Dorra Rakia Allegue1,2,3, Dahlia Kairy1,2, Johanne Higgins1,2, Philippe S Archambault4,2, Francois Michaud5, William Miller6, Shane Norman Sweet4,2, Michel Tousignant5. 1. School of Rehabilitation, Université de Montréal, Montreal, CA. 2. The Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Institut universitaire sur la réadaptation en déficience physique de Montréal, 6363 Chemin Hudson (fifth floor), Montreal, CA. 3. Mission Universitaire de Tunisie, Montreal, CA. 4. McGill University, Montreal, CA. 5. Université de Sherbrooke, Sherbrooke, CA. 6. University of British Columbia, Vancouver, CA.
Abstract
BACKGROUND: In Canada, only 11% of stroke survivors have access to outpatient and community-based rehabilitation after discharge from inpatient rehabilitation. Hence, innovative community-based strategies are needed to provide adequate post-rehabilitation services. The VirTele program, which combines VIRtual-reality exergames and TELErehabilitation application, was developed to give stroke survivors with residual upper extremity (UE) deficits the opportunity to participate in a personalized home rehabilitation program. OBJECTIVE: 1) To determine the feasibility of VirTele for remote UE rehabilitation in a chronic stroke survivor; 2) To explore the preliminary efficacy of VirTele on UE motor function, the amount and quality of UE use, impact on quality of life and motivation; 3) To explore the determinants of behavioral intention and use behavior of VirTele and indicators of empowerment. METHODS: A 63-year-old male stroke survivor (3 years) with moderate UE impairment participated in a two-month VirTele intervention. He was instructed to use Jintronix-exergames (5 games for UE) for 30 minutes, five-times per week, and the Reacts application to conduct videoconference sessions with a clinician at least once per week. Motivational interviewing was incorporated into video conference sessions to empower the participant to continue exercising and using his UEs in everyday activities. UE motor function (Fugl-Meyer Assessment-UE), amount and quality of UE use (Motor-Activity-Log-30), impact on quality of life (Stroke-Impact-Scale-16) and motivation (Treatment-Self-regulation-Questionnaire) were measured before (T1), after (T2) VirTele intervention and during a one (T3) and two-month (T4) follow-up period. Qualitative data were collected through logs and a semi-directed interview. Feasibility data (eg, number and duration of video-conference sessions, adherence) were documented at the end of each week. RESULTS: The participant completed 48 exergame sessions (33 hours) and 8 videoconference sessions. The results suggest that the VirTele intervention (combining Reacts audio-video platform with Jintronix-exergames) and the study protocol could be feasible to use with stroke survivors. The participant exhibited clinically meaningful improvements at T2 on the Fugl-Meyer-UE and Stroke-Impact-Scale-16 and maintained these gains at T3 and T4. During the follow-up periods, the amount and quality of UE use (Motor-Activity-Log-30) showed meaningful change, suggesting more involvement of the affected UE in daily-activities. The participant demonstrated a high level of autonomous motivation (Treatment-Self-regulation-Questionnaire), which may explain his adherence. Performance, effort and social influence have meaningful weight in the behavioral intention of VirTele-use. However, the lack of control over technical and organizational infrastructures may influence the long-term use of the technology. At the end of VirTele, the participant demonstrated considerable empowerment on both behavioral and capacity level. CONCLUSIONS: VirTele was shown to be feasible to use with a chronic stroke survivor for remote UE rehabilitation. Meaningful determinants of behavioral intention and use behavior of VirTele were identified. Preliminary efficacy results are promising but further research is needed to investigate the VirTele-use among varied population. INTERNATIONAL REGISTERED REPORT: RR2-10.2196/14629.
BACKGROUND: In Canada, only 11% of stroke survivors have access to outpatient and community-based rehabilitation after discharge from inpatient rehabilitation. Hence, innovative community-based strategies are needed to provide adequate post-rehabilitation services. The VirTele program, which combines VIRtual-reality exergames and TELErehabilitation application, was developed to give stroke survivors with residual upper extremity (UE) deficits the opportunity to participate in a personalized home rehabilitation program. OBJECTIVE: 1) To determine the feasibility of VirTele for remote UE rehabilitation in a chronic stroke survivor; 2) To explore the preliminary efficacy of VirTele on UE motor function, the amount and quality of UE use, impact on quality of life and motivation; 3) To explore the determinants of behavioral intention and use behavior of VirTele and indicators of empowerment. METHODS: A 63-year-old male stroke survivor (3 years) with moderate UE impairment participated in a two-month VirTele intervention. He was instructed to use Jintronix-exergames (5 games for UE) for 30 minutes, five-times per week, and the Reacts application to conduct videoconference sessions with a clinician at least once per week. Motivational interviewing was incorporated into video conference sessions to empower the participant to continue exercising and using his UEs in everyday activities. UE motor function (Fugl-Meyer Assessment-UE), amount and quality of UE use (Motor-Activity-Log-30), impact on quality of life (Stroke-Impact-Scale-16) and motivation (Treatment-Self-regulation-Questionnaire) were measured before (T1), after (T2) VirTele intervention and during a one (T3) and two-month (T4) follow-up period. Qualitative data were collected through logs and a semi-directed interview. Feasibility data (eg, number and duration of video-conference sessions, adherence) were documented at the end of each week. RESULTS: The participant completed 48 exergame sessions (33 hours) and 8 videoconference sessions. The results suggest that the VirTele intervention (combining Reacts audio-video platform with Jintronix-exergames) and the study protocol could be feasible to use with stroke survivors. The participant exhibited clinically meaningful improvements at T2 on the Fugl-Meyer-UE and Stroke-Impact-Scale-16 and maintained these gains at T3 and T4. During the follow-up periods, the amount and quality of UE use (Motor-Activity-Log-30) showed meaningful change, suggesting more involvement of the affected UE in daily-activities. The participant demonstrated a high level of autonomous motivation (Treatment-Self-regulation-Questionnaire), which may explain his adherence. Performance, effort and social influence have meaningful weight in the behavioral intention of VirTele-use. However, the lack of control over technical and organizational infrastructures may influence the long-term use of the technology. At the end of VirTele, the participant demonstrated considerable empowerment on both behavioral and capacity level. CONCLUSIONS: VirTele was shown to be feasible to use with a chronic stroke survivor for remote UE rehabilitation. Meaningful determinants of behavioral intention and use behavior of VirTele were identified. Preliminary efficacy results are promising but further research is needed to investigate the VirTele-use among varied population. INTERNATIONAL REGISTERED REPORT: RR2-10.2196/14629.
Authors: Khadijeh Moulaei; Abbas Sheikhtaheri; Mansour Shahabi Nezhad; AliAkbar Haghdoost; Mohammad Gheysari; Kambiz Bahaadinbeigy Journal: Arch Public Health Date: 2022-08-23
Authors: Dorra Rakia Allegue; Shane Norman Sweet; Johanne Higgins; Philippe S Archambault; Francois Michaud; William C Miller; Michel Tousignant; Dahlia Kairy Journal: JMIR Rehabil Assist Technol Date: 2022-09-15