Evaluation of the acceptability and usability of the MAGIC-GLASS virtual reality solution as part of the care pathway in people with acute, sub-acute and chronic stroke: a study protocol

Background: Intensive rehabilitation is one of the most important aspects of care for people with stroke, and there is evidence that it leads to better recovery and higher levels of independence. However, pressure on resources in government funded secondary and primary healthcare settings means that for many people with stroke, intense rehabilitation is not available. Effective and efficient ways of increasing rehabilitation intensity, engagement, and motivation for rehabilitation are needed; as well as innovative treatment approaches that enable people with stroke to self-manage this rehabilitation. Technology offers a solution; virtual reality (VR) computer games have the potential to enhance engagement, improve adherence, and outcomes in stroke rehabilitation therapy. However, their integration into current health care pathways needs to be tested. Aims: The aim of the trial is to test the feasibility of incorporating VR computer games into a stroke rehabilitation system called 'MAGIC-GLASS', and its integration into the current care pathway for people with stroke. Design: Multicenter, prospective uncontrolled, pre-post intervention study. Setting: Participants will be recruited from Stroke Services, GP Practices or via Stroke Support Groups, and the intervention will be carried out in the hospital setting, or at home after discharge. Population: Adults (>= 18 years) who have had a stroke. Interventions: Magic Glass is a clinician facilitated VR-based stroke rehabilitation system. Clinical facilitation includes a minimum of one initial face-to-face contact followed by up to 13 weekly/fortnightly remote contacts (to month six) with a clinician. Outcomes: The usability and acceptability of the intervention; process and resource requirements for the new care pathway; changes in clinical outcomes and potential cost-effectiveness of the solution will be measured to assess change from baseline to six months post intervention. Sample size: In order to have 50 patients in the subgroups identified (time since stroke; severity of stroke; age) we plan to recruit 300 participants, 150 in Northern Ireland and 150 in Italy. Fifty is considered the optimal sample size for this feasibility analysis. Duration: 18 months. Follow up will be post intervention (up to six months post entry into the study). The nested qualitative study will start once the first cohort of participants has completed and will continue throughout the intervention period.