title: Effectiveness, usability, and cost-benefit of a virtual reality-based telerehabilitation program for balance recovery after stroke: a randomized controlled trial.
abstract: OBJECTIVE
  First, to evaluate the clinical effectiveness of a virtual reality (VR)-based telerehabilitation program in the balance recovery of individuals with hemiparesis after stroke in comparison with an in-clinic program; second, to compare the subjective experiences; and third, to contrast the costs of both programs.
  
  
  METHODS
  Single-blind, randomized, controlled trial.
  
  
  METHODS
  Neurorehabilitation unit.
  
  
  METHODS
  Chronic outpatients with stroke (N=30) with residual hemiparesis.
  
  
  METHODS
  Twenty 45-minute training sessions with the telerehabilitation system, conducted 3 times a week, in the clinic or in the home.
  
  
  METHODS
  First, Berg Balance Scale for balance assessment. The Performance-Oriented Mobility Assessment balance and gait subscales, and the Brunel Balance Assessment were secondary outcome measures. Clinical assessments were conducted at baseline, 8 weeks (posttreatment), and 12 weeks (follow-up). Second, the System Usability Scale and the Intrinsic Motivation Inventory for subjective experiences. Third, cost (in dollars).
  
  
  RESULTS
  Significant improvement in both groups (in-clinic group [control] and a home-based telerehabilitation group) from the initial to the final assessment in the Berg Balance Scale (ηp(2)=.68; P=.001), in the balance (ηp(2)=.24; P=.006) and gait (ηp(2)=.57, P=.001) subscales of the Tinetti Performance-Oriented Mobility Assessment, and in the Brunel Balance Assessment (control: χ(2)=15.0; P=.002; experimental: χ(2)=21.9; P=.001). No significant differences were found between the groups in any balance scale or in the feedback questionnaires. With regard to subjective experiences, both groups considered the VR system similarly usable and motivating. The in-clinic intervention resulted in more expenses than did the telerehabilitation intervention ($654.72 per person).
  
  
  CONCLUSIONS
  First, VR-based telerehabilitation interventions can promote the reacquisition of locomotor skills associated with balance in the same way as do in-clinic interventions, both complemented with a conventional therapy program; second, the usability of and motivation to use the 2 interventions can be similar; and third, telerehabilitation interventions can involve savings that vary depending on each scenario.
authors.affiliation: Instituto Interuniversitario de Investigación en Bioingeniería y Tecnología Orientada al Ser Humano, Universitat Politècnica de València, Valencia, Spain; Servicio de Neurorrehabilitación y Daño Cerebral de los Hospitales NISA, Fundación Hospitales NISA, Valencia, Spain. Electronic address: rllorens@labhuman.com.
authors.forename: Roberto
authors.initials: R
authors.lastname: Lloréns
authors.affiliation: Servicio de Neurorrehabilitación y Daño Cerebral de los Hospitales NISA, Fundación Hospitales NISA, Valencia, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Noé
authors.affiliation: Servicio de Neurorrehabilitación y Daño Cerebral de los Hospitales NISA, Fundación Hospitales NISA, Valencia, Spain.
authors.forename: Carolina
authors.initials: C
authors.lastname: Colomer
authors.affiliation: Instituto Interuniversitario de Investigación en Bioingeniería y Tecnología Orientada al Ser Humano, Universitat Politècnica de València, Valencia, Spain; Ciber, Fisiopatología Obesidad y Nutrición, CB06/03 Instituto de Salud Carlos III, Univesitat Jaume I, Castellón, Spain.
authors.forename: Mariano
authors.initials: M
authors.lastname: Alcañiz
mesh_terms: D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010291:Paresis / Q000191:economics / Q000503:physiopathology / Q000534:rehabilitation*; D026741:Physical Therapy Modalities; D004856:Postural Balance / Q000502:physiology*; D016037:Single-Blind Method; D020521:Stroke / Q000191:economics / Q000503:physiopathology; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome; D014584:User-Computer Interface
keywords: Cost comparison; Postural balance; Rehabilitation; Stroke; Virtual reality therapy