Getting to know VR: Using a Knowledge Translation tool for therapists

A knowledge translation intervention to enhance clinical application of a virtual reality system in stroke rehabilitation

Single Group

Levac D, Glegg SMN, Sveistrup H, Colquhoun H, Miller PA, Finestone H, DePaul V, Harris JA & Velikonja D

BMC Health Serv Res. 2016; 16: 557. Published online 2016 Oct 6. doi: 10.1186/s12913-016-1807-6

Full text: www.ncbi.nlm.nih.gov/pmc/articles/PMC5052802/

Objective: In a sample of therapists, does a Knowledge Translation (KT) tool result in pre- to post-intervention improvements in VR technology adoption?

Process: Therapists were rated on the ADOPT-VR tool (Assessing Determinants of Prospective Takeup - Virtual Reality) before and after the KT intervention which included interactive e-learning modules, hands-on workshops and experiential learning practice sessions.

Outcomes: Pre- to post-intervention changes included improvement in therapists’ sense of agency and in increased facilitating conditions. Therapist knowledge and skills for using VR also increased. Barriers to use, intention to use and actual use did not change with the KT intervention for using VR. Low perceived usability of the VR system and some IREX-specific problems represented barriers, too.

Rating game play

Single group

Development and Reliability Evaluation of the Movement Rating Instrument for Virtual Reality Video Game Play

Levac D, Nawrotek J, Deschenes E, Giguere T, Serafin J, Bilodeau M & Sveistrup H

JMIR Serious Games 2016;4(1):e9
URL: http://games.jmir.org/2016/1/e9/
doi:10.2196/games.5528
PMID:27251029

Objective: to "develop and evaluate the feasibility and reliability" of a measure for separating and quantifying the movements children make during VR therapy. The Movement Rating Instrument for Virtual Reality Video Game Play (MRI-VRGP) was applied to IREX and Kinect game systems.

Process: Movements were parsed into items and after several iterations, the selected items were trialled. Reviewers watched videotapes of subjects to rate upper extremity movements (unilateral or bilateral; close or far) and lower extremity movements within or without the base of support. They rated the activities as movements on a spectrum of easy to difficult and rated their confidence in making the rating.

Outcome: Within-rater reliability was higher (good) than inter-rater reliability (moderate). Finer movements were harder to rate consistently within therapists. Inter-rater reliability varied widely, and upper extremity fine (close) movements were rated less consistently.
More "item definition clarification and further psychometric property evaluation" will allow therapists to sort VR games by the type and frequency of their body movements.

Survey of VR Clinical Use

Survey

Using Virtual Reality in Clinical Practice: A Multi-Site Exploratory Study
Glegg, M. N. S., Holsti, L., Stanton, S., Hanna, S., Velikonja, D., Ansley, B., Sartor, D. & Brum, C.
NeuroRehabilitation : 2014 Sep 18 pg
DOI: 10:3233/NRE-141152

Link to abstract: www.ncbi.nlm.nih.gov/pubmed/25238866

Objective: For inpatients with acquired brain injury, how is GestureTek virtual reality used for rehabilitation?

Method: 11 therapists at two rehab centres collected data over 8 months on 39 clients; their VR interventions and the therapists’ treatment goals.

Findings and conclusions: Clinical “treatment characteristics and several outcomes of interest paralleled those in the literature; however, novel outcome areas were identified as research gaps. By study’s end, more than half of clients’ VR programs had been discontinued, for reasons consistent with documented barriers to VR use. These findings can help… inform the design of research that has high clinical relevance, and… provide a point of reference for clinicians incorporating VR into their practices.”

The GestureTek Virtual Reality system in Rehabilitation: a Scoping Review

Scoping Review

Glegg, S.M.N., Tatla, S.K. & Holstii, L., Disability and Rehabilitation Assistive Technology 2014, 9(2); 89 – 111

Link to abstract:
www.ncbi.nlm.nih.gov/pubmed/23713408

Objective: This scoping review examines research literature with quantitative data specific to the GestureTek virtual reality system used in physical and cognitive rehabilitation. The purpose of this scoping review is to determine the practicality of a systematic review, to identify areas for further research, “…and to allow therapists to be able to seek out readily pertinent evidence to support their clinical decisions about their use of the technology”.

Method: An explicit search strategy was used, resulting in 44 included studies mostly relating to stroke. For cerebral palsy, five studies were reported with evidence level I, II or III: one single case study reported level III evidence for balance and mobility improvement, and another single case reported level I evidence for improved reach, by American Academy for Cerebral Palsy and Developmental Medicine criteria.

Findings: Few strong quality or high level evidence studies are available: lack of common outcome measures limits the possibility of a systematic review. High level, larger studies are needed. This scoping review provides a database of rated studies related to cerebral palsy habilitation and outcomes of balance, mobility and upper extremity improvement.