Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Aug 28, 2020
Open Peer Review Period: Aug 28, 2020 - Oct 23, 2020
Date Accepted: Mar 16, 2021
(closed for review but you can still tweet)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Effect of a Virtual Reality-enhanced Exercise and Education Intervention on Patient Engagement and Learning in Cardiac Rehabilitation: Randomized Controlled Trial
ABSTRACT
Background:
Cardiac rehabilitation is clinically proven to reduce morbidity and mortality, but many patients do not attend treatment. Those who do attend frequently do not finish their full course of treatment. This is greatly influenced by socioeconomic factors but is also due to patients’ lack of understanding on the importance of their care and a lack of motivation to maintain attendance.
Objective:
The goal of this study was to explore the potential benefits of virtual reality (VR) walking trails within cardiac rehabilitation treatment, specifically on patient education retention, satisfaction with treatment, and overall attendance of treatment sessions.
Methods:
New cardiac rehabilitation patients were enrolled and randomized on a rolling basis to either control or intervention groups. Intervention patients completed time on the treadmill with VR walking trails, including audio recorded education; control patients completed standard of care therapy. Both groups were assisted by nursing staff for all treatment sessions. Primary outcomes were determined by assessing six-minute-walk-test (6MWT) improvement. Additionally, secondary outcomes of patients’ cardiac knowledge and satisfaction were assessed via computer-based questionnaire; patient adherence to recommended number of sessions was also monitored. Cardiac knowledge assessment included a pre-rehabilitation education quiz, the same quiz repeated at their final visit, and again at a 2-month follow up. The satisfaction questionnaire was completed at their final visit.
Results:
Between January 2018 and May 2019, 72 patients were enrolled, 41 to the intervention group and 31 to the control group. Based upon the results of the pre- and post-rehabilitation 6MWT, no differences were seen between intervention and control groups (P = .23). No statistical differences were seen between groups on education (P = .50) or satisfaction (P = .30) at any time point. The control group had statistically more favorable rates of attendance, both by risk group (P = .024) and by completion of minimum sessions (P = .046), but no correlation was seen between study group and reason for ending treatment.
Conclusions:
While no improvements were seen in the VR intervention group over the control group, it is worth noting that limitations in the study design may have influenced these outcomes, not the medium itself. Furthermore, qualitative information suggests that patients may have indeed enjoyed their experience with VR in a way that the quantitative data in this study may not have captured. Suggested within this paper are further considerations of how and when VR should be applied to cardiac rehabilitation. Clinical Trial: ClinicalTrials.gov NCT03945201
Citation
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Copyright
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