Virtually home: Feasibility study and pilot randomised controlled trial of a virtual reality intervention to support patient discharge after stroke

Abstract

Introduction: Virtual reality has the potential to assist occupational therapists in preparing patients for discharge by facilitating discussions and providing education about relevant practical issues and safety concerns. This study aimed to explore the feasibility of using a virtual reality intervention to support patient discharge after stroke and pilot its use. Method: Practical aspects of delivering a virtual reality intervention prior to discharge were explored by means of a non-randomised feasibility study and a subsequent pilot randomised controlled trial. Factors considered included eligibility, recruitment, intervention delivery, attrition, and suitability of outcome measures. Outcome measures included standardised assessments of stroke severity, mobility, health-related quality of life, functional ability, satisfaction with services, and concerns about falling. Results: Thirty-three participants were recruited in total: 17 to the feasibility study and 16 to the pilot trial. At one-month follow-up, 14 participants (82%) were reassessed in the feasibility and 12 (75%) in the pilot. The main difficulties encountered related to recruitment, particularly regarding post-stroke cognitive impairments, the presence of mild deficits, or illness. Conclusion: It was feasible to recruit and retain participants, deliver the intervention and collect outcome measures, despite slow recruitment rates. These findings could inform the design of a definitive trial.

Effects, Barriers and Facilitators in Predischarge Home Assessments to Improve the Transition of Care from the Inpatient Care to Home in Adult Patients: An Integrative Review

“…(1) an individual or cluster-randomized controlled or controlled trial design was used, (2) study participants were aged ≥ 18 years, admitted to hospitals or rehabilitation facilities for any diagnosis except for mental / cognitive disorders only and subsequently discharged home, (3) PDHA was reported as a primary intervention, though it could vary in purpose (e.g., discharge planning or functional assessment), delivery mode (e.g., with / without patient), intensity, length and frequency, (4) PDHA was compared to another intervention or to usual care, (5) outcomes were associated with a successful return to community living (e.g., functioning in the home environment, readmissions), quality of life, patient satisfaction, caregiver burden and / or the immediate output of the predischarge home assessment (e.g., home modi cations), (6) the study was published in the English or German language.…”

“…Seven RCTs with 1072 participants were included [2,4,7,[21][22][23][24][25]. The size of the studies ranged from ten to 400 participants.…”

“…Predischarge home assessments (PDHA) are conducted in hospitals and inpatient rehabilitation facilities to gain information for therapy and discharge management [1] and to provide individual technical aids and modi cation of the home environment. Practice widely varies [2][3][4], ranging from ward-based assessments of abilities and environment [6] to home assessment visits [2][3][4]. The latter are described as costly and time consuming [3,5,6].…”

“…The latter are described as costly and time consuming [3,5,6]. Sometimes, "access visits" at the patient's home are performed by occupational therapists (OTs) on their own to assess any environmental demands for assistive equipment and access issues [4,7].…”

“…In recent years, studies on new technologies for PDHA have been published, which were not included in the review by Lockwood et al [8]. These studies focus on 3D visualization that offers computer-generated environments, scenarios and objects [3,4,9] that are used to avoid travelling to a patient's home and to improve the patient's involvement in home modi cation planning. Thus, an update of the evidence synthesis on PDHA is warranted.…”