Virtual reality based training - a motivating and effective way of regaining arm motor function after stroke? A multi-center RCT

The trial startet in 2014 with preparations, training of therapists and standardization of procedures at all participating institutions. Recruitment of patients has been terminated at all 5 clinical sites in May 2016 when the targeted number of patients was reached. The last follow up examinations took place in August 2016. Data analysis is completed and the first results have been published. We expect to publish the main results in 2017. A previous substudy on intensity of training in Virtual Reality as compared to control training was presented as an oral presentation at World Congress for Neurorehabilitation (WCNR) in Philadelphia in May 2016. An article about this substudy has been published in BMC Neurology in 2016. This study was also be presented (poster) at the American Congress of Rehabilitation Medicine in Chicago and orally at the Technically-assisted rehabilitation congress in Berlin in March 2017. Two more articles based on data from the study are in progress.

Stroke is the leading cause of lasting disability in the western world and a substantial increase of patients suffering from stroke due to an aging population is expected. Approximately two thirds of these patients experience impaired arm motor function, which compromises independence in activities of daily living, occupational areas and quality of life. High intensity training of challenging tasks with many repetitions are key factors for regaining motor function after stroke. Novel virtual reality (VR) rehabilitation systems provide the potential to increase intensity and offer challenging and motivating tasks. The efficacy of VR systems has not been demonstrated yet in sufficiently powered studies. In this study patients in 5 participating Norwegian,Da nish and Belgian rehabilitation institutions will be randomized to either a group receiving VR training in addition to conventional arm training or a group receiving dose-matched and therapist attention-matched conventional arm-training. During a period o f 4 weeks the patients will be offered additional 4-5 training sessions a week of 45-60 minutes duration by a physiotherapist or an occupational therapist. Arm motor function, dexterity and independence in daily life activities will be evaluated at baseli ne, post and 6 months follow-up assessments with the Action Research Arm Test, Box and Blocks Test and the Functional Independence Measure. Patient satisfaction and therapist satisfaction with the implementation of a new technology based rehabilitation sy stem will also be assessed with questionnaires and interviews. Cost-effectiveness will be calculated to gauge benefits in relation to resources needed. The primary objective is to study the effectiveness and acceptance of a novel VR training approach. The study will provide evidence-based knowledge of new technology based treatment strategies to clinicians, patients and health economists.