Research Article
Therapists’ Perspective on Virtual Reality Training in
Patients after Stroke: A Qualitative Study Reporting Focus
Group Results from Three Hospitals
Ludwig Schmid,
1,2
Andrea Glässel,
3
and Corina Schuster-Amft
4,5
1
Physiotherapy Department, Rehabilitation Centre, KliniK Lengg, Zurich, Switzerland
2
Department of Physiotherapy, School of Health Professions, Bern University of Applied Sciences, Burgdorf, Switzerland
3
School of Health Professions, Institute of Health Sciences, Zurich University of Applied Sciences, Winterthur, Switzerland
4
Research Department, Reha Rheinfelden, Rheinfelden, Switzerland
5
Institute for Rehabilitation and Performance Technology, Bern University of Applied Sciences, Burgdorf, Switzerland
Correspondence should be addressed to Corina Schuster-Amf; c.schuster@reha-rhf.ch
Received 5 August 2016; Revised 4 November 2016; Accepted 7 November 2016
Academic Editor: Wai-Kwong Tang
Copyright © 2016 Ludwig Schmid et al. Tis is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background. During the past decade, virtual reality (VR) has become a new component in the treatment of patients afer stroke.
Terefore aims of the study were (a) to get an insight into experiences and expectations of physiotherapists and occupational
therapists in using a VR training system and (b) to investigate relevant facilitators, barriers, and risks for implementing VR training
in clinical practice. Methods. Tree focus groups were conducted with occupational therapists and physiotherapists, specialised
in rehabilitation of patients afer stroke. All data were audio-recorded and transcribed verbatim. Te study was analysed based
on a phenomenological approach using qualitative content analysis. Results. Afer code refnements, a total number of 1289 codes
emerged out of 1626 statements. Intercoder reliability increased from 53% to 91% until the last focus group. Te fnal coding scheme
included categories on a four-level hierarchy: frst-level categories are (a) therapists and VR, (b) VR device, (c) patients and VR, and
(d) future prospects and potential of VR developments. Conclusions. Results indicate that interprofessional collaboration is needed
to develop future VR technology and to devise VR implementation strategies in clinical practice. In principal, VR technology
devices were seen as supportive for a general health service model.
1. Background
Stroke is a frequent cause of livelong disability in adulthood
and is one of the most expensive diseases regarding patient-
centred care [1]. To reduce the burden of upper limb limita-
tions and to improve patients’ outcomes and independence,
new treatment concepts have to be developed and efective-
ness of patient outcomes has to be investigated, respectively
[2]. Virtual reality (VR) is a novel computer technology that
was adapted for rehabilitation over the past decade [3]. It
is a computer technology that simulates real-life learning
while providing augmented feedback and a high intensity
of massed practiced tasks [4]. VR can be diferentiated into
immersive and nonimmersive gaming systems. Immersive
systems enable players to move an avatar in a simulated
environment. Nonimmersive systems ofen focus on arm
or leg movements in simulated 3D environments [5]. VR
provides a safe environment for patients to explore func-
tional capability without interference from their physical or
cognitive limitations [6]. As an example of a therapeutic VR
system, YouGrabber (YG, YouRehab© Ltd.) will be explored
in this study: it is a training system for upper limb train-
ing in stroke rehabilitation (Figure 1). It provides training
of bimanual reaching and grasping in combination with
diferent game options on a computer or television screen.
Patients’ movements are captured by two size-adjustable
data gloves and infrared arm tracking [7]. As Saposnik and
Levin reported in their meta-analysis, there are benefcial
efects for upper limb rehabilitation using VR in combina-
tion with conventional treatment approaches [8]. Analysed
Hindawi Publishing Corporation
Stroke Research and Treatment
Volume 2016, Article ID 6210508, 12 pages
http://dx.doi.org/10.1155/2016/6210508