To evaluate the feasibility of implementing immersive virtual reality-based rehabilitation for upper extremity recovery in acute and subacute stroke patients, focusing on its integration into clinical practice, patient comfort-safety, and therapeutic effectiveness.
A pilot, interventional, non-controlled, prospective cohort clinical trial was conducted to evaluate the feasibility of immersive virtual reality-based rehabilitation (imVR) for upper extremity recovery in acute and subacute stroke patients with arm motor impairment. Participants were randomly assigned to two groups: Group A received 10 sessions of imVR combined with conventional rehabilitation (CR), while Group B received 20 sessions of imVR in addition to CR. Feasibility was assessed with User Satisfaction Evaluation Questionnaire (USEQ) for patients, focus interviews and the System Usability Scale (SUS) for therapists. Outcome measures included the Fugl-Meyer Assessment Upper-Extremity (FMA UE), Box and Block Test (BBT) and SAFE score, at baseline, post-intervention, and 4-week follow-up. Feasibility values are showed with descriptive statistics. Differences in outcome measures were analyzed with Friedman´s ANOVA for all participants, Mann Whithney U Test and Probability of Superiority (PS) for differences and effect size between groups. Statistical significance were set with p ≤ 0.05. The results were evaluated to determine if they exceed the minimum detectable change and minimal clinical important difference post imVR intervention.
A total of 10 stroke patients were enrolled (5 assigned to each group) and 7 therapists conducted the intervention. The USEQ showed 86% patient satisfaction, and therapists reported 92.5% positive acceptability via the SUS. No severe adverse effects were reported, with two minor cases of short-term visual discomfort. Focus interviews identified two key clinical challenges: internet stability for continuous imVR operation and therapist agency in exercise selection for patient-specific guidance.
There were significant differences for all participants at baseline, post-intervention, and 4-week follow-up in BBT affected side (p=0.0042), BBT non-affected side (p=0.0064) and SAFE (p=0.0054). No significant differences were found between group A and B. Probability of Superiority (PS) analysis indicated that Group B had a 79% probability of superior performance over Group A in the FMA UE.
80% and 60% of participants exceed the minimum detectable change in BBT non-affected side and BBT affected side respectively. 5 of 10 participants exceed the minimal clinically importance difference in FMA UE.
Immersive virtual reality-based rehabilitation (imVR) is feasible, acceptable and safe intervention for upper extremity recovery in acute and subacute stroke patients.
The results of this study demonstrate preliminary effectiveness of imVR in addition with conventional rehabilitation which may be evaluated in an appropriately powered randomised controlled trial.
These results help to improved implementation and design future efficacy studies of imVR, anticipating the complexities of patients, clinicians and institutions, contributing to the integration of new technologies into clinical practice for the challenge of upper extremity recovery after stroke.
Stroke
Virtual reality
