JMIR Publications

ABSTRACT

Background:

Conventional rehabilitation approaches involve therapists simulating various occupational tasks in healthcare settings or recreating real-life situations to assess and train patients in instrumental activities of daily living (IADL). As an alternative technology, immersive virtual reality (IVR) has been widely used in stroke rehabilitation for years, but limited research has compared occupational performances between virtual and real environments.

Objective:

This study aims to introduce a novel IVR shopping system designed for stroke patients and to investigate the correlation of the occupational performances between virtual and real environments in stroke patients.

Methods:

Ten stroke patients were recruited from the Department of Rehabilitation of Shenzhen Hospital, Southern Medical University according to inclusion and exclusion criteria in this observational randomised cross-over study with male (n=7), ischemic stroke (n=9), age (14y-73), time since stroke (1-42 months). All patients tried to carry out shopping tasks in virtual and real environments. Mini-mental Status Examination (MMSE), Timed Up and Go Test (TUGT), Modified Barthel Index (MBI), and Lawton Index (LI) were used to assess cognition, ambulation, and activities of daily living. Memory capacity and duration in the virtual and real environments were recorded as the primary parameters of occupational performance. Wilcoxon test and Spearman correlation coefficients were used to analyse the differences and correlations between the two circumstances.

Results:

Wilcoxon test showed no significant differences between virtual and real environments in memory capacity and duration for task completion (P=1.00 and P=.99), and memory capacity in both environments correlated with LI (ρ=0.81, P=.005). The duration presented a relationship with the TUGT in the virtual environment (ρ=0.68, P=.03) and a borderline negative correlation with MMSE in the real environment (ρ=-0.58, P=.077).

Conclusions:

Considering the small sample size used in this study, the significantly correlated shopping performances between the IVR and the real-world, it is too early to conlude that IVR is a non-inferior approach, but present the potential to be an alternative approach for assessment and training in IADL when resources are limited. However, further research is needed to investigate the psychometric properties, clinical effects, and the impact of virtual training on real-world performance. The implications to practice might include a) Occupational performance in virtual shopping might be the same as real-world shopping, more virtual IADL could be developed. b) Virtual IADL assessment and training systems could be used at remote or limited resource places. c) More objective parameters of IADL could be extracted from virtual environments. Clinical Trial: Chinese Clinical Trial Registry ChiCTR2000041058; https://www.chictr.org.cn