Use of client-centered virtual reality in rehabilitation after stroke: a feasibility study

ABSTRACT Patient-centered virtual reality (VR) programs could assist in the functional recovery of people after a stroke. Objectives: To analyze the feasibility of a rehabilitation protocol using client-centered VR and to evaluate changes in occupational performance and social participation. Methods: This was a mixed methods study. Ten subacute and chronic stroke patients participated in the rehabilitation program using games in non-immersive VR for 40 minutes/day, three days/week, for 12 weeks. Sociodemographic information was collected and the outcome variables included were the Canadian Occupational Performance Measure (COPM) and the Participation Scale. A field diary was used to record the frequency of attendance and adherence of participants and an interview was conducted at the end of program. Results: There were significant and clinically-relevant statistical improvements in the COPM performance score (p < 0.001; CI = 1.29 − 4.858) and in the COPM satisfaction score (p < 0.001; CI = 1.37 − 5.124), with a difference greater than 4.28 points for performance and 4.58 points for satisfaction. The change in the scores for participation was statistically significant (p = 0.046), but there was no clinical improvement (dcohen = −0.596, CI = −1.862 − 0.671). The majority of participants reported more than 75% consecutive attendance of sessions and there was 100% adherence to the program. In the interviews, the participants described their post-stroke difficulties; how the video game motivated their engagement in rehabilitation; and the improvement of occupational performance and social participation after participating in the program. Conclusions: VR is a viable tool for the rehabilitation of stroke patients with functional gains, mainly regarding occupational performance and performance satisfaction.

摘要：以患者为中心的虚拟现实（Virtual Reality, VR）方案可助力卒中后患者的功能康复。
研究目的：分析以患者为中心的虚拟现实康复方案的可行性，并评估其对作业表现与社会参与度的改善效果。
方法：本研究为混合方法研究。招募10名亚急性及慢性卒中患者参与非沉浸式虚拟现实游戏康复方案，每日训练40分钟，每周3次，持续12周。收集受试者的社会人口学信息，结局指标包括加拿大作业表现测量表（Canadian Occupational Performance Measure, COPM）与参与量表。采用现场日志记录受试者的出勤频次与方案依从性，并于训练结束后开展访谈。
结果：COPM表现评分（p < 0.001；置信区间[CI] = 1.29 ~ 4.858）与COPM满意度评分（p < 0.001；CI = 1.37 ~ 5.124）均出现具有统计学意义且临床相关的改善，表现评分差值超过4.28分，满意度评分差值超过4.58分。参与度评分的变化具有统计学意义（p = 0.046），但未达到临床改善水平（科恩d值 = −0.596，CI = −1.862 ~ 0.671）。多数受试者报告连续训练出席率超过75%，整体方案依从率达100%。访谈中，受试者提及了卒中后所面临的困境、本虚拟现实游戏如何激发其康复参与积极性，以及参与本方案后作业表现与社会参与度的改善情况。
结论：虚拟现实（VR）是卒中患者康复的可行工具，可带来功能获益，尤其在作业表现与表现满意度方面效果显著。