180 CHAPTER 8 8.2.4 Protocol VR-therapy was offered three times a week for 20 min. in the ICU and on the post-ICU hospital ward. Training started when clinical staff deemed the patient physically and mentally capable to use the VR-headset until hospital discharge or for a maximum of four weeks. A trained researcher was present during VR-therapy. The trained researcher provided thepatientwithabrief introduction to the software and then helped to put on the VR-headset and to select the level of difficulty, the number of puzzle pieces, and the use of left and/or right hand. Patients could perform VR-therapy in a seated position in bed or a chair. 8.2.5 Outcomes Primary feasibility outcomes were the number and duration of VR-therapy sessions, actual time spent using the VR-game, session efficiency (the actual time spent using the VR-game/duration of VR-therapy session*100%), and adherence to VR-therapy. Feasibility outcomes were presented per patient and per VR-therapy session to explore changes over time. During each session, the number and nature of adverse events (e.g. dizziness, pain) were monitored as well as fatigue and satisfaction level using the Borg Rating of Perceived Exertion Scale (Borg-RPE) (6-20)28 and Visual Analogue Scale (VAS) (0-100), respectively. Additionally, patients’ self-reported probability of using the VR-game in a home situationusingaVAS (0-100), hand-gripstrengthbyahandhelddynamometer,29 and the MortonMobility Index (DEMMI)30 were evaluated by a pre and post-test. DEMMI consists of 15 mobility items (bed, chair, static balance, walking, and dynamic balance items) and ranges from 0 to 100, whereas 0 represents poor mobility and 100 independent mobility. 8.2.6 Statistical analyses Quantitative data were presented as categorical and continuous variables and qualitative data from patient and trainer experiences were described as in-text quotes. Descriptive statistics were used to obtain a detailed picture of the data. Wilcoxon signed-rank tests were used to assess differences in self-reported probability of using VR-game in a home situation, DEMMI, and handgrip strength between pre and post-test data. Analyses were conducted using SPSS Statistics 24 software (IBM, Irvine, CA, USA) with p<0.05 considered to be statistically significant.
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