Virtual reality to aid recovery from critical illness: a feasibility trial of a rehabilitation intervention co-developed with key stakeholders

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BACKGROUND: Improved survival from critical illness has led to an increase in patients with long-term physical and psychological morbidity. Postintensive care rehabilitation services are variable and it is recognised that there is a need for inclusive and accessible interventions to support recovery after critical illness. We engaged with people with lived experience of critical care admission to co-produce a virtual reality mediated intervention (ViRtual REality to AiD recoverY post intensive care unit (ICU) (VR READY). OBJECTIVES: included assessment of the feasibility and acceptability of selected outcome measures for use in future efficacy and cost-effectiveness studies for ICU recovery. DESIGN: The co-developed intervention (VR READY) was evaluated in a single arm, non-randomised feasibility trial with embedded process evaluation in patients leaving critical care. SETTING: District General Hospital in Wales. PARTICIPANTS: Adults who had been admitted to an ICU requiring organ support for more than 48 hours during their current hospital admission. Patients were approached at the point of stepping down from the ICU to a general ward (±48 hours). 87 patients were screened for eligibility, 37 were approached and 22 participants were recruited. INTERVENTION: Participants were asked to use VR READY for at least 5 min per day for 14 days. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was feasibility defined by prespecified criteria. Secondary outcomes prioritised by patients and pertaining to recovery and well-being were assessed at baseline and 14 days. A qualitative interview was conducted 4-6 weeks later. RESULTS: 22 participants were recruited with 91% completion of baseline measures, 49.5% completion at 14-day follow-up and 27.3% completing the qualitative interview. Intervention adherence was poor (37.9%), however qualitative findings suggested that participants that engaged with the intervention considered VR READY beneficial to their recovery. While feasibility criteria were met for recruitment and data completion, criteria for retention and intervention adherence were not. CONCLUSIONS: Critical illness is a traumatic experience. Our co-developed rehabilitation intervention VR READY was not feasible in its current format, potentially as a result of being offered too early in recovery when patients were struggling with fatigue, motivation and resilience. VR READY may be beneficial to recovery but further research is needed into optimal mode and timing. TRIAL REGISTRATION NUMBER: ISRCTN88854487.

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