VRx: Feasibility Trial

Abstract accepted to Special Research Topic - Frontiers in Medicine, Geriatric Medicine

Manuscript currently under review: check back soon!

Background: Older adults living in long term care and seniors’ residences often experience reduced mobility, thereby becoming confined indoors and isolated. This can introduce or aggravate symptoms of depression, anxiety, loneliness, and apathy. As Virtual Reality (VR) technologies become increasingly accessible and affordable, there is a unique opportunity to enable these older adults to escape from their restricted physical realities and be transported to both stimulating and calming places; experiences that may reduce the negative effects associated with reduced mobility and improve general wellbeing. VR therapies have demonstrated promise in improving health-related outcomes in other patient populations (e.g. anxiety and pain); however, to date no scientific evaluations of the feasibility of introducing immersive VR experiences to frail older adults have been reported. VR may prove to be a safe and inexpensive means of managing symptoms and providing a unique form of engagement and enjoyment to this rapidly growing demographic.

 

Objectives: The main objective of this study was to establish whether it is feasible to use immersive VR technology as therapy for frail older adults living in long-term care who may be experiencing age-related health conditions including reduced mobility and/or impaired cognition. This included an evaluation of the tolerability, comfort and ease of use of VR head-mounted-displays (HMD), and the potential for immersive VR experiences to produce enjoyment and reduce apathy and depression. Potential negative side effects related to using immersive VR were also documented.

 

Methods: Sixty-six frail older adults (M = 81 years of age) with varying ranges of cognitive abilities (normal=28, mild impairment =17, moderate impairment =12, severe impairment =3), were recruited into a non-randomized interventional study at four sites across Toronto, Canada (an ambulatory mental health day clinic for older adults living with complex medical and psycho-social issues, a long-term rehabilitation hospital for medically complex and predominantly older adult population, a long-term care facility for people with Alzheimer’s disease and dementias, and a day center for adults with memory loss due to mild to moderate dementia). Nearly half of participants (30/66) were in a wheelchair, 39 had limited body mobility and 15 had limited head mobility. Each participant experienced a 5 to 20 minutes intervention which consisted of viewing 360° VR-footage of nature scenes displayed on Samsung GearVR HMD. Data was collected through: (1) a pre/post-intervention survey (modified version of the STAI (State-Trait Anxiety Inventory)), (2) standardized observations (modified version of MiDAS (Music in Dementia Assessment Scales)) conducted by two research assistants during the VR intervention, and (3) a post-intervention semi-structured interview that included custom-developed Likert-scale questions and open-ended questions regarding the VR experience.

 

Results: All participants completed the study and no negative side effects were reported (no dizziness or disorientation, no interference with/by hearing aids). The average time that participants spent viewing the immersive VR experience was eight minutes, with a maximum of 20 minutes exposure before the research assistant removed the headset. Fifty participants (76%) experienced at least one full round of VR (six minutes). Participants tolerated the VR headset very well; some stating they “forgot I had it on”, others reporting “it was worth the mild discomfort”. Common feedback included a desire for higher resolution images/better stereoscopic image quality and an increase in the narrative of the video content. Most participants had positive feedback, reported feeling more relaxed and adventurous and 80% wanted to try VR again.

 

Conclusion: The results of our study show that being exposed to immersive VR using an HMD is a feasible, safe approach to providing beneficial experiences to older frail adults with mobility, sensory and/or cognitive impairments. Participants tolerated the VR hardware, were able to exploit the ability to physically explore the virtual environments through head/body movements and did not report any adverse side effects. The majority of participants reported positive emotional changes following the intervention, were enthusiastic about trying VR again and would recommend the experience to others. We recommend further research to evaluate the potential psychological and bio-physiological benefits of longer-term use of VR and optimizing / customizing VR experiences for this user population. Future studies should expand research into different types of healthcare institutions and community care, from acute-care hospitals to private homes.

Peer-reviewed conference Presentations:

  1. Appel, L. Bogler, O., Appel, E., Wiseman, M., Cohen, L., Hill, D., Ein, N., Abrams, H., and Campos, J. (2019) Providing frail older adults with therapeutic experiences using immersive Virtual Reality. National Conference on Frailty, September 26-27. Toronto, Canada

  2. Appel, L. Bogler, O., Appel, E., Wiseman, M., Cohen, L., Hill, D., Ein, N., Abrams, H., and Campos, J. (2018) Prescribing Virtual Reality (VRx): A novel therapy for people living with Dementia and Mild Cognitive Impairment – Preliminary results from a multi-site study. Presented at The State of the Art in Dementia Research Congress July 16 - 18, Valencia, Spain

  3. Appel, L. Bogler, O., Appel, E., Wiseman, M., Cohen, L., Hill, D., Ein, N., Abrams, H., and Campos, J. (2018) Prescribing Virtual Reality (VRx): A novel therapy for people living with Dementia and Mild Cognitive Impairment – Preliminary results from a multi-site study. Presented at the European Healthcare Design - Utopia or dystopia: Visioning the future of health Royal College of Physicians, June 11–13, 2018. London, UK

  4. Appel, L. Bogler, O., Appel, E., Wiseman, M., Cohen, L., Hill, D., Ein, N., Abrams, H., and Campos, J. (2018) Prescribing Virtual Reality (VRx): A novel therapy for people living with Dementia and Mild Cognitive Impairment – Preliminary results from a multi-site study. Presented at Virtual Reality and Healthcare Symposium ‘18, Harvard Medical School, March 5-6, 2018. Boston, MA

  5. Appel, L. Bogler, O., Appel, E., Wiseman, M., Cohen, L., Hill, D., Ein, N., Abrams, H., and Campos, J. Prescribing Virtual Reality (VRx): Can exposure to simulated natural environments using Virtual Reality (VR) offer an alternative therapy for those living with dementia/ cognitive impairment who are limited from being outside? Canadian Conference on Dementia, November 2017. Toronto CA.

  6. Appel, L. Bogler, O., Appel, E., Wiseman, M., Cohen, L., Hill, D., Ein, N., Abrams, H., and Campos, J.  Prescribing Virtual Reality (VRx): Can exposure to simulated natural environments using Virtual Reality (VR) offer an alternative therapy for those living with dementia/ cognitive impairment who are limited from being outside? Toronto General Hospital Research Day. October 2017. Toronto CA.