Older Adults' Experiences of Commercial Virtual Reality for Stroke Rehabilitation: A Mixed-Methods Study

Background and Objectives: Stroke is a leading cause of long-term disability in older adults, who often face persistent motor, cognitive, and functional challenges. Conventional stroke rehabilitation programs often involve highly repetitive motor tasks, which may reduce patient motivation and contribute to suboptimal adherence over time. Virtual reality (VR) offers an engaging alternative; however, much of the existing research has focused on specialized rehabilitation-oriented VR systems rather than off-the-shelf commercial platforms. This study evaluated older stroke survivors' acceptance, tolerability, and lived experiences of a short VR-based rehabilitation session using a commercial game on a commercial wearable VR system. Methods: A single-session convergent mixed-methods design was employed. Thirteen community-dwelling older stroke survivors (mean age 79.2 ± 7.1 years; 9 males, 4 female) completed a 15 min VR session using a commercial wearable VR system. The Technology Acceptance Model (TAM) questionnaire and Simulator Sickness Questionnaire (SSQ) assessed acceptance and tolerability, while semi-structured interviews explored lived experiences. Qualitative data were thematically analyzed. Results: Participants reported high acceptance across all TAM domains (overall M = 4.35 ± 0.79, scale 1-5). Enjoyment/intention to use was rated highest (M = 4.77 ± 0.42), while perceived usefulness was lowest (M = 4.15 ± 0.77). VR was well tolerated: the SSQ total score was 17.38 ± 1.73, with most symptoms rated at the mild level only. Exploratory Spearman correlations revealed a significant positive association between age and SSQ total score (r_h = +0.568, p = 0.043). Thematic analysis identified five themes: (1) usability and accessibility; (2) therapeutic value; (3) engagement and motivation; (4) social and clinical support; and (5) physical and cognitive demands. Conclusions: A commercial wearable VR system was found to be acceptable, safe, and engaging for older stroke survivors. With supervision and therapeutic framing, it may serve as a motivating adjunct to conventional rehabilitation.