Virtual Reality home exercises to increase possible independence of Long COVID patients

An immersion in a digital world with a virtual reality (VR) headset must provide effective self-treatment for patients with Long COVID symptoms and result in more independence. For 12 weeks, 300 patients will do physical exercises at home as well as exercises for improved concentration, memory and breathing. Especially the integration of several types of home exercises in the app store that the VR headset is linked to renders the treatment both unique and innovative. The physiotherapist prescribes the apps in a tailored manner, dependent on the patient’s symptoms. Besides the basic apps each patient receives, there are also apps specifically for treating the patient’s prominent symptoms. For example, an app with extra breathing exercises is a logical addition if a patient suffers from shortness of breath.

It is expected that the VR headset in this COVR2HOME study will lead to a better and faster participation of Long COVID patients. The effectiveness of the treatment on physical activity is therefore not the most important aspect of our study but instead secondary. I mainly expect lot of improvements in the area of patients’ ability to care for themselves, which is also the final goal of our study: setting up the physiotherapy in primary care in such a way that it provides more self-management. We also examine the demographic factors: does educational level, SES, gender or cultural background influence the success of the VR headset? This research is not only concerned with the outcomes, but also whether these factors influence the use of the VR headset for home exercises. The number of patients that need to be included is less of a nightmare because it is not a randomised study.

The effectiveness of the home exercises with the VR headset will be compared with a group of patients in the ParaCOV study from 2020, who did standard home exercises and were followed for the same outcomes. Improvements in the apps and the study approach with questionnaires at three and six months have been implemented in line with patients’ experiences within the feedback panels. Based on the interviews with patients and physiotherapists who participated in that study, the content of the app was adjusted again. For example, the physical games have sometimes been adjusted to a sitting position for older patients. This adjustment therefore is a form of co-creation, as the app development takes place in consultation with the patient. Experiences with the questionnaires are also included in this new study with the VR home exercises. For example, the questionnaire has now been given a more extensive design and includes, in particular, more questions about cognitive capabilities and mental health. This is also what I consider the added value of our research: developing an optimal product on the basis of co-creation that can soon be implemented in practice.

We expect more therapy compliance with the VR exercises than in the case of traditional, standard physiotherapy exercises. The added value of VR is that the immersion in a digital world helps patients to concentrate better. They are less distracted by external influences. Especially patients with concentration problems benefit from this. The study design also gives primary care providers more control over and insight into the results achieved than is the case with a standard treatment. A dashboard with weekly results can be discussed straightaway with the physiotherapist during the consultation. That makes it possible to offer a modified follow-up treatment. This also means that a physical check-up is no longer always necessary: a video consultation can also suffice.

I wouldn’t want to go as far as to argue that the VR headset will replace primary care providers. But I do think it will allow us to combine several treatments: physiotherapy, occupational therapy and the psychological part. Combining treatments makes it easier for patients with Long COVID to perform the exercises each day. Patients train their working memory with the VR headset by doing physical exercises that require them to apply their mind at the same time.

It is still quite a challenge to get the digital platform – through which data is collected and to which the dashboard is connected – to work without any hiccups. We are now taking the platform into the second test phase. Another challenge is coordinating the contact with the many participating physiotherapy practices, and the logistics of the VR headset for home use is also an intensive task. We nevertheless believe that we will obtain enough inclusions. The number of inclusions needed is less of a nightmare than in a standard study because our study is not randomised. In March 2023, the first patient was included, and a start was made with the home training exercises.