186 CHAPTER 8 8.4 DISCUSSION In this study, we aimed to evaluate the feasibility and efficacy of VR-therapy using a VR-headset during ICU and subsequent general ward-admission. We showed that it was feasible to offer VR-therapy three times a week for 20 min. in addition to standard daily physical therapy and early mobilisation to train upper extremity functionality in patients with critical illness. Ten out of twelve eligible patients gave consent to participate in this study, potentially showing patients’ curiosity to VR-therapy. Overall, clinical staff deemed patients clinically capable to start VR-therapy at day five of ICU-admission. Most patients (80%) showed moderate to high adherence to VR-therapy. No serious adverse events were reported or experienced by patients or trained researchers. Patients rated a high satisfaction level and were not extremely fatigued after VR-therapy. VR-therapy in ICU-patients is feasible when having a seated position in bed or chair as underlined by previous evidence.24,26 Norouzi-Gheidari et al.25 concluded that VR-therapy was feasible in stroke patients with a session efficiency of 49%, which is comparable to our session efficiency of 57%. However, our predetermined goal to train 20 min. was generally not achieved. We observed that VR-therapy using our prototype VR-game was too exhausting for some patients. Moreover, fatigue led to non-adherence to VR-therapy. Fatigue has been shown to be a reason for activity cessation and a barrier to adhere to exercise in ICU-patients by others as well.14,24,33 On the other hand, VR-therapy was not challenging enough to stay motivated for 20 min. for other patients. The challenge of VR-therapy should match the skills of patients to make them enjoy and endure VR-therapy,34 which should be considered in the further development of VR-therapy. This may also increase adherence on long-term, as adherence decreased with more consecutive VR-therapy sessions in the current study. Patients reported fatigue levels of 7/20 to 13/20 after VR-therapy, indicating that our VR-therapy led to very light to somewhat hard activity levels. Training intensities corresponding to a Borg-RPE range 11–13 are recommended in sedentary, less fit, and untrained individuals, as well as patients with cardiovascular diseases.28 This suggests that our VR-therapy met the recommended training intensities for most ICU-patients. For patients who scored lower on the BORG, more advanced levels may be needed to achieve adequate training intensity.
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