Effects of therapy based on virtual reality on motivation, engagement, adherence and hemodynamic repercussions in patients with heart disease

Author(s)

Mayara Moura Alves da Cruz

• Document type: Master's Dissertation
• Press: Presidente Prudente. 2019-01-29.
• Institution: Universidade Estadual Paulista (Unesp). Faculdade de Ciências e Tecnologia. Presidente Prudente
• Defense date: 2018-12-14
• Advisor: Luiz Carlos Marques Vanderlei

Abstract

Introduction: there is a concern regarding to the low adherence of patients in cardiovascular rehabilitation (CR), despite their benefits. It may be related to several factors, among them, motivation and engagement to treatment. Alternative therapies can improve motivation, engagement reflecting in better adherence and, in this context, virtual reality based therapy (VRBT) appears as an option for cardiac patients. However, in this population, a greater control of hemodynamic parameters is necessary, once if exceed they can cause a greater risk to health. Objective: to investigate engagement, motivation, barriers and adherence through the application of VRBT in patients with cardiovascular diseases or patients with risk factors who regularly participate in CR. In addition, to evaluate their acute hemodynamic repercussions. Methods: participants of CR program were randomized to CR or CR+ VRBT. The interventions were performed for 12 weeks. The primary endpoint was engagement (User Engagement Scale), motivation (Behavioral Regulation in Exercise Questionnaire 3), barriers (Cardiac Rehabilitation Barriers Scale), and patient’s adherence (frequency recorded on the chart). The secondary endpoint was the acute hemodynamic repercussions before, during and after a session through blood pressure (BP), heart rate (HR), HR reserve, respiratory rate (rr), oxygen saturation and rate of perceived exertion (RPE). Statistical analysis: homogeneity of the data had been evaluated (Mauchley sphericity test) followed by the Greenhouse-Geisser correction, if necessary. After this, Anova Two-Way for repeated measures had been analyzed, p <0.05. Results: In both groups, patients had low barriers, high engagement and motivation. The results demonstrate that VRBT promoted an increase in adherence of patients with low adherence to conventional CR, but this increment was not maintained after 12 weeks of protocol interruption. Regarding the analysis of hemodynamic data, VRBT produce physiological acute hemodynamic responses similar to CR. However, there was a greater magnitude during its execution and until 5 minutes of recovery after session for the HR, rr and RPE (p <0.01), observed at rest, up to one, three and five minutes of recovery respectively in relation to VRBT. It was also observed that 74.07% of the patients who underwent VRBT reached HR reserve of training at some point in the session and the HR and RPE responses, suggesting VRBT promoted greater effort intensity. Conclusion: The insertion of VRBT to the conventional CR increased adherence after admission in patients who participated with unsatisfactory frequency, what did not happen with the patients in the conventional CR program, however, adherence returns to basal values after 12 weeks of the program. In addition, VRBT did not stimulated motivation and neither influence patients’ barriers and engagement. Regarding hemodynamic data, VRBT produce physiological acute hemodynamic responses similar to CR, although with greater magnitude for some variables during its execution and up to five minutes after session. (AU)

• FAPESP's process: 17/12254-8 - Effects of virtual reality exposure therapy in motivation, engagement, adherence and hemodynamic parameters in patients with cardiovascular diseases
• Grantee: Mayara Moura Alves da Cruz
• Support Opportunities: Scholarships in Brazil - Master