Rehabilitation using virtual gaming for Hospital and hOMe-Based training for the Upper limb in acute and subacute Stroke (RHOMBUS II): a qualitative analysis of participants’ experience

Abstract

Objectives: To explore the experience of participants using the Neurofenix (Naples, Florida, USA) platform for hospital and home-based upper limb rehabilitation in acute and subacute stroke, and to report acceptability of trial and data collection processes in a feasibility randomised controlled trial (Rehabilitation using virtual gaming for Hospital and hOMe-Based therapy for the Upper limb in acute and subacute Stroke (RHOMBUS II)). The trial investigated safety, feasibility and acceptability of the platform, a non-immersive virtual reality (VR) tool, to facilitate upper limb rehabilitation following stroke. The intervention group (n=16) received usual care plus the platform for 7 weeks. The control group (n=8) received usual care only.

Design: A qualitative descriptive approach using semi-structured interviews. Interviews were audio-recorded, transcribed verbatim, and analysed using the Framework Method. The Theoretical Framework of Acceptability informed the development of the topic guide and the analysis.

Setting: Homes of participants and an inpatient stroke rehabilitation unit, London, UK.

Participants: A purposive sample of 11 adults (≥18 years) was recruited from the trial intervention group, 35–89 years of age, ranging from mild to severe upper limb impairment and representing varying levels of engagement with the Neurofenix platform. Additionally three participants were recruited from the trial control group.

Results: Six themes were developed: (1) trial enrolment, indicated that participants enrolled in the study due to hope and for distraction; (2) affective attitude, described feelings associated with the platform, such as the subthemes ‘enjoyment of the games’ but also ‘frustration’, often caused by Wi-Fi connection issues; (3) barriers and facilitators, explored environmental factors such as having a suitable space to use the platform, usability factors such as comfort and the need for support from others; (4) perceived effectiveness of the intervention, described an overall belief that the platform had beneficial effects on both upper limb and cognitive function; (5) self-efficacy, showed how confidence with the platform grew with time and the value placed on performance tracking and routine; (6) trial processes, indicated that assessment burden was manageable and potential allocation to the control group was not a deterrent to trial enrolment.

Conclusion: This study demonstrated the overall acceptability of the platform and offers valuable insights to guide the further development of rehabilitation technologies. This study also adds to the limited literature on the user experience of VR technologies early post-stroke.

Trial registration number: ISRCTN11440079.