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StrokeNCT02285933

Virtual Reality Exercise for Stroke Rehabilitation in Inpatients Who Are Unable to Stand

A study testing virtual reality training in people with Stroke, run by Bruyère Health Research Institute. at 1 site in Canada.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The purpose of this study is to determine if the addition of 10 to 12 sessions of sitting balance exercises using virtual reality training will provide additional gains in balance ability and function over standard inpatient rehabilitation in stroke patients. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Stroke
What is being tested?
virtual reality training
Could I receive a placebo?
No, everyone receives an active treatment
How many people
76 participants
Where
1 siteCanada
Study dates
Jan 2015to 30 Mar 2017
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • ischemic or hemorrhagic stroke in the left or right cortical or subcortical regions
  • medically stable
  • cannot stand independently for >1 minute or cannot stand at all
  • can sit for at least 20 minutes with or without trunk support and can sit for at least 1 minute without trunk support
  • able to provide informed consent

Who cannot join

  • unstable cardiovascular, respiratory, endocrine, orthopedic or neurological condition that precludes exercise of low to moderate intensity
  • vestibular deficits or vertigo
  • seizure activity in the previous 6 months

Trial locations and contacts

1 site in 1 country.

Canada1 site
  • Elisabeth Bruyere Hospital

    Ottawa, Ontario, K1N 5C8

Other trials in Canada

About this study

Official title: Does the Addition of Virtual Reality Training to a Standard Program of Inpatient Rehabilitation Improve Sitting Balance Ability and Function After Stroke? A Blinded Randomized Controlled Trial.

The purpose of this study is to determine if the addition of 10 to 12 sessions of sitting balance exercises using virtual reality training will provide additional gains in balance ability and function over standard inpatient rehabilitation in stroke patients.

Read the detailed description

Introduction Sitting balance may be affected by stroke, resulting in functional impairment and reduced mobility. Early return of sitting balance predicts greater return of motor function and mobility after stroke. Task-specific therapy is effective but patients must be motivated to perform the exercises repeatedly for the greatest benefit.

Virtual reality training (VRT) allows patients to do exercises while interacting with a video game interface. It is enjoyable and may encourage repetition of therapeutic exercises. Past work in our laboratory showed that standing balance exercises performed with VRT produced additional improvements in gait speed and leg function over traditional inpatient rehabilitation (1). Because of legislative change in Ontario most stroke rehabilitation inpatients today cannot stand independently. There have been no studies on the effect of VRT on sitting balance.

Purpose To assess whether additional sitting balance exercises performed via VRT can improve sitting balance and sitting function (ex. reaching) in stroke rehabilitation inpatients.

Hypothesis The addition of VRT for sitting balance will significantly improve sitting balance and function, beyond the gains realized from traditional inpatient rehabilitation.

Experimental Approach In this blinded randomized control trial funded by the Heart \& Stroke Foundation, 76 participants with stroke will be recruited from an inpatient rehabilitation unit. This number will provide enough power to detect a large effect size (0.83) with the primary outcome measure and accounting for a 20% drop-out rate. Individuals who are medically stable and who can sit for at least 20 minutes with or without trunk support but cannot stand independently for more than one minute will be eligible. These criteria will target our selection to those who need to work most on sitting balance. Participants will be randomized into experimental and control groups.

Participants in both groups will perform VRT for 30-50 minutes daily for 10-12 sessions, in addition to their rehabilitation program. VRT will be delivered with Jintronix software and motion capture technology. Exercises for the experimental group will challenge sitting balance control, reaching and shifting the base of support. Control group exercises will require limited hand and arm movements, to equalize the additional time spent in an engaging activity without working on trunk balance. Control group participants will be strapped into their chair to minimize trunk movement. A CONFORMat pressure mat will be used to monitor centre of pressure changes during the intervention.

Outcome measures will be performed pre-, post- and 1 month post-intervention, by an assessor blinded to group allocation. The primary outcome measure will be the Function in Sitting Test. Secondary outcome measures will be: Ottawa Sitting Scale, Reaching Performance Scale, Wolf Motor Function Test and quantitative measures of postural control performed in sitting. Two-way analyses of variance [factors: time (pre-, post-, 1 month post-)and group(experimental, control)] and Tukey's post-hoc analyses will be used to test the effect of VRT on the outcome measures.

Significance and Knowledge Translation If we show that the addition of sitting balance exercises via VRT to traditional rehabilitation improves sitting balance and function, VRT may be added to inpatients' rehabilitation therapy. The ultimate goal is to improve the quality of patients' lives and decrease the burden on their caregivers. Since the Jintronix system is portable, we hope to acquire funding for several units. We would then be able to assess the use of VRT by therapists for inpatients and outpatients with stroke.

(1) McEwen D et al. Stroke 2014;45:1853-1855

Conditions
Stroke
Being tested
virtual reality training, control
Keywords
stroke, physical therapy specialty, exercise therapy, virtual reality, man-machine systems, randomized control trial, inpatients, rehabilitation
Medical subject headings
Stroke

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • virtual reality trainingOther

    Each participant will engage in 10-12 sessions of 30-50 minutes each of virtual reality training (VRT) using Jintronix Rehabilitation Software and three-dimensional motion capture technology. A camera captures the movements of the participant and allows him or her to control an avatar, which interacts with the game. Exercises challenge sitting balance control, reaching and shifting the base of support; for example, controlling a ball as it rolls down a maze or reaching to put dishes away in a virtual kitchen. The difficulty of the games is monitored to maintain a challenge to sitting balance. The participant sits on a CONFORMat pressure mat which continuously monitors his or her centre of pressure to ensure that the participant is adequately challenged during the VRT.

  • controlOther

    Each participant will engage in 10-12 sessions of 30-50 minutes each of virtual reality training (VRT) using Jintronix Rehabilitation Software and three-dimensional motion capture technology. A camera captures the movements of the participant and allows him or her to control an avatar, which interacts with the game. Control group exercises require limited hand and arm movements; for example, using an arm to move a fish along a simple pathway or using the arms to pop balloons without reaching. Control group participants are strapped into their chair to minimize trunk movement. The participant sits on a CONFORMat pressure mat which continuously monitors his or her centre during the VRT.

Study groups in NCT02285933
Study groupRoleWhat they receive
VRTExperimentalsitting balance exercises delivered via virtual reality training
Receives: Other: virtual reality training
controlActive comparatorvirtual reality training requiring limited arm movements and no challenge to sitting balance
Receives: Other: control

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Change in the Function In Sitting Test (FIST) from baseline to after 10-12 treatment sessions

    assesses static, dynamic and reactional sitting balance

    Measured: baseline, immediately after 10-12 treatments

  2. Change in the Function In Sitting Test (FIST) from baseline to 1 month after second assessment

    assesses static, dynamic and reactional sitting balance

    Measured: baseline,1 month after second assessment

Secondary outcomes (17)
  1. Change in the Ottawa Sitting Scale (OSS) from baseline to after 10-12 treatment sessions

    assesses static and dynamic sitting balance

    Measured: baseline, immediately after 10-12 treatments

  2. Change in the Ottawa Sitting Scale (OSS) from baseline to 1 month after second assessment

    assesses static and dynamic sitting balance

    Measured: baseline, 1 month after second assement

  3. Change in Limits of stability in sitting (LoS) from baseline to after 10-12 treatment sessions

    assesses dynamic sitting balance using a force plate or pressure mat

    Measured: before treatment, immediately after 10-12 treatments

  4. Change in Limits of stability in sitting (LoS) from baseline to 1 month after second assessment

    assesses dynamic sitting balance using a force plate or pressure mat

    Measured: baseline, 1 month after second assement

  5. Change in Postural sway in sitting from baseline to after 10-12 treatment sessions

    assesses static sitting balance using a force plate or pressure mat

    Measured: baseline, immediately after 10-12 treatments

  6. Change in Postural sway in sitting from baseline to 1 month after second assessment

    assesses static sitting balance using a force plate or pressure mat

    Measured: baseline, 1 month after second assement

  7. Change in the Reaching Performance Scale (RPS) from baseline to after 10-12 treatment sessions

    assesses sitting balance function during reaching

    Measured: baseline, immediately after 10-12 treatments

  8. Change in the Reaching Performance Scale (RPS) from baseline to 1 month after second assessment

    assesses sitting balance function during reaching

    Measured: baseline, 1 month after second assement

  9. Change in the Wolf Motor Function Test (WMFT) from baseline to after 10-12 treatment sessions

    assesses sitting balance function using global arm function

    Measured: baseline, immediately after 10-12 treatments

  10. Change in the Wolf Motor Function Test (WMFT) from baseline to 1 month after second assessment

    assesses sitting balance function using global arm function

    Measured: baseline, 1 month after second assement

  11. Change in The Motivation for Physical Activity Questionnaire from baseline to after 10-12 treatment sessions

    Likert scale from 0-6 to assess motivation to engage in exercise

    Measured: before treatment, immediately after 10-12 treatments

  12. Change in The Motivation for Physical Activity Questionnaire from baseline to 1 month after second assessment

    Likert scale from 0-6 to assess motivation to engage in exercise

    Measured: baseline, 1 month after second assement

  13. Change in the Behavioral Regulation in Exercise Questionnaire (BREQ-2) from baseline to after 10-12 treatment sessions

    assesses quality of motivation to engage in exercise

    Measured: baseline, immediately after 10-12 treatments

  14. Change in the Behavioral Regulation in Exercise Questionnaire (BREQ-2) from baseline to 1 month after second assessment

    assesses quality of motivation to engage in exercise

    Measured: baseline, 1 month after second assessment

  15. Psychosocial Impact of Assistive Devices Scale (PIADS)

    assesses the psychosocial impact of assistive devices or technology on "functional independence, well-being and quality of life"

    Measured: immediately after 10-12 treatments

  16. Psychosocial Impact of Assistive Devices Scale (PIADS)

    assesses the psychosocial impact of assistive devices or technology on "functional independence, well-being and quality of life"

    Measured: 1 month after first assement

  17. The ability to enroll an average of five new participants a month, to obtain a consent rate of 60% of eligible patients and a rate of protocol violations resulting in noncompliance with VRT of less than 10%.

    assesses the feasibility of performing a larger multicentre trial of VRT with rehabilitation inpatients

    Measured: immediately after 76 participants have finished the protocol and assessments

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted7 Nov 2014 (estimated)
  2. Study startJan 2015
  3. Primary completion1 Mar 2017
  4. Study completion30 Mar 2017

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
76 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02285933
Sponsor's protocol ID
G-14-0005830
Status last verified
Apr 2017
First submitted
3 Nov 2014
Last updated
12 Apr 2017
Results posted
No
Data monitoring committee
No
Individual data sharing
No: As this is not part of a larger, multi-centre trial, we do not plan to share our data.

Publications

  • McEwen D, Taillon-Hobson A, Bilodeau M, Sveistrup H, Finestone H. Virtual reality exercise improves mobility after stroke: an inpatient randomized controlled trial. Stroke. 2014 Jun;45(6):1853-5. doi: 10.1161/STROKEAHA.114.005362. Epub 2014 Apr 24.

    PubMed 24763929
  • Sheehy L, Taillon-Hobson A, Sveistrup H, Bilodeau M, Fergusson D, Levac D, Finestone H. Does the addition of virtual reality training to a standard program of inpatient rehabilitation improve sitting balance ability and function after stroke? Protocol for a single-blind randomized controlled trial. BMC Neurol. 2016 Mar 31;16:42. doi: 10.1186/s12883-016-0563-x.

    PubMed 27036515
  • Sheehy L, Taillon-Hobson A, Sveistrup H, Bilodeau M, Finestone H. Implementation of a randomized controlled trial on an inpatient stroke rehabilitation unit: Lessons learned. Contemp Clin Trials Commun. 2020 Apr 6;18:100563. doi: 10.1016/j.conctc.2020.100563. eCollection 2020 Jun.

    PubMed 32617429
  • Sheehy L, Taillon-Hobson A, Sveistrup H, Bilodeau M, Yang C, Finestone H. Sitting Balance Exercise Performed Using Virtual Reality Training on a Stroke Rehabilitation Inpatient Service: A Randomized Controlled Study. PM R. 2020 Aug;12(8):754-765. doi: 10.1002/pmrj.12331. Epub 2020 Feb 21.

    PubMed 31970898

Questions about this trial

What is this clinical trial studying?

A study testing virtual reality training in people with Stroke, run by Bruyère Health Research Institute. at 1 site in Canada.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 5 inclusion and 3 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 12 Apr 2017. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Canada. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Change in the Function In Sitting Test (FIST) from baseline to after 10-12 treatment sessions (time frame: baseline, immediately after 10-12 treatments). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02285933, which also lists 4 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 12 Apr 2017.

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