Virtual Reality Rehabilitation in long COVID patients; a pilot effectiveness study

R.J. Achttien PT, PhD(1), M.L.M. Smits MSc(2), J.B. Staal PT, PhD(1,3), T. Groenveld, H. van Goor, MD, PhD, FRCS(2) and the VREHAB group

(1)Department of IQ Healthcare, Radboudumc, Nijmegen, The Netherlands;
(2)Department of Surgery, Radboudumc, Nijmegen, the Netherlands,
(3)School for Allied Health, Musculoskeletal Rehabilitation Research Group, HAN University of Applied Sciences, Nijmegen, The Netherlands

Introduction

Post-COVID-19 patients, including those not admitted to hospital, are expected to have high needs for physical, psychological, and cognitive rehabilitation (long COVID) [1]. Resources needed to provide rehabilitation treatment are expected to be inadequate [2].Virtual Reality (VR) rehabilitation at home offers a unique solution for the impending surge of long-COVID-19 rehabilitation requests. VR therapy comprises efficient home-based personalized rehabilitation [3]. However, several barriers for implementation of such rehabilitation solution should be tackled such as acceptability by patients and care providers and cost-effectiveness. Aim of this study is to gain insights in use and effect of an existing VR games’ suite as add-on treatment in long COVID patients, referred to a general physical therapy practice or rehabilitation center.

Methods

Patients were recruited from 10 participating physical therapy practices and one rehabilitation facility (Klimmendaal). Participating physical therapists (PT) received verbal on-site instructions on use of the VR suite, consisting of exercising games in three domains: physical, mental and cognitive. Participants underwent 6 weeks of VR rehabilitation in addition to long-COVID physiotherapy, according to the guidelines of the professional association. VR was used first at the PTs’ practices and if judged safe by the PT at home. Type, time, and frequency of VR intervention was individualized to the baseline performance tests and outcome goals and adapted according to patient’s feedback, physical parameters (e.g. vital signs) and digitally tracking information from the VR head, when used at home. Home use was supported by a research team with experience in VR therapy. Validated questionnaires (e.g. ADL, Activities of Daily Living; HADS, Hospital Anxiety and Depression Scale; CFQ, cognitive failure questionnaire; PCS, patient specific complaints questionnaire; SF12, Short Form (12) Health Survey, positive health survey) and a panel of standard physical therapy measurements (e.g.; 6 minute walk test (6MWT), Hand grip force measurement for upper extremity or Handheld Dynamometer; BORG scale for dyspnoea and fatigue; 30 sec sit to stand test) were performed at baseline and at 6 weeks.

SPSS version 25 was used for statistical analyses. Patient, disease and treatment characteristics are presented as descriptive analyses. Outcomes at 6 weeks are compared with baseline data with univariate analysis and where applicable with regression analyses.

Results and discussion

Between July 2020 and March 2021, 48 patients were included in the study. 8 dropped out, mostly for experiencing sensory overload, 40 were evaluable. 27 participants were female, 13 male with an average age of 48, ranging from 20 to 69 years. On average, 4 participants were included per practice. 4 patients were included in the rehabilitation facility. Because the last patient has not completed the 6-weeks intervention period further results will be presented at the meeting for the first time.

Conclusion

VR therapy is a promising add-on to standard physical therapy for rehabilitation long COVID.

References

[1] Biehl, M. and D. Sese, Post-intensive care syndrome and COVID-19 – Implications post pandemic. Cleve Clin J Med, 2020.

[2] Davidson, J.E. and M.A. Harvey, Patient and Family Post-Intensive Care Syndrome. AACN Adv Crit Care, 2016. 27(2): p. 184-6.

[3] Smits, M., J.B. Staal, and H. van Goor, Could Virtual Reality play a role in the rehabilitation after COVID-19 infection? BMJ Open Sport & Exercise Medicine, 2020. 6(1): p. e000943.