187 VR-THERAPY FOR UPPER EXTREMITIES MOBILISATION 8 Overall, ICU-patients significantly improved their balance and mobility from baseline to hospital discharge. We found a better mobility score than previous studies observed in ICU-patients receiving conventional therapy at ICUdischarge,30,35 but comparable to mobility scores measured at hospital discharge [36]. Moreover, our ICU-patients’ hand-grip strength is/was comparable to hand-grip strengths after standard care at hospital discharge.13 However, Beumeler et al.37 not only found a lower hand-grip strength, but also a poorer mobility score at ICU-discharge in ICU-survivors of the same ICU- department as our study. This may indicate that VR-therapy resulted in better recovery of muscle strength and mobility. However, it is of note that patients in this study received VR-therapy in addition to standard daily early mobilisation and physical therapy, which have been associated with improvement inmuscle strength and function as well.11-13 Ingeneral, patientswere satisfiedwithVR-therapy. In linewith this, complementing care with applications of eHealth, serious gaming, and remote care may ensure continuity in rehabilitation. Our results show that the self-reported probability of using the VR-game at home increased from baseline to hospital discharge. In stroke patients, adherence to a home-based VR-therapy is good38 and the efficacy seems comparable with clinic-based VR-therapy.39 The present findings are important for ICU-patients, because physical activity has shown benefit in preventing PICS.11-13 This is the first study evaluating the feasibility of using a dedicated VR-game for early ICU-mobilisation. Our prototype VR-game provided individualised therapy as we were able to set the level of difficulty, number of puzzle pieces, and use of left and/or right hand. The high satisfaction rate indicates that individualised VR-therapy may be successful in treatment of the heterogeneous ICU-population. In addition, the VR-headset provides detailed rotational and positional data of the head and hands over time,40 which may help to optimise and individualise VR-therapy. However, processing of these data was beyond the scope of this paper. Despite the promising results of this study, there are some limitations to take into consideration. As a pilot feasibility study, our study design did not include a control group. We therefore cannot comment on the efficacy on physical recovery of VR-therapy when compared to standard daily early mobilisation and physical therapy. In addition, the small sample size limited the ability to detect clinically relevant differences. However, in this high-risk population it was important to prove first that VR-therapy using a VR-headset is feasible and without significant adverse events before proceeding into larger trials.
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