Therapists’ Perspective on Virtual Reality Training in Patients after Stroke: A Qualitative Study Reporting Focus Group Results from Three Hospitals

Hindawi Publishing Corporation Stroke Research and Treatment Volume 2016, Article ID 6210508, 12 pages http://dx.doi.org/10.1155/2016/6210508 Research Article Therapists’ Perspective on Virtual Reality Training in Patients after Stroke: A Qualitative Study Reporting Focus Group Results from Three Hospitals Ludwig Schmid,1,2 Andrea Glässel,3 and Corina Schuster-Amft4,5 1 Physiotherapy Department, Rehabilitation Centre, KliniK Lengg, Zurich, Switzerland Department of Physiotherapy, School of Health Professions, Bern University of Applied Sciences, Burgdorf, Switzerland 3 School of Health Professions, Institute of Health Sciences, Zurich University of Applied Sciences, Winterthur, Switzerland 4 Research Department, Reha Rheinfelden, Rheinfelden, Switzerland 5 Institute for Rehabilitation and Performance Technology, Bern University of Applied Sciences, Burgdorf, Switzerland 2 Correspondence should be addressed to Corina Schuster-Amft; Received 5 August 2016; Revised 4 November 2016; Accepted 7 November 2016 Academic Editor: Wai-Kwong Tang Copyright © 2016 Ludwig Schmid et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. During the past decade, virtual reality (VR) has become a new component in the treatment of patients after stroke. Therefore aims of the study were (a) to get an insight into experiences and expectations of physiotherapists and occupational therapists in using a VR training system and (b) to investigate relevant facilitators, barriers, and risks for implementing VR training in clinical practice. Methods. Three focus groups were conducted with occupational therapists and physiotherapists, specialised in rehabilitation of patients after stroke. All data were audio-recorded and transcribed verbatim. The study was analysed based on a phenomenological approach using qualitative content analysis. Results. After code refinements, a total number of 1289 codes emerged out of 1626 statements. Intercoder reliability increased from 53% to 91% until the last focus group. The final coding scheme included categories on a four-level hierarchy: first-level categories are (a) therapists and VR, (b) VR device, (c) patients and VR, and (d) future prospects and potential of VR developments. Conclusions. Results indicate that interprofessional collaboration is needed to develop future VR technology and to devise VR implementation strategies in clinical practice. In principal, VR technology devices were seen as supportive for a general health service model. 1. Background Stroke is a frequent cause of livelong disability in adulthood and is one of the most expensive diseases regarding patientcentred care [1]. To reduce the burden of upper limb limitations and to improve patients’ outcomes and independence, new treatment concepts have to be developed and effectiveness of patient outcomes has to be investigated, respectively [2]. Virtual reality (VR) is a novel computer technology that was adapted for rehabilitation over the past decade [3]. It is a computer technology that simulates real-life learning while providing augmented feedback and a high intensity of massed practiced tasks [4]. VR can be differentiated into immersive and nonimmersive gaming systems. Immersive systems enable players to move an avatar in a simulated environment. Nonimmersive systems often focus on arm or leg movements in simulated 3D environments [5]. VR provides a safe environment for patients to explore functional capability without interference from their physical or cognitive limitations [6]. As an example of a therapeutic VR system, YouGrabber (YG, YouRehab© Ltd.) will be explored in this study: it is a training system for upper limb training in stroke rehabilitation (Figure 1). It provides training of bimanual reaching and grasping in combination with different game options on a computer or television screen. Patients’ movements are captured by two size-adjustable data gloves and infrared arm tracking [7]. As Saposnik and Levin reported in their meta-analysis, there are beneficial effects for upper limb rehabilitation using VR in combination with conventional treatment approaches [8]. Analysed 2 Stroke Research and Treatment studies evaluated different aspects of VR including number of repetitions and exercise intensity. While rehabilitation targets are functional skills, most of VR implementation is working with simulations that are playful but not directly relevant to patients’ daily life [4]. To maximise benefits, the therapeutic application of VR should be compatible with the therapeutic goal setting [9]. Moreover, patients’ motivation and attention are important factors stimulating motor relearning after stroke [10]. Hence, patients often describe VR as an opportunity to participate in enjoyable activities bridging environmental or psychological barriers [11]. Patients welcome the opportunity to increase functional independence and to extend therapeutic practice beyond the conventional therapy sessions [12]. However, limited knowledge exists about the therapists’ points of view on VR technology in general and their experiences and expectations on VR in stroke rehabilitation in particular. Research Questions are as follows: (1) What are experiences and expectations of physiotherapists (PT) and occupational therapists (OT) in rehabilitation using a VR training system? (2) What are important facilitators, barriers, and risks for implementing VR training in clinical practice? The YouGrabber training system (YG, YouRehab© Ltd.) is an example of a therapeutic VR system for upper limb training in stroke rehabilitation (Figure 1). It provides training of bimanual reaching and grasping in combination with different game options on a computer or television screen. Patients’ movements are captured by two size-adjustable data gloves and infrared arm tracking [7]. 2. Methods 2.1. Aim, Design, and Data Collection Process. The study aimed to explore the experiences and expectations of PTs and OTs in neurorehabilitation using a VR training system. The focus group method with a purposeful sampling strategy was selected to collect in-depth information about the phenomenon of professional expert interaction [13]. The framework of this qualitative study design was based on a phenomenology approach to explore participants’ conceptions and everyday explanations. Phenomenology is a characteristic approach for collecting and analysing lived experiences and personal opinions, in particular in complex interactions as a therapeutic treatment session [14]. Therapists from three different neurological rehabilitation centres in the German speaking part of Switzerland (Reha Rheinfelden, University Hospital Inselspital Bern, Bürgerspital Solothurn) were invited to participate in one focus group session by email or personal communication. (...truncated)