Effectiveness, safety and patients' perceptions of an immersive virtual reality-based exercise system for poststroke upper limb motor rehabilitation: A proof-of-concept and feasibility randomized controlled trial

Objective

This study aimed to examine the effectiveness, safety and patients' perceptions of an immersive virtual reality (VR)-based exercise system for poststroke upper limb rehabilitation.

Methods

A proof-of-concept, 2-week randomized controlled trial was conducted. Fifty stroke patients were randomly assigned to either use the immersive VR-based exercise system to perform upper limb exercises for 2 weeks (intervention) or play commercial games (control). Effectiveness, safety and patients' perceptions of the exercise system were assessed at baseline and at 1- and 2-week follow-ups.

Results

Intention-to-treat analysis revealed that after 2 weeks, statistically significant improvements in shoulder flexion active range of motion (AROM), shoulder abduction AROM, perceived upper limb motor function and quality of life (QoL) were observed in one or both groups, but not between the groups. Per-protocol analysis showed that after 2 weeks: (i) statistically significant improvement in shoulder abduction AROM was obtained in the intervention group, and the difference in the mean changes between the groups was statistically significant; (ii) statistically significant improvements in coordination/speed (Fugl-Meyer Assessment for Upper Extremity), shoulder flexion AROM, perceived upper limb motor function and QoL were obtained in one or both groups, but not between the groups.

Conclusions

The immersive VR-based exercise system is a potentially effective, safe and acceptable approach for supporting poststroke motor rehabilitation. These findings can serve as a basis for larger-scale studies on the application of VR for poststroke exercises.

Patient ergonomics: 10-year mapping review of patient-centered human factors

Patient ergonomics is the application of human factors or related disciplines to study and improve patients' and other non-professionals' performance of effortful work activities in pursuit of health goals. We performed a mapping review of 212 full-text patient ergonomics publications in two conference proceedings, 2007-2017. The review revealed a robust and growing body of literature on patient ergonomics, particularly in the areas of aging and chronic disease, tools and technologies, and evaluations of patient-centered interventions on outcomes such as usability, user acceptance, and performance. Findings highlighted gaps deserving future research, including research with understudied populations such as children, informal caregivers, networks and collectives (groups), and marginalized populations; on topics such as health promotion and transitions of care; and using longitudinal and experimental study designs. The growth of patient-centeredness in general and of patient ergonomics in particular compel other more focused reviews, new primary research, and developing a roadmap for future patient ergonomics research.

2019 Town Hall on Human Factors and Ergonomics for Patient Work

The 2019 Town Hall gathers stakeholders in the human factors and ergonomics (HFE) community who share an interest in applying HFE to study and improve patient work, an area called “patient ergonomics.” The objective of this town hall is to communally scope, prioritize, and develop applications of HFE for patient work. Whereas the 2018 Town Hall was primarily an initial community gathering, the 2019 Town Hall is envisioned as a space for further developing a community of practice in this area. The central activity of the 2019 Town Hall is a public commentary period, with live scribing, inviting attendees to address the (1) scope of patient ergonomics; (2) prioritization of future efforts; and (3) proposals to lead future development efforts.

Beyond Disease: Technologies for Health Promotion

Health promotion is defined by the World Health Organization as “the process of enabling people to increase control over their health and its determinants, and thereby improve their health.” This is different from the bulk of formal healthcare processes, which are characterized by the treatment of an established disease. Much important human factors research and practice has been done to improve the healthcare delivery process and increasingly human factors professionals are also involved in work on health promotion. Such work has included examining the use and usability of wearable fitness tracking devices, studies of online health information seeking by healthy individuals, and human factors research on social robots for older adults, to name but a few examples. We discuss human factors applications in health promotion, focusing on examples from technology-related research.

Town Hall on Patient-Centered Human Factors and Ergonomics

A central paradigm in the current era of health and healthcare is the centrality of patients, families, and community members in their own health. Patients and other nonprofessionals are increasingly recognized as working independently or in concert with healthcare professionals in an effort to achieve health-related goals. This patient work has been the topic of much recent research in an area of human factors and ergonomics (HFE) we call patient-centered HFE. The town hall on patient-centered HFE draws on the community of healthcare HFE researchers and practitioners to communicate and document the scope of existing work, identify future opportunities, and develop recommendations for future work in this area. The town hall primarily consists of an open floor session with a 40-minute comment period and 40-minute generative exercise to discuss and plan with one another future work in patient-centered HFE.

Patient Work Methods: Current Methods of Engaging Patients in Systems Design in Clinical, Community and Extraterrestrial Settings

As Human Factors and Ergonomics (HF/E) practice in health care expands, there is growing recognition of the need to consider and design for patient work. Over the past several years HF/E practitioners and researchers have begun to formalize the theoretical foundations of a patient work approach. Methodologically, patient work approaches have required adaptations of existing HF/E and social science approaches as well as the development of new approaches. This panel will focus on current approaches of engaging patients in designing interventions in the multiple settings in which patient work is performed. Each panelist will introduce their work by discussing the health care challenge and how existing methods were adapted or new methods created to engage patients in the design of systems. The panelists will then interact with audience members to solicit current health care challenges and to brainstorm ways in which methods could be adapted or innovated to engage patients in addressing these challenges.

Patient Work as a Maturing Approach Within HF/E

Over the last five years, human factors and ergonomics (HF/E) applications in healthcare have expanded beyond the institution to encompass the homes and communities of patients. The patient work approach has been developed as a means of formalizing the theoretical and methodological foundations of applying HF/E within this new domain. Early applications of the patient work approach were confined to studies of relatively straightforward self-management tasks. As the patient work approach matures, however, its application is spreading to more complex subdomains of health management in home and community settings. This panel will focus on cutting edge application and methodological areas of patient work. Each panelist will introduce their work, present challenges related to expanding the patient work approach in a new direction, and engage with audience members to address these challenges and brainstorm ways in which the patient work approach can be further adapted to more intricate healthcare challenges.