Application of Immersive Virtual Reality in Occupational Therapy-based Pulmonary Rehabilitation Program: A Mixed-method Study

Introduction: The management of chronic respiratory conditions critically relies on Pulmonary Rehabilitation (PR). Traditional PR programs often encounter obstacles in patient engagement and adherence. To overcome these issues, immersive virtual reality (VR) technology is being explored. Immersive VR, experienced through a head-mounted display, provides an interactive simulated environment. Its integration into occupational therapy (OT) PR programs holds the potential to boost the effectiveness of rehabilitation and patient experience. Objective: This study aimed to probe the effects of VR-based training on PR patients' psychological well-being, training engagement, adherence to breathing control exercises and sense of security. The assessment of these outcomes is intended to ascertain the potential benefits of VR in augmenting PR efficacy. Methods: A mixed-method, single-group design was adopted, involving a one-week trial with daily half-hour VR sessions. Pre-post assessments, incorporating qualitative and quantitative approaches, were conducted for data collection and analysis. Quantitative measures assessed functional capacity (Barthel Index-Dyspnea; BI-D), psychological well-being (Hospital Anxiety and Depression Scale; HADS) and symptom assessment (Shortness of Breath Questionnaire; SOBQ and Chronic Respiratory Disease Questionnaire; CRQ). Qualitative analysis hinged on semi-structured interviews, with thematic analysis used to discern underlying themes and patterns from participant experiences. The study, conducted from August to November 2023, involved 10 in-patients of the PR program from a rehabilitation hospital, aged 67 to 91, and diagnosed with COPD, COVID-19, and lung cancer. Results: Quantitative results showed significant improvements across all measures, including BI-D (p<0.001; MD -19.60), HADS-Anxiety (p<0.001; MD -4.60), HADS-Depression (p<0.001; MD-3.90), SOBQ (p=0.002; MD-19.85), CRQ-Dyspnea (p=0.002; MD+1.01), CRQ-Emotion (p=0.004; MD+0.89), CRQ-Management (p=0.010; MD+1.2), and CRQ-Fatigue (p<0.001; MD+1.16). In qualitative analysis, noteworthy enhancements in psychological well-being were reported by all participants. VR resulted in relaxation, stress reduction, and distraction, highlighting a positive mental health impact. The captivating and motivating nature of the simulated environment led to increased engagement and improved breathing exercise compliance. VR also offered a secured platform for practicing breathing control, contributing to an enhanced rehabilitation experience. Conclusion: Merging VR technology into OT services for PR yields positive results. VR enhances psychological well-being, training engagement, and exercise compliance, while also providing a secure virtual environment. Future research should explore a greater variety of VR training programs to meet a wider range of therapeutic needs.