Improved survival following critical illness has led to an increased population of patients living with long-term physical and psychological problems. Postintensive care rehabilitation services are variable and there is a recognised need for more inclusive and accessible interventions to support recovery after critical illness. To address this gap, people with lived experience of ICU admission were engaged to co-produce a virtual reality–mediated rehabilitation intervention termed VR READY.
The primary aim of the reported work was to determine the feasibility and acceptability of virtual reality–mediated rehabilitation (VR READY) to improve the patient experience during recovery from critical illness. Secondary aims included assessing the feasibility and acceptability of selected outcome measures prioritised by patients for use in future efficacy and cost-effectiveness studies.
VR READY was evaluated in a single-arm, non-randomised feasibility trial with an embedded process evaluation. The trial was conducted at a District General Hospital in Wales. The design focused on practical implementation and on collecting both quantitative and qualitative data to inform future definitive trials.
Eligible participants were adults who had been admitted to an intensive care unit and required organ support for more than 48 hours during the current hospital admission. Patients were approached about participation at the point of stepping down from the ICU to a general ward (±48 hours). Screening and recruitment numbers reported: 87 patients were screened for eligibility, 37 were approached, and 22 participants were recruited.
The intervention was co-produced with people who had direct lived experience of critical care admission. The involvement of patients and stakeholders in design informed content, usability and acceptability considerations intended to make the intervention relevant to the recovery priorities of ICU survivors.
Participants were asked to use the VR READY intervention for at least 5 minutes per day for 14 consecutive days. The trial protocol specified this minimum daily exposure as the adherence target. The intervention was delivered soon after patients left the ICU and while they remained in hospital on the general ward.
The primary outcome was feasibility, defined by prespecified criteria (reported in the source). Secondary outcomes were measures prioritised by patients relating to recovery and well-being; these were assessed at baseline and at day 14. In addition, a qualitative interview was scheduled for 4–6 weeks after enrolment to capture participant experiences and process insights.
Of the 22 recruited participants, baseline data completeness was 91%. At the 14-day follow-up the completion rate was 49.5%. Only 27.3% of participants completed the planned qualitative interview at 4–6 weeks. Reported intervention adherence was low at 37.9%.
Although the trial met feasibility criteria for recruitment and initial data completion, it did not meet prespecified criteria for retention or for adherence to the intervention schedule.
Qualitative data were limited by low interview completion (27.3%). Among participants who did engage with the intervention and with qualitative follow-up, accounts suggested that those users considered VR READY beneficial to their recovery. However, many participants struggled with factors that impeded engagement, including fatigue, reduced motivation and limited resilience during the early recovery period after ICU.
The feasibility evaluation found a mixed result: recruitment and initial data collection met the trial's prespecified feasibility thresholds, but retention over the 14-day follow-up period and adherence to the at-least-5-minutes-per-day protocol did not meet the criteria. The investigators attributed these shortcomings, in part, to the timing of the offer — the intervention was provided early in recovery when patients commonly experience fatigue and motivational challenges.
The co-developed VR READY rehabilitation intervention was not feasible in its current format when offered at the point of ICU step-down in this single-centre feasibility trial. While there is suggestion from qualitative feedback that participants who used the intervention perceived benefit, low adherence and limited retention indicate the need to modify delivery.
Key implications are that optimal timing and mode of delivery require further investigation before proceeding to larger efficacy or cost-effectiveness trials. Future work should explore when during recovery patients are most able and willing to engage with a virtual reality intervention and how to support adherence, given the common early-post-ICU challenges of fatigue, low motivation and diminished resilience.
Trial registration number: ISRCTN88854487.