Impact of an Intradialytic Nonimmersive Virtual Reality Platform on Functional Capacity: The GoodRENal Pilot Feasibility Study.

RATIONALE &

OBJECTIVE

Sedentarism and low health-related quality of life (HRQoL) are common in people receiving hemodialysis, and innovative approaches are needed to improve HRQoL.

AIMS: We investigated the feasibility and safety of an intradialytic exercise intervention using the GoodRENal virtual reality platform in people receiving hemodialysis and tested the impact on physical function and muscle strength.

STUDY

DESIGN

In a randomized control trial of feasibility and safety, participants were enrolled into a 4-to 12-week intradialytic exercise and were randomly allocated to a usual care control group (CG) or GoodRENal intervention group (GIG).

SETTING &

PARTICIPANTS

Participants were recruited from two hemodialysis units in Spain and Greece.

EXPOSURE: GIG was exposed to a platform delivered via laptop consisting of several virtual reality scenarios (serious games) for physical activity, nutritional information, psychological well-being, and cognitive function.

OUTCOMES: The primary outcomes for feasibility were recruitment, retention, and adherence rates. Physical performance and lower-limb muscle strength were assessed at baseline and at follow-up.

ANALYTICAL APPROACH: A two-way repeated-measures analysis of variance was applied.

RESULTS

Forty-one patients (64.5 ± 13.3 years; women 29.3%) were randomized. The recruitment rate (recruited participants / potential identified participants) was 53.2%. The retention ranged from 91% to 100%. Adherence ranged from 61% to 100%. No adverse effects were reported. Gait speed decreased significantly in CG participants (-0.06 m/s). A significant increase in lower-limb muscle strength was found in the GIG (change in hip flexors, 29.3 N; hip abductors, 27.4 N) after 12 weeks of participation, but not in the CG.

LIMITATIONS: These results are based on a small sample and the games were not developed by a videogame company.

CONCLUSIONS

The GoodRENal platform is a feasible and safe intervention to promote intradialytic exercise and results in increased lower-limb muscle strength. Future research should determine the effectiveness by recruitment of a larger sample for a longer period of intervention.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: An intradialytic nonimmersive virtual reality platform that promotes a healthy lifestyle (diet, physical activity, and good cognitive and psychological state) is feasible and safe. A holistic approach involving patients and health care professionals is important to overcome barriers to a healthier lifestyle while receiving HD. Enhancing competencies of renal nurses on physical activity promotion might improve the healthy lifestyle of patients receiving HD. The implementation of the GoodRENal platform resulted in increased lower-limb muscle strength and preserved gait speed.

WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: •People receiving hemodialysis are sedentary. Encouraging patients receiving dialysis to increase their physical activity is difficult; thus, it is important to create/develop ways to facilitate their engagement in physical activity.•A nonimmersive virtual reality intradialytic platform is feasible and safe and resulted in an increase in lower-limb muscle strength and preserved gait speed in people receiving hemodialysis.•Because sarcopenia and frailty are highly prevalent, dialysis units should consider integrating intradialytic training for all medically stable patients.

REPORTING METHOD: We have adhered to relevant EQUATOR guidelines (CONSORT).

PATIENT OR PUBLIC CONTRIBUTION: Patients and renal nurses answered a satisfaction questionnaire with the GoodRENal platform use.