The feasibility, acceptability and preliminary efficacy of a low-cost, virtual-reality based, upper-limb stroke rehabilitation device: a mixed methods study

Abstract

Purpose: To establish feasibility, acceptability and preliminary efficacy of an adapted version of a commercially available, virtual-reality gaming system (the Personalised Stroke Therapy system) for upper-limb rehabilitation with community dwelling strokesurvivors. Method: Twelve stroke-survivors (nine females, mean age 58 years, [standard deviation 7.1], median stroke chronicity 42 months [interquartile range 34.7], Motricity index 14 to 25 for shoulder and elbow) were asked to complete nine, 40- minute intervention sessions using two activities on the system over three-weeks. Feasibility and acceptability were assessed though semi-structured interview, recording of adverse effects, adherence, enjoyment (using an 11-point Likert scale) and perceived exertion (using the BORG scale). Assessments of impairment (Fugl-Meyer Assessment Upper extremity), activity (ABILHAND, Action Research Arm Test, Motor Activity Log-28) and participation (Subjective Index of Physical and Social Outcome), were completed at baseline, following intervention and at four-week follow-up. Data was analysed using Thematic Analysis of interview and intervention field-notes and Wilcoxon Signed Ranks. Side-by-side displays were used to integrate findings. Results: Participants received between 175 and 336 minutes of intervention. Thirteen nonserious adverse effects were reported by five participants. Participants reported a high level of enjoyment (8.1 and 6.8 out of 10) and rated exertion between 11.6 and 12.9 out of 20. Themes of improvements in impairments and increased spontaneous use in functional activities were identified and supported by improvements in all outcome measures between baseline and post-intervention (p<0.05 for all measures). Conclusions: Integrated findings suggested that the system is feasible and acceptable for use with a group of community dwelling stroke-survivors including those with moderately-severe disability.