183 VR-THERAPY FOR UPPER EXTREMITIES MOBILISATION 8 needed more support with the VR headset and could only sustain VR-therapy for a short time resulting in low session efficiencies. On the other hand, patient 7 really liked VR-therapy and therefore trained with extremely light to very light activity levels to last longer. Patients rated a satisfaction and fatigue level of 80/100 and 11/20, respectively. Reasons for non-adherence to VR-therapy were: tiredness (4 (11%)), patient was unable to sit up properly (1 (3%)), no motivation (4 (11%)), patient saw no added value of VR-therapy (6 (17%)), or hand-tracking difficulties (1 (3%)). No serious adverse events were experienced by patients or observed by trained researchers. Two patients experienced pain due to fractured ribs and sternum and were unable to play a higher level. Another patient reported some dizziness after VR-therapy. In general, patients experienced VR-therapy sessions as a “fun activity”, “special experience”, and “fun and at the same time effective activity during the long hospital days”. With more consecutive VR-therapy sessions, the session duration, VR-gaming duration, session efficiency, satisfaction level, and fatigue level increased, whereas adherence decreased (Table 3). The median self-reported probability of using the VR-game in a home situation increased from pre to post-test, but not significantly (Table 4). DEMMI scores significantly increased over time (p=0.005), indicating better balance and Table 4. Difference of probability of using game in home situation, handgrip strength, and DEMMI between pre and post-test. Baseline (ICU) Post-test (ICU/general ward) p-value VAS-score Probability of using game in home situation 45 [285-70] 78 [26-88]a 0.066 DEMMI 26 [24-44] 57 [41-85] 0.005* Absolute hand-grip strengthb Right hand (kg) Left hand (kg) 24 [12-35] 25 [11-29] 31 [13-40] 25 [17-35] 0.368 0.368 Relative hand-grip strengthc Right hand (%) Left hand (%) 70 [52-92] 74 [57-106] 89 [50-106] 93 [70-121] 0.114 0.074 Data are presented as median [IQR]. Abbreviations: ICU=Intensive Care Unit; VAS=visual analogue scale; DEMMI=the Morton Mobility Index. *Significantly different (p<0.05) with Wilcoxon signed rank test. Notes: aMissing for one patient. bThe right hand was dominant for nine patients and the left hand for one patient.
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