Patients' use of a home-based virtual reality system to provide rehabilitation of the upper limb following stroke

Background: A low cost, virtual reality system that translates movements of the hand, fingers and thumb into game play was designed to provide a flexible and motivating approach to increasing adherence to home based rehabilitation. Objective: Effectiveness depends on adherence, so did patients use the intervention to the recommended level. If not, what reasons did they give? Design: Prospective cohort study plus qualitative analysis of interviews. Methods: 17 patients recovering from stroke recruited to the intervention arm of a feasibility trial had the equipment left in their homes for eight weeks and were advised to use it three times a day for periods of no more than 20 minutes. Frequency and duration of use were automatically recorded. At the end of the intervention, participants were interviewed to determine barriers to using it in the recommended way. Results: Duration of use and how many days they used the equipment are presented for the 13 participants who successfully started the intervention. These figures were highly variable and could fall far short of our recommendations. There was a weak (p=0.053) positive correlation between duration and baseline reported activities of daily living. Participants reported familiarity with technology and competing commitments as barriers to use although appreciated the flexibility of the intervention and found it motivating