Effect of Virtual Reality Gait Training on Participation in Survivors of Subacute Stroke: A Randomized Controlled Trial

Ilona J M de Rooij, Ingrid G L van de Port, Michiel Punt, Pim J M Abbink-van Moorsel, Michiel Kortsmit, Ruben P A van Eijk, Johanna M A Visser-Meily, Jan-Willem G Meijer, Ilona J M de Rooij, Ingrid G L van de Port, Michiel Punt, Pim J M Abbink-van Moorsel, Michiel Kortsmit, Ruben P A van Eijk, Johanna M A Visser-Meily, Jan-Willem G Meijer

Abstract

Objective: After stroke, people experience difficulties with walking that lead to restrictions in participation in daily life. The purpose of this study was to examine the effect of virtual reality gait training (VRT) compared to non-virtual reality gait training (non-VRT) on participation in community-living people after stroke.

Methods: In this assessor-blinded, randomized controlled trial with 2 parallel groups, people were included between 2 weeks and 6 months after stroke and randomly assigned to the VRT group or non-VRT group. Participants assigned to the VRT group received training on the Gait Real-time Analysis Interactive Lab (GRAIL), and participants assigned to the non-VRT group received treadmill training and functional gait exercises without virtual reality. Both training interventions consisted of 12 30-minute sessions during 6 weeks. The primary outcome was participation measured with the restrictions subscale of the Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-P) 3 months postintervention. Secondary outcomes included subjective physical functioning, functional mobility, walking ability, dynamic balance, walking activity, fatigue, anxiety and depression, falls efficacy, and quality of life.

Results: Twenty-eight participants were randomly assigned to the VRT group and 27 to the non-VRT group, of whom 25 and 22 attended 75% or more of the training sessions, respectively. No significant differences between the groups were found over time for the USER-P restrictions subscale (1.23; 95% CI = -0.76 to 3.23) or secondary outcome measures. Patients' experiences with VRT were positive, and no serious adverse events were related to the interventions.

Conclusions: The effect of VRT was not statistically different from non-VRT in improving participation in community-living people after stroke.

Impact: Although outcomes were not statistically different, treadmill-based VRT was a safe and well-tolerated intervention that was positively rated by people after stroke. VR training might, therefore, be a valuable addition to stroke rehabilitation.

Lay summary: VRT is feasible and was positively experienced by people after stroke. However, VRT was not more effective than non-VRT for improving walking ability and participation after stroke.

Keywords: Gait; Gait Training; Participation; Rehabilitation, Stroke; Virtual Reality.

© The Author(s) 2021. Published by Oxford University Press on behalf of the American Physical Therapy Association.

Figures

Figure
Figure
Flow diagram of participants *Complete follow-up included both the postintervention assessment (T1, 6 wk) and the follow-up assessment (T2, 3 mo postintervention).

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