Clinical Perceptions and Feasibility Analysis of a Virtual Reality Game for Post-Stroke Rehabilitation
Abstract
The increasing prevalence of strokes has led to the search for innovative rehabilitation methods. Immersive virtual reality (VR), especially personalized games, offers an interactive and motivating approach to therapy adherence. The perception and acceptance of physiotherapists are crucial to its implementation and require further investigation. The objective of this research was to evaluate the attitudes and perceptions of physiotherapists regarding the feasibility and effectiveness of a personalized VR game called Motion Health VR for post-stroke rehabilitation. The methodology employed consisted of using three strategies to collect subjective data. First, a multiple-choice questionnaire was administered to 73 physicians and physiatrists during the ISPRM 2023 Conference (International Society of Physical and Rehabilitation Medicine) to collect quantitative data on the utility and feasibility of Motion Health VR. Subsequently, a focus group was conducted with four physiotherapists to obtain qualitative information on the usability, accessibility, and cost-effectiveness of the game. Finally, a feasibility and cost-effectiveness analysis were performed to evaluate the possible long-term benefits and financial implications of implementing Motion Health VR in Colombia. The results obtained were a broad acceptance of VR as a complementary tool in post-stroke rehabilitation and the recognition of personalized games as motivators for patient participation. Physiotherapists highlighted the playability and immersion of the game, although they noted limitations related to costs and spasticity of the patient. The analysis indicated that initial costs, while significant, could be justified by long-term savings and improved patient outcomes. Finally, it is concluded that Motion Health VR demonstrated significant potential to complement post-stroke rehabilitation, receiving positive feedback from physiotherapists. Key challenges include improving access, reducing costs, and providing VR training to optimize rehabilitation outcomes.
References
K. C. Wagle, and C. S. Ivan, “Cerebrovascular Disease,” in Family Medicine, P. M. Paulman, R. B. Taylor, A. A. Paulman, and L. S. Nasir, Eds., Cham: Springer International Publishing, 2022, pp. 905–922. https://doi.org/10.1007/978-3-030-54441-6_72
Z. Adey-Wakeling, and M. Crotty, “Upper Limb Rehabilitation Following Stroke: Current Evidence and Future Perspectives,” Aging health, vol. 9, no. 6, pp. 629–647, Nov. 2013. https://doi.org/10.2217/ahe.13.67
R. L. Harvey MD, “Predictors of Functional Outcome Following Stroke,” Phys. Med. Rehabil. Clin. N. Am., vol. 26, no. 4, pp. 583–598, Nov. 2015. https://doi.org/10.1016/j.pmr.2015.07.002
K. S. Hayward et al., “A systematic review protocol of timing, efficacy and cost effectiveness of upper limb therapy for motor recovery post-stroke,” Syst. Rev., vol. 8, no. 1, p. 187, Jul. 2019. https://doi.org/10.1186/S13643-019-1093-6
N. Aderinto, G. Olatunji, M. Opeyemi Abdulbasit, M. Edun, G. Aboderin, and E. Egbunu, “Exploring the efficacy of virtual reality-based rehabilitation in stroke: a narrative review of current evidence,” Ann Med., vol. 55, no. 2, Dec. 2023. https://doi.org/10.1080/07853890.2023.2285907
I. Göttgens, and S. Oertelt-Prigione, “The Application of Human-Centered Design Approaches in Health Research and Innovation: A Narrative Review of Current Practices,” JMIR Mhealth Uhealth, vol. 9, no. 12, p. e28102, Dec. 2021. https://doi.org/10.2196/28102
O. Postolache, D. Jude Hemanth, R. Alexandre, D. Gupta, O. Geman, and A. Khanna, “Remote Monitoring of Physical Rehabilitation of Stroke Patients Using IoT and Virtual Reality,” IEEE journal on selected areas in communications, vol. 39, no. 2, Feb. 2021. https://doi.org/10.1109/JSAC.2020.3020600
M. Jones et al., “Big Data Analytics and Sensor-Enhanced Activity Management to Improve Effectiveness and Efficiency of Outpatient Medical Rehabilitation,” Int. J. Environ. Res. Public Health., vol. 17, no. 3, p. 748, Jan. 2020. https://doi.org/10.3390/ijerph17030748
P. C. Alves Brepohl, and H. Leite, “Virtual reality applied to physiotherapy: a review of current knowledge,” Virtual Real, vol. 27, pp. 71–95, Mar. 2023. https://doi.org/10.1007/s10055-022-00654-2
W.-S. Kim et al., “Clinical Application of Virtual Reality for Upper Limb Motor Rehabilitation in Stroke: Review of Technologies and Clinical Evidence,” Journal Clinical Medicine, vol. 9, no. 10, p. 3369, Oct. 2020. https://doi.org/10.3390/jcm9103369
C. Tuena et al., “Usability Issues of Clinical and Research Applications of Virtual Reality in Older People: A Systematic Review,” Front. Hum. Neurosci., vol. 14, Apr. 2020. https://doi.org/10.3389/fnhum.2020.00093
C. Vieira, C. Ferreira da Silva Pais-Vieira, J. Novais, and A. Perrotta, “Serious Game Design and Clinical Improvement in Physical Rehabilitation: Systematic Review,” JMIR Serious Games, vol. 9, no. 3, p. e20066, Sep. 2021. https://doi.org/10.2196/20066
J. Seinsche et al., “A Newly Developed Exergame-Based Telerehabilitation System for Older Adults: Usability and Technology Acceptance Study,” JMIR Hum Factors, vol. 10, p. e48845, May. 2023. https://doi.org/10.2196/48845
L. Bryant et al., “Collaborative co-design and evaluation of an immersive virtual reality application prototype for communication rehabilitation (DISCOVR prototype),” Disability and Rehabilitation: Assistive Technology, vol. 19, no. 1, pp. 90–99, Apr. 2024. https://doi.org/10.1080/17483107.2022.2063423
S. Krishnan, M. A. Mandala, S. L. Wolf, A. Howard, and T. M. Kesar, “Perceptions of stroke survivors regarding factors affecting adoption of technology and exergames for rehabilitation,” PM&R, vol. 15, no. 11, pp. 1403–1410, Nov. 2023. https://doi.org/10.1002/pmrj.12963
G. A. Albanese et al., “Robotic systems for upper-limb rehabilitation in multiple sclerosis: a SWOT analysis and the synergies with virtual and augmented environments,” Front Robot AI, vol. 11, Feb. 2024. https://doi.org/10.3389/frobt.2024.1335147
A. Vaezipour, D. Aldridge, S. Koenig, D. Theodoros, and T. Russell, “‘It’s really exciting to think where it could go’: a mixed-method investigation of clinician acceptance, barriers and enablers of virtual reality technology in communication rehabilitation,” Disabil. Rehabil., vol. 44, no. 15, pp. 3946–3958, Mar. 2022. https://doi.org/10.1080/09638288.2021.1895333
M. M. T. E. Kouijzer, H. Kip, Y. H. A. Bouman, and S. M. Kelders, “Implementation of virtual reality in healthcare: a scoping review on the implementation process of virtual reality in various healthcare settings,” Implementation Science Communications, vol. 4, p. 67, Jun. 2023. https://doi.org/10.1186/s43058-023-00442-2
M. Endresen Moan, E. Klaebo Vonstad, X. Su, B. Vereijken, M. Solbjør, and N. Skjæret-Maroni, “Experiences of Stroke Survivors and Clinicians with a Fully Immersive Virtual Reality Treadmill Exergame for Stroke Rehabilitation: A Qualitative Pilot Study,” Front Aging Neurosci, vol. 13, p. 735251, Nov. 2021. https://doi.org/10.3389/FNAGI.2021.735251
R. C. Stockley, and D. L. Christian, “A focus group study of therapists’ views on using a novel neuroanimation virtual reality game to deliver intensive upper-limb rehabilitation early after stroke,” Arch. Physiother., vol. 12, no. 1, Jan-Dec. 2022. https://doi.org/10.1186/S40945-022-00139-0
J.-A. Lee, J.-G. Kim, and H. Kweon, “A Study on Rehabilitation Specialists’ Perception of Experience with a Virtual Reality Program,” Healthcare, vol. 11, no. 6, p. 814, Mar. 2023. https://doi.org/10.3390/HEALTHCARE11060814
N. Roman et al., “The Benefits of Combining Mixed Virtual Reality Exergaming with Occupational Therapy for Upper Extremity Dexterity,” Electronics, vol. 12, no. 6, p. 1431, Mar. 2023. https://doi.org/10.3390/electronics12061431
M. Gustavsson, E. K. Kjörk, M. Erhardsson, and M. Alt Murphy, “Virtual reality gaming in rehabilitation after stroke – user experiences and perceptions,” Disabil. Rehabil., vol. 44, no. 22, pp. 6759–6765, Aug. 2021. https://doi.org/10.1080/09638288.2021.1972351
H. Morse, L. Biggart, V. Pomeroy, and S. Rossit, “Exploring perspectives from stroke survivors, carers and clinicians on virtual reality as a precursor to using telerehabilitation for spatial neglect post-stroke,” Neuropsychol Rehabil, vol. 32, no. 5, pp. 767–791, Sep. 2020. https://doi.org/10.1080/09602011.2020.1819827
L. Wang, J.-L. Chen, A. M. K. Wong, K.-C. Liang, and K. C. Tseng, “Game-Based Virtual Reality System for Upper Limb Rehabilitation After Stroke in a Clinical Environment: Systematic Review and Meta-Analysis,” Games Health, vol. 11, no. 5, pp. 277–297, Oct. 2022. https://doi.org/10.1089/G4H.2022.0086
K. J. Miller, B. S. Adair, A. J. Pearce, C. M. Said, E. Ozanne, and M. M. Morris, “Effectiveness and feasibility of virtual reality and gaming system use at home by older adults for enabling physical activity to improve health-related domains: a systematic review,” Age and Ageing, vol. 43, no. 2, pp. 188–195, Dec. 2013. https://doi.org/10.1093/AGEING/AFT194
I. Laffont et al., “Rehabilitation of the upper arm early after stroke: Video games versus conventional rehabilitation. A randomized controlled trial,” Annals of Physical and Rehabilitation Medicine, vol. 63, no. 3, pp. 173–180, May. 2020. https://doi.org/10.1016/J.REHAB.2019.10.009
D. B. Mekbib et al., “Virtual reality therapy for upper limb rehabilitation in patients with stroke: a meta-análisis of randomized clinical trials,” Brain Injury, vol. 34, no. 4, pp. 456–465, Feb. 2020. https://doi.org/10.1080/02699052.2020.1725126
D. E. Levac, and P. A. Miller, “Integrating virtual reality video games into practice: Clinicians’ experiences,” Physiother. Theory Pract., vol. 29, no. 7, pp. 504–512, Jan. 2013. https://doi.org/10.3109/09593985.2012.762078
C. J. Winstein et al., “Guidelines for Adult Stroke Rehabilitation and Recovery,” Stroke, vol. 47, no. 6, May. 2016. https://doi.org/10.1161/STR.0000000000000098
P. M. Kato, “Video games in health care: Closing the gap,” Rev. Gen. Psychol., vol. 14, no. 2, pp. 113–121, Jun. 2010. https://doi.org/10.1037/a0019441
M. Matamala-Gomez et al., “Telemedicine and Virtual Reality at Time of COVID-19 Pandemic: An Overview for Future Perspectives in Neurorehabilitation,” Front Neurol, vol. 12, Mar. 2021. https://doi.org/10.3389/fneur.2021.646902
A. Nuara, M. Fabbri-Destro, E. Scalona, S. E. Lenzi, G. Rizzolatti, and P. Avanzini, “Telerehabilitation in response to constrained physical distance: an opportunity to rethink neurorehabilitative routines,” J. Neurol., vol. 269, no. 2, pp. 627–638, Jan. 2021. https://doi.org/10.1007/s00415-021-10397-w
B. J. Hernández, P. Benjumea, and L. Tuso, “Indicadores del desempeño clínico fisioterapéutico en el manejo hospitalario temprano del accidente,” Revista Ciencias de la salud, vol. 11, no. 1, Apr. 2013. https://revistas.urosario.edu.co/index.php/revsalud/article/view/2456
M. F. Montoya, J. F. Villada Villada, J. E. Muñoz Cardona, O. A. Henao Gallo, and J. F. López, “Diseño contextual para la creación de videojuego basado en Realidad Virtual usado en terapia de rehabilitación física en personas con accidente cerebrovascular,” Rev. EIA, vol. 19, no. 38, Jun. 2022. https://doi.org/10.24050/reia.v19i38.1549
J. F. Villada Castillo et al., “Design of Virtual Reality Exergames for Upper Limb Stroke Rehabilitation Following Iterative Design Methods: Usability Study,” JMIR Serious Games, vol. 12, no. 1, p. e48900, Jan. 2024. https://doi.org/10.2196/48900
O. Espinosa, G. Puentes, J. Rodríguez, A. Robayo, and J.-M. Anaya, “Science, technology, and innovation in health for the next twenty years: A survey analysis in Colombia,” Health Care Science, vol. 3, no. 2, pp. 78–87, Feb. 2024. https://onlinelibrary.wiley.com/doi/epdf/10.1002/hcs2.87?src=getftr
N. J. García Ríos, D. M. Sánchez Moriones, and O. L. Montoya Hurtado, “Estrategias de intervención de fisioterapia en neurorehabilitación utilizadas en Colombia: Revisión bibliográfica,” Mov. cient., vol. 9, no. 1, pp. 60–66, May. 2015. https://revmovimientocientifico.ibero.edu.co/article/view/857
J. Suárez-Escudero, S. Restrepo Cano, E. Ramírez, C. L. Bedoya, and I. Jiménez, “Descripción clínica, social, laboral y de la percepción funcional individual en pacientes con ataque cerebrovascular,” Acta Neurol. Colomb., vol. 27, no. 2, pp. 97–105, Apr-Jun. 2011. https://www.actaneurologica.com/index.php/anc/article/view/1478/1175
K. Sevcenko, and I. Lindgren, “The effects of virtual reality training in stroke and Parkinson’s disease rehabilitation: a systematic review and a perspective on usability,” European Review of Aging and Physical Activity, vol. 19, no. 1, Jan. 2022. https://doi.org/10.1186/S11556-022-00283-3
A. Cormican, S. P. Hirani, and E. McKeown, “Healthcare professionals’ perceived barriers and facilitators of implementing clinical practice guidelines for stroke rehabilitation: A systematic review,” Clin. Rehabil., vol. 37, no. 5, pp. 701–712, May. 2023. https://doi.org/10.1177/02692155221141036
F. A. Silva-Sieger, J. P. Garzón-Hernández, J. A. Mendoza-Sánchez, J. E. Arias, and C. Ortiz, “Costos directos asumidos por pacientes y gastos de bolsillo en ACV isquémico durante el primer año,” Rev. Salud Pública, vol. 23, no. 4, p. 1, Jul-Aug. 2021. https://revistas.unal.edu.co/index.php/revsaludpublica/article/view/91507
I. Patsaki et al., “The effectiveness of immersive virtual reality in physical recovery of stroke patients: A systematic review,” Front. Syst. Neurosci., vol. 16, Sep. 2022. https://doi.org/10.3389/fnsys.2022.880447
O. Espinosa, G. Puentes, J. Rodríguez, A. Robayo, and J.-M. Anaya, “Science, technology, and innovation in health for the next twenty years: A survey analysis in Colombia,” Health Care Science, vol. 3, no. 2, pp. 78–87, Apr. 2024. https://doi.org/10.1002/HCS2.87
R. Kapur, Digital platforms and transformation of healthcare organizations: Integrating digital platforms with advanced IT systems and work transformation. Boca Ratón, FL, USA: CRC Press, 2023. https://doi.org/10.4324/9781003366584
J. Powles, and H. Hodson, “Google DeepMind and healthcare in an age of algorithms,” Health Technol, vol. 7, no. 4, pp. 351–367, Dec. 2017. https://doi.org/10.1007/s12553-017-0179-1
E. A. Moreno Vargas, K. Sánchez Acosta, L. A. Parada, J. Zuluaga, and H. Bayona Ortíz, “Análisis de costos de la atención hospitalaria en un paciente con fibrilación auricular no valvular y accidente cerebrovascular a repetición,” Acta Neurol. Colomb., vol. 38, no. 3, pp. 139–147, Jul-Sep. 2022. https://doi.org/10.22379/24224022419
L. Baatiema, A. de‐Graft Aikins, F. S. Sarfo, S. Abimbola, J. K. Ganle, and S. Somerset, “Improving the quality of care for people who had a stroke in a low‐/middle‐income country: A qualitative analysis of health‐care professionals’ perspectives,” Health Expectations, vol. 23, no. 2, pp. 450–460, Apr. 2020. https://doi.org/10.1111/hex.13027
G. Sampaio Silva, and E. Rocha, “Developing Systems of Care for Stroke in Resource-limited Settings,” Semin Neurol, vol. 44, no. 2, pp. 119–129, Mar. 2024. https://doi.org/10.1055/S-0044-1782617
K. J. Bower, M. Verdonck, A. Hamilton, G. Williams, D. Tan, and R. A. Clark, “What factors influence clinicians’ use of technology in neurorehabilitation? A multisite qualitative study,” Phys. Ther., vol. 101, no. 5, May. 2021. https://doi.org/10.1093/ptj/pzab031
B. Ferreira, and P. Menezes, “Gamifying motor rehabilitation therapies: Challenges and opportunities of immersive technologies,” Information, vol. 11, no. 2, p. 88, Feb. 2020. https://doi.org/10.3390/info11020088
R. Proffitt, and B. Lange, “Considerations in the efficacy and effectiveness of virtual reality interventions for stroke rehabilitation: Moving the field forward,” Phys. Ther., vol. 95, no. 3, pp. 441–448, Mar. 2015. https://doi.org/10.2522/ptj.20130571
Y. Chen, K. Travis Abel, J. T. Janecek, Y. Chen, K. Zheng, and S. C. Cramer, “Home-based technologies for stroke rehabilitation: A systematic review,” Int J Med Inform., vol. 123, pp. 11–22, Mar. 2019. https://doi.org/10.1016/j.ijmedinf.2018.12.001
N. W. Moon, P. Ma Baker, and K. Goughnour, “Designing wearable technologies for users with disabilities: Accessibility, usability, and connectivity factors,” Journal of Rehabilitation and Assistive Technologies Engineering, vol. 6, Aug. 2019. https://doi.org/10.1177/2055668319862137
J. L. Pérez Medina, P. Acosta-Vargas, and Y. Rybarczyk, “A systematic review of usability and accessibility in Tele-rehabilitation systems,” in Assistive and Rehabilitation Engineering, England, UK: IntechOpen, 2019. https://doi.org/10.5772/INTECHOPEN.85869
I. Lehmann, G. Baer, and C. Schuster-Amft, “Experience of an upper limb training program with a non-immersive virtual reality system in patients after stroke: a qualitative study,” Physiotherapy, vol. 107, pp. 317–326, Jun. 2020. https://doi.org/10.1016/j.physio.2017.03.001
R.-C. Lin et al., “Effectiveness of early rehabilitation combined with virtual reality training on muscle strength, mood state, and functional status in patients with acute stroke: A randomized controlled trial,” Worldviews Evid. Based. Nurs., vol. 17, no. 2, pp. 158–167, 2020. https://doi.org/10.1111/wvn.12429
F. Zanatta, A. Giardini, A. Pierobon, M. D’Addario, and P. Steca, “A systematic review on the usability of robotic and virtual reality devices in neuromotor rehabilitation: patients’ and healthcare professionals’ perspective,” BMC Health Serv. Res., vol. 22, p. 523, Apr. 2021. https://doi.org/10.1186/s12913-022-07821-w
R. Teasell et al., “Canadian Stroke Best Practice Recommendations: Rehabilitation, recovery, and Community Participation following Stroke. part one: Rehabilitation and Recovery Following Stroke; 6th edition update 2019,” Int. J. Stroke, vol. 15, no. 7, pp. 763–788, Jan. 2020. https://doi.org/10.1177/1747493019897843
R. Cano-de-la-Cuerda et al., “Economic Cost of Rehabilitation with Robotic and Virtual Reality Systems in People with Neurological Disorders: A Systematic Review,” Journal of Clinical Medicine, vol. 13, no. 6, p. 1531, Mar. Mar. 2024. https://doi.org/10.3390/jcm13061531
G. Fregna, N. Schincaglia, A. Baroni, S. Straudi, and A. Casile, “A novel immersive virtual reality environment for the motor rehabilitation of stroke patients: A feasibility study,” Front. Robot. AI, vol. 9, Aug. 2022. https://doi.org/10.3389/frobt.2022.906424
Z. Liu, L. Ren, C. Xiao, K. Zhang, and P. Demian, “Virtual Reality Aided Therapandtowards Health 4.0: A Two-Decade Bibliometric Analysis,” International Journal of Environmental Research and Public Health, vol. 19, no. 3, p. 1525, Jan. 2022. https://doi.org/10.3390/IJERPH19031525
M. Veras et al., “Cost Analysis of a Home-Based Virtual Reality Rehabilitation to Improve Upper Limb Function in Stroke Survivors,” Global Journal Health Sci., vol. 12, no. 2, p. 98, Jan. 2020. https://doi.org/10.5539/gjhs.v12n2p98
J. Jonsdottir et al., “Virtual Reality for Motor and Cognitive Rehabilitation From Clinic to Home: A Pilot Feasibility and Efficacy Study for Persons With Chronic Stroke,” Front. Neurol., vol. 12, Apr. 2021. https://doi.org/10.3389/fneur.2021.601131
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