Effect of virtual reality gait training on participation in survivors of subacute stroke: a randomized controlled trial

IJM de Rooij(1,2), IGL van de Port(1), M Punt(3), PJM Abbink-van Moorsel(1), M Kortsmit(1), RPA van Eijk(4,5), JMA Visser-Meily(2,6), JWG Meijer(1,2,7)

(1)Revant Rehabilitation Centres, Breda, the Netherlands.
(2)Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, the Netherlands.
(3)Research group Lifestyle and Health, Utrecht University of Applied Sciences, Utrecht, the Netherlands.
(4)Department of Neurology, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht, the Netherlands.
(5)Biostatistics & Research Support, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands.
(6)Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, the Netherlands.7De Hoogstraat Rehabilitation, Utrecht, the Netherlands.

Introduction

After stroke, people often experience difficulties with walking leading to restrictions in participation in daily life. The aim of this study was to examine the effect of virtual reality gait training (VRT) compared to non-virtual reality gait training (non-VRT) on participation in community-living people after stroke.

Methods

The study was an assessor-blinded randomized controlled trial with two parallel groups. Fifty-five people after stroke were randomly assigned to the VRT or non-VRT group between two weeks and six months after stroke. Participants in the VRT group received training on the Gait Real-time Analysis Interactive Lab (GRAIL) and participants in the non-VRT group received treadmill training and functional gait exercises without virtual reality. Both training interventions consisted of twelve 30-minute sessions during six weeks and were conducted in the rehabilitation center, Revant Rehabilitation Centres, Breda, the Netherlands. Assessments were performed at baseline, post-intervention, and three months post-intervention. Primary outcome was the restrictions subscale of the Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-P). Secondary outcomes included patient experiences, subjective physical functioning, functional mobility, walking ability, dynamic balance, walking activity, fatigue, anxiety, depression, falls efficacy, and quality of life. The effectiveness of VRT was determined using an analysis of covariance (ANCOVA) linear mixed effects model.

Results and discussion

The VRT group consisted of 28 participants and the non-VRT group of 27 participants, of which 25 and 22 attended 75% or more of the training sessions, respectively. No significant differences between the groups were found over time for the USER-P restrictions scale (1.23, 95% CI -0.76 to 3.23, p=0.22) or secondary outcome measures. Participation improved over time in both groups. Patients’ experiences with VRT were positive, and VRT was shown to be well-tolerated with limited adverse events. Future research should give more insight in which people after stroke can benefit from VRT. Studies should also further explore the added value of VR for specific rehabilitation goals after stroke, optimal treatment intensity of VR, and cost-effectiveness.

Conclusions

Treadmill-based VRT appeared a safe intervention that was well-tolerated by people after stroke. Despite the fact that the effect of VRT was not statistically different from non-VRT on participation in community-living people after stroke, the use of VRT can be considered in stroke rehabilitation depending on the patient characteristics and rehabilitation goals.