JMIR Publications

ABSTRACT

Background:

The rising prevalence of Parkinson’s disease and the growing demand on the healthcare system underscore the need for accessible and innovative care solutions such as Reality DTx® - an augmented-reality (AR) neurorehabilitation program with remotely-prescribed gait-and-balance exercises at home for people with Parkinson’s disease.

Objective:

At a pre-implementation stage, this qualitative study aimed to explore the acceptability of Reality DTx®.

Methods:

Exploratory qualitative design. We conducted semi-structured interviews, guided by the Theoretical Framework of Acceptability, with 22 people with Parkinson’s disease who used Reality DTx® at home for six weeks as part of a feasibility trial. We applied a reflexive thematic analysis with an inductive, semantic, critical realist approach.

Results:

The results of the reflexive thematic analysis are described in three themes: ‘There was considerable interindividual variation’, ‘The intervention is complementary to supervised physical therapy’ and ‘Adherence in the long term is crucial’, and nine subthemes. Participants reported variable perceptions of effectiveness and variable experiences of effort to complete the Reality DTx® program. They viewed Reality DTx® as a valuable complement to supervised physical therapy and emphasized the indispensable role of the physical therapist for external control of long-term exercise adherence and for meaningful feedback on motor performance, as well as the desire for social connection. Flexibility in time and location was mentioned as a very important program characteristic, supporting long-term exercise adherence. Suggestions for improvement included enhanced visibility of progression in scores, increased variation in games, and integration of competitive elements.

Conclusions:

Remotely-prescribed AR exercises at home, complementary to supervised physical therapy, are acceptable to people with Parkinson’s disease. The findings inform future Reality DTx® development and implementation from the perspective of people with Parkinson’s, which should be weighted with the perspectives of other stakeholders like clinicians and other key decision makers.