Feasibility, acceptability, and preliminary efficacy of AdaptRehab VR, an immersive virtual reality system for upper limb stroke rehabilitation: A mixed-methods study in Ethiopia
4 affiliations
- 1Department of Information Science, Faculty of Computing and Informatics, Jimma Institute of Technology, Jimma University, Jimma, Oromia, Ethiopia
- 2REVAL Rehabilitation Research Center, Technology-Supported and Data-Driven Rehabilitation, Data Science Institute, Faculty of Rehabilitation Sciences, University of Hasselt, Diepenbeek, Belgium
- 3Department of Special Needs and Inclusive Education, Jimma University, Jimma, Oromia, Ethiopia
- 4Department of Physiotherapy, Faculty of Medical Sciences, Institute of Health, Jimma University, Jimma, Oromia, Ethiopia
Abstract
Stroke is a leading cause of long-term disability, with a disproportionate burden in low- and middle-income countries (LMICs), where upper limb impairment emerges as one of its most prevalent and debilitating consequences. Upper limb impairment significantly limits independence and community participation, and this makes rehabilitation a critical priority. While conventional therapy is essential, its effectiveness is often limited by challenges in patient engagement and adherence. To address these barriers, immersive virtual reality (imVR) offers a promising modality for enhancing upper limb rehabilitation. This study examined the feasibility, acceptability, safety, and upper extremity outcomes of the AdaptRehab VR system in Ethiopia with the aim of informing future randomized controlled trials. A mixed-methods design was used, including quantitative assessments of upper extremity function, usability, user experience, and cybersickness, alongside qualitative interviews and focus group discussion (FGD). The study was conducted at Jimma University Teaching Hospital, Ethiopia, and enrolled 20 adults aged ≥18 years with subacute or chronic stroke. Eighteen participants completed nine AdaptRehab VR sessions over three weeks. Physiotherapists collected baseline and post-intervention data. In addition, 18 participants (interview) and 6 physiotherapists (FGD) provided qualitative feedback. The study followed CONSORT guidelines for pilot and feasibility studies. Feasibility was excellent, with 93% adherence. System Usability Scale scores indicated good usability (mean 76.2 ± 12.1). User Experience Questionnaire ratings were positive across attractiveness (1.92 ± 0.84), pragmatic quality (1.78 ± 0.79), and hedonic quality (1.84 ± 0.81). Cybersickness was minimal, with mild transient symptoms (sweating: n = 6; fatigue and headache: n = 3). Significant improvements were observed in the Action Research Arm Test (33.0 ± 13.2 to 48.6 ± 13.1, p < .001), and Box and Block Test (medians of 21.5 to 29, p < .001). Qualitative findings confirmed high acceptability, motivation, and perceived functional gains. The AdaptRehab VR system demonstrated strong feasibility, acceptability, and safety for upper limb stroke rehabilitation in Ethiopia. Positive user experiences and functional improvements support its potential in LMICs settings, warranting a fully powered randomized controlled trial. Trial registration: ClinicalTrials.gov NCT07412899
Related
- SOFTPEERS: feasibility, acceptability, and preliminary effectiveness of a peer-led intervention to prevent binge drinking in adolescents. Results from a mixed-methods pilot cluster-randomized controlled trial
- Feasibility and acceptability of a randomized controlled trial of a patient-centred transition program for stroke survivors and their caregivers—P-NAVISTROKE study
- F-OGS, a new “Follow-up Onco-Geriatric Screening” tool during the follow-up of older patients undergoing oncological treatment. Pilot study of feasibility and acceptability
- Exploring the feasibility, acceptability and impact of genomic newborn screening for rare diseases in England: A study protocol for the Generation Study - Process and Impact Evaluation (Version 2)
- Implementing computer‑aided detection for TB active case finding: A qualitative study of feasibility and acceptability in Tondo, Manila
BibTeX
@article{kenea2026feasibility,
title = {{Feasibility, acceptability, and preliminary efficacy of AdaptRehab VR, an immersive virtual reality system for upper limb stroke rehabilitation: A mixed-methods study in Ethiopia}},
author = {Chala Diriba Kenea and Teklu Gemechu Abessa and Dheeraj Lamba and Bruno Bonnechère},
journal = {PLOS One},
year = {2026},
month = oct,
doi = {10.1371/journal.pone.0360216},
url = {https://doi.org/10.1371/journal.pone.0360216},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Feasibility, acceptability, and preliminary efficacy of AdaptRehab VR, an immersive virtual reality system for upper limb stroke rehabilitation: A mixed-methods study in Ethiopia
AU - Chala Diriba Kenea
AU - Teklu Gemechu Abessa
AU - Dheeraj Lamba
AU - Bruno Bonnechère
PY - 2026
DA - 2026/10/09
JO - PLOS One
DO - 10.1371/journal.pone.0360216
UR - https://doi.org/10.1371/journal.pone.0360216
AB - Stroke is a leading cause of long-term disability, with a disproportionate burden in low- and middle-income countries (LMICs), where upper limb impairment emerges as one of its most prevalent and debilitating consequences. Upper limb impairment significantly limits independence and community participation, and this makes rehabilitation a critical priority. While conventional therapy is essential, its effectiveness is often limited by challenges in patient engagement and adherence. To address these barriers, immersive virtual reality (imVR) offers a promising modality for enhancing upper limb rehabilitation. This study examined the feasibility, acceptability, safety, and upper extremity outcomes of the AdaptRehab VR system in Ethiopia with the aim of informing future randomized controlled trials. A mixed-methods design was used, including quantitative assessments of upper extremity function, usability, user experience, and cybersickness, alongside qualitative interviews and focus group discussion (FGD). The study was conducted at Jimma University Teaching Hospital, Ethiopia, and enrolled 20 adults aged ≥18 years with subacute or chronic stroke. Eighteen participants completed nine AdaptRehab VR sessions over three weeks. Physiotherapists collected baseline and post-intervention data. In addition, 18 participants (interview) and 6 physiotherapists (FGD) provided qualitative feedback. The study followed CONSORT guidelines for pilot and feasibility studies. Feasibility was excellent, with 93% adherence. System Usability Scale scores indicated good usability (mean 76.2 ± 12.1). User Experience Questionnaire ratings were positive across attractiveness (1.92 ± 0.84), pragmatic quality (1.78 ± 0.79), and hedonic quality (1.84 ± 0.81). Cybersickness was minimal, with mild transient symptoms (sweating: n = 6; fatigue and headache: n = 3). Significant improvements were observed in the Action Research Arm Test (33.0 ± 13.2 to 48.6 ± 13.1, p < .001), and Box and Block Test (medians of 21.5 to 29, p < .001). Qualitative findings confirmed high acceptability, motivation, and perceived functional gains. The AdaptRehab VR system demonstrated strong feasibility, acceptability, and safety for upper limb stroke rehabilitation in Ethiopia. Positive user experiences and functional improvements support its potential in LMICs settings, warranting a fully powered randomized controlled trial. Trial registration: ClinicalTrials.gov NCT07412899
SN - 1932-6203
ER -