178 CHAPTER 8 aim of this study is therefore to evaluate the feasibility of VR-therapy using a VR-headset during ICU and subsequent general ward admission. The secondary aim is to examine the effect of VR-therapy on physical recovery during ICU and general ward admission. Based on previous evidence,24-26 we hypothesise that using a dedicated VR-game is feasible for early ICU-mobilisation. In addition, we expect that VR-therapy benefits physical recovery. 8.2 MATERIALS & METHODS 8.2.1 Study design A healthcare innovation pilot study was performed with a pre-post design. A local medical ethics committee ruled that the Medical Research Involving Humans Act (Dutch: Wet medisch-wetenschappelijk onderzoek met mensen, WMO) was not applicable, due to the non-incriminating character of the study (Regionale Toetsingscommmissie Patiëntgebonden Onderzoek, Leeuwarden, The Netherlands; nWMO-number: nWMO 20210056). Nevertheless, a written informed consent procedure for data collection was deemed reasonable. 8.2.2 Population Patients were recruited from March 2022 through May 2022 at the ICU of a tertiary teaching hospital in Leeuwarden, the Netherlands. Inclusion criteria were: ≥ 18 years old, mechanically ventilated for ≥ 48h in the ICU, and capable to participate based on clinical assessment by clinical staff. Patients were excluded in case of an active delirium, indicated by an ICU-nurse, clinician, or Confusion Assessment Method for ICU ≥ 1,27 and/or if they did not understand Dutch. All patients gave written informed consent for data collection prior to participation. 8.2.3 VR-therapy VR-therapy was offered as a complement to standard daily physical therapy and early ICU-mobilisation. A VR-headset, the Oculus Quest 2® (Meta Technologies, LLC), was used for VR-therapy. To ensureVR-therapywas suitable for recovering ICU-patients, a dedicated prototype game was developed by experts from the field of VR-games with involvement of researchers, clinicians, ex-ICU-patients, and their informal caregivers. Patients were instructed to complete puzzles with increasing levels of difficulty to train upper extremity functionality (Figure 1). The puzzles were made on a table-like surface in a virtual home environment, while the hand movements were tracked by the VR-headset and displayed in the VR-environment.
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