The feasibility and acceptability of virtual reality gaming technologies for upper-limb stroke rehabilitation: A mixed-methods study

Abstract

Background: Evaluation of virtual-reality gaming technologies for upper-limb stroke rehabilitation has focused on those with mild to moderate impairment. This mixed-methods study details the development and evaluation of the feasibility, acceptability and preliminary efficacy of the custom-developed, Personalised Stroke Therapy (PST) system, in strokesurvivors with mild to moderately-severe levels of impairment. Methods: The PST system was iteratively designed with input from stakeholders. Twelve stroke-survivors (nine females, mean age 58 years, median stroke chronicity 42 months, stroke severity 14-25 for shoulder and elbow on the Motricity Index) aimed to complete nine, 40-minute sessions on the PST system over three-weeks. Feasibility and acceptability were assessed though semi-structured interview, recording of adverse effects, adherence, enjoyment and perceived exertion. Assessments of impairment, activity and participation, were completed at baseline, immediately post-intervention and 4-weeks post-intervention. Data were analysed using Thematic Analysis of interview transcripts and field-notes, and Wilcoxon Signed Ranks. Side-by-side displays were used to integrate quantitative and qualitative findings. Findings: Integrated findings of safety and ability to use the PST system suggested system feasibility. Themes of the need for personalisation of activities and the necessity of a handsfree system helped explain findings of feasibility. Integrated findings of enjoyment, the acceptability of using the system in different settings and the importance of feedback provided evidence of acceptability. Themes of physical and psychological benefits were supported by improvements in measures of impairment, activity and participation between baseline and immediately post-intervention (p<0.05 for all measures). Conclusion: Personalisation of activities and use of a hands-free system resulted in feasibility and acceptability of the PST system in a group of community dwelling strokesurvivors including those with moderately-severe disability. Therapists should consider using such technologies as an adjunct to traditional rehabilitation, particularly in those with greater stroke severity for whom a lack of suitable alternatives are available.