JMIR Publications

ABSTRACT

Background:

In Canada, only 11% of stroke survivors access to outpatient and community-based rehabilitation, after discharge. Hence, innovative community-based strategies are needed in order to provide adequate post-rehabilitation services. The VirTele-program (a program that combines VIRtual-reality exergames and TELErehabilitation), was developed to give stroke survivors with residual Upper Extremity(UE) deficits the opportunity to participate in a personalized home rehabilitation training.

Objective:

1/To determine the feasibility of VirTele for remote UE rehabilitation in a chronic stroke survivor 2/To determine the preliminary efficacy of VirTele on UE motor function, amount and quality of use, impact on quality of life and motivation 3/To explore the determinants of behavioral-intention and use-behavior of VirTele and indicators of empowerment.

Methods:

A 63- year-old male stroke survivor (3 years), with a moderate impairment of the UE, participated in VirTele intervention, during two-months. He was instructed to use the Jintronix exergame (5 games for UE) for 30-minutes, 5-times per week and the Reacts application to conduct videoconference-sessions, with a clinician, one to three times per-week. Motivational interviewing was incorporated into video-conference sessions, to empower the participant to continue exercising and using his UE in everyday-activities. The UE motor function (Fugl-Meyer-Assessment-UE), amount and quality of use (Motor-Activity-Log-30), impact on quality-of-life(Stroke-Impact-Scale-16) and motivation (Treatment-Self-regulation-Questionnaire) were measured before(T1), after(T2) VirTele intervention and during a one(T3) and two-month(T4) follow-up period. Qualitative data were collected through logs and a semi-directed interview (administered at T2). Feasibility data (number and duration of video-conference sessions, adherence to exergames, etc.,) were documented at the end of each week.

Results:

The participant completed 48 sessions(33 hours) of exergames and 8 videoconference sessions. Regarding the combination of Reacts and Jintronix, the results show that it is feasible and acceptable by the participant. The participant exhibited clinically meaningful improvements at T2, on the Fugl-Meyer-UE and Stroke-Impact-Scale-16, with maintenance of these gains at T2 and T3. At the follow-up period, the amount and quality of use of UE (Motor-Activity-Log-30) showed meaningful change, suggesting more implication of the affected UE in daily-activities. The participant demonstrated a high level of autonomous motivation (Treatment-Self-regulation-Questionnaire) during VirTele, which may in part explain his adherence. The performance, efforts and social influence have meaningfully weighed in the behavioral intention of VirTele-use. However, the lack of control over technical(internet access, etc.,) and organisational(access difficulty to virtual reality at the individual level, limited resources in health system) infrastructures, may influence the long-term use of the technology. At the end of VirTele, the participant demonstrated a lot of empowerment at the behavior and capacity levels.

Conclusions:

The results suggest that it is relevant to continue investigating the use of exergames combined with telerehabilitation in order to improve UE motor function and enhance the UE quality and amount of use in activities of daily-living.