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

Prosjektet startet i 2014 med forberedelser, opplæring av terapeuter og standardisering av prosedyrer ved alle deltakende institusjoner. Rekrutteringen av pasienter ble avsluttet ved alle 5 kliniske sentre i mai 2016 når det tilsiktede antall av 120 pasienter var inkludert. De siste oppfølgende undersøkelsene ble gjennomført i august 2016. Dataanalyse er avsluttet og de første resultatene har blitt publisert. Vi regner med å publisere hovedresultatene i løpet av 2017. En tidligere gjennomført delstudie om intensitet av Virtual Reality treningen sammenlignet med kontrollgruppetrening ble presentert muntlig på World Congress for Neurorehabilitation (WCNR) i Philadelphia i mai 2016. En artikkel om denne delstudien er publisert i BMC Neurology i 2016. Studien ble også presentert som poster på American Congress of Rehabilitation Medicine i Chicago og muntlig på Technically-assisted rehabilitation congress i Berlin i mars 2017. To andre artikler basert på studiens data er under arbeid.

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.