An Integrated Virtual Reality-Based Telerehabilitation Platform to Support Recovery and Maintenance of Functional Abilities Among Older Adults: Protocol for a Usability and Acceptability Study.

backgroundPopulation aging leads to increased disability, implying a significant effect on health care systems and the lives of caregivers. As an example, stroke is a major cause of common diseases and is one of the leading causes of disability in older adults. Rehabilitation is the most effective intervention to counteract patient disability and simultaneously reduce the burden on caregivers. In particular, repetitive and task-specific training seems to be the most effective intervention for poststroke rehabilitation. Virtual reality (VR) is a very useful tool to provide this type of intervention, making it fun through gamification.

objectiveThis paper aims to present a protocol to evaluate the acceptability and usability of an upper limb rehabilitation solution based on VR. The RecoveryFun telerehabilitation system consists of a VR headset, wearable sensor, caregiver app, and clinical platform.

methodsA total of 15 older adult patients with neurological conditions (eg, stroke or brain injury) fulfilling the inclusion and exclusion criteria were recruited in 3 recruitment centers, 5 from each site. The system was given to patients, and they were free to use it when they preferred at their home, with or without caregiver help, following the clinical session set by the physiotherapist. At least 20 minutes of use per week was requested. The physical therapist was able to remotely monitor the progress of the therapy and increase the difficulty and repetitions of the exergames, also considering the patient's fatigue and stress levels. The system was kept by the patients for 4 weeks, and there were several meetings and supervision via phone calls by the therapist. The main dimensions investigated were system usability, using the System Usability Scale (SUS) and User Experience Questionnaire, and acceptability, using the Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST) 2.0. Upper limb function and patient's quality of life, as well as caregiver's perceived stress, were also assessed as secondary outcomes.

resultsThe study started in May 2024 and ended in June 2024. We recruited 16 patients with their caregivers and 6 health care professionals in Italy, Belgium, and Switzerland. Results are expected to be published by winter 2025.

conclusionsThe aim of the study is to propose and evaluate a new telemedicine system that would allow greater adherence to therapy without moving from home, reducing the burden on the caregiver. The system could also be used in rehabilitation centers as a complement to traditional rehabilitation. Finally, with the calibration system enabling the therapist to create customized clinical sessions for the patient, the system could be versatile and fun for a wide range of patients.

trial registrationClinicalTrials.gov NCT06640452; https://clinicaltrials.gov/study/NCT06640452. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/68358.