Effectiveness of virtual reality assisted active limb movement exercises for patients in the respiratory intensive care unit: a randomized pilot study
DOI:
https://doi.org/10.2340/jrm.v57.28399Keywords:
Early Limb Mobilization, Exercise Compliance, Virtual Reality Rehabilitation, Respiratory Intensive Care, Muscle Strength Improvement, RICU Patient OutcomesAbstract
Objective: The primary aim of this study is to compare the effectiveness of early active limb movement facilitated by virtual reality technologies with conventional exercise therapy in enhancing patient recovery in the Respiratory Intensive Care Unit. The follow-up period covers 1 week.
Methods: In this prospective randomized controlled trial, patients were allocated to either a control group, which received standard exercise therapy, or a virtual reality group, which utilized virtual reality software and equipment for active exercises. Patients were followed for 1 week. The study compared compliance, safety, and rehabilitative outcomes between these groups. Data were analysed using a linear mixed-effects model.
Results: Patients in the virtual reality-based exercise group exhibited significantly higher levels of average daily exercise time, out-of-bed exercise time, and overall exercise compliance compared with the control group (p < 0.05). There were no reports of adverse events related to exercise in either group. Notably, within the first week of intervention, the virtual reality-based exercise group showed significant improvements in various parameters, including muscle strength, grip strength, body mass index, and the Barthel Index, outperforming the control group in these areas (all p < 0.05).
Conclusion: Based on 1 week of follow-up data, the study confirms that virtual reality-based exercise modalities are more efficacious than traditional exercise approaches in enhancing exercise duration, compliance, and various health outcomes in Respiratory Intensive Care Unit patients. This approach also contributes to reducing Respiratory Intensive Care Unit stay duration. The system’s effectiveness could be further increased by integrating more varied and engaging rehabilitation games and features tailored to the needs of ICU patients.
Trial registration: Chictr.org: ChiCTR1900021452
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References
Hashem MD, Nelliot A, Needham DM. Early Mobilization and Rehabilitation in the ICU: Moving Back to the Future. Respir Care 2016; 61: 971-979.
https://doi.org/10.4187/respcare.04741 DOI: https://doi.org/10.4187/respcare.04741
Clarissa C, Salisbury L, Rodgers S, Kean S. Early mobilisation in mechanically ventilated patients: a systematic integrative review of definitions and activities. J Intensive Care 2019; 7: 3.
https://doi.org/10.1186/s40560-018-0355-z DOI: https://doi.org/10.1186/s40560-018-0355-z
Investigators TS, Hodgson C, Bellomo R, Berney S, Bailey M, Buhr H, et al. Early mobilization and recovery in mechanically ventilated patients in the ICU: a bi-national, multi-centre, prospective cohort study. Crit Care 2015; 19: 81.
https://doi.org/10.1186/s13054-015-0765-4 DOI: https://doi.org/10.1186/s13054-015-0765-4
Nydahl P, Ruhl AP, Bartoszek G, Dubb R, Filipovic S, Flohr HJ, et al. Early mobilization of mechanically ventilated patients: a 1-day point-prevalence study in Germany. Crit Care Med 2014; 42: 1178-1186.
https://doi.org/10.1097/CCM.0000000000000149 DOI: https://doi.org/10.1097/CCM.0000000000000149
Jolley SE, Moss M, Needham DM, Caldwell E, Morris PE, Miller RR, et al. Point prevalence study of mobilization practices for acute respiratory failure patients in the United States. Crit Care Med 2017; 45: 205-215.
https://doi.org/10.1097/CCM.0000000000002058 DOI: https://doi.org/10.1097/CCM.0000000000002058
Liu H, Tian Y, Jiang B, Song Y, Du A, Ji S. Early mobilisation practice in intensive care units: A large-scale cross-sectional survey in China. Nurs Crit Care 2023; 28: 510-518.
https://doi.org/10.1111/nicc.12896 DOI: https://doi.org/10.1111/nicc.12896
Hsu SH, Campbell C, Weeks AK, Herklotz M, Kostelecky N, Pastores SM, et al. A pilot survey of ventilated cancer patients' perspectives and recollections of early mobility in the intensive care unit. Support Care Cancer 2020; 28: 747-753.
https://doi.org/10.1007/s00520-019-04867-1 DOI: https://doi.org/10.1007/s00520-019-04867-1
Sibilla A, Nydahl P, Greco N, Mungo G, Ott N, Unger I, et al. Mobilization of mechanically ventilated patients in Switzerland. J Intensive Care Med 2020; 35: 55-62.
https://doi.org/10.1177/0885066617728486 DOI: https://doi.org/10.1177/0885066617728486
Corner EJ, Murray EJ, Brett SJ. Qualitative, grounded theory exploration of patients' experience of early mobilisation, rehabilitation and recovery after critical illness. BMJ Open 2019; 9: e026348.
https://doi.org/10.1136/bmjopen-2018-026348 DOI: https://doi.org/10.1136/bmjopen-2018-026348
Cameron S, Ball I, Cepinskas G, Choong K, Doherty TJ, Ellis CG, et al. Early mobilization in the critical care unit: A review of adult and pediatric literature. J Crit Care 2015; 30: 664-672.
https://doi.org/10.1016/j.jcrc.2015.03.032 DOI: https://doi.org/10.1016/j.jcrc.2015.03.032
Goodson CM, Friedman LA, Mantheiy E, Heckle K, Lavezza A, Toonstra A, et al. Perceived Barriers to Mobility in a Medical ICU: The Patient Mobilization Attitudes & Beliefs Survey for the ICU. J Intensive Care Med 2020; 35: 1026-1031.
https://doi.org/10.1177/0885066618807120 DOI: https://doi.org/10.1177/0885066618807120
Walker DM, Sieck CJ, Menser T, Huerta TR, Scheck McAlearney A. Information technology to support patient engagement: where do we stand and where can we go? J Am Med Inform Assoc 2017; 24: 1088-1094.
https://doi.org/10.1093/jamia/ocx043 DOI: https://doi.org/10.1093/jamia/ocx043
Yeung S, Rinaldo F, Jopling J, Liu B, Mehra R, Downing NL, et al. A computer vision system for deep learning-based detection of patient mobilization activities in the ICU. NPJ Digit Med 2019; 2: 11.
https://doi.org/10.1038/s41746-019-0087-z DOI: https://doi.org/10.1038/s41746-019-0087-z
Kho ME, Damluji A, Zanni JM, Needham DM. Feasibility and observed safety of interactive video games for physical rehabilitation in the intensive care unit: a case series. J Crit Care 2012; 27: 219 e211-216.
https://doi.org/10.1016/j.jcrc.2011.08.017 DOI: https://doi.org/10.1016/j.jcrc.2011.08.017
Abdulsatar F, Walker RG, Timmons BW, Choong K. "Wii-Hab" in critically ill children: a pilot trial. J Pediatr Rehabil Med 2013; 6: 193-204.
https://doi.org/10.3233/PRM-130260 DOI: https://doi.org/10.3233/PRM-130260
Parke S, Hough CL, A EB. The Feasibility and Acceptability of Virtual Therapy Environments for Early ICU Mobilization. PM R 2020; 12: 1214-1221.
https://doi.org/10.1002/pmrj.12352 DOI: https://doi.org/10.1002/pmrj.12352
Prohaska CC, Sottile PD, Nordon-Craft A, Gallagher MD, Burnham EL, Clark BJ, et al. Patterns of utilization and effects of hospital-specific factors on physical, occupational, and speech therapy for critically ill patients with acute respiratory failure in the USA: results of a 5-year sample. Crit Care 2019; 23: 175.
https://doi.org/10.1186/s13054-019-2467-9 DOI: https://doi.org/10.1186/s13054-019-2467-9
Wang J, Zhang C, Jia Y, Shi C, Choi T, Xiao Q. Development of a virtual reality system for early mobilization of critically Ill patients. Stud Health Technol Inform 2019; 264: 1805-1806. DOI: https://doi.org/10.3233/SHTI190657
Xiong T, Bai X, Wei X, Wang L, Li F, Shi H, et al. Exercise rehabilitation and chronic respiratory diseases: effects, mechanisms, and therapeutic benefits. Int J Chron Obstruct Pulmon Dis 2023; 18: 1251-1266.
https://doi.org/10.2147/COPD.S408325 DOI: https://doi.org/10.2147/COPD.S408325
Bevilacqua R, Maranesi E, Riccardi GR, Donna VD, Pelliccioni P, Luzi R, et al. Non-immersive virtual reality for rehabilitation of the older people: a systematic review into efficacy and effectiveness. J Clin Med 2019; 8: 1882.
https://doi.org/10.3390/jcm8111882 DOI: https://doi.org/10.3390/jcm8111882
Jones T, Moore T, Choo J. The impact of virtual reality on chronic pain. PLoS One 2016; 11: e0167523.
https://doi.org/10.1371/journal.pone.0167523 DOI: https://doi.org/10.1371/journal.pone.0167523
Hoffman HG, Patterson DR, Carrougher GJ, Sharar SR. Effectiveness of virtual reality-based pain control with multiple treatments. Clin J Pain 2001; 17: 229-235.
https://doi.org/10.1097/00002508-200109000-00007 DOI: https://doi.org/10.1097/00002508-200109000-00007
Maani CV, Hoffman HG, Morrow M, Maiers A, Gaylord K, McGhee LL, et al. Virtual reality pain control during burn wound debridement of combat-related burn injuries using robot-like arm mounted VR goggles. J Trauma 2011; 71: S125-130.
https://doi.org/10.1097/TA.0b013e31822192e2 DOI: https://doi.org/10.1097/TA.0b013e31822192e2
Freeman-Sanderson AL, Togher L, Elkins MR, Phipps PR. Return of voice for ventilated tracheostomy patients in ICU: a randomized controlled trial of early-targeted intervention. Crit Care Med 2016; 44: 1075-1081.
https://doi.org/10.1097/CCM.0000000000001610 DOI: https://doi.org/10.1097/CCM.0000000000001610
Ayed I, Ghazel A, Jaume ICA, Moya-Alcover G, Varona J, Martinez-Bueso P. Vision-based serious games and virtual reality systems for motor rehabilitation: A review geared toward a research methodology. Int J Med Inform 2019; 131: 103909.
https://doi.org/10.1016/j.ijmedinf.2019.06.016 DOI: https://doi.org/10.1016/j.ijmedinf.2019.06.016
Kim A, Darakjian N, Finley JM. Walking in fully immersive virtual environments: an evaluation of potential adverse effects in older adults and individuals with Parkinson's disease. J Neuroeng Rehabil 2017; 14: 16.
https://doi.org/10.1186/s12984-017-0225-2 DOI: https://doi.org/10.1186/s12984-017-0225-2
Zheng J, Ma Q, He W, Huang Y, Shi P, Li S, et al. Cognitive and motor cortex activation during robot-assisted multi-sensory interactive motor rehabilitation training: An fNIRS based pilot study. Front Hum Neurosci 2023; 17: 1089276.
https://doi.org/10.3389/fnhum.2023.1089276 DOI: https://doi.org/10.3389/fnhum.2023.1089276
Herridge MS, Azoulay E. Outcomes after Critical Illness. N Engl J Med 2023; 388: 913-924.
https://doi.org/10.1056/NEJMra2104669 DOI: https://doi.org/10.1056/NEJMra2104669
Hodgson CL, Bailey M, Bellomo R, Berney S, Buhr H, Denehy L, et al. A Binational Multicenter Pilot Feasibility Randomized Controlled Trial of Early Goal-Directed Mobilization in the ICU. Crit Care Med 2016; 44: 1145-1152.
https://doi.org/10.1097/CCM.0000000000001643 DOI: https://doi.org/10.1097/CCM.0000000000001643
Schaller SJ, Anstey M, Blobner M, Edrich T, Grabitz SD, Gradwohl-Matis I, et al. Early, goal-directed mobilisation in the surgical intensive care unit: a randomised controlled trial. Lancet 2016; 388: 1377-1388.
https://doi.org/10.1016/S0140-6736(16)31637-3 DOI: https://doi.org/10.1016/S0140-6736(16)31637-3
Ding N, Yao L, Zhang Z, Yang L, Jiang L, Jiang B, et al. [Safety criteria for early goal-oriented rehabilition exercise in patients undergoing mechanical ventilation in intensive care unit: a systematic review]. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue 2019; 31: 91-97.
Menges D, Seiler B, Tomonaga Y, Schwenkglenks M, Puhan MA, Yebyo HG. Systematic early versus late mobilization or standard early mobilization in mechanically ventilated adult ICU patients: systematic review and meta-analysis. Crit Care 2021; 25: 16.
https://doi.org/10.1186/s13054-020-03446-9 DOI: https://doi.org/10.1186/s13054-020-03446-9
Wang J, Ren D, Liu Y, Wang Y, Zhang B, Xiao Q. Effects of early mobilization on the prognosis of critically ill patients: A systematic review and meta-analysis. Int J Nurs Stud 2020; 110: 103708.
https://doi.org/10.1016/j.ijnurstu.2020.103708 DOI: https://doi.org/10.1016/j.ijnurstu.2020.103708
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