Exploring barriers and facilitators to the clinical use of virtual reality for post-stroke unilateral spatial neglect assessment

Abstract

Background: Hemineglect, defined as a failure to attend to the contralesional side of space, is a prevalent and disabling post-stroke deficit. Conventional hemineglect assessments lack sensitivity as they contain mainly non-functional tasks performed in near-extrapersonal space, using static, two-dimensional methods. This is of concern given that hemineglect is a strong predictor for functional deterioration, limited post-stroke recovery, and difficulty in community reintegration. With the emerging field of virtual reality, several virtual tools have been proposed and have reported better sensitivity in neglect-related deficits detection than conventional methods. However, these and future virtual reality-based tools are yet to be implemented in clinical practice.

Objectives: The present study aimed to explore the barriers/facilitators perceived by clinicians in the use of virtual reality for hemineglect assessment; and to identify features of an optimal virtual assessment.

Methods: A qualitative descriptive process, in the form of focus groups, self-administered questionnaire and individual interviews was used.

Results: Two focus groups (n = 11 clinicians) were conducted and experts in the field (n = 3) were individually interviewed. Several barriers and facilitators, including personal, institutional, client suitability, and equipment factors, were identified. Clinicians and experts in the field reported numerous features for the virtual tool optimization.

Conclusion: Factors identified through this study lay the foundation for the development of a knowledge translation initiative towards an implementation of a virtual assessment for hemineglect. Addressing the identified barriers/facilitators during implementation and incorporating the optimal features in the design of the virtual assessment could assist and promote its eventual adoption in clinical settings.

Implications for rehabilitation

• A multimodal and active knowledge translation intervention built on the presently identified modifiable factors is suggested to be implemented to support the clinical integration of a virtual reality-based assessment for post-stroke hemineglect.

• To amplify application and usefulness of a virtual-reality based tool in the assessment of post-stroke hemineglect, optimal features identified in the present study should be incorporated in the design of such technology.

Keywords:

• Knowledge translation
• qualitative research
• hemineglect
• evaluation
• technology
• cerebrovascular accident

Acknowledgements

T. O. was supported by the Richard & Edith Strauss Fellowship in Rehabilitation Sciences and The Fonds de Recherche du Québec – Santé (FRQS). This project was supported by the Canadian Institute of Health Research (MOP – 77548) and A. L. is the recipient of a Senior Scientist FRQS Salary Award. The authors would like to acknowledge the involvement of clinical/research coordinators, Franceen Kaizer (Jewish Rehabilitation Hospital) and Isabelle David (Institut de Réadaptation Gingras-Lindsay de Montréal), focus group study participants at both clinical sites, experts in the field for their interview time, Marco Bühler (School of Physical and Occupational Therapy, McGill University) for coding verbatim transcripts, and Myriam Villeneuve (Jewish Rehabilitation Hospital) for assistance with the focus groups.

Disclosure statement

The authors report no declarations of interest.

Additional information

Funding

T. O. was supported by the Richard & Edith Strauss Fellowship in Rehabilitation Sciences and The Fonds de Recherche du Québec – Santé (FRQS). This project was supported by the Canadian Institute of Health Research (MOP – 77548) and A. L. is the recipient of a Senior Scientist FRQS Salary Award.