Journal Article

POS1504-HPR THE FEASIBILITY OF VIRTUAL REALITY SUPPORTED EXERCISE THERAPY FOR AXIAL SPONDYLOARTHRITIS IN A HOME AND A PHYSIOTHERAPY SETTING: A MIXED METHODS STUDY FROM A MULTI-DISCIPLINARY PERSPECTIVE

Franke, M., Vonkeman, H. E., Gerritsen, D., Weenink, M., Bode, C., Hegeman, M.

2024

Overview

Background:Non-pharmacological treatment, such as exercise therapy, is crucial in the treatment of axial spondyloarthritis (axSpA). Physical activity helps maintain axial flexibility and has been shown to improve physical function, pain, fatigue, and quality of life. However, practical, financial and disease-related barriers lower the motivation to exercise, leading to long-term adherence rates of 30% or less. The use of immersive Virtual Reality (VR) as an innovative solution to guide and support exercise therapy for axSpA could lower barriers and boost the motivation to exercise.Objectives:This study aims to (1) examine the feasibility of implementing a study protocol that uses VR to support exercise therapy in patients with axSpA, and to (2) determine the feasibility, acceptability and demand of using VR guided exercise therapy at home or in a physiotherapy practice setting.Methods:A convergent, mixed methods study design was used and included patients with axSpA and healthcare professionals (HCPs). All participants performed supervised VR guided exercises in a laboratory setting, using a recently developed VR guided exercise program Walk in Nature, to improve mental and physical vitality. That included the modules Breathing Tree Exercise, Butterfly Task and Yoga Exercise. Feasibility and acceptability of the VR guided exercise therapy was assessed with a pre and post VR pain VAS score, and a post VR Virtual Reality Sickness Questionnaire (VRSQ), perceived appropriateness (UEQ-s), and satisfaction (IPQ) questionnaire. Perceived demand for VR guided exercise therapy and intention to use VR was assessed in a semi-structured interview with 32 open- and closed-ended questions based on the UTAUT model.Results:In total, 17 participants (8 patients and 9 HCPs: 3 physiotherapists experienced in treating axSpA, 3 physiotherapists experienced in VR guided treatment, and 3 rheumatologists) were included. Patients were mean 47 (±17) years and 50% male, HCPs mean 30 (±3) years and 44% male. Although some participants experienced slight symptoms of cybersickness, VR acceptability was good as both groups had a positive user experience (mean patient UEQ-s 1.57 ± 0.7, mean HCP UEQ-s 1.75 ± 0.55) and a high level of presence in the virtual environment (mean patient IPQ 5.5 (±0.8) and mean HCP IPQ 5.72 ±0.86). In the patients, VAS pain mostly remained unchanged, mean 3.6 (±2.4) before and 3.8 (±3.2) after VR. Secondly, overall perceived demand for this pilot version of VR guided exercise therapy was low, due to difficulty in use and lack of feedback to the patient. However, healthcare professionals saw greater potential in VR guided exercise therapy than patients. Patients preferred to use VR in a physiotherapy setting while healthcare professionals preferred implementation at home.Conclusion:VR guided exercise therapy has potential for patients with axial spondyloarthritis as users have positive user experiences with high levels of presence. Perceived demand may be increased by improving ease of use and by implementing patient feedback in a physiotherapy setting. Efficacy will subsequently be investigated in a future randomized controlled trial.REFERENCES:[1] Brepohl PCA, Leite H. Virtual reality applied to physiotherapy: a review of current knowledge. Virtual Reality 2022 27:1 [Internet]. 2022 Jul 22 [cited 2023 Nov 13];27(1):71–95.Figure 1.Still of the yoga exercise with a virtual yoga coach in VR Walk in NatureTable 1.Acceptability outcomes patients N=8NAge(yrs)SexBASDAIPrior VRTechnical skillsVRSQ generalVAS beforeVAS afterIPQUEQ-s HomeUEQ-s Physio177M2,1NoYesSlightly225,811,750,88264M6,1YesYesNone5,565,772,382,50338M1,2YesYesNone213,632,000,50432M4,2NoYesNone445,712,001,50553F8,1NoYesNone8106,441,133,00642F4,2NoYesSlightly335,130,131,50734F6NoYesNone445,771,751,88832F1,1YesYesNone005,730,381,00Mean(SD)47(17)4,2(2,5)3,6(2,4)3,8(3,2)5,50(0,83)1,57(0.70)1,60(0,84)VRSQ= Motion sickness questionnaire, VAS= Visual Analogue Score pain, IPQ= IGroup Presence questionnaire, UEQ-s= User Experience Questionnaire short formAcknowledgements:NIL.Disclosure of Interests:Myrthe Franke: None declared, Marieke Weenink: None declared, Mirjam Hegeman: None declared, Demy Gerritsen: None declared, Christina Bode: None declared, Harald E. Vonkeman AbbVie, Novartis, Pfizer, UCB, Johnson and Johnson, Galapagos, Boehringer Ingelheim.

• Publisher: BMJ Publishing Group Ltd and European League Against Rheumatism,Elsevier B.V,Elsevier Limited
• Subject: Arthritis / Computer applications / Digital health / Digital health/Measuring health / Drug therapy / Exercise / Feasibility studies / Feedback / Health care / Health Professionals in Rheumatology Abstracts / Inflammatory diseases / Medical personnel / Mixed methods research / Motion detection / Motion sickness / Outcome measures / Pain / Patients / Physical activity / Physical fitness / Physical therapy / Physical therapy/Physiotherapy / Physical training / Quality of life / Questionnaires / Rheumatic diseases / Self-management / User experience / Virtual reality