Effect of a Virtual Reality-Enhanced Exercise and Education Intervention on Patient Engagement and Learning in
Victoria Gulick1, Daniel Graves2, Shannon Ames2
1Information Services & Technologies, Jefferson Health, Philadelphia, PA, United States.
Insights
Virtual reality (VR) did not improve cardiac rehabilitation outcomes in this study. While patients may have enjoyed VR, it did not enhance knowledge, satisfaction, or attendance compared to standard care.
Area of Science:
- Cardiology
- Rehabilitation Medicine
- Virtual Reality Applications
Background:
- Cardiac rehabilitation (CR) is vital for reducing morbidity and mortality.
- Low enrollment and completion rates in CR are significant clinical challenges.
- Socioeconomic factors, lack of patient understanding, and motivation impact CR adherence.
Purpose of the Study:
- To explore virtual reality (VR) walking trails' impact on CR patient knowledge retention.
- To assess VR's effect on patient satisfaction within cardiac rehabilitation.
- To evaluate VR's influence on treatment session attendance in CR.
Main Methods:
- Randomized controlled trial comparing VR walking trails with standard CR therapy.
- Intervention group used VR with audio education; control group received standard care.
- Outcomes included 6-minute walk test, cardiac knowledge questionnaires, patient satisfaction, and attendance rates.
Main Results:
- No significant differences in 6-minute walk test improvement between VR and control groups (P=.64).
- No statistical differences in cardiac knowledge (P=.86) or satisfaction (P=.32) were observed.
- The control group demonstrated statistically better attendance rates (P=.02).
Conclusions:
- The VR intervention did not show significant benefits over standard cardiac rehabilitation.
- Study design limitations may have influenced outcomes, not the VR technology itself.
- Qualitative data suggest potential patient enjoyment of VR, warranting further investigation into its application in CR.
Background:
Cardiac rehabilitation (CR) is clinically proven to reduce morbidity and mortality; however, many eligible patients do not enroll in treatment. Furthermore, many enrolled patients do not complete their full course of treatment. This is greatly influenced by socioeconomic factors but is also because of patients' lack of understanding of the importance of their care and a lack of motivation to maintain attendance.
Objective:
This study aims to explore the potential benefits of virtual reality (VR) walking trails within CR treatment, specifically with regard to patient knowledge retention, satisfaction with treatment, and the overall attendance of treatment sessions.
Methods:
New CR patients were enrolled and randomized on a rolling basis to either the control group or intervention group. Intervention patients completed their time on the treadmill with VR walking trails, which included audio-recorded education, whereas control patients completed the standard of care therapy. Both groups were assisted by nursing staff for all treatment sessions. Primary outcomes were determined by assessing 6-minute walk test improvement. In addition, secondary outcomes of patients' cardiac knowledge and satisfaction were assessed via a computer-based questionnaire; patient adherence to the recommended number of sessions was also monitored. Cardiac knowledge assessment included a prerehabilitation education quiz, and the same quiz was repeated at patients' final visit and again at the 2-month follow-up. The satisfaction questionnaire was completed at the final visit.
Results:
Between January 2018 and May 2019, 72 patients were enrolled-41 in the intervention group and 31 in the control group. On the basis of the results of the prerehabilitation and postrehabilitation 6-minute walk test, no significant differences were observed between the intervention and control groups (P=.64). No statistical differences were observed between groups in terms of education (P=.86) or satisfaction (P=.32) at any time point. The control group had statistically more favorable rates of attendance, as determined by the risk group comparison (P=.02) and the comparison of the rates for completing the minimum number of sessions (P=.046), but no correlation was observed between the study group and reasons for ending treatment.
Conclusions:
Although no improvements were seen in the VR intervention group over the control group, it is worth noting that limitations in the study design may have influenced these outcomes, not the medium itself. Furthermore, the qualitative information suggests that patients may have indeed enjoyed their experience with VR, even though quantitative satisfaction data did not capture this. Further considerations for how and when VR should be applied to CR are suggested in this paper.
Trial Registration:
ClinicalTrials.gov NCT03945201; https://clinicaltrials.gov/ct2/show/NCT03945201.
