Stroke Survivor and Caregiver Experiences of Virtual Reality Gaming to Promote Social Participation: A Qualitative Study

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2024 Dec 18

PMID 39693334

Authors

Suzanne Hoi Shan Lo

Janita Pak Chun Chau

Kai Chow Choi

Laveeza Butt

Alexander Yuk Lun Lau

Vivian Wing Yan Lee

Eddie Chi Fai Kwok

David R Thompson

Affiliations

Soon will be listed here.

Abstract

Background: Virtual reality (VR) gaming is a promising technology that can be applied in stroke rehabilitation to increase survivors' social engagement, though its optimal usage and effects on stroke recovery are not fully understood. This qualitative study aimed to investigate stroke survivors' and caregivers' perspectives of VR-based gaming rehabilitation modules for supporting post-stroke recovery and social participation.

Methods: Twenty-eight participants (18 stroke survivors and 10 caregivers) were recruited through purposive sampling from acute hospitals in Hong Kong. Two rounds of semi-structured interviews were carried out, with the first round exploring participants' previous knowledge of VR, views about its relevance to stroke rehabilitation, and expected benefits. The second round of interviews was conducted immediately post-intervention to investigate participants' experience, satisfaction, and areas for improvement. Resulting data were thematically analysed.

Results: Most participants were female (75%) with secondary education or above (82%). For stroke survivors, the average duration since stroke was 9.39 (SD = 10.48) years and most were first-time survivors (89%). Main themes identified included (1) Shift in attitudes towards VR technology; (2) Perceptions of VR effectiveness; and (3) Practical drawbacks and design recommendations. Participants reported positive experiences with the VR-based gaming modules, including increased confidence in mobility and heightened awareness regarding outdoor safety and accessibility. Despite concerns regarding hygiene and discomfort with gaming equipment, participants found VR gaming to be engaging and conducive to their recovery.

Conclusion: The VR-based gaming modules were well-received by survivors and their caregivers and considered as an appealing and useful method of post-stroke rehabilitation. Improvements in survivors' attitudes towards VR technology, and self-observed benefits to their physical and psychosocial health, were noted. Areas for optimisation included expansion of game length and contents, options for alternative gaming equipment, and enhanced design elements.

References

Ezekiel L, Collett J, Mayo N, Pang L, Field L, Dawes H . Factors Associated With Participation in Life Situations for Adults With Stroke: A Systematic Review. Arch Phys Med Rehabil. 2018; 100(5):945-955. DOI: 10.1016/j.apmr.2018.06.017. View

Zhang Y, Qiu X, Jin Q, Ji C, Yuan P, Cui M . Influencing factors of home exercise adherence in elderly patients with stroke: A multiperspective qualitative study. Front Psychiatry. 2023; 14:1157106. PMC: 10113471. DOI: 10.3389/fpsyt.2023.1157106. View

Chen J, Or C, Chen T . Effectiveness of Using Virtual Reality-Supported Exercise Therapy for Upper Extremity Motor Rehabilitation in Patients With Stroke: Systematic Review and Meta-analysis of Randomized Controlled Trials. J Med Internet Res. 2022; 24(6):e24111. PMC: 9253973. DOI: 10.2196/24111. View

Jurkiewicz M, Marzolini S, Oh P . Adherence to a home-based exercise program for individuals after stroke. Top Stroke Rehabil. 2011; 18(3):277-84. DOI: 10.1310/tsr1803-277. View

Lee M, Yoon S, Kang J, Kim J, Kim J, Han J . Efficacy and Safety of Caregiver-Mediated Exercise in Post-stroke Rehabilitation. Ann Rehabil Med. 2018; 42(3):406-415. PMC: 6058591. DOI: 10.5535/arm.2018.42.3.406. View

Souza F, Sales M, Laporte L, Melo A, Ribeiro N . Body structure/function impairments and activity limitations of post-stroke that predict social participation: a systematic review. Top Stroke Rehabil. 2022; 30(6):589-602. DOI: 10.1080/10749357.2022.2095086. View

Woodman P, Riazi A, Pereira C, Jones F . Social participation post stroke: a meta-ethnographic review of the experiences and views of community-dwelling stroke survivors. Disabil Rehabil. 2014; 36(24):2031-43. DOI: 10.3109/09638288.2014.887796. View

Saposnik G, Levin M . Virtual reality in stroke rehabilitation: a meta-analysis and implications for clinicians. Stroke. 2011; 42(5):1380-6. DOI: 10.1161/STROKEAHA.110.605451. View

Dominguez-Tellez P, Moral-Munoz J, Salazar A, Casado-Fernandez E, Lucena-Anton D . Game-Based Virtual Reality Interventions to Improve Upper Limb Motor Function and Quality of Life After Stroke: Systematic Review and Meta-analysis. Games Health J. 2020; 9(1):1-10. DOI: 10.1089/g4h.2019.0043. View

10.

Kim E, Shin G . User discomfort while using a virtual reality headset as a personal viewing system for text-intensive office tasks. Ergonomics. 2020; 64(7):891-899. DOI: 10.1080/00140139.2020.1869320. View

11.

Luker J, Lynch E, Bernhardsson S, Bennett L, Bernhardt J . Stroke Survivors' Experiences of Physical Rehabilitation: A Systematic Review of Qualitative Studies. Arch Phys Med Rehabil. 2015; 96(9):1698-708.e10. DOI: 10.1016/j.apmr.2015.03.017. View

12.

Choo W, Jiang Y, Chan K, Ramachandran H, Teo J, Seah C . Effectiveness of caregiver-mediated exercise interventions on activities of daily living, anxiety and depression post-stroke rehabilitation: A systematic review and meta-analysis. J Adv Nurs. 2022; 78(7):1870-1882. DOI: 10.1111/jan.15239. View

13.

Zhang Q, Fu Y, Lu Y, Zhang Y, Huang Q, Yang Y . Impact of Virtual Reality-Based Therapies on Cognition and Mental Health of Stroke Patients: Systematic Review and Meta-analysis. J Med Internet Res. 2021; 23(11):e31007. PMC: 8663637. DOI: 10.2196/31007. View

14.

Della Vecchia C, Preau M, Haesebaert J, Viprey M, Rode G, Termoz A . Factors associated with post-stroke social participation: A quantitative study based on the ICF framework. Ann Phys Rehabil Med. 2022; 66(3):101686. DOI: 10.1016/j.rehab.2022.101686. View

15.

Szczepanska-Gieracha J, Mazurek J . The Role of Self-Efficacy in the Recovery Process of Stroke Survivors. Psychol Res Behav Manag. 2020; 13:897-906. PMC: 7649225. DOI: 10.2147/PRBM.S273009. View

16.

Zhang B, Li D, Liu Y, Wang J, Xiao Q . Virtual reality for limb motor function, balance, gait, cognition and daily function of stroke patients: A systematic review and meta-analysis. J Adv Nurs. 2021; 77(8):3255-3273. DOI: 10.1111/jan.14800. View

17.

Wang L, Chen J, Wong A, Liang K, Tseng K . Game-Based Virtual Reality System for Upper Limb Rehabilitation After Stroke in a Clinical Environment: Systematic Review and Meta-Analysis. Games Health J. 2022; 11(5):277-297. DOI: 10.1089/g4h.2022.0086. View

18.

Felipe F, de Carvalho F, Ramos Silva E, Lima Santos N, Fontes P, de Almeida A . Evaluation instruments for physical therapy using virtual reality in stroke patients: a systematic review. Physiotherapy. 2019; 106:194-210. DOI: 10.1016/j.physio.2019.05.005. View

19.

Chatterjee K, Buchanan A, Cottrell K, Hughes S, Day T, John N . Immersive Virtual Reality for the Cognitive Rehabilitation of Stroke Survivors. IEEE Trans Neural Syst Rehabil Eng. 2022; 30:719-728. DOI: 10.1109/TNSRE.2022.3158731. View

20.

Chen X, Liu F, Lin S, Yu L, Lin R . Effects of Virtual Reality Rehabilitation Training on Cognitive Function and Activities of Daily Living of Patients With Poststroke Cognitive Impairment: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil. 2022; 103(7):1422-1435. DOI: 10.1016/j.apmr.2022.03.012. View