JMIR Publications

ABSTRACT

Background:

Stroke is the third leading cause of death and disability in the world. 60-70% of stroke survivors experience upper limb (UL) movement impairment impacting both their functional independence and quality of life. Clinical guidelines for UL rehabilitation after stroke recommend high doses of repetitive practice but these recommendations are often unmet. Therapists working with stroke survivors use prescribed exercise programmes to supplement face to face provision, but this relies on high levels of patient adherence and self-efficacy. XR technology delivered via head-mounted displays may be able to address the gap in face-to-face therapy provision and increase adherence to exercise programmes which will support UL movement rehabilitation. NeuroVirt is comprised of an XR software that uses mixed reality (VR+AR) to promote repetitive, high-intensity, goal-oriented therapy via interactive rehabilitation games. The technology has been co-designed with stroke survivors and technical feasibility testing has shown it to be highly stable.

Objective:

To evaluate the feasibility of carrying on to a future trial to examine the effectiveness of the NeuroVirt training programme in promoting hand and arm recovery post-stroke.

Methods:

We employed a mixed methods multi-site randomised, assessor blinded, controlled trial. Participants (n=36) were included if they had a stroke (ischaemic or haemorrhagic) at least 3-months previously, had at least a little motion of the upper limb but did not have full dexterity. Exercise prescription took place in either an outpatient clinic or in participant’s own homes. Participants were randomised to receive their exercise prescription on paper (control) or via NeuroVirt. Interventions were completed in participant’s own homes. We measured feasibility outcomes including recruitment, retention, safety and acceptability. Clinical outcome measures were Fugl-Meyer Assessment for Upper Extremity and upper limb activity was measured with the Action Research Arm Test.

Results:

Thirty-six people were recruited over eight months. Our recruitment rate as a proportion of people screened was 48%. Twenty-nine participants completed the study (attrition rate of 19%). The mean duration time spent in NeuroVirt was 37.5 minutes / session (IQR: 28.25–44.00). The control group participants (n=16) completed a median of 34/72 exercise sessions (IQR: 17.0-37.0) and NeuroVirt participants (n=13) completed a median of 42/72 exercise sessions (IQR: 30.00-51.50). There was one treatment related adverse event leading. Clinical outcome measures were completed by 100% of participants who finished the study per protocol (n=29). Analysis of the interviews led to the development of four themes: level-up anywhere; precision and purposeful progression; motivation to rehabilitate; in control and connected.

Conclusions:

Our findings justify progression to a future trial to evaluate the effectiveness and cos-effectiveness of NeuroVirt on improving upper limb recovery after stroke. This feasibility trial provides encouraging evidence that NeuroVirt, a gamified XR rehabilitation system, is acceptable, and practical for post-stroke upper-limb rehabilitation in real-world settings. Clinical Trial: This study was prospectively registered with ISRCTN: ISRCTN54249743. Registered on 7th July 2023.