Allegue Dorra Rakia, Sweet Shane Norman, Higgins Johanne, Archambault Philippe S, Michaud Francois, Miller William C, Tousignant Michel, Kairy Dahlia
The Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Institut universitaire sur la réadaptation en déficience physique de Montréal, Montreal, QC, Canada.
School of Rehabilitation, Université de Montréal, Montreal, QC, Canada.
JMIR Rehabil Assist Technol. 2022 Sep 15;9(3):e31305. doi: 10.2196/31305.
In Canada, stroke survivors have difficulty accessing community-based rehabilitation services because of a lack of resources. VirTele, a personalized remote rehabilitation program combining virtual reality exergames and telerehabilitation, was developed to provide stroke survivors an opportunity to pursue rehabilitation of their chronic upper extremity (UE) deficits at home while receiving ongoing follow-up from a clinician.
We aimed to identify the behavioral and motivational techniques used by clinicians during the VirTele intervention, explore the indicators of empowerment among stroke survivors, and investigate the determinants of VirTele use among stroke survivors and clinicians.
This multiple case study involved 3 stroke survivors with chronic UE deficits and their respective clinicians (physiotherapists) who participated in the VirTele intervention, a 2-month remote rehabilitation intervention that uses nonimmersive virtual reality exergames and telerehabilitation aimed at improving UE deficits in stroke survivors. Study participants had autonomous access to Jintronix exergames and were asked to use them for 30 minutes, 5 times a week. The VirTele intervention included 1-hour videoconference sessions with a clinician 1 to 3 times a week, during which the clinician engaged in motivational interviewing, supervised the stroke survivors' use of the exergames, and monitored their use of the affected UE through activities of daily living. Semidirected interviews were conducted with the clinicians and stroke survivors 4 to 5 weeks after the end of the VirTele intervention. All interviews were audiorecorded and transcribed verbatim. An abductive thematic analysis was conducted to generate new ideas through a dynamic interaction between data and theory.
Three stroke survivors (n=2, 67%, women and n=1, 33%, man), with a mean age of 58.8 (SD 19.4) years, and 2 physiotherapists participated in the study. Five major determinants of VirTele use emerged from the qualitative analyses, namely technology performance (usefulness and perception of exergames), effort (ease of use), family support (encouragement), facilitators (considerations of the stroke survivors' safety as well as trust and understanding of instructions), and challenges (miscommunication and exergame limits). During the VirTele intervention, both clinicians used motivational and behavioral techniques to support autonomy, competence, and connectivity. All these attributes were reflected as empowerment indicators in the stroke survivors. Lessons learned from using telerehabilitation combined with exergames are provided, which will be relevant to other researchers and contexts.
This multiple case study provides a first glimpse into the impact that motivational interviewing can have on adherence to exergames and changes in behavior in the use of the affected UE in stroke survivors. Lessons learned regarding the supportive role caregivers play and the new responsibilities clinicians have when using the VirTele intervention may inform the use of exergames via telerehabilitation. These lessons will also serve as a model to guide the implementation of similar interventions.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/14629.
在加拿大，由于资源匮乏，中风幸存者难以获得基于社区的康复服务。VirTele是一个个性化的远程康复项目，结合了虚拟现实运动游戏和远程康复技术，旨在为中风幸存者提供在家中进行慢性上肢功能障碍康复的机会，同时接受临床医生的持续随访。
我们旨在确定临床医生在VirTele干预过程中使用的行为和激励技巧，探索中风幸存者的赋权指标，并调查中风幸存者和临床医生使用VirTele的决定因素。
这项多案例研究涉及3名患有慢性上肢功能障碍的中风幸存者及其各自的临床医生（物理治疗师），他们参与了VirTele干预，这是一项为期2个月的远程康复干预，使用非沉浸式虚拟现实运动游戏和远程康复技术，旨在改善中风幸存者的上肢功能障碍。研究参与者可自主使用Jintronix运动游戏，并被要求每周使用5次，每次30分钟。VirTele干预包括每周与临床医生进行1至3次1小时的视频会议，在此期间，临床医生进行动机访谈，监督中风幸存者使用运动游戏，并通过日常生活活动监测他们受影响上肢的使用情况。在VirTele干预结束后的4至5周，对临床医生和中风幸存者进行了半结构化访谈。所有访谈都进行了录音并逐字转录。进行了归纳主题分析，以通过数据与理论之间的动态互动产生新的想法。
3名中风幸存者（2名女性，占67%；1名男性，占33%）参与了研究，平均年龄为58.8岁（标准差19.4），还有2名物理治疗师。定性分析得出了VirTele使用的五个主要决定因素，即技术性能（运动游戏的有用性和感知）、努力程度（易用性）、家庭支持（鼓励）、促进因素（对中风幸存者安全的考虑以及对指示的信任和理解）和挑战（沟通不畅和运动游戏的局限性）。在VirTele干预期间，两名临床医生都使用了激励和行为技巧来支持自主性、能力和联系。所有这些属性都反映为中风幸存者的赋权指标。还提供了将远程康复与运动游戏相结合的经验教训，这将与其他研究人员和背景相关。
这项多案例研究首次揭示了动机访谈对中风幸存者坚持运动游戏以及受影响上肢使用行为变化的影响。关于护理人员所起的支持作用以及临床医生在使用VirTele干预时所承担的新责任的经验教训，可能会为通过远程康复使用运动游戏提供参考。这些经验教训也将作为指导类似干预措施实施的模型。
国际注册报告标识符（IRRID）：RR2-10.2196/14629。
