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Efficacy of Virtual Reality Exercises in STroke Rehabilitation: A Multicentre Study (EVREST Multicentre)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT01406912
Recruitment Status : Completed
First Posted : August 1, 2011
Last Update Posted : November 13, 2015
Heart and Stroke Foundation of Ontario
Ontario Stroke Network
Ontario Ministry of Health and Long Term Care
Information provided by (Responsible Party):
St. Michael's Hospital, Toronto

Brief Summary:

A multicentre, randomized, two parallel group study comparing virtual reality using Wii gaming technology versus Recreational activities in patients receiving conventional rehabilitation after an ischemic stroke.

Primary Hypothesis: Virtual reality using the Wii gaming system is more efficacious in improving motor function than recreational therapy among patients receiving conventional rehabilitation following a recent ischemic stroke.

Condition or disease Intervention/treatment Phase
Ischemic Stroke Other: Recreational Activity Other: Wii Gaming System Arm Not Applicable

Detailed Description:
Virtual reality (VR) gaming systems are novel and potentially useful technologies that allow users to interact in three dimensions with a computer-generated scenario (a virtual world). In particular, the Nintendo Wii gaming system applies relevant concepts in rehabilitation (i.e. repetition, intensity, and task-oriented training of the paretic extremity) showing benefits in motor function improvement after stroke. While standard rehabilitation (i.e. physiotherapy and occupational therapy) helps improve motor function after stroke, the magnitude of its benefit is suboptimal. The implementation of conventional rehabilitation is resource-intensive and costly, usually requiring transportation of patients and affecting adherence. Moreover, as improvement of motor function may be achieved after multiple sessions over a period of rehabilitation. The duration and intensity of the rehabilitation strategy are important factors in its effectiveness. Some studies compared an intervention plus conventional physical therapy versus conventional physical therapy alone, which by necessity allowed for more rehabilitation time in the experimental group. This creates a bias in favour of the new intervention as the intensity and frequency of rehabilitation per se is known to directly and beneficially affect functional outcomes. Therefore, the investigators are proposing comparing VR Wii versus an active control [(recreational activities (RA)].

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 141 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Official Title: Efficacy of Virtual Reality Exercises Using Wii Gaming Technology in STroke Rehabilitation: A Multicentre Randomized Clinical Trial (EVREST Multicentre)
Study Start Date : July 2011
Actual Primary Completion Date : October 2015
Actual Study Completion Date : October 2015

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Active Comparator: Recreational Activity Arm
recreational activity includes playing cards, ominoes, jenga or a ball game.
Other: Recreational Activity
Recreational activities (playing cards, arts and crafts, dominoes, jenga or a ball game) and conventional rehabilitation.

Experimental: Wii Gaming System Arm
Use of Wii gaming technology (e.g. commercially available games)
Other: Wii Gaming System Arm
Virtual reality Wii games (tennis and bowling from Wii® Sports, and bean bag, bocce ball, ping cup, darts or shuffleboard from Wii® Game Party 3) and conventional rehabilitation.
Other Name: Virtual Reality Wii games

Primary Outcome Measures :
  1. Difference in motor performance between groups measured using the Wolf Motor function Test. [ Time Frame: 1 (±3) days after the end of the intervention ]
    Efficacy in motor function improvement at the end of the intervention will be measured by the abbreviated Wolf Motor Function Test. The Wolf MFT is a time-based method to evaluate upper extremity performance while providing insight into total limb movements. It consists of 15 timed measures and 2 force-based measures which progress in complexity. Difference in Wolf MFT is one of the most commonly used outcome measures in stroke rehabilitation trials.

Secondary Outcome Measures :
  1. Improvement in motor function, performing activities of daily living, and quality of life, as well as sustainability of motor improvement [ Time Frame: End of intervention and 4 weeks post-intervention ]
    Secondary efficacy outcome measures include Box & Block Test, quality of life as measured by the Stroke Impact Scale, and Barthel Index at the end of the interventions. In addition, sustainability of motor improvement will be assessed through the Wolf Motor Function Test and Box & Block Test conducted at 4 weeks post-intervention, which is approximately 3 months from stroke onset.

  2. Proportion of patients experiencing intervention-related adverse events or any serious adverse events during the study period [ Time Frame: Subjects will be followed for the duration of their participation in the study, an expected time frame of 6 weeks ]
    Secondary safety outcome will be measured as the proportion of patients experiencing intervention-related adverse events (e.g. pain, dizziness), or any serious adverse event (death, life-threatening, requires inpatient hospitalization or prolongation of existing hospitalization, or results in persistent or significant disability/incapacity) during the study period. We will also measure patients' perceived exertion after treatment by using the Borg Perceived Exertion scale (excessive fatigue defined as any score > 13 points)

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 85 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Patient has provided written informed consent prior to entry into the study
  • Males or females, aged 18 to 85 years
  • In-patient at the time of randomization
  • Evidence of ischemic stroke confirmed by CT or MRI head scan
  • Patients with onset of symptoms less than 3 months at time of randomization
  • Measurable deficit of the upper extremity (arm) equal to or greater than 3 according to the Chedoke McMaster scale (e.g.: participants should be able to touch their chin and contralateral knee to be eligible)
  • Functional independence prior to present stroke (baseline mRS = 0-1)
  • Patient is alert, medically stable according to the treating physician and able to follow simple verbal commands

Exclusion Criteria:

  • Acute stroke onset more than 3 months ago
  • Patient is unable to follow verbal commands or has global aphasia
  • Severe illness and life expectancy less than 3 months (cancer, endocarditis, metastasis with an occult primary malignancy, coagulopathy)
  • Uncontrolled hypertension according to the treating physician
  • Unstable angina or recent myocardial infarction (within the last 3 months), current NY Heart Association Class III (marked limitation of physical activity; although patients are comfortable at rest, less-than-ordinary activity leads to fatigue, dyspnea, palpitations, or angina) or IV (symptomatic at rest; symptoms of CHF are present at rest; discomfort increases with any physical activity) or symptomatic ventricular tachyarrhythmias, as per medical history (a baseline ECG will not be required.)
  • Any history of seizure, except for febrile seizures of childhood
  • Pain or joint problems limiting movement of the arm (e.g. shoulder pain)
  • Participation in another clinical trial involving rehabilitation (recreational therapy, occupational therapy, physiotherapy) or involving an investigational drug
  • Patient is unwilling or unable to comply with the protocol or cannot / will not cooperate fully with the investigator or study personnel
  • Any condition(s) that, in the Investigator's opinion, would a) warrant exclusion from the study (i.e., participation in the study is not in the best interest of the patient) or b) prevent the patient from completing the study.
  • Any medical condition that might confound the interpretation of results or put the patient at risk (amputation of one extremity).

Enrollment Criteria

  • Upon meeting all eligibility criteria and providing written informed consent, the patient will be enrolled into the study contingent on successfully completing a one hour training session with Virtual Reality Wii.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT01406912

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Buenos Aires, Argentina
Lucy Montoro Network
Sao Paulo, Brazil
Canada, Alberta
University of Calgary
Calgary, Alberta, Canada, T2N 0P8
Canada, Manitoba
Riverview Health Centre
Winnipeg, Manitoba, Canada, R3L 2P4
Canada, Newfoundland and Labrador
LA Miller Centre
St John's, Newfoundland and Labrador, Canada
Canada, Ontario
Hamilton Health Sciences
Hamilton, Ontario, Canada, L8L 2X2
Parkwood Hospital, St. Joseph's Health Care London
London, Ontario, Canada, N6C 5J1
Trillium Health Partners
Mississauga, Ontario, Canada, L5B 1B8
Providence Healthcare
Scarborough, Ontario, Canada, M1L 1W1
Toronto Rehabilitation Institute
Toronto, Ontario, Canada, M5G 2A2
Canada, Quebec
CSSS Cavendish Richardson Hospital
Montreal, Quebec, Canada
Clinica San Felipe
Lima, Peru
Siriraj Hospital
Bangkok, Thailand
Sponsors and Collaborators
St. Michael's Hospital, Toronto
Heart and Stroke Foundation of Ontario
Ontario Stroke Network
Ontario Ministry of Health and Long Term Care
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Principal Investigator: Gustavo Saposnik, MD St. Michael's Hospital, Toronto
Principal Investigator: Mark Bayley, MD Toronto Rehabilitation Institute
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Responsible Party: St. Michael's Hospital, Toronto Identifier: NCT01406912    
Other Study ID Numbers: 11-188C
First Posted: August 1, 2011    Key Record Dates
Last Update Posted: November 13, 2015
Last Verified: November 2015
Keywords provided by St. Michael's Hospital, Toronto:
Stroke Rehabilitation
Ischemic Stroke
Virtual Reality
Nintendo Wii
Recreational Activity
Motor Function
Additional relevant MeSH terms:
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Cerebrovascular Disorders
Brain Diseases
Central Nervous System Diseases
Nervous System Diseases
Vascular Diseases
Cardiovascular Diseases