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Khalil H.1, Alham Al-Sharman A.2, Alghwiri A.A.3, Kazaaleh S.2, Abu foul L.2, Al-Shorafat D.2, El-Salem K.2
1Jordan University of Science and Technology, Rehabilitation Sciences, Irbid, Jordan, 2Jordan University of Science and Technology, Irbid, Jordan, 3University of Jordan, Amman, Jordan
Background: Balance deficits are considered a challenging risk factor for falls in MS patients. Therefore, developing innovative approaches to improve balance in MS is required. One possible approach is the use of virtual reality (VR). VR allows users to interact with computer simulated 3D environments. It offers three cornerstones of motor learning; repetition, motivation, and feedback.
Purpose: The aims of this study were
1) to develop VR scenarios that target balance deficits in MS,
2) to evaluate feasibility, acceptability and potential of the developed VR scenarios.
1) to develop VR scenarios that target balance deficits in MS,
2) to evaluate feasibility, acceptability and potential of the developed VR scenarios.
Methods: Consultation in the form of focus groups were undertaken with MS patients (n=16) and therapists (n=12) to refine a set of required criteria that guided the development of VR scenarios. Feasibility and acceptability of the developed VR scenarios were explored using a randomized controlled pilot trail. Participants were randomly allocated to either a VR rehabilitation programme (i.e. intervention group) (n=20) or a control group (n=20). Intervention group received VR training twice a week for 6 weeks. Control group received home-based traditional balance exercises without the VR three times a week for 6 weeks. Participants were assessed at baseline (week 0) and follow-up (6 weeks later) on Berg Balance Scale (BBS), Timed Up and Go (TUG) and Fall Efficacy Scale- International (FES-I). MS participants in the VR group were asked to complete The System Usability Scale at end of intervention to determine acceptability of the developed VR scenarios.
Results: Six VR scenarios that focused on balance training were developed. These were considered in the light of the responses from the therapists and the patients and included
1) sit to stand,
2) squatting,
3) stepping over an object,
4) standing on toes,
5) weight shifting, and
6) reaching over head.
For the pilot study, sixteen participants in the intervention and seventeen in the control group completed the study (retention rate of 75%). No serious adverse events were recorded. The adherence rate (SD) to the sessions of the VR training in the intervention group was high; 87.5% of the participants completed more than 50% of the total 12 prescribed VR training sessions. The vast majority of participants (93%) in the intervention group indicated that the developed VR scenarios were enjoyable and appropriate to their health status. A significant change (P 0.05) from base-line to follow-up on BBS was observed in the VR group but not in the control group. A standardized difference of 0.5 between groups (which is a medium effect size) was observed on BBS.
Conclusion(s): Findings demonstrated the feasibility and acceptability of a VR-based programme specifically to help address the imbalance and mobility problems in people with MS. Our findings support the implementation of a larger trial of longer-term VR programme.
Implications: The use of the VR in rehabilitation may contribute to an integrated physiotherapy service for people with MS. Further development may need to emphasize the home-use of the developed VR programme as this may help in providing a sustainable resource of use in term of exercise for people with MS.
Funding acknowledgements: Jordan University of Science and Technology
Topic: Neurology
Ethics approval: IRB at King Abdulla University Hospital (HK-20160003)
All authors, affiliations and abstracts have been published as submitted.
