Virtual reality-based pre-discharge home assessment (ReTHo) to improve participation-focused patient transition from rehabilitation to home: development and feasibility testing.

Abstract

Background Pre-discharge home assessments (PDHA) aim to identify environmental barriers to patients’ activities, to recommend and provide aids and home modifications and to assess activity performance within “real life conditions”. PDHA are time consuming. Virtual approaches might overcome these obstacles. Aim This study aimed to develop a technical system (ReTho) supporting ward-based PDHA within the virtual twin of the real patients´ home and to evaluate the feasibility of the Virtual Reality (VR)-PDHA within clinical processes. Methods ReTho was developed within 11 months involving users (workshops, pre-pilot testing, usability testing groups, interviews) to achieve usability and fit of the intervention to the context. ReTho comprised a smartphone-home scan, a data backend with interface to organize data and applications to measure the home as a 3D model on desktop and immersively in VR. Feasibility and acceptance of the intervention and feasibility of study processes were testet as single-arm study in an inpatient rehabilitation clinic. Results Twelve patients (neurological diagnoses n=11, geriatric diagnosis n=1) received the intervention. The scan took between 40 and 90 minutes per patient. Per PDHA, on average 7.76 (SD 1.97) rooms were assessed. Therapy sessions took 43.67 (SD 10.52, range from 25 to 65) minutes in total. On average 12.42 (SD 5.02) recommendations per patient were given, and on average 36% (SD 21%) of them were ongoing two weeks after discharge. Data collection procedures were feasible with minor implications for improvement. Therapists rated satisfaction in usability and usefulness of the tool overall as very good. ReTho had the potential to enable tailored recommendations and advice on home modifications/aids, to increase patients’ acceptance of recommendations and to improve activity goals. Information flow and communication within the discharge preparation process was not enhanced due to misssing interfaces between the system and the clinic IT. Performance and satisfaction with activities increased slightly after discharge (4.41 to 5.3 and 4.53 to 4.90). The fear of falling remained consistent. Conclusions: The study demonstrates the clinical feasibility of ReTho. The system goes beyond functions of other previously known applications for PDHA. Further intervention development concerns the connection of process stakeholders in the rehabilitation context inside and outside the ward setting. Trial Registration: Study registration of the pilot study occurred prior to inclusion of the first study participant as DRKS00025836 in a publicly accessible study registry (German Clinical Trials Register).