Award Title: How can immersive virtual reality be used to facilitate recovery and rehabilitation of patients following a stay in intensive care?
Funder: Health and Care Research Wales (Welsh Government)

Abstract: Post intensive care syndrome (PICS) is a very common occurrence in people who have experienced a stay in an Intensive Care Unit (ICU) and can be significantly debilitating. A mix of cognitive, psychological and physical impairments leads to a profound impact on the lives of patients and their families. Whilst standardised developments in treatment strategies during a stay in ICU have positively impacted survival,  there are few,  if any recognised standardised programs for supporting recovery and rehabilitation post-ICU. Additionally, the recent Sars-CoV2 pandemic has seen a significant increase on the number of ICU admissions, inflating the already large number of 130,000 discharged alive form ICU across the UK each year. This has created  a “tsunami of need” for effective post-ICU rehabilitation, with recent UK critical care guidelines recommending a holistic and accessible approach to recovery. This pressing issue is further compounded by the documented lack of available staff and resource to support holistic recovery post-ICU.
A potential avenue for developing accessible interventions at relatively low cost for people recovering from ICU lies within immersive virtual reality (VR). VR has been utilised in a variety of healthcare settings and has demonstrated promise in a range of clinical areas. For instance, VR has shown equal effectiveness to conventional therapies in rehabilitation after stroke, but with the added benefits of independent home-based use, more accurate feedback and the ability to stimulate users more than traditional methods.
Building on our previous feasibility work with VR in ICU settings, this study aims to create a VR
mediated, home-based intervention to support post-ICU rehabilitation and evaluate how readily this may be adopted by patients and healthcare providers.
To achieve this aim we plan to research the patient experience of recovery from critical illness to identify intervention priorities and outcome measures considered important and acceptable to ICU survivors, their loved ones and relevant critical care and rehabilitation staff. Using this information, we will adapt a VR kit already in use within the NHS to co-produce (with service users and key stakeholders) a VR-mediated intervention to aid recovery and rehabilitation after critical illness.
This intervention will then be tested in a small group of patients discharged from ICU to examine
the feasibility and acceptability of the intervention and delivery in an at-home setting. The intervention will be evaluated via a series of qualitative interviews with study participants and healthcare professionals involved in intervention delivery to provide  in-depth  and contextual analysis of the intervention’s feasibility and acceptability, plus detailed insights into the applicability of outcome measures for critical care research, including economic evaluation.
The information generated by the feasibility study will provide  important insights into a potential new therapeutic and resource light intervention for supporting and improving recovery and rehabilitation in people experiencing PICS. Not only will this benefit ICU survivors directly, but in learning about the components of recovery and how to adapt DR.VR for self-directed use at home, we will have developed a framework that can be simply altered to generate accessible, low cost interventions for a plethora of patient groups.

Lay Abstract: People admitted to intensive care (ICU) often experience ongoing health problems once they leave and have returned home. This is described as Post Intensive Care Syndrome (PICS) and can include problems with memory and thinking, physical impairments and reduced psychological wellbeing. This can result in a reduced quality of life, which also affects family members and friends. Although improvements have been made in caring for people within ICU, there is no standard approach to care after leaving ICU to support patients' recovery. A lack of staff and resources have also been a barrier to standard post -ICU care. With the recent increase in admissions to ICU, there is an urgent need to find ways of supporting the recovery of people with PICS that is readily available to patients. A recent review of how to combat PICS suggested that home-based and virtual care plans would be one way of making sure that as many people as possible could take advantage of rehabilitation support.

Immersive virtual reality (VR) can be accessed simply at home with an easy -to-use headset. VR has already been shown to be useful in helping relaxation and in combatting pain and anxiety. We think that VR might help support people recovering from PICS at home and this study is aimed at developing a VR program (intervention) that can be used at home.

In order to do this, we are proposing a three stage program of research. First, we need to
understand what the recovery journey looks like. We will conduct a series of focus groups with ICU survivors, their family members and healthcare professionals involved in the care and rehabilitation of ICU patients. In these sessions, we will explore what the patient recovery journey looks like what the critical parts of recovery are. We will also work with these groups to determine, in terms of recovery, what is important to measure (known as outcomes) to find out whether or not a homebased care intervention works or not.

The second stage will use data from the focus groups which will then be used to alter an existing VR set-up (DR.VR) to specifically support the recovery of ICU patients, working with previous ICU patients and their family members to inform the design.  We will also ask this group what features need to be included when testing the intervention at home and use this input to design the next stage of the project.

In the third part of the study, we will test the adapted VR intervention in a small group of patients admitted to ICU. The aim of this study will be to see if using a home-based VR intervention is possible and if people are happy and willing to use it. We will also explore how acceptable participants find the outcomes selected from the earlier focus groups. We will do this by interviewing participants about their experience. We will also interview the healthcare professionals involved in the care and rehabilitation of these participants to gather their views on the VR intervention. The interview data will be analysed qualitatively to provide an in-depth understanding of the intervention and outcomes. This data can then be used to inform the design of larger studies in the future to test how effective the VR intervention is at supporting the recovery of ICU patients. 

At the end of the study, we will share the results with all of the study participants and more widely through appropriate web pages, social media and organisations concerned with the care of ICU patients.

Research Activity Codes: 5.3 MEDICAL DEVICES
Health Categories: GENERIC HEALTH RELEVANCE