Therapists’ Perspective on Virtual Reality Training in Patients after Stroke: A Qualitative Study Reporting Focus Group Results from Three Hospitals

Abstract

Background. During the past decade, virtual reality (VR) has become a new component in the treatment of patients after stroke. Therefore aims of the study were (a) to get an insight into experiences and expectations of physiotherapists and occupational therapists in using a VR training system and (b) to investigate relevant facilitators, barriers, and risks for implementing VR training in clinical practice. Methods. Three focus groups were conducted with occupational therapists and physiotherapists, specialised in rehabilitation of patients after stroke. All data were audio-recorded and transcribed verbatim. The study was analysed based on a phenomenological approach using qualitative content analysis. Results. After code refinements, a total number of 1289 codes emerged out of 1626 statements. Intercoder reliability increased from 53% to 91% until the last focus group. The final coding scheme included categories on a four-level hierarchy: first-level categories are (a) therapists and VR, (b) VR device, (c) patients and VR, and (d) future prospects and potential of VR developments. Conclusions. Results indicate that interprofessional collaboration is needed to develop future VR technology and to devise VR implementation strategies in clinical practice. In principal, VR technology devices were seen as supportive for a general health service model.

Barriers, Facilitators and Interventions to Support Virtual Reality Implementation in Rehabilitation: A Scoping Review

“…Therapist experience with the system [4,14,18,22] Client experience with the system [30] Skills to optimize patient outcomes [17] Opportunity for practice [7,14,15,19,30,32] Interactive education/training for hands-on learning [5,6,17,19,20,29,30] Use of case examples [6] Video tutorials targeting specific learning needs [19,20] Individualized 1:1 clinical mentoring [6,22] Online support strategies [4,6] Competency development framework to guide self-evaluation and development of competencies required for clinical VR use [6,22,29] Social/professional role and identity: A coherent set of behaviors and displayed personal qualities of an individual in a social or work setting Attitude of therapist toward the technology [4,6,7,22,30] Attitude of patient toward the technology [7,19,21] Reconciling therapist role in gaming context [7,25] Being tech-savvy (clients and therapists) [4,14,22] Compatibility with treatment preferences/needs [4,…”

“…Perceived therapeutic benefit to clients [4,6,14,16,19,22,27] Perceived match to client's goals/needs [4,6,7,14,17,19,22,25,30,31] Perceived match to therapist's needs [4,6,22,30,31] Perceived motivational utility [4,6,7,19,22,28] Evidence syntheses to raise awareness of the potential benefits of VR use [6,29] Demonstrate clinical utility in the clinical setting [30] Concerns about screen time [6,17] Transfer of training to real life [4,16,18,20,22,24,25,32] Privacy concerns of social media use/confidentiality of data [25] Potential for physical fatigue [26] Confidence in expert clinician/mentor [14] Ethical issues [24] Legal issues [24] Relative advantage over other options [4,…”

“…Being reminded to use the system [14] Email reminders [14] Intentions: A conscious decision to perform a behavior or a resolve to act in a certain way Therapist's motivation/interest in using VR/video games with clients [4,6,7,16e18,22,30] Therapist's interest in learning more about clinical VR/AVG use [4,17] Target theory-based determinants of intention (attitudes, perceived ease of use, perceived usefulness, compatibility, social influences, perceived behavioral control, self-efficacy, facilitating conditions and barriers) [6,22] Share evidence on effectiveness [30] Engage clinicians in research [22] Goals: Mental representations of outcomes or end states that an individual wants to achieve Fun and meaningful [5] Degree of client motivation [4,6,7,18,19,22] Ability to use for home-based treatment [15,27,28] Integrates physical and cognitive tasks [28] Targets fine-motor goals [19] Potential to target a range of goals [14] Opportunity for client self-practice [5] Opportunity for additional practice outside of regular therapy sessions [14] Opportunity for social interaction [5] Opportunity for competition [4] Degree of system/game's match to client's needs/goals [4,6,7,14,19,22] Identifying direct links between functional goals, activity grading, and outcome measurement [6] Memory, attention, and decision processes:…”

“…Technical issues [4e6, 14,15,18,19,22] Appropriateness of instructions and feedback provided by the system (eg, complexity, clarity, negative vs positive) [7,14] Sensory feedback provided [4,18] Age appropriateness of use [16,17,25,34] Technology-specific:…”

“…Virtual Reality Implementation in Rehabilitation Accessible to clients eg, compatibility with mobility equipment, cognitive impairment [6,14,17,22,32] Compatibility of applications across devices [24] Degree of risk of motion sickness [24,32] Potential for compensation and overuse injuries [15,26] Safety concerns [21] Privacy concerns for online platforms [17,25] Pop-up ads and in-app purchases [15,17] Graphics offered by the system [17,18,22] Time to set up and clean [6,22,33] Support for equipment set-up/take-down and to administer treatment programs [4,6,14,16,22,33] Need to supervise treatment [14,15,24,29] Access to evidence [4,6,17,22,31] Quality of evidence [4e6,17,22] Availability of evidence [5,24,32] Familiarity with/awareness of evidence [4,6,17,22] Availability of clinical tools/required resources [4,…”