VR-based rehabilitation as a Feasible and Engaging Tool for the Management of Chronic Post-Stroke Upper Extremity Function Recovery: A Randomized Controlled Trial (Preprint)

BACKGROUND A growing number of stroke survivors are left with little to no rehabilitation services upon discharge from stroke rehabilitation, although arm deficits may persist or develop from disuse once rehabilitation services have ceased. Virtual reality-based rehabilitation, combined with new technologies such as telerehabilitation, including serious games using virtual reality environments that encourage users to practice functional movements from home with minimal supervision, may have an important role to play in optimizing and maintaining upper-extremity (UE) function. OBJECTIVE The primary objective was to determine the extent to which a one-month intervention using a virtual reality-based serious game is effective in improving upper extremity function compared to an evidence-based home exercise program. A secondary objective was to assess the feasibility of implementing the intervention for chronic stroke rehabilitation in participants’ homes. METHODS Fifty-one chronic stroke participants were randomized to Treatment (n=26; Jintronix system) or Standard care (n=25; standardized GRASP kit home program) groups. Participants were evaluated at baseline (pre), immediately after the intervention (post) and at follow-up (4 weeks). The primary outcome measure was the Fugl-Meyer Assessment for the Upper Extremity (FMA-UE). Secondary outcome measures included the Stroke Impact Scale (SIS) and an abridged version of the Motor Activity Log (MAL-14). RESULTS No statistically significant differences between groups were found across measures. Overall time effects were found for the FMA-UE (P=.045), specifically between pre-intervention and post-intervention time points for both groups (P=.03). Nine participants in the treatment group reached or surpassed minimally clinically important difference (MCID) in scores for the FMA-UE, 7 of them having baseline low or moderate arm function, as compared to 3 participants for the standard care group. Nine of the 16 participants in the treatment group who used the system for a total of at least 400 minutes in the program reached MCID for the FMA-UE, as compared to none of the 10 participants who used it less than 400 minutes. CONCLUSIONS These findings suggest that UE training for chronic stroke survivors using virtual rehabilitation in their home may be as effective as a gold-standard home exercise program, and that those who on average used the system more than 20 minutes a day 5 times a week achieved greater improvement in UE function, indicating its relevance to be included as part of ongoing rehabilitation services. CLINICALTRIAL NCT02491203 (www.clinicaltrials.gov) INTERNATIONAL REGISTERED REPORT RR2-10.1016/j.cct.2015.12.006