Background Extended reality (XR) has previously been used to train control of upper limb prostheses. It is however unclear what characteristics an XR environment should have in order to become a usable and effective training tool. Objective The objective was to develop a framework describing the most important factors to be incorporated when designing an XR environment to train prosthesis control. Methods A mixed method approach was used. A narrative review was conducted to explore factors that should be considered when designing an XR environment for prosthesis control. Subsequently, a preliminary framework, based on these factors, was rated by prosthesis users and therapists and discussed during focus groups. Results Fifty out of 489 articles were included. The preliminary framework comprised 62 factors in four domains: feedback, control, exercise and environment. Five prosthesis users and eight therapists participated in three focus groups. A final framework was developed which contained 46 factors in the four domains. End-users considered all domains to be equally important, since domains and factors influence each other. Conclusions The developed framework can be used to guide the design of an XR environment to train prosthesis control.
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