title: Patients' use of a home-based virtual reality system to provide rehabilitation of the upper limb following stroke.
abstract: BACKGROUND
  A low-cost virtual reality system that translates movements of the hand, fingers, and thumb into game play was designed to provide a flexible and motivating approach to increasing adherence to home-based rehabilitation.
  
  
  OBJECTIVE
  Effectiveness depends on adherence, so did patients use the intervention to the recommended level? If not, what reasons did they give? The purpose of this study was to investigate these and related questions.
  
  
  METHODS
  A prospective cohort study, plus qualitative analysis of interviews, was conducted.
  
  
  METHODS
  Seventeen patients recovering from stroke recruited to the intervention arm of a feasibility trial had the equipment left in their homes for 8 weeks and were advised to use it 3 times a day for periods of no more than 20 minutes. Frequency and duration of use were automatically recorded. At the end of the intervention, participants were interviewed to determine barriers to using it in the recommended way.
  
  
  RESULTS
  Duration of use and how many days they used the equipment are presented for the 13 participants who successfully started the intervention. These figures were highly variable and could fall far short of our recommendations. There was a weak positive correlation between duration and baseline reported activities of daily living. Participants reported lack of familiarity with technology and competing commitments as barriers to use, although they appreciated the flexibility of the intervention and found it motivating.
  
  
  CONCLUSIONS
  The small sample size limits the conclusions that can be drawn.
  
  
  CONCLUSIONS
  Level of use is variable and can fall far short of recommendations. Competing commitments were a barrier to use of the equipment, but participants reported that the intervention was flexible and motivating. It will not suit everyone, but some participants recorded high levels of use. Implications for practice are discussed.
authors.affiliation: P.J. Standen, Division of Rehabilitation and Ageing, University of Nottingham, B Floor Medical School, QMC, Clifton Boulevard, Nottingham NG7 2UH, United Kingdom. p.standen@nottingham.ac.uk.
authors.forename: Penny J
authors.initials: PJ
authors.lastname: Standen
authors.affiliation: K. Threapleton, School of Health Sciences, University of Nottingham.
authors.forename: Kate
authors.initials: K
authors.lastname: Threapleton
authors.affiliation: L. Connell, School of Health, University of Central Lancashire, United Kingdom.
authors.forename: Louise
authors.initials: L
authors.lastname: Connell
authors.affiliation: A. Richardson, Derbyshire Community Health Services, Derbyshire, United Kingdom.
authors.forename: Andy
authors.initials: A
authors.lastname: Richardson
authors.affiliation: D.J. Brown, Computing and Technology Team, School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom.
authors.forename: David J
authors.initials: DJ
authors.lastname: Brown
authors.affiliation: S. Battersby, Computing and Technology Team, School of Science and Technology, Nottingham Trent University.
authors.forename: Steven
authors.initials: S
authors.lastname: Battersby
authors.affiliation: C.J. Sutton, Division of Rehabilitation and Ageing, University of Nottingham.
authors.forename: Catherine Jane
authors.initials: CJ
authors.lastname: Sutton
authors.affiliation: F. Platts, Sherwood Forest Hospitals NHS Foundation Trust, Nottinghamshire, United Kingdom.
authors.forename: Fran
authors.initials: F
authors.lastname: Platts
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005240:Feasibility Studies; D005260:Female; D006699:Home Care Services; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance; D011446:Prospective Studies; D000071939:Stroke Rehabilitation; D034941:Upper Extremity; D014584:User-Computer Interface; D018910:Video Games