Immersive virtual reality rehabilitation after lower limb surgery in paediatric patients

Purpose

Patients who have undergone lower limb surgery require rehabilitation to regain movement and function in the affected leg. Unfortunately, physical rehabilitation can be painful, reducing compliance and recovery. This feasibility study aimed to demonstrate that immersive virtual reality (IVR) applications can provide potential benefits of anxiety reduction and pain distraction for children during gait rehabilitation, increased engagement and enjoyment, and improved perceived walking quality.

Methods

This study included 15 children aged 11–16 who required weight-bearing rehabilitation following lower limb surgery. A mixed methods (quantitative and qualitative) approach and a multidirectional perspective (patients, parents and physiotherapists) were adopted to measure. Changes in anxiety (General Anxiety Disorder-7) and pain (visual analogue scale) before and after the intervention were assessed. Qualitative data were collected through interviews with children, their parents, and physiotherapists, focusing on their experiences, satisfaction, perceived effectiveness, and acceptability of the IVR intervention.

Results

Results demonstrated that IVR for rehabilitation after lower limb surgery in children (1) reduced anticipatory anxiety; (2) reduced the level of pain experienced during gait rehabilitation; (3) improved rehabilitation, such that children were walking more than expected and with better quality; (4) increased confidence; (5) made rehabilitation more enjoyable; and (6) was delivered via a system that was easy to learn and accept.

Conclusion

This rehabilitation IVR is the first product of its class for paediatric lower limb postoperative rehabilitation. These preliminary results will inform improvements to the system in a future multi-site study with a large calculated sample size to demonstrate its clinical effectiveness and safety in acquiring medical device markings and adoption.

What is it about?

The study evaluated the feasibility of using immersive virtual reality (IVR) applications for gait rehabilitation in children post-lower limb surgery. It involved 15 children aged 11-16 and utilized a mixed-methods approach, incorporating both quantitative measures of anxiety and pain, and qualitative data from interviews with patients, parents, and physiotherapists. The study measured changes in anxiety and pain levels using the General Anxiety Disorder-7 scale and a visual analogue scale, respectively. Results showed that IVR reduced anticipatory anxiety and pain during rehabilitation, enhanced walking quality, and increased patient confidence and enjoyment. The IVR system was designed to be user-friendly and received positive feedback regarding its acceptability. The study concluded that IVR could be a valuable tool for paediatric lower limb rehabilitation, warranting further investigation in larger, multi-site studies to establish clinical effectiveness and safety.

Why is it important?

This study is important as it pioneers the use of immersive virtual reality (IVR) in pediatric lower limb postoperative rehabilitation, addressing the challenge of pain and anxiety that often hinder recovery. By providing a novel, engaging, and effective method to enhance rehabilitation compliance and efficacy, the research offers significant implications for improving paediatric healthcare outcomes. This approach holds promise for reducing long-term complications associated with inadequate rehabilitation and could lead to widespread adoption in clinical settings if further validated, ultimately contributing to better recovery experiences and outcomes for children undergoing lower limb surgery.

Key Takeaways:

1. Anxiety and Pain Reduction: The study shows that using IVR significantly reduces both anticipatory anxiety and pain levels in children during gait rehabilitation, facilitating a more positive rehabilitation experience.

2. Enhanced Rehabilitation Outcomes: Children utilizing IVR demonstrated improved rehabilitation results, including increased walking distances and better walking quality, surpassing expected outcomes.

3. High Engagement and Acceptance: The IVR system was found to make rehabilitation more enjoyable and was easy to learn and accept, leading to increased confidence and motivation among young patients, which are critical for successful recovery.