Highlights
- •Virtual reality–based training can be effectively combined with conventional programs.
- •Telerehabilitation and in-clinic interventions can promote similar motor improvement.
- •Usability and motivation of both interventions can be similar.
- •Telerehabilitation interventions can involve savings that vary depending on each scenario.
Abstract
Objectives
First, to evaluate the clinical effectiveness of a virtual reality (VR)–based telerehabilitation
program in the balance recovery of individuals with hemiparesis after stroke in comparison
with an in-clinic program; second, to compare the subjective experiences; and third,
to contrast the costs of both programs.
Design
Single-blind, randomized, controlled trial.
Setting
Neurorehabilitation unit.
Participants
Chronic outpatients with stroke (N=30) with residual hemiparesis.
Interventions
Twenty 45-minute training sessions with the telerehabilitation system, conducted 3
times a week, in the clinic or in the home.
Main Outcome Measures
First, Berg Balance Scale for balance assessment. The Performance-Oriented Mobility
Assessment balance and gait subscales, and the Brunel Balance Assessment were secondary
outcome measures. Clinical assessments were conducted at baseline, 8 weeks (posttreatment),
and 12 weeks (follow-up). Second, the System Usability Scale and the Intrinsic Motivation
Inventory for subjective experiences. Third, cost (in dollars).
Results
Significant improvement in both groups (in-clinic group [control] and a home-based
telerehabilitation group) from the initial to the final assessment in the Berg Balance
Scale (=.68; P=.001), in the balance (=.24; P=.006) and gait (=.57, P=.001) subscales of the Tinetti Performance-Oriented Mobility Assessment, and in the
Brunel Balance Assessment (control: χ2=15.0; P=.002; experimental: χ2=21.9; P=.001). No significant differences were found between the groups in any balance scale
or in the feedback questionnaires. With regard to subjective experiences, both groups
considered the VR system similarly usable and motivating. The in-clinic intervention
resulted in more expenses than did the telerehabilitation intervention ($654.72 per
person).
Conclusions
First, VR-based telerehabilitation interventions can promote the reacquisition of
locomotor skills associated with balance in the same way as do in-clinic interventions,
both complemented with a conventional therapy program; second, the usability of and
motivation to use the 2 interventions can be similar; and third, telerehabilitation
interventions can involve savings that vary depending on each scenario.
Keywords
List of abbreviations:
ANOVA (analysis of variance), BBA (Brunel Balance Assessment), BBS (Berg Balance Scale), IMI (Intrinsic Motivation Inventory), POMA-B (Performance-Oriented Mobility Assessment balance subscale), POMA-G (Performance-Oriented Mobility Assessment gait subscale), SUS (System Usability Scale), VR (virtual reality)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: November 13, 2014
Footnotes
Supported in part by the Ministry of Economy and Competitiveness, Project TEREHA (IDI-20110844) and by the Ministry of Education and Science, projects Consolider-C (SEJ2006-14301/PSIC), “CIBER of Physiopathology of Obesity and Nutrition, an initiative of ISCIII,” and the Excellence Research Program PROMETEO (Generalitat Valenciana, Conselleria de Educación, 2008-157).
Disclosures: none.
Identification
Copyright
© 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
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- Effectiveness, Usability, and Cost-Benefit of a Virtual Reality–Based Telerehabilitation Program for Balance Recovery After Stroke: A Randomized Controlled TrialArchives of Physical Medicine and RehabilitationVol. 96Issue 8
- PreviewI have concerns about the level of detail provided regarding the design of visual feedback and exercise in the article by Llorens et al1 featured in the March issue of the Archives. I was excited to see an article about interactivity in the Archives, an area of study that has been called “interactive neurorehabilitation therapies”2.
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