Objective:To assess the feasibility of conducting a randomised controlled trial of a home-based virtual reality system for rehabilitation of the arm following stroke.Design:Two group feasibility randomised controlled trial of intervention versus usual care.Setting:Patients’ homes.Participants:Patients aged 18 or over, with residual arm dysfunction following stroke and no longer receiving any other intensive rehabilitation.Interventions:Eight weeks’ use of a low cost home-based virtual reality system employing infra-red capture to translate the position of the hand into game play or usual care.Main measures:The primary objective was to collect information on the feasibility of a trial, including recruitment, collection of outcome measures and staff support required. Patients were assessed at three time points using the Wolf Motor Function Test, Nine-Hole Peg Test, Motor Activity Log and Nottingham Extended Activities of Daily Living.Results:Over 15 months only 47 people were referred to the team. Twenty seven were randomised and 18 (67%) of those completed final outcome measures. Sample size calculation based on data from the Wolf Motor Function Test indicated a requirement for 38 per group. There was a significantly greater change from baseline in the intervention group on midpoint Wolf Grip strength and two subscales of the final Motor Activity Log. Training in the use of the equipment took a median of 230 minutes per patient.Conclusions:To achieve the required sample size, a definitive home-based trial would require additional strategies to boost recruitment rates and adequate resources for patient support.

Level of use is variable and can fall far short of recommendations. Competing commitments were a barrier to use of the equipment, but participants reported that the intervention was flexible and motivating. It will not suit everyone, but some participants recorded high levels of use. Implications for practice are discussed.

Introduction: The level of assessment and intervention received by patients prior to discharge varies widely across stroke services\ud in the United Kingdom. This study aimed to explore the potential value of virtual reality in preparing patients for discharge\ud following stroke.\ud Method: Semi-structured interviews were carried out with 13 occupational therapists, eight patients with a stroke and four\ud community stroke survivors. Views were sought of the perceived acceptability, potential utility and limitations of a ‘virtual\ud home’ environment for use in pre-discharge education and assessment. Data were analysed thematically.\ud Findings: Interviewees found the virtual home to be an acceptable and visual means of facilitating discussions about discharge. It\ud was perceived as valuable in assessing patient insight into safety risks and exploring the implications of installing assistive\ud equipment at home. Limitations were identified relating to specific software issues and the use of virtual reality with patients with\ud cognitive or perceptual impairments.\ud Conclusion: The results demonstrate the potential utility of the virtual home within stroke rehabilitation. Patients and therapists\ud engaged with the virtual home and, moreover, made practical suggestions for future development. Feasibility and pilot testing in a\ud clinical setting is required to compare the use of the virtual home with traditional approaches of pre-discharge assessment

Introduction: Virtual reality has the potential to assist occupational therapists in preparing patients for discharge by facilitating discussions and providing education about relevant practical issues and safety concerns. This study aimed to explore the feasibility of using a virtual reality intervention to support patient discharge after stroke and pilot its use. Method: Practical aspects of delivering a virtual reality intervention prior to discharge were explored by means of a non-randomised feasibility study and a subsequent pilot randomised controlled trial. Factors considered included eligibility, recruitment, intervention delivery, attrition, and suitability of outcome measures. Outcome measures included standardised assessments of stroke severity, mobility, health-related quality of life, functional ability, satisfaction with services, and concerns about falling. Results: Thirty-three participants were recruited in total: 17 to the feasibility study and 16 to the pilot trial. At one-month follow-up, 14 participants (82%) were reassessed in the feasibility and 12 (75%) in the pilot. The main difficulties encountered related to recruitment, particularly regarding post-stroke cognitive impairments, the presence of mild deficits, or illness. Conclusion: It was feasible to recruit and retain participants, deliver the intervention and collect outcome measures, despite slow recruitment rates. These findings could inform the design of a definitive trial.

The combination of low levels of demands and high levels of control and supportive relationships is good for the well-being of mental health staff. Our results suggest that management initiatives in mental health services should be targeted at creating this combination within the working environment, and particularly at increasing levels of job control.