Effect of a Virtual Reality-Enhanced Exercise and Education Intervention on Patient Engagement and Learning in Cardiac Rehabilitation: Randomized Controlled Trial

Victoria Gulick, Daniel Graves, Shannon Ames, Pavitra Parimala Krishnamani, Victoria Gulick, Daniel Graves, Shannon Ames, Pavitra Parimala Krishnamani

Abstract

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://ichgcp.net/clinical-trials-registry/NCT03945201.

Keywords: VR; cardiac rehabilitation; exercise; outpatient therapy; patient education; patient experience; virtual reality.

Conflict of interest statement

Conflicts of Interest: None declared.

©Victoria Gulick, Daniel Graves, Shannon Ames, Pavitra Parimala Krishnamani. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 15.04.2021.

Figures

Figure 1
Figure 1
Vertically oriented television screen in front of a treadmill showing an example of Bionautica Trails.
Figure 2
Figure 2
Flow diagram of research design and patient completion status.
Figure 3
Figure 3
Average education test scores for pretest, posttest, and 2-month follow-up.

References

    1. Ades PA, Keteyian SJ, Wright JS, Hamm LF, Lui K, Newlin K, Shepard DS, Thomas RJ. Increasing cardiac rehabilitation participation from 20% to 70%: a road map from the million hearts cardiac rehabilitation collaborative. Mayo Clin Proc. 2017 Feb;92(2):234–242. doi: 10.1016/j.mayocp.2016.10.014.
    1. Blum MR, Schmid J, Eser P, Saner H. Long-term results of a 12-week comprehensive ambulatory cardiac rehabilitation program. J Cardiopulm Rehabil Prev. 2013;33(2):84–90. doi: 10.1097/HCR.0b013e3182779b88.
    1. Karmali KN, Davies P, Taylor F, Beswick A, Martin N, Ebrahim S. Promoting patient uptake and adherence in cardiac rehabilitation. Cochrane Database Syst Rev. 2014;(6):CD007131. doi: 10.1002/14651858.CD007131.pub3.
    1. Kerins M, McKee G, Bennett K. Contributing factors to patient non-attendance at and non-completion of Phase III cardiac rehabilitation. Eur J Cardiovasc Nurs. 2011 Mar;10(1):31–6. doi: 10.1016/j.ejcnurse.2010.03.006.
    1. Mikkelsen T, Korsgaard Thomsen K, Tchijevitch O. Non-attendance and drop-out in cardiac rehabilitation among patients with ischaemic heart disease. Dan Med J. 2014 Oct;61(10):A4919.
    1. Ganry L, Hersant B, Sidahmed-Mezi M, Dhonneur G, Meningaud J. Using virtual reality to control preoperative anxiety in ambulatory surgery patients: A pilot study in maxillofacial and plastic surgery. J Stomatol Oral Maxillofac Surg. 2018 Sep;119(4):257–61. doi: 10.1016/j.jormas.2017.12.010.
    1. Thompson-Butel AG, Shiner CT, McGhee J, Bailey BJ, Bou-Haidar P, McCorriston M, Faux SG. The role of personalized virtual reality in education for patients post stroke-a qualitative case series. J Stroke Cerebrovasc Dis. 2019 Feb;28(2):450–457. doi: 10.1016/j.jstrokecerebrovasdis.2018.10.018.
    1. Vieira Á, Melo C, Machado J, Gabriel J. Virtual reality exercise on a home-based phase III cardiac rehabilitation program, effect on executive function, quality of life and depression, anxiety and stress: a randomized controlled trial. Disabil Rehabil Assist Technol. 2018 Feb;13(2):112–123. doi: 10.1080/17483107.2017.1297858.
    1. Sloot LH, van der Krogt MM, Harlaar J. Effects of adding a virtual reality environment to different modes of treadmill walking. Gait Posture. 2014 Mar;39(3):939–45. doi: 10.1016/j.gaitpost.2013.12.005.
    1. Ekstrand C, Jamal A, Nguyen R, Kudryk A, Mann J, Mendez I. Immersive and interactive virtual reality to improve learning and retention of neuroanatomy in medical students: a randomized controlled study. CMAJ Open. 2018 Feb 23;6(1):E103–E109. doi: 10.9778/cmajo.20170110.
    1. Inc Bionautica trails. [2020-08-28]. .
    1. Inc Inc. [2020-08-28].
    1. Dankner R, Drory Y, Geulayov G, Ziv A, Novikov I, Zlotnick AY, Moshkovitz Y, Elami A, Schwammenthal E, Goldbourt U. A controlled intervention to increase participation in cardiac rehabilitation. Eur J Prev Cardiol. 2015 Sep;22(9):1121–8. doi: 10.1177/2047487314548815.
    1. Online survey software. Qualtrics. [2020-08-28].
    1. Solway S, Brooks D, Lacasse Y, Thomas S. A qualitative systematic overview of the measurement properties of functional walk tests used in the cardiorespiratory domain. Chest. 2001 Jan;119(1):256–70. doi: 10.1378/chest.119.1.256.
    1. Valerio G, Bracciale P, Valerio F. Metabolic requirements during six minutes walking tests in patients affected by chronic obstructive pulmonary disease in different stages. Open J Resp Disease. 2012;2(4):83–90. doi: 10.4236/ojrd.2012.24012.
    1. Zimmerli L, Jacky M, Lünenburger L, Riener R, Bolliger M. Increasing patient engagement during virtual reality-based motor rehabilitation. Arch Phys Med Rehabil. 2013 Sep;94(9):1737–46. doi: 10.1016/j.apmr.2013.01.029.
    1. Burke JW, McNeill MD, Charles DK, Morrow PJ, Crosbie JH, McDonough SM. Optimising engagement for stroke rehabilitation using serious games. Vis Comput. 2009 Aug 27;25(12):1085–99. doi: 10.1007/s00371-009-0387-4.
    1. Ryan R, Frederick C, Lepes D, Rubio N, Sheldon K. Intrinsic motivation and exercise adherence. Int J Sport Psychol. 1997;28:335–354.
    1. Agarwal AK, Murinson BB. New dimensions in patient-physician interaction: values, autonomy, and medical information in the patient-centered clinical encounter. Rambam Maimonides Med J. 2012 Jul;3(3):e0017. doi: 10.5041/RMMJ.10085.
    1. Vertemati M, Cassin S, Rizzetto F, Vanzulli A, Elli M, Sampogna G, Gallieni M. A virtual reality environment to visualize three-dimensional patient-specific models by a mobile head-mounted display. Surg Innov. 2019 Jun;26(3):359–370. doi: 10.1177/1553350618822860.
    1. Krokos E, Plaisant C, Varshney A. Virtual memory palaces: immersion aids recall. Virtual Real. 2018 May 16;23(1):1–15. doi: 10.1007/s10055-018-0346-3.
    1. Stepan K, Zeiger J, Hanchuk S, Del Signore A, Shrivastava R, Govindaraj S, Iloreta A. Immersive virtual reality as a teaching tool for neuroanatomy. Int Forum Allergy Rhinol. 2017 Oct;7(10):1006–1013. doi: 10.1002/alr.21986.
    1. Weech S, Kenny S, Barnett-Cowan M. Presence and cybersickness in virtual reality are negatively related: a review. Front Psychol. 2019;10:158. doi: 10.3389/fpsyg.2019.00158. doi: 10.3389/fpsyg.2019.00158.
    1. Tate DF, Lyons EJ, Valle CG. High-tech tools for exercise motivation: use and role of technologies such as the internet, mobile applications, social media, and video games. Diabetes Spectr. 2015 Jan;28(1):45–54. doi: 10.2337/diaspect.28.1.45.
    1. Hinyard LJ, Kreuter MW. Using Narrative Communication as a Tool for Health Behavior Change: A Conceptual, Theoretical, and Empirical Overview. Health Educ Behav. 2007 Oct;34(5):777–792. doi: 10.1177/1090198106291963.

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