Is upper limb virtual reality training more intensive than conventional training for patients in the subacute phase after stroke? An analysis of treatment intensity and content.
BACKGROUND
Virtual reality (VR) training is thought to improve upper limb (UL) motor function after stroke when utilizing intensive training with many repetitions. The purpose of this study was to compare intensity and content of a VR training intervention to a conventional task-oriented intervention (CT).


METHODS
A random sample of 50 video recordings was analyzed of patients with a broad range of UL motor impairments (mean age 61y, 22 women). Patients took part in the VIRTUES trial and were randomized to either VR or CT and stratified according to severity of paresis. A standardized scoring form was used to analyze intensity, i.e. active use of the affected UL expressed in % of total time, total active time and total duration of a training session in minutes, content of training and feedback. Two raters collected data independently. Linear regression models as well as descriptive and graphical methods were used.


RESULTS
Patients in the VR group spent significantly more time actively practicing with an activity rate of 77.6 (8.9) % than patients in the CT 67.3 (13.9) %, (p = .003). This difference was attributed to the subgroup of patients with initially severe paresis (n = 22). While in VR severely impaired patients spent 80.7 % (4.4 %) of the session time actively; they reached 60.6 (12.1) % in CT. VR and CT also differed in terms of tasks and feedback provided.


CONCLUSIONS
Our results indicate that patients with severely impaired UL motor function spent more time actively in VR training, which may influence recovery. The upcoming results of the VIRTUES trial will show whether this is correlated with an increased effect of VR compared to CT.


BACKGROUND
ClinicalTrials.gov NCT02079103 , February 27, 2014.
Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, 5018, Bergen, Norway. Iris.Brunner@uib.no.|Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Bergen, Norway. Iris.Brunner@uib.no.
Iris
http://orcid.org/0000-0002-7194-3087
I
Brunner
Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, 5018, Bergen, Norway.|Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Bergen, Norway.
Jan Sture
JS
Skouen
Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Bergen, Norway.
Håkon
H
Hofstad
Competence Center for Clinical Research, Haukeland University Hospital, Bergen, 5012, Norway.
Jörg
J
Aßmuss
Department of Research, Sunnaas Rehabilitation Hospital, Oslo, Norway.|Department of Clinical Medicine, University of Oslo, Oslo, Norway.
Frank
F
Becker
Hammel Neurorehabilitation Centre and University Research Clinic, Voldbyvej 15, 8450, Hammel, Denmark.
Hanne
H
Pallesen
Rehabilitation Campus Sint-Ursula, Jessa Hospitals, Herk-de-Stad, 3540, Belgium.
Liselot
L
Thijs
Department of Rehabilitation Sciences, KU Leuven, Postbus 1501, Leuven, 3000, Belgium.
Geert
G
Verheyden
D003198:Computer Simulation; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010291:Paresis / Q000503:physiopathology / Q000534:rehabilitation*; D020521:Stroke / Q000503:physiopathology*; D000071939:Stroke Rehabilitation / Q000379:methods*; D034941:Upper Extremity / Q000503:physiopathology*
Motor function; Neurorehabilitation; Occupational therapy; Physical therapy; Stroke; Upper limb; Virtual reality