Effects of Immersive Virtual Therapy as a Method Supporting Recovery of Depressive Symptoms in Post-Stroke Rehabilitation: Randomized Controlled Trial

Abstract

Purpose: Depressive symptoms constitute an important group of mental problems that alter the course of post-stroke rehabilitation by reducing quality of life, physical activity, social functioning, and interpersonal relationships. Although several studies have shown the efficacy of virtual reality (VR) in the motor treatment of poststroke patients, there is a lack of studies that would also evaluate the impact of VR on psychological aspects. Thus, we investigated the effectiveness of immersive VR therapy on both functional activity and depressive symptoms in stroke survivors.

Patients and methods: We conducted a single blind, randomized controlled trial comparing VR therapy with Schultz's Autogenic Training (SAT). Patients randomized to the VR group received treatment in an immersive VR therapeutic garden with elements of psychotherapy and physical activity of the upper extremities, whereas patients in the control group received SAT. Additionally, patients in both groups received standard neurological rehabilitation. The full research cycle lasted six weeks. We used Geriatric Depression Scale, Generalized Self-Efficacy Scale, Acceptance of Illness Scale, Visual Analogue Scale of pain, Hospital Anxiety and Depression Scale, Barthel Index, Lawton Instrumental Activities of Daily Living Scale and Rivermead Motor Assessment for outcome assessment. This trial was registered with ClinicalTrials.gov (NCT03830372).

Results: We assessed 60 patients and randomly assigned to the VR or control group. The VR group showed a significant reduction in depressive symptoms (ηp² = 0.13, p < 0.01) compared to SAT. The applied VR therapy significantly increased the sense of self-efficacy and the level of acceptance of the illness; however, this effect was similar to that obtained with the standard intervention. We did not observe statistically significant changes in the functional parameters of post-stroke patients.

Conclusion: The use of VR therapy combined with neurological rehabilitation had a positive effect on improving mood and reducing depressive symptoms in post-stroke patients.

Keywords: depressive symptoms; mental health; neurorehabilitation; stroke; virtual reality.

Figure 1

Flow diagram of the study procedure.

Figure 2

Timeline of the study. T0 = assessment before rehabilitation; three weeks of combined interventions with VR therapy in experimental group and SAT in control group; T1 = assessment post treatment; three weeks of combined interventions without VR therapy and SAT; T2 = follow-up assessment after six weeks.

Figure 3

Sample changes of symbolic steps in cultivating the virtual garden and its revival. At the beginning of therapy, the garden is neglected and grey, which symbolizes the health of the patient before treatment and rehabilitation. Step-by-step, the patient performs the tasks of colouring the mandala and watering the plants. When the tasks are completed, new plants appear in the garden, and the entire landscape regains its colours.

Figure 4

Mean values of the psychological and functional parameters results at individual time points.