Abstract
Background Virtual reality (VR)–based rehabilitation is gaining attention as a way to promote early mobilization in patients with acute stroke. However, given the motor weakness and cognitive impairment associated with acute stroke, implementation strategies for overcoming patient-perceived difficulty need to be developed to enhance their motivation for training.
Objective The purpose of this study was to explore patient-perceived difficulty and enjoyment during VR-based rehabilitation and the factors affecting those experiences.
Design An exploratory mixed-method design was used in this study.
Methods Eight individuals with acute stroke participated in 2 training modes of VR-based rehabilitation (ie, workout and game modes) 20 to 30 minutes per day for 5 to 8 sessions. A visual analog scale was used to assess patient-perceived difficulty and enjoyment at every session. Then semistructured interviews were conducted to explore the factors affecting those experiences.
Results Levels of difficulty and enjoyment varied depending on the training mode and participants' phases of recovery. Five major factors were identified as affecting those varied experiences: (1) ease of following the directions, (2) experience of pain, (3) scores achieved, (4) novelty and immediate feedback, and (5) self-perceived effectiveness.
Conclusions Levels of difficulty and enjoyment during VR-based rehabilitation differed depending on the phases of recovery and training mode. Therefore, graded implementation strategies for VR-based rehabilitation are necessary for overcoming patient-perceived difficulty and enhancing enjoyment. Ease of following the directions might be best considered in the very early stage, whereas multisensory feedback may be more necessary in the later stage. Health professionals also should find a way for patients to avoid pain during training. Feedback, such as knowledge of results and performance, should be used appropriately.
Footnotes
Ms Lee, Dr Chung, and Mr Kim provided concept/idea/research design. Mr Lee provided writing. Professor Pyun and Mr Kim provided data collection. Ms Lee, Dr Eun, and Professor Yoon provided data analysis. Professor Yoon provided project management. Dr Eun provided fund procurement. Professor Pyun provided participants, facilities/equipment, and institutional liaisons. Dr Chung provided consultation (including review of manuscript before submission). The authors thank the physical therapists of Korea University Anam Hospital for their contribution to the design of software for this study. They also thank all participants of this study.
Approval for this study was obtained from the Institutional Review Board of Korea University Anam Hospital (ED13049).
This research was supported by R&D grant (No. 2013006) on rehabilitation by Korea National Rehabilitation Center Research Institute, Ministry of Health & Welfare.
Clinical trial registration: ISRCTN04144761
- Received May 10, 2015.
- Accepted April 28, 2016.
- © 2016 American Physical Therapy Association
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