dynamic, e.g., switching from right to left leg)\u0026rdquo; (F(1,20)= 4.675; p=0.044) and \u0026ldquo;Everyday exercises\u0026rdquo; (e.g., walking and using the phone) (F(1,20)= 4.675; p=0.044), ratings from health professionals were also higher. Conversely, \u0026ldquo;Flexibility exercises (e.g., gymnastics; specific exercises for foot flexibility)\u0026rdquo; and \u0026ldquo;Performing exercises with music or background noise\u0026rdquo; received higher ratings from hearing-impaired older adults compared to the health professional experts, but this difference was not significant. Items that did not meet the threshold of a 7.0 rating, such as \u0026ldquo;Strength exercises (e.g., squats)\u0026rdquo; were excluded from the final recommendations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5 Agreement on training instruction, feedback and monitoring\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"604\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 372px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eQuestion Item\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRating Hearing affected person\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMean + SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRating Health professionals\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMean + SD\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 604px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eInstruction\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 372px;\"\u003e\n \u003cp\u003eCombination of short videos and explanatory text\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e8.5 \u0026plusmn; 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e9.6 \u0026plusmn; 0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 372px;\"\u003e\n \u003cp\u003eCombination of images and text\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e8 \u0026plusmn; 2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e8.7 \u0026plusmn; 2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 372px;\"\u003e\n \u003cp\u003eShort videos\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e7.7 \u0026plusmn;2.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e8.6 \u0026plusmn; 0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 372px;\"\u003e\n \u003cp\u003eImages\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e7.2 \u0026plusmn; 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e7.6 \u0026plusmn; 2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 604px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eFeedback\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 372px;\"\u003e\n \u003cp\u003eAvailable at any time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e8.4 \u0026plusmn; 1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e7.9 \u0026plusmn; 2.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 372px;\"\u003e\n \u003cp\u003eFeedback on current performance compared to the goal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e8.1 \u0026plusmn; 1.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e8.6 \u0026plusmn; 2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 372px;\"\u003e\n \u003cp\u003ePresentation format: Visual (e.g., pop up of points gained)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e8 \u0026plusmn; 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e7.6 \u0026plusmn; 2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 372px;\"\u003e\n \u003cp\u003eFeedback on current performance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e7.8 \u0026plusmn; 1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e8.8 \u0026plusmn; 0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 372px;\"\u003e\n \u003cp\u003eCorrection during the execution of exercises\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e7.6 \u0026plusmn; 2.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e8.9 \u0026plusmn; 1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 372px;\"\u003e\n \u003cp\u003eFeedback on current exercise progress (e.g., number of exercises completed)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e7.5 \u0026plusmn; 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e8.4 \u0026plusmn; 1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 372px;\"\u003e\n \u003cp\u003eFeedback Timing: Weekly\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e7.3 \u0026plusmn; 2.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e7.6 \u0026plusmn; 2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 372px;\"\u003e\n \u003cp\u003eFeedback after each session\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e7.1 \u0026plusmn; 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e7.6 \u0026plusmn; 3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 372px;\"\u003e\n \u003cp\u003eFeedback on the difficulty level of the exercise\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e7.1 \u0026plusmn; 1.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e8 \u0026plusmn; 2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 604px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eMonitoring\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 372px;\"\u003e\n \u003cp\u003eHearing everyday sounds despite various background noises\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e8.9 \u0026plusmn; 1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e9.5 \u0026plusmn; 1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 372px;\"\u003e\n \u003cp\u003eHearing everyday sounds, hearing threshold (e.g., PTA)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e8.8 \u0026plusmn;1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e9.5 \u0026plusmn; 1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 372px;\"\u003e\n \u003cp\u003eSpeech discrimination\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e8.7 \u0026plusmn; 1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e9.8 \u0026plusmn; 0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 372px;\"\u003e\n \u003cp\u003eWord recognition in background noise\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e8.7 \u0026plusmn; 1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 372px;\"\u003e\n \u003cp\u003eRisk of falls\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e8.6 \u0026plusmn; 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e9.4 \u0026plusmn; 0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 372px;\"\u003e\n \u003cp\u003eNumber of steps per day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e8.1 \u0026plusmn; 2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e8.1 \u0026plusmn;1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 372px;\"\u003e\n \u003cp\u003eSound localization\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e8.2 \u0026plusmn; 1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e9.8 \u0026plusmn; 0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 372px;\"\u003e\n \u003cp\u003eRecognition of the content of spoken words\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e8.1 \u0026plusmn; 3.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 372px;\"\u003e\n \u003cp\u003eLeg mobility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e8 \u0026plusmn; 2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e7.3 \u0026plusmn; 1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 372px;\"\u003e\n \u003cp\u003ePostural stability/balance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e8 \u0026plusmn; 2.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e9.2 \u0026plusmn; 0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 372px;\"\u003e\n \u003cp\u003eReaction speed to signals\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e7.8 \u0026plusmn; 2.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e8.6 \u0026plusmn; 0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 372px;\"\u003e\n \u003cp\u003eCombination of strength, balance, and gait (e.g., SPPB or TUG)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e7.7 \u0026plusmn; 2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e9.3 \u0026plusmn; 0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 372px;\"\u003e\n \u003cp\u003eSensitivity to tone discrimination\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e7.7 \u0026plusmn; 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e9.3 \u0026plusmn; 1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 372px;\"\u003e\n \u003cp\u003eAuditory memory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e7.6 \u0026plusmn; 2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e9.3 \u0026plusmn; 1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 372px;\"\u003e\n \u003cp\u003eGait analysis (e.g., speed, posture, safety)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e7.4 \u0026plusmn; 2.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e8.2 \u0026plusmn; 0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eFeedback and monitoring.\u003c/em\u003e The item \u0026ldquo;Feedback Available at any time\u0026rdquo; was the only item that was rated higher by the hearing-impaired older adults compared to the health professional experts, although this difference was not statistically significant (cf. Table 5). The item \u0026ldquo;Presentation of performance curves\u0026rdquo; received an average rating of 5.8 \u0026plusmn; 2.6 points from the hearing impaired and 8.0 \u0026plusmn; 1.0 points by the health professional experts (F(1,20)= 5.970; p=0.027). \u0026nbsp; Similarly, the item \u0026ldquo;Feedback after each exercise\u0026rdquo; was also excluded, because the score was \u0026lt;7 in both groups. Within the section for Monitoring, the item \u0026ldquo;Leg Mobility\u0026ldquo; was rated higher by the hearing-impaired older adults but did not reach significance.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6 App requirements, user barriers and features\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"603\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 381px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eQuestion Item\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRating Hearing affected person\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMean + SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRating Health professionals\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMean + SD\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 603px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRequirements of the App design and its functionalities\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 381px;\"\u003e\n \u003cp\u003eOptions for integrating personal hearing aids\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e9.1 \u0026plusmn; 1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e8.7 \u0026plusmn;1.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 381px;\"\u003e\n \u003cp\u003eEase of use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e9.1 \u0026plusmn;1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e9.3 \u0026plusmn; 1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 381px;\"\u003e\n \u003cp\u003eUser manual\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e9 \u0026plusmn; 1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e7.1 \u0026plusmn;2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 381px;\"\u003e\n \u003cp\u003eCompatibility with existing devices\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e9 \u0026plusmn; 1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e9 \u0026plusmn; 1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 381px;\"\u003e\n \u003cp\u003eEasily understandable instructions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e8.9 \u0026plusmn; 1.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 381px;\"\u003e\n \u003cp\u003eSupport for learning how to use the App upon initial use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e8.8 \u0026plusmn; 1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e9.2 \u0026plusmn; 1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 381px;\"\u003e\n \u003cp\u003eExercises that are enjoyable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e8.7 \u0026plusmn; 1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e8.9 \u0026plusmn; 1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 381px;\"\u003e\n \u003cp\u003eOption to receive technical support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e8.7 \u0026plusmn; 1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e9.1 \u0026plusmn; 1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 381px;\"\u003e\n \u003cp\u003eSimple graphics for monitoring progress\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e8.4 \u0026plusmn; 1.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e9.3 \u0026plusmn; 1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 381px;\"\u003e\n \u003cp\u003eSimple tests to assess hearing ability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e8.4 \u0026plusmn; 1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e8.8 \u0026plusmn; 1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 381px;\"\u003e\n \u003cp\u003eInstructions for creating a safe training environment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e8.3 \u0026plusmn;2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e9.4 \u0026plusmn; 0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 381px;\"\u003e\n \u003cp\u003eSimple tests to assess physical fitness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e8.1 \u0026plusmn;1.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e9.1 \u0026plusmn;0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 381px;\"\u003e\n \u003cp\u003eSimple barrier-free design (e.g., large letters and input buttons)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e8 \u0026plusmn; 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e9.4 \u0026plusmn; 0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 381px;\"\u003e\n \u003cp\u003eMovement tracking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e8 \u0026plusmn; 1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e7.7 \u0026plusmn; 1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 381px;\"\u003e\n \u003cp\u003eOption for training without additional functions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e7.4 \u0026plusmn; 2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e9.1 \u0026plusmn; 1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 603px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBarriers for users\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 381px;\"\u003e\n \u003cp\u003eLow self-efficacy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e8.3 \u0026plusmn; 2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e8.4 \u0026plusmn; 1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 381px;\"\u003e\n \u003cp\u003ePoor user-friendliness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e7.6 \u0026plusmn; 2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e9.8 \u0026plusmn; 0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 381px;\"\u003e\n \u003cp\u003eLack of clear or absent rationale for recommendations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e8 \u0026plusmn; 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e8 \u0026plusmn; 2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 381px;\"\u003e\n \u003cp\u003eFeeling overwhelmed/Frustration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e7.8 \u0026plusmn; 2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e9.2 \u0026plusmn; 1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 381px;\"\u003e\n \u003cp\u003eToo high complexity of the App and its operation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e7.3 \u0026plusmn; 2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e9.8 \u0026plusmn; 0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 381px;\"\u003e\n \u003cp\u003eTime and opportunity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e7 \u0026plusmn; 2.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e7.9 \u0026plusmn; 2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 603px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eFunctionalities and features\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 381px;\"\u003e\n \u003cp\u003eOpportunities for networking with medical care (e.g., personal counseling)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e8.3 \u0026plusmn; 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e8.8 \u0026plusmn;1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 381px;\"\u003e\n \u003cp\u003eButtons for repeating instructions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e8.3 \u0026plusmn; 2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e9.6 \u0026plusmn; 0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 381px;\"\u003e\n \u003cp\u003eOption to select the format (verbal, video, or written) for exercise instructions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e7.9 \u0026plusmn; 2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e9.8 \u0026plusmn; 0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 381px;\"\u003e\n \u003cp\u003eReminder function\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e7.8 \u0026plusmn; 1.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e8.3 \u0026plusmn; 2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 381px;\"\u003e\n \u003cp\u003eDisplay of current heart rate and calorie expenditure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e7.9 \u0026plusmn; 3.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e6.1 \u0026plusmn; 2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 381px;\"\u003e\n \u003cp\u003eInformation on techniques for behavior change\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e7.4 \u0026plusmn;2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e7 \u0026plusmn;2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 381px;\"\u003e\n \u003cp\u003eInformation material on hearing impairment and balance difficulties\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e7.6 \u0026plusmn; 2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e6.8 \u0026plusmn;2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 381px;\"\u003e\n \u003cp\u003eInformation on how training adjustments are made\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e7.6 \u0026plusmn;1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e8.4 \u0026plusmn; 2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 381px;\"\u003e\n \u003cp\u003eSpecific elements to enhance motivation (e.g., positive messages)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e7.4 \u0026plusmn; 2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e8.8 \u0026plusmn;1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 381px;\"\u003e\n \u003cp\u003eOption to select the format (verbal, video, or written) for exercise feedback\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e7.3 \u0026plusmn; 3.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e9.3 \u0026plusmn; 1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eApp features and barriers\u003c/em\u003e. The following items, identified under barriers to using a training App, had significant differences: \u0026ldquo;Poor user-friendliness\u0026rdquo; (F(1,20)= 7.143; p=0.017) and \u0026ldquo;Too high complexity of the App and its operation\u0026rdquo; (F(1,20)= 6.368; p=0.022) and showed lower ratings by hearing-impaired adults (cf. Table 6). \u0026ldquo;Too high complexity of the App and its operation\u0026rdquo;, along with \u0026ldquo;incompatibility with older smartphone models\u0026rdquo;, \u0026ldquo;Lack of technology/equipment\u0026rdquo;, \u0026ldquo;Low willingness to use smartphones\u0026rdquo; and \u0026ldquo;Visual impairment\u0026rdquo; were excluded due to ratings \u0026lt;7 by the hearing-impaired adults. The feature \u0026ldquo;Option to select the format (verbal, video, or written) for exercise instructions\u0026rdquo; differed between the two groups (F(1,20)= 5.985; p=0.027), with higher ratings from the health professionals. The items \u0026ldquo;Gamification elements (e.g., high scores, rewards for participation and achievements, etc.)\u0026rdquo; and \u0026ldquo;Competitions with other users\u0026rdquo; were excluded due to scores \u0026lt;7 by the hearing-impaired older adults.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 7 Data protection and safety\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"603\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 380px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eQuestion Item\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRating Hearing affected person\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMean + SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRating Health professionals\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMean + SD\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 380px;\"\u003e\n \u003cp\u003eSafety instructions for use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e8.6 \u0026plusmn; 1.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e8.9 \u0026plusmn; 1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 380px;\"\u003e\n \u003cp\u003eSafety instructions during training, warnings\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e8.1 \u0026plusmn; 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e8.9 \u0026plusmn; 1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 603px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVoluntary submission of data to professionals\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 380px;\"\u003e\n \u003cp\u003ePhysical fitness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e8.2 \u0026plusmn; 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e8.6 \u0026plusmn; 1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 380px;\"\u003e\n \u003cp\u003eTraining results/success\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e8.1 \u0026plusmn; 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e8.7 \u0026plusmn; 2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 380px;\"\u003e\n \u003cp\u003eTraining participation/duration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e8 \u0026plusmn; 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e9.4 \u0026plusmn; 1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 380px;\"\u003e\n \u003cp\u003eThresholds for clinically relevant changes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e7.7 \u0026plusmn; 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e9.3 \u0026plusmn; 1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 380px;\"\u003e\n \u003cp\u003eUser satisfaction feedback\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e7 \u0026plusmn; 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e8.1 \u0026plusmn; 2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eData protection and safety\u003c/em\u003e. All data protection items were rated higher by the health professionals. However, the item \u0026ldquo;Legal data protection including information about the collection and use of personal data\u0026rdquo; was removed due to an overall rating \u0026lt;7, reflecting possible concerns or differing priorities between the groups regarding data security measures.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study used a Delphi process to explore the design needs for an mHealth App aimed at cognitive-motor training for older adults with hearing impairments. By involving both health professionals and the target demographic, this research sought to create a robust, evidence-based framework that addresses the unique challenges this group faces in maintaining mobility, balance and cognitive function. The results from the third round of the Delphi process highlighted critical insights into the consensus and discrepancies between health professional experts and hearing-impaired older adults. Notably, there were significant differences in the perceived importance of various training components, particularly those related to motor functions, hearing capabilities and DT training.\u003c/p\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eTraining components and characteristics\u003c/h2\u003e \u003cp\u003eConsensus across both participant groups underscored the inclusion of traditional falls prevention exercises (including walking, strength and balance exercises), confirming their evidence-based role in physical health [e.g., 25; 26]. Moreover, DT training was rated to be highly relevant, which helps to increase cognitive and motor performance [27; 28; 17].\u003c/p\u003e \u003cp\u003eDistinct preferences became apparent in the assessment of specific exercises. Health professionals frequently rated complex exercises like \"Combined strength and balance exercises for fall prevention\" and \"Exercises with closed eyes\" higher than the hearing-impaired participants. This disparity suggests a professional inclination towards comprehensive, sensory-challenging protocols that may not resonate as strongly with hearing-impaired individuals, who might view these exercises as overly demanding or inaccessible without additional support [e.g., 29; 30].\u003c/p\u003e \u003cp\u003eFor the hearing-related aspects, items such as \"Listening exercises with background noise\", \"Exercises with and without hearing aids\", and \"Exercises for distinguishing pitch\" received higher ratings from health professionals, reflecting a recognition of the importance of practicing in varied auditory environments to enhance real-world functional hearing [31; 32]. However, hearing-impaired participants often rated these tasks lower, possibly indicating perceived difficulties or lesser relevance, highlighting a gap between expert recommendations and user preferences [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFor the DT component, the items \"Listening tasks during balance exercises\u0026rdquo; and \"Everyday exercises\" (e.g., walking and using the phone) also exhibited significant differences. Health professionals rated these dual-task exercises higher, emphasizing the integration of cognitive and physical tasks more than the hearing-impaired participants, who might prioritise immediate auditory comfort over potential cognitive benefits [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. On the other hand, hearing-impaired participants may have been less inclined to view these exercises as necessary, especially if they perceive balance and cognitive training to be secondary to their hearing needs [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe exclusion of \"Strength exercises (e.g., squats)\" from the program due to low ratings underscores a consensus that these may not be essential for the targeted training goals of hearing-impaired older adults. Similarly, the omission of specified frequent training sessions reflects practical concerns about the feasibility of intensive regimens for this group, highlighting the need for adaptable training schedules that accommodate individual capabilities and lifestyle needs [35; 36]. However, the results indicate, that more knowledge on exercise physiology might benefit future applications. Frequent training sessions stimulate neuroplasticity, enhancing both cognitive and motor functions, which is crucial for older adults facing sensory deficits. The intensity of the exercises should match the individual's abilities, gradually increasing to ensure engagement without overwhelming participants. For those with hearing impairments, exercises should challenge their cognitive abilities, especially since auditory deficits may require additional focus on visual or tactile cues [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. The duration of sessions and total training time must be balanced to avoid fatigue while still providing adequate stimulation for cognitive and physical benefits. The types of exercises should be varied, incorporating cognitive and motor tasks tailored to each individual's needs, particularly considering hearing loss. Moreover, individualisation ensures that training programs are personalised to the participant's specific cognitive and physical abilities, increasing engagement and effectiveness [eg., 38]. Moreover, personalised approaches might reduce frustration and improve long-term adherence to training. These aspects might also align with feedback and training instruction.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eTraining Instruction, Feedback and Monitoring\u003c/h2\u003e \u003cp\u003eFeedback preferences within the study revealed a significant trend: hearing-impaired participants particularly valued the option for \"Feedback available at any time\". This preference underscores the importance of adaptable feedback mechanisms that can be accessed on-demand, aligning with the fluctuating needs and capacities of hearing-impaired older adults. Such flexibility not only enhances user autonomy but also accommodates the variable nature of hearing impairments, which may affect a person\u0026rsquo;s ability to engage with the training program consistently [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Conversely, the relatively low interest in \"Presentation of performance curves\" and \"Feedback after each exercise\" suggests a nuanced approach to feedback is necessary, especially as the variability in the response behavior was rather high. These findings indicate a preference for less frequent feedback that does not overwhelm or disrupt the training experience. This could be particularly relevant for hearing-impaired users who might find continuous feedback too intrusive or distracting, especially if it relies on auditory cues that are less accessible to them. Developers might consider implementing customisable feedback options that allow users to select how and when they receive updates about their progress, thus tailoring the experience to individual preferences and needs.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eRequirements and Barriers to App Use\u003c/h2\u003e \u003cp\u003eThe study highlighted the critical importance of ease of use and accessibility in App design, with both hearing-impaired participants and health professionals prioritising these aspects. Simple, intuitive App interfaces are essential, particularly for older adults who may not be as technologically savvy or who might face additional challenges due to hearing impairments. This is reflected by the hearing-impaired older adults rating the item \u0026ldquo;low self-efficacy\u0026rdquo; as the greatest barrier. Apps for this target group need to enable and empower their users to keep the motivation high. The significant differences in ratings regarding \"Poor user-friendliness\" and \"High complexity of the App operation\" suggest that while hearing-impaired users may find certain technological interfaces manageable, these factors still represent significant barriers that can hinder the effective use of mHealth solutions [e.g., 40; 41]. Developers must focus on reducing the complexity of the App\u0026rsquo;s operation, ensuring that features are straightforward and that help and support resources are readily available. Simplifying navigation and minimising the need for frequent adjustments or settings changes can make Apps more accessible and less intimidating for users with sensory impairments. Furthermore, ensuring that Apps are compatible with assistive technologies, such as screen readers or enhanced visual aids, can help bridge the gap between functional design and user needs.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eData protection and safety\u003c/h2\u003e \u003cp\u003eData protection and safety emerged as a unanimous concern among all study participants, underscoring the universal importance of securing sensitive personal information and ensuring safe use of the App and personal data. This emphasis is crucial not only for building trust but also for complying with legal standards concerning data security and privacy. Participants indicated a strong preference for features that ensure the confidentiality and integrity of data, such as secure login processes, encrypted data storage, and clear privacy policies that outline how data is collected, used, and shared. Additionally, safety features within the App, such as emergency contacts, alert systems for abnormal health readings, and easy access to support in case of difficulties during exercises, are vital. These features can provide users with the confidence to engage fully with the training program, knowing that safeguards are in place to protect them during use. This aspect is particularly critical for older adults who may be at increased risk of falls or other injuries during physical activities. Developers should incorporate robust safety protocols and consider integrating features that monitor user engagement and provide alerts or guidance when potentially risky situations are detected.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThis Delphi study has several limitations that could influence its outcomes and generalisability. Firstly, the diversity and size of the panel may limit the findings, comprising a specific group of health professionals and hearing-impaired older adults, therefore may not represent wider perspectives. Additionally, the response rates, particularly the low completion rate for the first round, might have skewed the consensus, affecting the reliability of the results. This also resulted in the problems to gain answers for the second round leading to a delay for the final round.\u003c/p\u003e \u003cp\u003eGeographical limitations are notable since the participant pool was international with regards to the experts but located in Germany only for affected persons, possibly not reflecting the needs and conditions of broader, diverse populations in lower to middle income countries. Lastly, the study\u0026rsquo;s reliance on technology for conducting surveys might have excluded those with limited access to digital resources or less familiarity with such tools, further affecting the inclusiveness and breadth of the data collected.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eStudy implications\u003c/h2\u003e \u003cp\u003eThe study fills critical knowledge gaps by providing a better understanding on exercise preferences and needs of older adults with hearing impairments, highlighted the need of tailoring interventions to accommodate both the physical and sensory limitations. The findings provide an empirical basis for developing tailored, user-centered cognitive-motor training programs. Exercise professionals can use this information to refine their training protocols, incorporating preferred activities such as exercises involving music and adjustable intensity into their routines, which have been identified as less demanding and more enjoyable by hearing-impaired participants. Furthermore, technology represents a potential avenue for personalising training experiences. Future research should focus on developing and testing advanced assistive technologies that improve the accessibility and efficacy of these training programs. It is essential for developers to implement robust safety protocols and to include features that alert users to potential risks during exercises. Conducting clinical trials to explore the long-term impacts of these tailored programs on health outcomes, self-efficacy and quality of life are needed to evaluate their effectiveness.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eCognitive-motor training represents a holistic approach to addressing the complex challenges faced by older adults with hearing impairment. The personalised nature of the recommended exercises ensures that the training adheres to the specific sensory and physical needs of this population. This type of training not only aims to improve cognitive and physical function but also significantly improve overall quality of life. By integrating feedback from this population into the design of training programs, it is possible to support the wellbeing and independence of older adults with hearing impairment effectively.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eUCD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 510px;\"\u003e\n \u003cp\u003eUser-centered design\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eDT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 510px;\"\u003e\n \u003cp\u003eDual-task\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eHuman Ethics and Consent to Participate\u003c/h2\u003e\n\u003cp\u003eEach survey round adhered to ethical standards outlined in the Declaration of Helsinki from 2018. The study was approved by the local ethics committee of the xx with the approval number: 2023_022.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eFunding Declaration\u003c/h2\u003e\n\u003cp\u003eThis study was part of the project \u0026ldquo;xx\u0026rdquo; funded by the German Federal Ministry for Economic Affairs and Climate Protection in the central innovation program (BMW-ZIM) with the grant number xx. \u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eClinical Trial Number\u003c/h2\u003e\n\u003cp\u003eAs this study was not a clinical trial, a clinical trial number is not applicable.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eConsent to Publish declaration\u003c/h2\u003e\n\u003cp\u003eThis study does not provide any details, images, or videos relating to an individual person so that a declaration is not required.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eBW and AW wrote the main mauscript with the help of MA and KD. The methodology was conducted by BW and AWE supervised by KD. Tabels and figures were conducted by BW and AW. All authors reviewed the manuscript. AW and KD serve as shared senior authors.Availability of data and materialsThe dataset(s) supporting the conclusions of this article is(are) included within the article (and its additional file(s)).Human Ethics and Consent to ParticipateEach survey round adhered to ethical standards outlined in the Declaration of Helsinki from 2018. The study was approved by the local ethics committee of the Universit\u0026auml;t Hamburg with the approval number: 2023_022.Funding DeclarationThis study was part of the project \u0026ldquo;GeH\u0026ouml;rBalance\u0026rdquo; funded by the German Federal Ministry for Economic Affairs and Climate Protection in the central innovation program (BMW-ZIM) with the grant number 16KN084649. Clinical Trial NumberAs this study was not a clinical trial, a clinical trial number is not applicable.Consent to Publish declarationThis study does not provide any details, images, or videos relating to an individual person so that a declaration is not required.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eAcknowledgmentsWe are especially grateful for the support by Andrei Calin Berbec and the input of our project partners in the GehH\u0026ouml;rBalance project, Ralph Warnke and Ren\u0026eacute; Sch\u0026uuml;ler. We thank all participants that want to remain anonymous and some of our experts in alphabetical order: Vera Belkin, Jacqueline Close, Catherine Dean, Eleftheria Giannouli, Hanin Karawani, Berit K. Labott, Antoine Langeard, Oron Levin, Stephen Lord, Daniela Meinrath, Jasmine Menant, Yael Netz, Carsten Passiel, Claudia Rodr\u0026iacute;guez-Aranda, Daniel Schoene, Daina Sturnieks, Morag Taylor.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eGoman AM, Lin FR. Prevalence of hearing loss by severity in the United States. Am J Public Health. 2016;106(10):1820\u0026ndash;2. \u003c/li\u003e\n\u003cli\u003eWorld Health Organization. Deafness and hearing loss. [Internet]. 2024 [cited 2025 Mar 8]. Available from: https://www.who.int/news-room/fact-sheets/detail/deafness-and-hearing-loss \u003c/li\u003e\n\u003cli\u003eDavis AC, Hoffman HJ. Hearing loss: rising prevalence and impact. Bull World Health Organ. 2019;97(10):646. \u003c/li\u003e\n\u003cli\u003eChang HP, Ho CY, Chou P. The factors associated with a self-perceived hearing handicap in elderly people with hearing impairment\u0026mdash;results from a community-based study. Ear Hear. 2009;30(5):576\u0026ndash;83. \u003c/li\u003e\n\u003cli\u003eGopinath B, McMahon CM, Burlutsky G, Mitchell P. Hearing and vision impairment and the 5-year incidence of falls in older adults. Age Ageing. 2016;45(3):409\u0026ndash;14. \u003c/li\u003e\n\u003cli\u003eGispen FE, Chen DS, Genther DJ, Lin FR. Association between hearing impairment and lower levels of physical activity in older adults. J Am Geriatr Soc. 2014;62(8):1427\u0026ndash;33. \u003c/li\u003e\n\u003cli\u003eMick P, Kawachi I, Lin FR. The association between hearing loss and social isolation in older adults. Otolaryngol Head Neck Surg. 2014;150(3):378\u0026ndash;84. \u003c/li\u003e\n\u003cli\u003eValentijn SA, Van Boxtel MP, Van Hooren SA, Bosma H, Beckers HJ, Ponds RW, et al. Change in sensory functioning predicts change in cognitive functioning: results from a 6-year follow-up in the Maastricht Aging Study. J Am Geriatr Soc. 2005;53(3):374\u0026ndash;80. \u003c/li\u003e\n\u003cli\u003eLin FR. Hearing loss and cognition in older adults: implications for dementia. JAMA Intern Med. 2011;171(16):1454\u0026ndash;5. \u003c/li\u003e\n\u003cli\u003eLentz JJ, Humes LE, Kidd GR. Differences in auditory perception between young and older adults when controlling for differences in hearing loss and cognition. Trends Hear. 2022;26:23312165211066180. \u003c/li\u003e\n\u003cli\u003eChen DS, Genther DJ, Betz J, Lin FR. Association between hearing impairment and self-reported difficulty in physical functioning. J Am Geriatr Soc. 2014;62(5):850\u0026ndash;6. \u003c/li\u003e\n\u003cli\u003eWollesen B, Scrivener K, Soles K, Billy Y, Leung A, Martin F, et al. Dual-task walking performance in older persons with hearing impairment: implications for interventions from a preliminary observational study. Ear Hear. 2018;39(2):337\u0026ndash;43. \u003c/li\u003e\n\u003cli\u003eWunderlich A, Wollesen B, Asamoah J, Delbaere K, Li K. The impact of cognitive-motor interference on balance and gait in hearing-impaired older adults: a systematic review. Eur Rev Aging Phys Act. 2024;21(1):17. \u003c/li\u003e\n\u003cli\u003eLin FR, Ferrucci L. Hearing loss and falls among older adults in the United States. Arch Intern Med. 2012;172(4):369\u0026ndash;71. \u003c/li\u003e\n\u003cli\u003eJiam NTL, Li C, Agrawal Y. Hearing loss and falls: a systematic review and meta-analysis. Laryngoscope. 2016;126(11):2587\u0026ndash;96. \u003c/li\u003e\n\u003cli\u003eLin TC, Yen M, Liao YC. Hearing loss is a risk factor of disability in older adults: a systematic review. Arch Gerontol Geriatr. 2019;85:103907. \u003c/li\u003e\n\u003cli\u003eWollesen B, Pocovi NC, Salvestro K, Hurley S, Seydell L, Scrivener K, et al. Multitask training to improve walking performance in older adults with hearing impairment: a feasibility study. Aging Health Res. 2021;1(3):100028. \u003c/li\u003e\n\u003cli\u003e\u0026Ouml;zdemir HU, Kitis A, Ardıc FN. Dual-and single-task training in older adults with age-related hearing loss: a randomized controlled study. J Aging Phys Act. 2024;32(1):1\u0026ndash;12. \u003c/li\u003e\n\u003cli\u003eWollesen B, Voelcker-Rehage C, Regenbrecht T, Mattes K. Influence of a visual-verbal Stroop test on standing and walking performance of older adults. Neuroscience. 2017;366:235\u0026ndash;44. \u003c/li\u003e\n\u003cli\u003eFoster JI, Williams KL, Timmer BH, Brauer SG. The association between hearing impairment and postural stability in older adults: a systematic review and meta-analysis. Trends Hear. 2022;26:23312165221144155. \u003c/li\u003e\n\u003cli\u003eFleming T, Dewhirst M, Haenga-O\u0026apos;Brien A, Chinn V, Ormerod F, Andreae H, et al. Digital tools for mental health and wellbeing: opportunities \u0026amp; impact. JMIR mHealth UHealth. 2024;12:1\u0026ndash;10. \u003c/li\u003e\n\u003cli\u003eTrevelyan EG, Robinson N. Delphi methodology in health research: how to do it? Eur J Integr Med. 2015;7(4):423\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eWorld Medical Association. WMA Declaration of Helsinki \u0026ndash; Ethical principles for medical research involving human subjects. [Internet]. 2018 [cited 2025 Mar 8]. Available from: https://www.wma.net/policies-post/wma-declaration-of-helsinki/ \u003c/li\u003e\n\u003cli\u003eSkulmoski GJ, Hartman FT, Krahn J. The Delphi method for graduate research. J Inf Technol Educ Res. 2007;6(1):1\u0026ndash;21. \u003c/li\u003e\n\u003cli\u003eSibley KM, Thomas SM, Veroniki AA, Rodrigues M, Hamid JS, Lachance CC, et al. Comparative effectiveness of exercise interventions for preventing falls in older adults: a secondary analysis of a systematic review with network meta-analysis. Exp Gerontol. 2021;143:111151. \u003c/li\u003e\n\u003cli\u003eMontero-Odasso M, Van Der Velde N, Martin FC, Petrovic M, Tan MP, Ryg J, et al. World guidelines for falls prevention and management for older adults: a global initiative. Age Ageing. 2022;51(9):afac205. \u003c/li\u003e\n\u003cli\u003eAgmon M, Belza B, Nguyen HQ, Logsdon RG, Kelly VE. A systematic review of interventions conducted in clinical or community settings to improve dual-task postural control in older adults. Clin Interv Aging. 2014;9:477\u0026ndash;92. \u003c/li\u003e\n\u003cli\u003eWollesen B, Wildbredt A, van Schooten KS, Lim ML, Delbaere K. The effects of cognitive-motor training interventions on executive functions in older people: a systematic review and meta-analysis. Eur Rev Aging Phys Act. 2020;17:1\u0026ndash;22. \u003c/li\u003e\n\u003cli\u003eWestlake KP, Culham EG. Sensory-specific balance training in older adults: effect on proprioceptive reintegration and cognitive demands. Phys Ther. 2007;87(10):1274\u0026ndash;83. \u003c/li\u003e\n\u003cli\u003eZhang SL, Liu D, Yu DZ, Zhu YT, Xu WC, Tian E, et al. Multisensory exercise improves balance in people with balance disorders: a systematic review. Curr Med Sci. 2021;41:635\u0026ndash;48. \u003c/li\u003e\n\u003cli\u003eVan Wilderode M, Vermaete E, Francart T, Wouters J, van Wieringen A. Effectiveness of auditory training in experienced hearing-aid users, and an exploration of their health-related quality of life and coping strategies. Trends Hear. 2023;27:23312165231198380.\u003c/li\u003e\n\u003cli\u003eLelic D, Nielsen J, Parker D, Marchman R\u0026oslash;nne F. Critical hearing experiences manifest differently across individuals: insights from hearing aid data captured in real-life moments. Int J Audiol. 2022;61(5):428\u0026ndash;36. \u003c/li\u003e\n\u003cli\u003eMeyer C, Hickson L. What factors influence help-seeking for hearing impairment and hearing aid adoption in older adults? Int J Audiol. 2012;51(2):66\u0026ndash;74. \u003c/li\u003e\n\u003cli\u003eRieker JA, Reales JM, Mui\u0026ntilde;os M, Ballesteros S. The effects of combined cognitive-physical interventions on cognitive functioning in healthy older adults: a systematic review and multilevel meta-analysis. Front Hum Neurosci. 2022;16:838968. \u003c/li\u003e\n\u003cli\u003ePower V, Clifford AM. Characteristics of optimum falls prevention exercise programmes for community-dwelling older adults using the FITT principle. Eur Rev Aging Phys Act. 2013;10:95\u0026ndash;106. \u003c/li\u003e\n\u003cli\u003eIzquierdo M, Merchant RA, Morley JE, Anker SD, Aprahamian I, Arai H, et al. International exercise recommendations in older adults (ICFSR): expert consensus guidelines. J Nutr Health Aging. 2021;25(7):824\u0026ndash;53. \u003c/li\u003e\n\u003cli\u003eFletcher MD. Using haptic stimulation to enhance auditory perception in hearing-impaired listeners. Expert Rev Med Devices. 2021;18(1):63\u0026ndash;74. \u003c/li\u003e\n\u003cli\u003eNetz Y, Yekutieli Z, Arnon M, Argov E, Tchelet K, Benmoha E, et al. Personalized exercise programs based upon remote assessment of motor fitness: a pilot study among healthy people aged 65 years and older. Gerontology. 2022;68(4):465\u0026ndash;79. \u003c/li\u003e\n\u003cli\u003ePichora-Fuller MK, Singh G. Effects of age on auditory and cognitive processing: implications for hearing aid fitting and audiologic rehabilitation. Trends Amplif. 2006;10(1):29\u0026ndash;59. \u003c/li\u003e\n\u003cli\u003eScheerens C, Gilissen J, Volow AM, Powell JL, Ferguson CM, Farrell D, et al. Developing eHealth tools for diverse older adults: lessons learned from the PREPARE for Your Care Program. J Am Geriatr Soc. 2021;69(10):2939\u0026ndash;49. \u003c/li\u003e\n\u003cli\u003eLiu N, Yin J, Tan SSL, Ngiam KY, Teo HH. Mobile health applications for older adults: a systematic review of interface and persuasive feature design. J Am Med Inform Assoc. 2021;28(11):2483\u0026ndash;501. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"european-review-of-aging-and-physical-activity","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [European Review of Aging and Physical Activity](https://eurapa.biomedcentral.com/)","snPcode":"11556","submissionUrl":"https://submission.springernature.com/new-submission/11556/3","title":"European Review of Aging and Physical Activity","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"hearing impairments, older adults, digital intervention, cognitive-motor training, Delphi study, exercise preferences, user-centered design","lastPublishedDoi":"10.21203/rs.3.rs-6293863/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6293863/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eAge-related hearing impairments significantly impact social interactions and physical activities for older adults. Recent studies have highlighted potential benefits of cognitive-motor training but lack specificity regarding the unique needs of this population. This study aimed to determine the exercise preferences and specific needs of older adults with hearing impairments to develop tailored cognitive-motor training programs.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A Delphi survey was conducted to gather expert opinions and user preferences to inform the development of an app. The survey engaged 220 health and exercise professionals and 30 older adults with hearing impairments across three rounds, using a combination of open and closed questions. Data collection lasted from December 2023 to July 2024 and resulted in 10 to 14 complete responses per group and round. Statistical analyses included frequency analysis, mean, standard deviation and one-way ANOVA to identify significant differences between expert and user responses.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The study gathered a lot of opinions and perspectives regarding the aspects of a training app. All 570 responses were clustered in 148 items and only 35 were removed due to low relevance. While revealing a high level of consensus, the data showed significant differences between the groups. For example, in the preference for training types, health professionals differed from hearing-impaired participants. While professionals emphasised the integration of sensory challenges and dual-task exercises, participants preferred less demanding physical activities and those incorporating music or ambient sounds. Strength exercises and prescribed frequent sessions were deemed less feasible, indicating a preference for more adaptable and enjoyable training regimes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e Tailored cognitive-motor training programs that incorporate the individual preferences and sensory capabilities of hearing-impaired older adults promise high adherence and effectiveness. Frequent training sessions stimulate neuroplasticity, enhancing both cognitive and motor functions, which is crucial for older adults facing sensory deficits. The intensity of the exercises should match the individual's abilities, gradually increasing to ensure engagement without overwhelming participants. These programs should emphasise ease of use, flexibility and autonomy to enhance the enjoyment while sensory accommodation helps to enhance physical and cognitive functions, supporting greater independence and quality of life for this vulnerable population.\u003c/p\u003e","manuscriptTitle":"Requirements of health professionals and affected persons for an App based Dual Task training for hearing impaired older adults - a Delphi survey","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-05 05:28:53","doi":"10.21203/rs.3.rs-6293863/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-06-13T06:52:31+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-12T22:44:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"248202550038946962205874904290750304276","date":"2025-06-12T16:01:45+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-22T10:43:09+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-21T10:08:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"168744585665816992279409910447100175413","date":"2025-04-07T17:19:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"234770222111090644850506609058905772546","date":"2025-04-04T14:28:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"246175223458501429014608910814959316343","date":"2025-04-02T15:12:55+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-02T13:34:34+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-02T13:00:10+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-01T07:52:58+00:00","index":"","fulltext":""},{"type":"submitted","content":"European Review of Aging and Physical Activity","date":"2025-03-24T09:29:32+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"european-review-of-aging-and-physical-activity","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [European Review of Aging and Physical Activity](https://eurapa.biomedcentral.com/)","snPcode":"11556","submissionUrl":"https://submission.springernature.com/new-submission/11556/3","title":"European Review of Aging and Physical Activity","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"494572a0-15f9-4bf2-9b8c-41cc79d0b611","owner":[],"postedDate":"May 5th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-09-23T08:23:25+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-05 05:28:53","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6293863","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6293863","identity":"rs-6293863","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}