Abstract

Patient adherence to physiotherapy is crucial for achieving successful outcomes, but it is often hindered by the routine nature of traditional rehabilitation exercises. This lack of engagement, along with psychological barriers like low self-efficacy, leads to less effective recovery. Gamification, which is the use of game design principles, has been proposed as a solution, but its success has been inconsistent, often because it emphasizes external rewards too much. This paper argues that for gamification to succeed in a therapeutic setting, its design must be rooted in intrinsic motivation. A framework combining Self-Determination Theory (SDT) and Flow Theory is presented, suggesting that to promote lasting adherence, a system must fulfill patients' basic psychological needs for autonomy, competence, and relatedness while creating a flow state by balancing challenge and skill. This paper outlines the components of this framework and introduces a model for the next generation of gamified systems, shifting from simple rewards to a genuinely motivating therapeutic experience.