Abstract
BackgroundVirtual reality (VR) has been broadly applied in post-stroke rehabilitation. However, studies on occupational performance and self-efficacy as primary outcomes of stroke rehabilitation using VR are lacking. Thus, this study aims to investigate the effects of VR training on occupational performance and self-efficacy in patients with stroke.MethodsThis was an assessor-blinded, randomized controlled trial. Sixty participants with first-ever stroke (< 1-year onset) underwent rehabilitation in a single acute hospital. Participants were randomly assigned to either the VR group (n = 30) or control group (n = 30). Both groups received dose-matched conventional rehabilitation (i.e., 45 min, five times per week over 3 weeks). The VR group received additional 45-min VR training for five weekdays over 3 weeks. The primary outcome measures were the Canadian Occupational Performance Measure and Stroke Self-Efficacy Questionnaire. Secondary outcome measures included Modified Barthel Index, Fugl-Meyer Assessment-Upper Extremity, and Functional Test for the Hemiplegic Upper Extremity. The assessment was conducted at baseline and after the 3-week intervention.ResultsA total of 52 participants (86.7%) completed the trial. Significant between-group differences in Stroke Self-Efficacy Questionnaire (Median Difference = 8, P = 0.043) and Modified Barthel Index (Median Difference = 10, P = 0.030) were found; however, no significant between-group differences in Canadian Occupational Performance Measure, Fugl-Meyer Assessment-Upper Extremity, and Functional Test for the Hemiplegic Upper Extremity were noted. No serious adverse reactions related to the program were reported.ConclusionsAdditional VR training could help improve the self-efficacy and activities of daily living of patients with stroke; however, it was not superior to conventional training in the improvement of upper limb functions, occupational performance, and satisfaction. Nevertheless, VR could be integrated into conventional rehabilitation programs to enhance self-efficacy of patients after stroke.Trial registrationThis study was successfully registered under the title “Effects of virtual reality training on occupational performance and self-efficacy of patients with stroke” on October 13 2019 and could be located in https://www.chictr.org with the study identifier ChiCTR1900026550.
Highlights
Virtual reality (VR) has been broadly applied in post-stroke rehabilitation
Primary outcome A significant between-group difference in Stroke Self-Efficacy Questionnaire (SSEQ) was found after intervention (Median Difference = 8, P = 0.043, Z = − 2.027), and only daily activities domain in SSEQ demonstrated significance (Median Difference = 6, P = 0.017, Z = − 2.392)
No significant differences in Canadian Occupational Performance Measure (COPM) were found between two groups
Summary
Virtual reality (VR) has been broadly applied in post-stroke rehabilitation. studies on occupa‐ tional performance and self-efficacy as primary outcomes of stroke rehabilitation using VR are lacking. 85% of stroke survivors had upper extremity dysfunction at the initial stage of onset [2], and approximately 30–36% of patients with stroke still had upper extremity dysfunction at 6 months after stroke [3]. Such dysfunctions could greatly affect patients’ quality of life and prognosis after stroke, and improvement in the ability to complete activities of daily living (ADL) is vital for functional recovery. Apart from sensation, motor function, and ADL, some important domains, including occupational performance and self-efficacy, have to be considered in stroke rehabilitation [4]. A previous study found that self-efficacy is a moderator of occupational performance in stroke self-management programs [9]
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