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VR TierOne therapy in orthopedic rehabilitation


Joanna Pidanty - December 5, 2024 - 0 comments

The psychological impact of living with chronic and progressive osteoarthritis can be depression. The disease has a negative impact on daily life, associated with pain, fear of loss of function and the stress of the prospect of surgical intervention and long-term rehabilitation. There is an opportunity to improve the psychological health aspects of patients in orthopedic rehabilitation with VR TierOne therapy.

Osteoarthritis

Osteoarthritis (OA, osteoarthrosis) is one of the most common reasons patients use orthopedic rehabilitation. The disease is characterized by degradation of articular cartilage, further involving the subchondral layer of the bone, ligaments, joint capsule, synovial membrane and periarticular muscles. Abnormalities in the quantity and quality of cartilage cause the sliding of joint surfaces to be impeded and unabsorbed. The disease can occur at different speeds and affect different joints, most often those that are heavily loaded, crucial for movement and daily activities (knee joints, hip joints, shoulder joints, joints of the hands, feet, spine). The determining factor in the development of the disease is age, the disease can be genetically determined, be induced by estrogen deficiency, develop under the influence of trauma and stresses, and acquired and congenital joint defects. Osteoarthritis causes pain, stiffness, crackling of joints and restrictions in their mobility. In the advanced form, effusion, thickening of the bony contour of the joint and instability are present.

Orthopedic surgical treatment

The goal of treatment is to slow the progression of the disease by using non-invasive methods and dismissing the need for the prospect of surgical intervention, which has elements of risk. Prematurely performed surgery will translate minimally into an improvement in quality of life, so it is rather performed at a later stage of the disease. In advanced osteoarthrosis, the primary surgical treatment is endoprosthesis, which relieves pain, increases the joint’s range of motion and improves function. Endoprosthetic surgery (partial or total joint replacement) is performed on people who have exhausted other treatment options. Endoprosthesis involves large joints such as the hip and knee, and is one of the most commonly performed orthopedic surgeries in the world. Because degenerative changes are more frequent and more advanced with age, the procedure is usually performed on older patients, who, however, must be in good enough general condition to cope with the demands of postoperative recovery.

Orthopedic surgical treatment is effective; however, it involves long-term rehabilitation.

Depression in osteoarthritis

Osteoarthrosis is a chronic disease, in the elderly population it is a major cause of significant reduction in function and independence, and consequently a reduction in quality of life and well-being. Osteoarthritis sufferers are exposed to severe pain and high levels of stress. Depression in chronic diseases is not uncommon, the incidence of depression in the group of osteoarthritis patients is 20% (in the general population it is 5%). The increased risk of depression in the group of patients with CAD may be due to the experience of chronic pain, progressive loss of function and limited ability to engage in social life. The link between osteoarthritis and mental health seems to be too often overlooked, yet comorbid depression in patients increases medical costs and worsens the effectiveness of rehabilitation. It’s important to manage not only the functional symptoms of the disease, but also to manage the psychological symptoms in parallel, as increased symptoms of depression, anxiety disorders and stress are not conducive to successful improvement.

VR TierOne therapy in orthopedic rehabilitation

An alternative to traditional (often unfortunately unavailable) psychological intervention for rehabilitated patients can be virtual therapy. The effectiveness of VR TierOne therapy as an adjunct to orthopedic rehabilitation was evaluated in a study conducted under the direction of Justyna Mazurek, MD, at the St. Jadwiga Śląska Hospital in Trzebnica, Poland. The study, registered in the ClinicalTrials.gov database under reference NCT06002139, involved 68 participants aged 60+ with osteoarthritis after recent hip or knee replacement surgery. The aim of the study was to evaluate the effectiveness of VR therapy in relieving depression, anxiety and reducing stress levels in lower extremity endoprosthesis patients undergoing inpatient rehabilitation. Study participants were divided into two groups – an experimental group with VR therapy and a control group. Both groups followed a four-week orthopedic rehabilitation program, except that in addition to standard treatments (kinesitherapy, ergotherapy, physiotherapy treatments), the experimental group benefited from a therapeutic cycle conducted with the VR TierOne medical device. VR TierOne therapy uses an immersive virtual environment for reducing symptoms of depression, anxiety and stress. Its effectiveness has been confirmed in earlier studies in the areas of cardiac, pulmonary, neurological, geriatric, and oncological rehabilitation. Positive results have given rise to further investigation of the applicability of virtual therapy to new patient groups.

VR TierOne therapy serves the psyche of rehabilitated patients, which translates into obtaining better rehabilitation results.

In the study conducted in the field of orthopedic rehabilitation, both psychological and functional outcomes were evaluated.

To assess the effect of the intervention in the subjects, levels were measured:

  • Anxiety and depression using the fourteen-item Hospital Anxiety and Depression Scale (HADS-14),
  • Stress using the Perceived Stress Scale (PSS-10).

Secondary measures of measurement included:

  • Strength of self-efficacy (Generalized Self-Efficacy Scale – GSES),
  • Degree of functional independence (Barthel Scale – BI),
  • Degree of mobility (Rivermead Mobility Index – RMI),
  • Assessment of balance and risk of falls (Tinetti Scale),
  • Assessment of physical fitness (SPPB Test),
  • Perception of stress (PSQ-27 Questionnaire),
  • Subjective assessment of pain (VAS Scale).

The study showed that the group receiving VR TierOne therapy benefited significantly on psychological and functional dimensions. It is noteworthy that people in orthopedic rehabilitation undergoing VR TierOne therapy experienced a significant decrease in their pain levels. This is important because pain, like depression, anxiety and stress, affects the effectiveness of rehabilitation programs. The improvements in orthopedic patients’ mental status achieved with VR TierOne therapy, as well as the noticeably better functional outcomes compared to the control group, encourage the integration of virtual intervention into a conventional rehabilitation program after endoprosthetic surgery. With the VR TierOne device, patient support is effective and possible, even with a limited staff of mental health clinicians in rehabilitation facilities and departments.

VR TierOne therapy device for depression, stress and anxiety patients in rehabilitation.

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