A Virtual Reality-Based Cognitive Restorative Intervention Using Nature to Improve Attention, Self-Care, and...

Cognitive dysfunction is prevalent and predictive of worse health outcomes among people with heart failure (HF).

The purpose of this study was to test the preliminary efficacy of the newly developed virtual reality-based cognitive restorative intervention using nature environments (Nature-VR) on improving attention, HF self-care, and health-related quality of life (HRQL) compared with the active control condition using urban environments (Urban-VR). Intervention effects were explored on other cognitive domains.

A 2-group single-blind pilot randomized controlled trial design was used. Participants randomized to Nature-VR viewed spherical images of nature environments on a virtual reality headset for 10 minutes/day, 5 days/week for 4 weeks (200 images total). Participants randomized to Urban-VR viewed spherical images of urban environments matched to Nature-VR intervention delivery mode and time. Data were collected at baseline, 4, 8, 26, and 52 weeks.

Of 73 participants, 68 (93%) completed the intervention or control condition. Fifty-one (70%) completed the study. Linear mixed models showed no significant group-by-time interactions on attention, HF self-care, or HRQL. Significant time effects were found on HF self-care (all scales, P < .001). Executive function measured by Verbal Fluency Test-Letter F improved more among participants in Nature-VR than those in Urban-VR at 4 weeks ( P = .041) after adjusting covariates.

Preliminary efficacy of Nature-VR compared with Urban-VR was not demonstrated for attention, HF self-care, and HRQL. There was preliminary evidence of improved executive function at 4 weeks. Factors associated with intervention responsiveness and strategies to optimize cognitive interventions should be considered.