Virtual reality-based pre-discharge home assessment (ReTHo) to improve participation-focused patient transition from rehabilitation to home: development and feasibility testing.

Virtual reality-based pre-discharge home assessment (ReTHo) to improve participation-focused patient transition from rehabilitation to home: development and feasibility testing. | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Virtual reality-based pre-discharge home assessment (ReTHo) to improve participation-focused patient transition from rehabilitation to home: development and feasibility testing. Uta Kirchner-Heklau, Susanne Saal This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3787670/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Pre-discharge home assessments (PDHA) aim to identify environmental barriers to patients’ activities, to recommend and provide aids and home modifications and to assess activity performance within “real life conditions”. PDHA are time consuming. Virtual approaches might overcome these obstacles. Aim This study aimed to develop a technical system (ReTho) supporting ward-based PDHA within the virtual twin of the real patients´ home and to evaluate the feasibility of the Virtual Reality (VR)-PDHA within clinical processes. Methods ReTho was developed within 11 months involving users (workshops, pre-pilot testing, usability testing groups, interviews) to achieve usability and fit of the intervention to the context. ReTho comprised a smartphone-home scan, a data backend with interface to organize data and applications to measure the home as a 3D model on desktop and immersively in VR. Feasibility and acceptance of the intervention and feasibility of study processes were testet as single-arm study in an inpatient rehabilitation clinic. Results Twelve patients (neurological diagnoses n=11, geriatric diagnosis n=1) received the intervention. The scan took between 40 and 90 minutes per patient. Per PDHA, on average 7.76 (SD 1.97) rooms were assessed. Therapy sessions took 43.67 (SD 10.52, range from 25 to 65) minutes in total. On average 12.42 (SD 5.02) recommendations per patient were given, and on average 36% (SD 21%) of them were ongoing two weeks after discharge. Data collection procedures were feasible with minor implications for improvement. Therapists rated satisfaction in usability and usefulness of the tool overall as very good. ReTho had the potential to enable tailored recommendations and advice on home modifications/aids, to increase patients’ acceptance of recommendations and to improve activity goals. Information flow and communication within the discharge preparation process was not enhanced due to misssing interfaces between the system and the clinic IT. Performance and satisfaction with activities increased slightly after discharge (4.41 to 5.3 and 4.53 to 4.90). The fear of falling remained consistent. Conclusions: The study demonstrates the clinical feasibility of ReTho. The system goes beyond functions of other previously known applications for PDHA. Further intervention development concerns the connection of process stakeholders in the rehabilitation context inside and outside the ward setting. Trial Registration: Study registration of the pilot study occurred prior to inclusion of the first study participant as DRKS00025836 in a publicly accessible study registry (German Clinical Trials Register). Pre-discharge home visit home assessment rehabilitation participation virtual reality 3D imaging digital healthcare Key messages regarding feasibility 1) What uncertainties existed regarding feasibility? It was uncertain how an immersive VR-based pre-discharge home assessment should be designed to meet the needs of HCP and patients when preparing discharge from inpatient rehabilitation. It was also unclear; to what extent the developed intervention would fit the requirements of the discharge process as well as the expectations of clinicians and patients. 2) What are the key feasibility findings? The desktop application and virtual home visits were in general feasible and accepted in the discharge preparation process by HCP and patients. Barriers to acceptance were identified among some patients regarding consenting to the scan. Detailed true-to-scale information about the home environment supported tailored recommendations from therapists as well as participation-oriented inpatient training. 3) What are the implications of the feasibility findings for the design of the main study? The recruitment process of geriatric inpatients needs to be optimized, taking into account the identified barriers to consent. In a next step, the feasibility of the 3D home scan conducted by relatives or carers has to be evaluated. Data Deposition Data available on request from the authors. Background The key goal of rehabilitation interventions is “to optimize functioning and reduce disability in individuals with health conditions in interaction with their environment” in order to enable participation in meaningful life roles (World Health Organization, 2023). Especially for older patients, living independently at home is one of the leading policies for the use of rehabilitation resources (Becker & Achterberg, 2022). Pre-discharge home assessments (PDHA) are home visits, conducted while patients are in inpatient rehabilitation in order to support discharge planning and therapy. PDHAs are used to assess the safety of the home environment, to identify possible environmental barriers to patients’ independence in activities of daily living, to prevent falls and injuries, to take room and furniture measurements in order to recommend and provide aids and home modifications. Another purpose of PDHAs is to assess the patient's current functional abilities within “real life conditions” and identify relevant activities regarding participation in the home environment. PDHAs are typically conducted by occupational therapists (OTs) alone, or with additional healthcare professionals (HCPs) (physical therapists (PTs), nurses, social workers) (Kirchner-Heklau et al., 2021). A “real-life” home visit with therapists and patients provides the opportunity for therapists to see the patient in his or her own environment, to identify and discuss individual fall hazards and for patients to target their rehabilitation (Godfrey et al., 2019). On this occasion, carers can be included in decision-making processes (Atwal et al., 2008), since a lack of patient and carer inclusion in the decision-making process is identified as a barrier to acceptance and implementation of home modifications (Harper et al., 2022). 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According to Lanfranchi et al., a total of approximately four hours were required to conduct a home visit (Lanfranchi et al., 2022). There are many factors that hamper the provision of a PDHA, even it is seen as necessary for patients: the availability of staff, cars and time, patients living outside the hospital catchment zone (Godfrey et al., 2019; Whitehead et al., 2014) , conflicts with family and potential for aggression and a potentially hazardous home environment that can impede the execution of home visits (Davis & Mc Clure, 2019). Virtual approaches can be conducted ward based and might partially overcome these obstacles. General technological progress has made it possible to introduce new ways of doing virtual PDHAs over the past few years. Several authors have developed and published methods as an alternative to real life PDHAs (e.g. (Atwal et al., 2014; Money et al., 2015; Threapleton et al., 2017). A recently published literature review outlines different approaches to using virtual components to perform home assessments (Hwang & Shim, 2021). Tools for the use of virtual reality in home assessments and assistive device planning have three different orientations: They serve 1) as an educational tool for trainees and/or patients, 2) for measuring room and furniture dimensions, or 3) to support communication between professionals and patients (Hwang & Shim, 2021). In the authors´ opinion, pre-discharge home assessments should, at best, achieve all of these orientations at the same time. Furthermore, PDHAs should enable therapists to give the patient individualized rather than general education, further enabling tailored advice and recommendations for aids and home modifications. Therefore, a virtual mode for PDHA must provide information about the home in as much detail as possible and support sharing information and data with other stakeholders in the discharge processes. In recent years, several publications have appeared on the use of virtual reality (VR) tools to support pre-discharge home visits. The characteristics of VR vary and can generally be classified as non-immersive and immersive. Non-immersive VR environments enable the user to interact with the VR environment normally via 2D interaction devices with sets of screens to watch, and keyboards, computer mice or joysticks without fully immersing into the environment (Galimberti et al.). Immersive VR systems enable users to immerse fully into the environment. The immersion is created by being surrounded by a 3D computer-generated system that represents the reality and delivers real-time changes in sensory information for the user according to the movement of the user’s head and body, as they would if he/she were in an equivalent physical environment (Fusco & Tieri, 2022; Sanchez-Vives & Slater, 2005). In some published tools, the non-immersive representation of three-dimensional ("virtual") living spaces is done only as a preconfigured default environment (e.g., (Money et al. 2015; Atwal et al. 2014; Hamm et al. 2017). This does not enable individualized education, recommendations and planning. Other tools are based on interior design apps to create floor plans (e. g. (Money et al., 2015; Palmon et al., 2004; Tsai et al., 2019). Using these tools, the therapists must first obtain specific detailed information, such as room sizes, door widths, and the presence and dimensions of furniture, so that they can then recreate the rooms with the help of the tool. Tools considering the real, individual living space were published by two research groups for on-site home adaptations using augmented reality (an object is inserted on the screen of a tablet into the real living environment on-site during a home visit) (Aoyama and Aflatoony 2020; Chandrasekera et al. 2017). However, this does not support the user scenario in inpatient rehabilitation facilities to avoid physical home visits. A simple idea is the use (digital) photographs to see the actual home surroundings (Daniel et al., 2013; Sim et al., 2015). However, unfortunately digital photos do not include the required measurements. 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Both photographs and video tools might lack reliable measurements (e.g., room sizes or furniture) for the therapist who wants to evaluate the home situation (Jones et al., 2022; Lanfranchi et al., 2022). In the case of videoconference-based home visits, there must of course be somebody in the home in order to carry out the visit (relatives are assumed here, e.g. (Latulippe et al., 2019)). Therefore, a 3D scan and representation of the real home might be a promising idea for therapists to evaluate the home situation in detail while the patient is staying in the clinic. One other research group to date has implemented the representation of the real home environment using home scans in the home assessment process: Guay et al. developed an app that scans the home and allows navigation of the 3D model of a home on the browser screen and provides measurement tools (Guay et al. 2021). The authors suggest that the use of the 3D model not only on screen, but also as an immersive “home visit”, using VR goggles could lead to an efficient way to perform PDHAs. An advantage of virtual reality, which is experienced with the help of VR goggles, is the immersive grasp of the environment. As in the real environment, users immediately obtain an impression of the proportions and spatial structure without necessarily having to take measurements. Furthermore, room dimensions and furniture sizes can be measured spontaneously if they emerge as important during the PDHA while discussing the home with other participants. The majority of publications on the topic of technology used in home assessments explore the general potential of an application or general technical usability and were tested without any actual application setting. Feasibility testing within a clinical context has been rather seldom. Therefore, we aimed to develop a technical system for scanning the real home of patients, for data processing, planning and conducting a home visit within the virtual twin of the home using a 3D model and VR goggles and to test the system for feasibility within the clinical discharge process. Aim The key aim was to develop and test a VR-based home assessment system that enables therapists to get detailed information about the home environment of the patients while they are staying in an inpatient rehabilitation clinic. Phase 1: Intervention development The design phase involved three stages, resulting in development and improvement of the system. The stages were as follows: To explore functional requirements based on the needs and perceptions of the rehabilitation team involved in discharge preparation. To develop and pretest a technical system allowing an immersive VR PDHA within the virtual home twins of the patients’ homes. To embed the system in a discharge preparation process. Phase 2: Feasibility testing The aim of the pilot study was to evaluate the feasibility of delivering the VR PDHA with ReTHo within clinical processes in a neurologic and a geriatric department of an inpatient rehabilitation clinic and to evaluate the acceptance of HCPs and patients in order to derive implications for further improvements and to inform a larger scale study. The specific aims of this phase were as follows: To explore in which manner HCP deliver the VR PDHA with ReTHo (e.g., in terms of frequency, duration, attendees) and the impact of the intervention on process outcomes (e.g., recommendations for home modifications and therapy). To explore the acceptance of the intervention by providers (HCP) and recipients (patients). To pilot study processes and materials (e.g., outcome measures) and to evaluate how the intervention suits the context. Methods This section first describes the intervention, and how it was designed and modified. In the second section, the feasibility study methodology is described. The overall approach followed the UK Medical Research Council (MRC) framework (Skivington et al., 2021) and integrated existing evidence and the expertise of healthcare professionals. Alongside the UK MRC framework, newly developed interventions were to be assessed for feasibility including the intervention and evaluation design (Skivington et al., 2021). Phase 1 Intervention development The design phase included the development of the technical system and the embedment into an overall study intervention. The technical development was guided by the user-centered, co-creative approach (Farao et al., 2020). This concept actively includes users in the development of an e-health intervention to prioritize their needs and finally obtain a tool adapted to the requirements of end users. The concept is divided into three overlapping and iteratively interconnected development stages. First, technical user requirements and relevant environmental factors of the application are revealed (relevance cycle). This leads to the creation of a technical prototype, which is evaluated by user involvement (design cycle). After reaching a certain level of readiness for use in the application context, it is deployed by the users with the aim of making further relevant adjustments from this application scenario (precision cycle). Our iterative intervention design process comprised the following steps (and methods): Identify utility needs on the VR -based home assessment (expert workshop with professionals involved in discharge planning processes). Identify usability problems of the technical prototype of a VR-based home assessment tool to increase user-friendliness (pre-pilot testing). Identify usability preferences of therapists to increase user-friendliness of ReTHo and VR-home representation (usability testing groups with OTs and PTs). Embedding the VR-based home assessment system into clinical processes (expert interviews with key persons involved in discharge planning processes and document analysis of clinical SOPs for patient flow in rehabilitation and professional assessment and discharge planning) The development steps are presented in Figure 1: Steps and methods of intervention development. Data analysis: Qualitative data from expert workshops, pretesting, literature and usability testing groups were analyzed regarding aspects of functionality and usability according to the definitions of the concept of the “perceived usefulness” and “perceived ease of use” of the “Technology acceptance model” (Venkatesh & Hillol, 2008). The analysis approach taken to the dataset was both inductive and deductive. The high-level themes were set a priori by the targets of the analysis: useful functionality and ease of use in the user context. These yielded a deductive frame for analysis. Subthemes were closely linked to the data (incorporating the views on iterative versions of the technical prototype) and were analyzed in an inductive manner. Datasets were produced and analyzed subsequently with each iteration step of the development phase. Furthermore, the qualitative data from expert interviews and data analysis of discharge processes within the study setting were analyzed with the same technique, guided by the categories of the updated Consolidated Framework for Implementation Research (Damschroder et al., 2022) to identify context factors. The characteristics of all the HCPs involved in the development steps are shown in detail in Additional File 1. Expert workshop The initial prototype concept (mock-up) comprised the following technical components: produce a 3D home scan (within the home environment), process data and organize data in backend (browser-based), and represent and use data (within the clinical setting). First, a scientist (OT) and an IT-developer, who was also responsible for the subsequent realization of the user requirements for the design, led an online expert workshop. The topics of the workshop were: type and quality of home information needed for the respective duties in the discharge process, discussion of technical tools currently known from the literature to support the performance of pre-discharge home visits, presentation and discussion of the initial concept of the prototype (mock-up stage) together with the exploration of specific technical requirements for the latter, and the prioritization of demands. The workshop was audio-recorded and transcribed verbatim. As the use of VR is not very common yet and none of the workshop participants had ever tried VR goggles, we sent VR goggles to three HCPs and asked them to try several applications to become accustomed to using them. In each online session with the IT-developer and one researcher, we discussed views on usability and ideas for functionality regarding the planned home assessment tool. The initial and overarching user demands on functionality to perform a VR PDHA while the patient stays in the clinic were: To gain a general impression of the home environment. To measure the home and objects within it. To take notes within the system. All generated data (surveys and notes) should be exportable for further use. In the next stage, the IT-expert developed a prototype to conduct virtual home visits at the patient`s real home by using the virtual twin of this home. The prototype system comprised the production of a 3D model of the home, the data processing of this model and the representation of the model in VR and 3D on the screen as well as a user desktop application with an interface to operate the data from each dataset. Software (ReTHo) was developed to access, navigate and measure the virtual twin of the home on screen interface and in VR using VR goggles. Furthermore, we implemented features to note measurements by default and any other information as free access options into each “customer” account on the therapist´s user interface. During the development phase from November 2020 to September 2021, a new smartphone model (I-Phone 12pro) with LIDAR technology and various, partly freely available LIDAR apps (e.g. Toolbox AI) for scanning the rooms could be integrated into our technical system and ReTHo was interconnected with a Data Management System to process and organize 3D scans of patients´ homes in a data-backend. Pretesting Once the initial system was conceptualized and the initial software was set up, one research team member pretested each form of technology in the system and gave feedback to the IT-developer about the perspectives for usability and usefulness of the technologies: 1) conducting the scan, 2) operating the data management system 3) operating ReTHo and 4) operating and using representations via VR goggles and on the 3D desktop application. During this pretesting phase, different options of scan-apps, designs of the user interface and functions for measuring and moving in VR and 3D models were tested. Additionally, from the researcher´s view, evidence from studies about usability aspects in virtual pre-discharge home assessment tools was included in the feedback. The main usability problems were the calibration of the immersive VR environment (leading to motion sickness) and the different performance qualities in mobile LIDAR-apps for scanning different textures and surfaces (e.g. reflecting surfaces like tiles in bathrooms and kitchens could not be scanned in good quality and these rooms are important for participation at home). Usability testing groups The goal was to identify any problems in functionality and usability regarding operating data representation, measurement functions and the use of ReTHo. Therefore, we conducted six user-testing groups. Field notes were taken during usability tests. The IT-developer iteratively solved problems and implemented users´ preferences. Expert interviews To achieve the best possible fit of the study intervention to the specific implementation context, the study intervention was adapted to the ward setting. Interviews with two leading therapists and one social worker from an inpatient rehabilitation clinic were conducted by telephone. Strategies to implement the intervention in clinical processes were discussed. These interviews were underlined by SOP documents reflecting clinical discharge preparation processes. Results of intervention development A total of 45 individual user demands for necessary functions or aspects of user friendliness were derived from pretesting, from the expert workshop and usability testing groups. The main themes in user demands are displayed in an additional file (Additional File 2). All technologies in the system, IT-infrastructures and implemented functions are shown in Table 1 Technical infrastructure and functions of the VR-based PDHA-tool. Figure 2 illustrates the concept and user scenario of the tool. Table 1 Technical infrastructure and functions of the system System technology Hardware/software/IT-infrastructure Functions Produce a 3D home scan - Smartphone with LIDAR-technology - Smartphone application to produce 3D scans - Scan room by room - Export anonymous 3D data to cloud Backend to process and organize data (technical writer role) - Ability to transmit data digitally to a content management system - Ability to store data (on a server from the Martin-Luther-University) - Ability to perform technical writing (secured with password) - Own data model to present data of each patient and to collect newly generated data while using the end-use application - Interface to retrieve data from server and collect newly generated data from end-use application - Log in with password for technical writer role -Creating a new patient folder with folder ID-number -Apply individual number of spaces for room data to the folder -Import scan data from cloud to backend -Assign scan data of rooms to each space and name the room ReTHo desktop application - External WLAN router (insufficient internet resources in clinic) - Laptop, mouse - User interface for organizing data, operable on the screen - Downloading data at clinic - Selecting subject account with respective list of scanned rooms - Automatic appearance of measurement data, listed in the currently named room-based organizational interface - Manual labelling and commenting of the list’s measurement data - Select relevant hazards from a clinic-based pre-configured checklist and add to the room-based data list. ReTHo application to represent 3D models on a screen or in VR - Additional large screen - Show rooms as 3D model and as floor plan on a screen - Navigate through the rooms on the screen by moving the 3D model on the screen in three dimensions - Measure with virtual folding rule in 3D model and floor plan - VR goggles with external sensors - Use of controllers - Immersive VR- representation of rooms - Navigate through the rooms in VR (physically move on the playing ground or "beam" in the VR room with controllers) - Measure with two different measuring tools: distance meter ("laser meter") and virtual folding rule Implementation strategies of the study intervention Clinical outcome measures and routine data collection were checked for suitability for study data collection and integrated, if possible, to keep the burden for study therapists low. There were two therapists formally appointed as study therapists responsible for data collection on site. There were no formally appointed “intervention therapists”. Prior to the start of the study, one researcher informed all the therapeutic staff about the intervention and trained them in its implementation (n=29). Implementation strategies that had been applied before and during the pilot study were evaluated (an overview of the strategies is displayed in Additional File 3). Intervention procedure The home scan was performed in the patients´ homes by the first author or carers/family in the presence of the author. After completing the scan, the data were uploaded into the backend. The therapists downloaded 3D data and performed a virtual pre-discharge home visit during the rehabilitation period with patients and other participants or alone. The therapists could perform the home assessment once or repeat it, if necessary. During the virtual home visit, the therapists took individual, relevant home measurements. Notes could be entered as free text on the user interface. Every data input item (measure or hazard or individual miscellaneous note) was required to be commented with a corresponding recommendation (e.g., for home modifications /aid installation or elimination of hazard or activity adaptation). Data could be exported as Excel spreadsheets with room-based lists of measurements and/or detected home hazards and/ or individual miscellaneous notes with corresponding recommendations. The intervention is described in detail according to the TIDieR checklist (T. C. Hoffmann et al., 2014) and presented in the Additional File 4. To focus process evaluation, a process-oriented logic intervention model was developed in accordance with the guideline by Rohwer et al. (Rohwer et al., 2016). The logic model of the intervention (figure 3) displays the a priori mechanisms of intervention activities that influence the intervention outcomes. Phase 2 Feasibility testing Design The study was designed as an exploratory single-arm feasibility study to evaluate the acceptance and suitability of the underlying logic intervention model as well as the implementation of the intervention. Furthermore, we wanted to test the feasibility of the study procedures (including outcome measures, data collection procedures and recruitment process) to prepare a larger-scale study and to improve the intervention design. The evaluation of the study processes was based on the MRC framework as an overarching research approach (Moore et al., 2015; Skivington et al., 2021). Since intervention stakeholders were therapists and patients, this process evaluation focused on the experiences and perspectives of both. Barriers and facilitators regarding delivering and receiving the intervention were analyzed following the Consolidated Framework for advancing Implementation Research (CFIR) (Damschroder et al., 2022). Participants and Setting Recruitment and implementation of the intervention took place in an inpatient rehabilitation clinic in a rural area in Germany with a large catchment area of up to 400 km. Recruitment was carried out at MEDIAN Saale Klinik Bad Kösen II, in the Departments of Neurology and Geriatrics, each of which was managed and staffed independently. Eligibility Criteria Patients were included in the trial according to the following criteria: (i) age at least 18 years, (ii) neurological diagnosis or geriatric syndrome (defined as “multimorbidity with impending risk of loss of autonomy in activities of daily living”), (iii) anticipated persistent functional limitation(s) associated with increased risk of falls in the home environment and/or need for environmental adaptations, and (iv) discharge destination home or uncertain. Patients were excluded according to the following criteria: (i) not able to understand the goal of the intervention (e.g., due to severe aphasia or severe cognitive impairment), (ii) not able to give consent and their legal care was not taken over by relatives, (iii) lethal course of disease, (iv) living outside a catchment area of 100 km distance from the rehabilitation facility, (v) patient or relatives did not consent. To increase the number of eligible patients four weeks after the start of recruitment, the eligibility criteria were adapted to (iv) living outside the defined catchment area of 150 km distance from the rehabilitation facility. Furthermore, “geriatric diagnoses or stroke only” was changed to “geriatric diagnoses or any neurological diagnoses”. Identification and recruitment After admission, all patients were screened for eligibility by the study therapists. After the eligible participants had been provided with comprehensive information by the study therapists, they could consent to participate. If other persons lived in the same home with the patient, a consent from this person was necessary for the study intervention and had to be obtained. The recruitment of patients and their relatives who were willing to participate in a problem-centered interview for process evaluation took place at the time when the research team conducted the standardized telephone follow-up, two weeks after discharge (T3). For process evaluation, HCPs were interviewed who either had implemented the intervention or were present during the intervention. Furthermore, HCPs were interviewed who potentially could have used the intervention or could have been affected by the output of the intervention. All the recruited patients were invited to participate in an interview for process evaluation. Data collection procedures An overview of the research questions, data collection instruments and the analysis plan is displayed in Additional File 5. Pre-screening list To specify future inclusion criteria for an RCT, study therapists in each department recorded reasons for exclusion, using a standardized pre-screening list for every patient after admission. Participant description To describe the participants, baseline data collection from routine documentation was recorded, including: sociodemographic data, comorbidities, functional status (ability to walk; Functional Ambulation Categories (FAC) (Martin & Cameron, 1996; Mehrholz et al., 2007; Park & An, 2016) fall events, paralysis; Motricity Index (Collin & Wade, 1990), ADL status; Barthel Index (BI) (Collin et al., 1988) ) and patient assistive devices. Process outcomes The number of recommendations and identified issues/hazards was collected, as well as the rates of installed aids/adaptations and elimination of issues/hazards after discharge. Feasibility and acceptance Fidelity and dosage in delivering the intervention were collected using standardized process data on the use of technology during the virtual assessment as well as during interviews. Therapists rated satisfaction in usability and usefulness of the tool by answering four questions at the time point of performing the VR assessment (NRS 0-10). Satisfaction with the tool was explored regarding feeling supported by technology when discussing home issues with the patient and pursuing therapeutic goals. Furthermore, the perceived overall effort in using the tool as well as the level of enjoyment when using the technology was rated. Problem-centered semi-structured interviews were used to obtain the participants' experiences of the intervention as well as factors affecting the delivery/reception of the intervention as well as the process and patient outcomes. Interview guidelines were agreed on by the research team prior to use. Interviews with HCPs were conducted face to face and interviews with patients via telephone, one time each, and were carried out exclusively by one researcher (UKH) who was trained and involved in the project. Further information about the researcher´s personal characteristics according to CORREQ (Tong et al., 2007) is provided in the Additional File 6. The duration of each interview should not exceed 30 minutes taking the time constraints of the participants into consideration. Interviews were audio-recorded and transcribed verbatim. (Guidelines can be requested from the authors.) Patient outcome measures In preparation for a subsequent effectiveness study, survey procedures and instruments were already tested to measure the effectiveness of the intervention. To assess performance and satisfaction with performance in client-identified daily activities in the individual home environment, we used the Canadian Occupational Performance Measure (COPM) (Law et al., 1990). Furthermore, the number of falls and fear of falling were measured. Quantitative data were collected after admission (t0), at the time of intervention (t1), at discharge (t2) and two weeks after discharge (t3), by telephone or with self-administered questionnaires, respectively. Sample size As this was a feasibility study, there was no formal sample size calculation. The target number of participants was based on clinical estimates of the likely number of patients who fit the inclusion criteria and could be enrolled during the enrollment period. The feasibility study was planned with a sample of 30 participants (15 each in the Department of Geriatrics and Department of Neurology). Data analysis As part of the feasibility study, quantitative data were analyzed and presented descriptively. Continuous characteristics are presented as the mean and standard deviation, and categorical variables are presented as absolute and percentage frequencies. Qualitative data from the problem-centered interviews and group discussions were analyzed using a mixed deductive-inductive approach based on the structured approach of directed content analysis (Malterud, 2012). For this purpose, audio interviews were pseudonymously transcribed. Transcripts were not returned to the participants before analysis. MAXQDA software and Excel were used for the analysis. The themes and categories of the coding guideline were based on the mechanisms of impact and acceptance outcomes derived from the logical model defined a priori, also allowing for emerging themes. Two members of the research team coded interviews independently in the first two stages of the analysis. Codes were condensed and synthesized by one researcher alone under the supervision of another researcher from the team. To evaluate the study processes, the implementation and fit of the intervention within the setting and to develop the intervention further, context factors were extracted and structured according to the Consolidated Framework for Implementation Research based on user feedback (Damschroder et al., 2022). Possible recommendations for future intervention designs were derived from the lessons learned here. Results Feasibility of recruitment process Reach and retention Recruitment of participants was planned from October 2020 to December 2020 and was prolonged for another two months due to a low recruitment rate. Of the 152 eligible patients 19 consented to be enrolled in the study (recruitment rate of 12.5%). One hundred and thirty-three of the eligible patients did not provide informed consent (87.5%). Of the 19 patients who consented, a total of 12 patients were enrolled in the study and received the intervention. Eleven patients had neurological diagnoses and one patient had a geriatric diagnosis. Reasons for non-enrollment in the study intervention after consenting were as follows: One inpatient no longer met the inclusion criteria due to a deterioration of his condition, and in six cases, the relatives did not consent to study participation. Figure 4 shows the consort diagram for participant flow. In the expert interviews, therapists reported that geriatric patients showed a decreased willingness to participate in the study compared to neurologic patients. Therapists assumed that - in contrast to inpatients with a stroke who experienced a sudden change in their health condition - geriatric patients adapted to the functional limitations due to the chronic course of disease. Another reason stated was that patients feared burdening their relatives too much by carrying out the room scan or by opening the door to the study team. Therapists stated that geriatric patients would often live with spouses who were also in need of care. Participant description Participant characteristics are shown in Table 2. The study participants were on average 68.83 years old, 57.1% men. Half of the participants (50%) lived at home alone. Half of the participants (50%) had a diagnosis of stroke with symptomatic hemiparesis or hemiplegia. After extending the inclusion criteria, five additional individuals with paraparesis were included (41.7%). One person was included with a geriatric diagnosis. Table 2 Participant characteristics Variables Baseline Discharge Age (SD) (range) 68.83 (10.61) (51-80) n. a. Male (%) 8 (57.1%) - Living alone 6 (50.0%) - Main diagnose - Stroke with hemiplegia/hemiparesis 6 (50.0%) Paraparesis 5 (41.7%) Geriatric syndrome 1 (8.3%) Motricity Index, mean (SD)** $ Sum score left side 75.64 (16.95) 85,45 (12.80) Sum score right side 90.40 (10.13) 95.27 (5.88) Falls pre-admission (6 months)/during rehabilitation No falls 5 (41.6%) 10 (83.3%) One fall 5 (41.6%) 1 (8.3%) Two falls 2 (16.6%) 1 (8.1%) Fear of falling (VAS 0 to 10)* (mean) 4 3.1 FAC ** § 0 2 (14.3%) 1 (8.3%) 1 1 (7.1%) 0 2 5 (35.7%) 5 (41.7%) 3 4 (28.6%) 1 (8.3%) 4 0 3 (25.0%) 5 0 2 (16.7%) Barthel-Index, mean (SD)** 56.26 (12.99) 63,33 (10.73) * lower score indicates better outcome ** higher score indicates better outcome $ performed for patients with paresis/plegia only (n=11) § FAC : 0=Not capable, needs two or more therapists, 1=Needs constantly help from one person for walking, 2=Patient needs intermittent help from one person, 3=Patient needs verbal help, 4=Patient walks independently on level ground, still little help needed, e.g. when climbing stairs or on difficult ground, 5=patient is capable of walking n. a.= not applicable Fidelity and dosage Scan In total, the intervention was conducted 12 times, once per participating patient. A study team member performed each living room scan. In three cases, relatives performed the scan in the team member´s presence. Each room was scanned within a few minutes (3 minutes to 10 minutes). An average of 8.67 rooms per patient were scanned. The entire scanning process for all rooms took between 40 and 90 minutes each time. Virtual-based home assessment Each of the patients (n=12) received the intervention once. Per VR-home visit, an average of 7.76 (SD 1.97) rooms were assessed and 12.3 (SD 5.02) recommendations were entered in the application interface during the assessment. Therapy sessions took 43.67 (SD 10.52, range from 25 to 65) minutes in total. The time between the start of the therapy session and the start of using the tool for the virtual visit took on average 11.17 (SD 5.57, range from 5 to 20) minutes. However, the VR-based part of the home assessment took 23.33 minutes (SD 9.31, range 13 to 42). The intervention was delivered in different constellations of participants with PTs, OTs, patients, one relative and one rehabilitation technician (see Additional File 7 for details). In most cases the therapists used the VR headset and the 3D screen (n=9), or only the screen (n=3). The rehabilitation patients did not put the VR headset on, but used the screen to view the home (n=11). Feasibility of data collection procedures Most data collection procedures were feasible with only minor implications for improvement, such as the use of symbols instead of numbers for visual analog scales to improve the self-assessment of the participants. Instead of assessing activities of daily living (ADL) with the COPM during or after the virtual-based home assessment (as required by the intervention protocol), therapists conducted the COPM prior to the intervention. The items were used during the virtual-based home assessment session for guiding the assessment. Apart from that, the target activity items had to be formulated as precisely as possible during the virtual-based home assessment to estimate the level of target achievement at the end of the intervention period. For example, "climbing stairs in the house" should be specified in the first assessment with "climbing stairs in the house without a person to help me" or "climbing stairs in the house without any aids”. Recommendations A total of 149 recommendations were derived during the virtual assessment interventions. On average 12.42 (SD 5.02) recommendations per patient were given, and on average 36% (SD 21%) of them were ongoing two weeks after discharge. (See Additional File 8 for details.) Acceptance Characteristics of the interviewed persons A total of nine HCPs participated in the interviews at the end of the intervention period. The majority were female (n=8). There were OTs (n=5), PTs (n=3) and one rehabilitation technician who was not an employee of the rehabilitation facility but worked closely with the therapists. A total of nine patients reported on their experiences with the intervention in expert interviews. Relatives took part in the interviews in some cases (n=4). Interviewee characteristics (HCPs and patients) are shown in detail in Additional File 6. Acceptance: Therapists´ and patients´ views Therapists rated satisfaction in usability and usefulness of the tool overall as very good. Satisfaction with regard to feeling supported by technology in discussing home issues with the patient was rated on average 9.83 (SD 0.58) and in pursuing therapeutic goals with 9.67 (SD 0.78). Satisfaction with the perceived overall effort in using the tool was rated 8.25 (SD 2.34) and the level of enjoyment in using the technology was rated 9.5 (SD 0.90). According to the predefined process-oriented logic intervention model, certain process outcomes should generate acceptance and health outcomes. Corresponding comments from HCPs from interviews are presented below. 1. Tailored recommendations and advice on home modifications/aids and fall prevention. The intervention was perceived as supportive by therapists for all participating inpatients. Reliable information about the home environment helped to prepare the discharge. “Therefore, for me as a therapist, it is simply the best possible way to prepare the patient for discharge at home. [….] That’s because it (standard approach) is only about a verbal piece of information, right? And the intervention here had a solid foundation because you saw the situation at home. The right things were prescribed and given.” (Therapist) 2. Increasing patients’ acceptance of recommendations The visualization of the home supported a trustful discussion between therapists and patients in some cases. “So just having a conversation, like "Gee, but you have a nice carpet." Simply to build up a basis of trust about it. That works out great.” (Therapist) From the patients´ point of view, the virtual-based home assessment facilitates the discussion because some things are difficult to explain and sketches can be challenging as well. “And that it is easier for me to imagine my home. Because that was also difficult for the therapists to comprehend with the stairs and stuff. You cannot explain all that at all. I would have had to make sketches or something.” (Patient). Most of the patients found virtual- based home assessment to be supportive because of the recommendations and aid prescription and home modifications. Patients mentioned the measurement function and visualization as helpful here and felt better prepared when facing discharge. “After you have been discharged, you are on your own. And then it is a good feeling, looking ahead, that things can work at home where you previously thought: "No, man, that cannot work at all." Yes?” (Patient). One patient could not return to his old home, and a new home was furnished by relatives. He stated: “ I was informed beforehand about what it would look like. I was able to anticipate it and see what might need to be modified.” There were two participants who were not very satisfied with the intervention. One patient stated that she generally lacked imagination based on any abstract room representations. “We have built a lot at home, and it is always better when you can stand inside and imagine it in nature. However, I'm a person who has to see it in the real world. So my husband, who used to be a technical draftsman, made a sketch of it. Well, I could always imagine very little about that.” (Patient) Another patient experienced the virtual-based home assessment as an emotional stressful situation, being aware that returning home might not be possible: “You get too worked up again and you know you cannot handle it. Have to let it all go.” (Patient) 3. Therapists and patients find improved activity goals (tailored, participation-oriented and operationalized). The assessment supported the goal-setting process for activity training. One therapist stated “And so you could at least say, "Okay, you might have to practice with them in that direction." Yes, all of us have the goal that the patients should be able to cope independently at home again, if possible. And that's why that was important to us.” Another therapist illustrated that being able to set goals with patients related to everyday life: “We want to be able to walk from the living room to the kitchen, right? And we are now recreating that in the therapy room. Then it's no longer just: "We'll walk down the hall in the clinic," but: "We'll walk from the kitchen to the living room. And now I'm going to put something in between and you have to step over the edge." (Therapist) One therapist pointed at the creation of hope and motivation for patients : "And that gives a boost to the therapy, so that the patient once again knows what they are doing it for and what they still need to practice specifically.” Having the real furniture dimensions, the therapists started to simulate home activities in training sessions, such as getting in and out of the shower tub, lifting the leg to the necessary height or climbing narrow stairs. “We discussed it with the therapist, for the first four or five steps, I can walk up by pulling on the the handrail. And where the spiral staircase begins, I walk a bit on all fours. And then, when it's straight again, I stand back up. (...) And that's what we practiced. We simulated it, so to speak.” (Patient) 4. Better information flow and communication with stakeholders in the discharge preparation process. It was planned to use Excel spreadsheets to pass on information within the clinic digitally or in print form to support the information flow. However, this function could not be used because the tool had not been integrated into the clinic IT system. Therefore, information data from the assessments were transferred to other HCPs within the clinic manually or verbally. In one case, a rehabilitation technician (RT) attended the VR-home assessment. She appreciated that having information about dimensions enables her to order suitable technical aids immediately. Furthermore, she anticipated that it might be useful to pass on 3D photographs to health insurance providers who pay for installations. There are some adaptations to the intervention design that might improve the intervention. The RT suggested that additional visual representation of technical aids within the tool would be helpful to further increase acceptance of necessary aids: “So that they can imagine that it does not look so bad after all. Because the grab rails are now available in white, chrome and black, right?” Furthermore, an interface between tool–software infrastructures and IT devices in the facility must be provided to enable a data output within the clinic (e.g., to store or print Excel sheets or share sheets or photographs via e-mail). Furthermore, an interface between the software of the IT system and the local software could connect the electronic patient documentation. Patient outcomes Before discharge, the Canadian Occupational Performance Measure (COPM) subscale execution rated an average of 4.41 (SD 1.82) out of 10 possible points which increased slightly to 5.3 (SD 1.87) after discharge. The COPM subscale satisfaction was rated 4.53 (SD 2.24) points before discharge and 4.90 (SD 2.00) after discharge. The Barthel Index (BI) declined from baseline with an average of 56.3 (SD 12.99) points to an average of 44.92 (SD 11.74) points after discharge. The lowest Barthel Index scores were caused by a deterioration of the condition due to a COVID-19 infection and due to another stroke. Seven participants reported single or multiple falls at baseline, and three reported falls within two weeks after discharge. The extent of fear of falling perceived by participants remained consistent across all survey time points (VAS 4.00 (SD 2.7) at baseline, VAS 3.17 (SD 2.65) before discharge and VAS 3.08 (SD 3.40) after discharge in seven (58.3%) participants who had fear of falling). A detailed overview of the outcome measures is shown in Additional File 9. Discussion This paper investigated the use of a newly developed technical application to perform a home assessment using digital data to provide a three-dimensional representation of the patient's home during inpatient rehabilitation in a clinical setting. The intervention comprised a virtual remote representation of the VR twin of the patient’s real home, which could be entered immersively in virtual reality or in 3D models on a screen interface. The focus of the feasibility study was to evaluate the intervention design and study processes. In this regard, information was obtained on how the HCPs delivered the intervention, to what extent the intervention was accepted by patients and therapists and which factors might affect delivery and outcomes. The first phase of the study aimed to identify the requirements defined by HCPs regarding the necessary kind and quality of functions of the VR-based PDHA system to represent and use home data before discharge. The development was carried out with the intensive involvement of the end users (HCP) and IT-developers, resulting in iterative improvements of a screen-based interface to organize patient home assessment data and an additional representation of the patients´ home as an immersive or non-immersive environment. Therapists were satisfied with usability regarding with regard to the functions. The appearance of the interface or operation of devices to navigate or take measurements were not seen as difficult in the clinical test phase (phase 2). Being able to take measurements, to identify and discuss barriers resulted in high satisfaction from being able to tailor recommendations for home modifications and goal setting in inpatient training. With the help of the VR PDHA, training and participation targets for life at home can be realistically adapted to the functional abilities of the patient and the requirements of the home environment. This enables an individual participation-oriented goal setting for the inpatient rehabilitation period. Using the true-to-scale visualization of the home, the therapists felt that recommendations for aids and home adaptations could be made and discussed with the patients in a more precise manner. The therapists highlighted that having measurements (such as room size and height of steps) enables advice that is more reliable. Therefore, a VR solution might be superior to any other ward-based PDHA that relied only on patients’ or relatives´ information about the home, especially where measurements were concerned. Another researcher group, Guay et al., also had the idea of using room scans for therapeutic assessments. While we developed our prototype, they published the development of a mobile app to scan rooms and produce a 3D model. They also developed a special software tool to take measurements from the virtual model of rooms and tested usability (Guay et al., 2021 ). We implemented some additional technical innovations: Software to enter, navigate and measure the virtual twin of the living space not only on the screen interface but also in VR using VR goggles. Furthermore, we implemented functions to notice measurements by default and any other information as free entry option in each “customer” account on the therapist´s user interface. Our results showed that, from a therapist's point of view, being able to discuss recommendations with the patients is in line with Guay et al., who found that therapists perceived a better understanding and ability to facilitate and explain recommendations when using the visual support (Guay et al., 2021 ). Results of a previous review indicated that the use of visualization as a joint basis for discussion of home modifications might be a facilitator to include patients in the decisions about home modifications and aids (Kirchner-Heklau et al., 2021 ). Giving them a chance to give immediate feedback on proposed changes leads to shared decision-making and thus appropriate visualization should be provided (Kirchner-Heklau et al., 2021 ). Results showed that the joint assessment with patients and therapists supported the mutual discussion of recommendations. Two patients, who were recommended not to return home, reported a negative emotional reaction. It is known from literature on traditional PDHA that these might provoke anxiety, if patients viewed the assessment as a test that they might fail (Atwal et al., 2008 ; Atwal et al., 2012 ). This strain might not be preventable by any kind of ward-based PDHA. A patient, being confronted with handicaps that restrict independent living in the familiar home - whether in VR or in reality - always requires the communicative support of the therapist carrying out the PDHA. Implementing the performance of the home scan in clinical processes might be a challenge in the future use of scenarios. Our findings confirmed Guay et al.´s concerns regarding conducting the scan in the clinical setting, especially in the geriatric setting. Indeed, relatives of geriatric patients in particular rejected being involved in providing a home scan. Conducting the scan by a staff member needed a physical home visit and its related resources. This, of course, does not meet the virtual home assessment goal of saving resources by avoiding physical home visits. This study focused on the feasibility testing of ward-based data use. However, in a next step, performing the scan efficiently should be tested. In the future intervention design, people who are available at home (e.g., relatives) could therefore perform the home scan. There is some evidence of good feasibility in using smartphone technology for taking and submitting photos for the therapeutic assessment for those in community dwelling (Leung & Brandis, 2023 ). However, only adults under 75 years of age in the community were recruited for this purpose. We agree with Guay et al.´s considerations that relatives, a government employee, or a healthcare professional could perform the scan. In the process of preparing the home before transition, not only generating the home scan might involve helpers and structures such as outpatient care services: With regard to the realization of the recommendations for home adaptations, inpatients living alone need help at home while they are still in the rehabilitation facilities. In this study, patients and relatives were not involved in the development, as we focused on the ward-based therapeutical use of ReTHo and they were therefore not identified as the main user group, but rather as stakeholders attending the assessment and providing the home data to be assessed. In the future development of the intervention design, relevant stakeholders to perform the scan should be involved. These people will primarily be relatives and carers. However, outpatient RTs and care services as well as OTs and PTs are also involved in providing care at home. This care is already initiated as part of the inpatient discharge preparation. In the future, possible temporal and organizational interfaces between the processes in the clinic and the aforementioned outpatient stakeholders should be identified when developing intervention processes. The duration of the intervention (excluding the scan) did not exceed the duration of a regular therapy session and is likely to be well below the effort and duration of a physical home assessment visit, which could take up to 4 hours in total (Lanfranchi et al., 2022 ). The virtual assessment could be delivered in clinical processes without straining therapists. A good fit between clinical routine and study intervention processes was integrated into the intervention design. The therapists could always access the scan in time to carry out the virtual PDHA during the rehabilitation interval, which often lasts just three weeks. ReTHo was equipped with one potential interface for data transfer by providing the opportunity to export data in Excel sheets and transfer them by mail or cloud or via a USB-slot as a data storage medium. However, these did not fit the clinical IT structures and processes. For future use, the fit between IT-Systems should be provided and tested. Strengths and limitations In our study, some therapists who were involved in the development of the intervention were also interview partners for the evaluation of the acceptance. The strict separation of participants for development and evaluation could possibly facilitate the objectivity of the evaluation. The instruments for measuring outcomes themselves were feasible. In our study, validated outcome measures were mainly used, and the participants were defined and represented the intended user group of the innovative tool within the intervention. Therefore, our study demonstrates a certain methodological strength compared to other studies investigating information and communication technology in the context of occupational home assessments as described in Ninnis et al., 2019 . Overall, fewer patients than anticipated were recruited. However, the follow-up interview was possible for many of them, so that the patient's perspective on the intervention was well represented. Patients with severe aphasia and severe cognitive impairment were excluded from the intervention. It is not precluded that these patients may benefit from the intervention and this should be investigated in the future. One inclusion criterion was “anticipated persistent functional limitation(s) associated with increased risk of falls in the home environment and/or need for environmental adaptations”. However, it cannot be precluded that less severely impaired persons could also benefit from more participation-oriented therapy planning and education on fall prevention in terms of satisfaction with the therapy. We used customized questions to evaluate satisfaction. There are validated measures for this purpose, which should be used, especially in studies with many participants. Potential for development and next steps HCPs expressed that the implementation of visual representations of aids would be helpful. This was one of several user demands from the expert workshop, which was not realized or implemented in the tool. There are recent publications on aid representations using augmented reality applications (Aoyama & Aflatoony, 2021 ). These findings inspire us to implement aid avatars in VR in the future. For this purpose, functions could be built into the application that supports the selection of aids. In this regard, there are already ideas for further developments. For example, in 2014 Atwal et al. evaluated a 3D application in terms of usability that included a furniture catalog with an occupational therapy object library (Atwal et al., 2014 ). Since the virtual PDHA is ward-based, it should also be possible to invite experts in the field of assistive technology (such as RTs who are responsible for equipping patients with home modification and aids in the German healthcare system) synchronously to consult about and order aids and home modifications immediately. For our study intervention, we found the exchange of information between one local rehabilitation technician and therapists during the home assessment to be a facilitator (which might be common in clinical settings). It would seem to be a good idea to include the actual providers of aids and home modifications in future technical applications for PDHA. Once it is clear that aids and modifications are needed, this could be discussed with all the stakeholders, and the rehabilitation technician could take steps to proceed. Even relevant stakeholders from the broader context of home modification remodeling, such as architects or builders, could be included early and start work. Moreover, it is important to involve relatives and patients in the process of providing aids and home modifications to meet the capabilities, needs and wishes (Harper et al., 2022 ; Lo Bianco et al., 2020 ). Despite the positive effects of the VR-based home visit on tailored advice, training and patient acceptance of recommendations, there were ongoing issues e.g. in aids provision after discharge. A tool incorporating the above-suggested elements of connecting stakeholders and focusing on aids provision could improve such outcomes. In the future, a large-scale study should investigate how the VR-PDHA affects the frequency with which PDHAs are performed in rehabilitation facilities and the amount of resources required (e.g. time, costs). Conclusions The present study demonstrates the clinical feasibility of the ReTHo desktop application to perform VR PDHA. The system used goes beyond previously known functions of other applications for the purpose of home assessment. It interconnects the scan of the real patient’s home via mobile phone, data processing and structuring in the backend, manual data enrichment and structuring via the user interface, and measurement of rooms and objects in the 3D model of the virtual twin of the patient's home on screen or in VR with VR goggles. Administering the intervention was easy to integrate into daily clinical practice. Thus, the application helped therapists and patients by counseling on meaningful participation-oriented training goals as well as counseling on aids that fit into the home and necessary home modifications. To promote not only counseling but also the actual provision of aids and modifications to patients, other relevant stakeholders (primarily RTs and relatives) should be involved in the intervention design and processes. Abbreviations COPM: Canadian Occupational Performance Measure; HCP: healthcare professionals, OT: occupational therapist, PT: physical therapist, RT: rehabilitation technician, VR: virtual reality Declarations Ethics approval and consent to participate The study was planned, conducted and evaluated in accordance with the Good Clinical Practice Guidelines and the ethical principles of the Declaration of Helsinki ( WMA Declaration of Helsinki – Ethical Principles for Medical Research Involving Human Subjects – WMA – the World Medical Association) . A study registration took place in a publicly accessible study register (DRKS) under the number DRKS00025836 before inclusion of the first study participant, and a vote of the ethics committee of Martin Luther University Halle-Wittenberg was obtained before the start of the study (processing number (2021-130 from August 8 th 2021). Consent for publication All participants provided written consent for the publication of their anonymous data. Availability of data and materials The datasets generated and/or analyzed during the current study are available by contacting the corresponding author. Competing interests The authors declare that they have no competing interests. Funding Research reported in this publication was funded by the German Federal Ministry of Education and Research (BMBF), Funding code: 03WIR3103A. The funding body had no impact on the design of the study, collection, analysis and interpretation of data, or writing of the manuscript. Authors' contributions SS wrote the study protocol and supervised the intervention development and writing of this manuscript. UKH developed the logical intervention model, collected and analyzed the data used for intervention development and pilot study evaluation. The manuscript was prepared by UKH. All the authors have read and approved the final manuscript. Acknowledgments We acknowledge the therapists of the Median Saale Rehabilitation Clinic Bad Kösen II for the recruitment of the patients and the performance of the intervention. Furthermore, we would like to thank the IT-developer codemacher for their cooperative work. Furthermore, we thank the head of the institute Gabriele Meyer for her general support. Authors' information SS has a professorship as a physical therapist, and UKH is an occupational therapist and doctoral candidate. References Aoyama, H., & Aflatoony, L. (2021). Occupational Therapy Meets Design: An Augmented Reality Tool for Assistive Home Modifications. 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British Journal of Occupational Therapy , 77 (8), 384–391. https://doi.org/10.4276/030802214X14071472109752 WMA Declaration of Helsinki – Ethical Principles for Medical Research Involving Human Subjects – WMA – The World Medical Associatio n . https://www.wma.net/policies-post/wma-declaration-of-helsinki-ethical-principles-for-medical-research-involving-human-subjects/ World Health Organization. (2023). Rehabilitation . https://www.who.int/news-room/fact-sheets/detail/rehabilitation Supplementary Files ReportingChecklistReTHo.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3787670","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":280974906,"identity":"6845e5b6-a341-491e-be5f-692b81487de2","order_by":0,"name":"Uta Kirchner-Heklau","email":"data:image/png;base64,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","orcid":"https://orcid.org/0000-0002-4593-4128","institution":"Martin-Luther-Universität Halle-Wittenberg: Martin-Luther-Universitat Halle-Wittenberg","correspondingAuthor":true,"prefix":"","firstName":"Uta","middleName":"","lastName":"Kirchner-Heklau","suffix":""},{"id":280974907,"identity":"36ce008f-1b00-4cdd-ad7d-6266c7c74318","order_by":1,"name":"Susanne Saal","email":"","orcid":"","institution":"Universität Halle-Wittenberg: Martin-Luther-Universitat Halle-Wittenberg","correspondingAuthor":false,"prefix":"","firstName":"Susanne","middleName":"","lastName":"Saal","suffix":""}],"badges":[],"createdAt":"2023-12-21 15:20:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3787670/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3787670/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":65847015,"identity":"fd6a193f-d516-4d3d-80f8-709efdb7a223","added_by":"auto","created_at":"2024-10-03 13:24:19","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":798777,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3787670/v1/2be2d43d-18f6-40df-95c3-a1fee652ef56.pdf"},{"id":53072510,"identity":"a920f844-b70b-401a-8c91-d411cc4ef97d","added_by":"auto","created_at":"2024-03-20 08:59:29","extension":"docx","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":39249,"visible":true,"origin":"","legend":"","description":"","filename":"ReportingChecklistReTHo.docx","url":"https://assets-eu.researchsquare.com/files/rs-3787670/v1/aa2d601fde38d55d3bf1fc7d.docx"}],"financialInterests":"","formattedTitle":"\u003cp\u003eVirtual reality-based pre-discharge home assessment (ReTHo) to improve participation-focused patient transition from rehabilitation to home: development and feasibility testing.\u003c/p\u003e","fulltext":[{"header":"Key messages regarding feasibility","content":"\u003cp\u003e\u003cstrong\u003e1) What uncertainties existed regarding feasibility?\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIt was uncertain how an immersive VR-based pre-discharge home assessment should be designed to meet the needs of HCP and patients when preparing discharge from inpatient rehabilitation. It was also unclear; to what extent the developed intervention would fit the requirements of the discharge process as well as the expectations of clinicians and patients.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2) What are the key feasibility findings?\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe desktop application and virtual home visits were in general feasible and accepted in the discharge preparation process by HCP and patients. Barriers to acceptance were identified among some patients regarding consenting to the scan. Detailed true-to-scale information about the home environment supported tailored recommendations from therapists as well as participation-oriented inpatient training.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3) What are the implications of the feasibility findings for the design of the main study?\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe recruitment process of geriatric inpatients needs to be optimized, taking into account the identified barriers to consent. 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According to Lanfranchi et al., a total of approximately four hours were required to conduct a home visit (Lanfranchi et al., 2022). There are many factors that hamper the provision of a PDHA, even it is seen as necessary for patients: the availability of staff, cars and time, patients living outside the hospital catchment zone (Godfrey et al., 2019; Whitehead et al., 2014) , conflicts with family and potential for aggression and a potentially hazardous home environment that can impede the execution of home visits (Davis \u0026amp; Mc Clure, 2019).\u003c/p\u003e\n\u003cp\u003eVirtual approaches can be conducted ward based and might partially overcome these obstacles. General technological progress has made it possible to introduce new ways of doing virtual PDHAs over the past few years. Several authors have developed and published methods as an alternative to real life PDHAs (e.g. (Atwal et al., 2014; Money et al., 2015; Threapleton et al., 2017). A recently published literature review outlines different approaches to using virtual components to perform home assessments (Hwang \u0026amp; Shim, 2021).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTools for the use of virtual reality in home assessments and assistive device planning have three different orientations: They serve 1) as an educational tool for trainees and/or patients, 2) for measuring room and furniture dimensions, or 3) to support communication between professionals and patients (Hwang \u0026amp; Shim, 2021).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn the authors\u0026acute; opinion, pre-discharge home assessments should, at best, achieve all of these orientations at the same time. Furthermore, PDHAs should enable therapists to give the patient individualized rather than general education, further enabling tailored advice and recommendations for aids and home modifications. Therefore, a virtual mode for PDHA must provide information about the home in as much detail as possible and support sharing information and data with other stakeholders in the discharge processes.\u003c/p\u003e\n\u003cp\u003eIn recent years, several publications have appeared on the use of virtual reality (VR) tools to support pre-discharge home visits. The characteristics of VR vary and can generally be classified as non-immersive and immersive. Non-immersive VR environments enable the user to interact with the VR environment normally via 2D interaction devices with sets of screens to watch, and keyboards, computer mice or joysticks without fully immersing into the environment (Galimberti et al.). Immersive VR systems enable users to immerse fully into the environment. The immersion is created by being surrounded by a 3D computer-generated system that represents the reality and delivers real-time changes in sensory information for the user according to the movement of the user\u0026rsquo;s head and body, as they would if he/she were in an equivalent physical environment (Fusco \u0026amp; Tieri, 2022; Sanchez-Vives \u0026amp; Slater, 2005).\u003c/p\u003e\n\u003cp\u003eIn some published tools, the non-immersive representation of three-dimensional (\u0026quot;virtual\u0026quot;) living spaces is done only as a preconfigured default environment (e.g., (Money et al. 2015; Atwal et al. 2014; Hamm et al. 2017). This does not enable individualized education, recommendations and planning. Other tools are based on interior design apps to create floor plans (e. g. (Money et al., 2015; Palmon et al., 2004; Tsai et al., 2019). Using these tools, the therapists must first obtain specific detailed information, such as room sizes, door widths, and the presence and dimensions of furniture, so that they can then recreate the rooms with the help of the tool.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTools considering the real, individual living space were published by two research groups for on-site home adaptations using augmented reality (an object is inserted on the screen of a tablet into the real living environment on-site during a home visit) (Aoyama and Aflatoony 2020; Chandrasekera et al. 2017). 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Both photographs and video tools might lack\u0026nbsp;reliable measurements (e.g., room sizes or furniture) for the therapist who wants to evaluate the home situation (Jones et al., 2022; Lanfranchi et al., 2022).\u0026nbsp;In the case of videoconference-based home visits, there must of course be somebody in the home in order to carry out the visit (relatives are assumed here, e.g. (Latulippe et al., 2019)).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTherefore, a 3D scan and representation of the real home might be a promising idea for therapists to evaluate the home situation in detail\u0026nbsp;while\u0026nbsp;the patient is staying in the clinic.\u003c/p\u003e\n\u003cp\u003eOne other research group to date has implemented the representation of the real home environment using home scans in the home assessment process: Guay et al. developed an app that scans the home and allows navigation of the 3D model of a home on the browser screen and provides measurement tools (Guay et al. 2021).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors suggest that the use of the 3D model not only on screen, but also as an immersive \u0026ldquo;home visit\u0026rdquo;, using VR goggles could lead to an efficient way to perform PDHAs. An advantage of virtual reality, which is experienced with the help of VR goggles, is the immersive grasp of the environment. As in the real environment, users immediately obtain an impression of the proportions and spatial structure without necessarily having to take measurements. Furthermore, room dimensions and furniture sizes can be measured spontaneously if they emerge as important during the PDHA while discussing the home with other participants.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe majority of publications on the topic of technology used in home assessments explore the general potential of an application or general technical usability and were tested without any actual application setting. Feasibility testing within a clinical context has been rather seldom. Therefore, we aimed to develop a technical system for scanning the real home of patients, for data processing, planning and conducting a home visit within the virtual twin of the home using a 3D model and VR goggles and to test the system for feasibility within the clinical discharge process.\u003c/p\u003e\n\u003ch2\u003eAim\u003c/h2\u003e\n\u003cp\u003eThe key aim was to develop and test a VR-based home assessment system that enables therapists to get detailed information about the home environment of the patients while they are staying in an inpatient rehabilitation clinic.\u003c/p\u003e\n\u003cp\u003ePhase 1: Intervention development\u003c/p\u003e\n\u003cp\u003eThe design phase involved three stages, resulting in development and improvement of the system. The stages were as follows:\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eTo explore functional requirements based on the needs and perceptions of the rehabilitation team involved in discharge preparation.\u003c/li\u003e\n \u003cli\u003eTo develop and pretest a technical system allowing an immersive VR PDHA within the virtual home twins of the patients\u0026rsquo; homes.\u003c/li\u003e\n \u003cli\u003eTo embed the system in a discharge preparation process.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003ePhase 2: Feasibility testing\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe aim of the pilot study was to evaluate the feasibility of delivering the VR PDHA with ReTHo within clinical processes in a neurologic and a geriatric department of an inpatient rehabilitation clinic and to evaluate the acceptance of HCPs and patients in order to derive implications for further improvements and to inform a larger scale study. The specific aims of this phase were as follows:\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eTo explore in which manner HCP deliver the VR PDHA with ReTHo (e.g., in terms of frequency, duration, attendees) and the impact of the intervention on process outcomes (e.g., recommendations for home modifications and therapy).\u003c/li\u003e\n \u003cli\u003eTo explore the acceptance of the intervention by providers (HCP) and recipients (patients).\u003c/li\u003e\n \u003cli\u003eTo pilot study processes and materials (e.g., outcome measures) and to evaluate how the intervention suits the context.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Methods","content":"\u003cp\u003eThis section first describes the intervention, and how it was designed and modified. In the second section, the feasibility study methodology is described.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe overall approach followed the UK Medical Research Council (MRC) framework (Skivington et al., 2021) and integrated existing evidence and the expertise of healthcare professionals.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAlongside the UK MRC framework, newly developed interventions were to be assessed for feasibility including the intervention and evaluation design (Skivington et al., 2021).\u003c/p\u003e\n\u003ch2\u003ePhase 1 Intervention development\u003c/h2\u003e\n\u003cp\u003eThe design phase included the development of the technical system and the embedment into an overall study intervention. The technical development was guided by the user-centered, co-creative approach (Farao et al., 2020). This concept actively includes users in the development of an e-health intervention to prioritize their needs and finally obtain a tool adapted to the requirements of end users. The concept is divided into three overlapping and iteratively interconnected development stages. First, technical user requirements and relevant environmental factors of the application are revealed (relevance cycle). This leads to the creation of a technical prototype, which is evaluated by user involvement (design cycle). After reaching a certain level of readiness for use in the application context, it is deployed by the users with the aim of making further relevant adjustments from this application scenario (precision cycle).\u0026nbsp;Our iterative intervention design process comprised the following steps (and methods):\u003c/p\u003e\n\u003col start=\"1\" style=\"list-style-type: lower-alpha;\"\u003e\n \u003cli\u003eIdentify utility needs on the VR -based home assessment (expert workshop with professionals involved in discharge planning processes).\u003c/li\u003e\n \u003cli\u003eIdentify usability problems of the technical prototype\u0026nbsp;of a VR-based home assessment tool to increase user-friendliness (pre-pilot testing).\u003c/li\u003e\n \u003cli\u003eIdentify usability preferences of therapists to increase user-friendliness of ReTHo and VR-home representation (usability testing groups with OTs and PTs).\u003c/li\u003e\n \u003cli\u003eEmbedding the VR-based home assessment system into clinical processes (expert interviews with key persons involved in discharge planning processes and document analysis of clinical SOPs for patient flow in rehabilitation and professional assessment and discharge planning)\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eThe development steps are presented in Figure 1: Steps and methods of intervention development.\u003c/p\u003e\n\u003ch3\u003eData analysis:\u0026nbsp;\u003c/h3\u003e\n\u003cp\u003eQualitative data from expert workshops, pretesting, literature and usability testing groups were analyzed regarding aspects of functionality and usability according to the definitions of the concept of the \u0026ldquo;perceived usefulness\u0026rdquo; and \u0026ldquo;perceived ease of use\u0026rdquo; of the \u0026ldquo;Technology acceptance model\u0026rdquo; (Venkatesh \u0026amp; Hillol, 2008). The analysis approach taken to the dataset was both inductive and deductive. The high-level themes were set a priori by the targets of the analysis: useful functionality and ease of use in the user context. These yielded a deductive frame for analysis. Subthemes were closely linked to the data (incorporating the views on iterative versions of the technical prototype) and were analyzed in an inductive manner.\u003c/p\u003e\n\u003cp\u003eDatasets were produced and analyzed subsequently with each iteration step of the development phase.\u003c/p\u003e\n\u003cp\u003eFurthermore, the qualitative data from expert interviews and data analysis of discharge processes within the study setting were analyzed with the same technique, guided by the categories of the updated Consolidated Framework for Implementation Research (Damschroder et al., 2022) to identify context factors.\u003c/p\u003e\n\u003cp\u003eThe characteristics of all the HCPs involved in the development steps are shown in detail in Additional File 1.\u0026nbsp;\u003c/p\u003e\n\u003ch3\u003eExpert workshop\u003c/h3\u003e\n\u003cp\u003eThe initial prototype concept (mock-up) comprised the following technical components: produce a 3D home scan (within the home environment), process data and organize data in backend (browser-based), and represent and use data (within the clinical setting).\u003c/p\u003e\n\u003cp\u003eFirst, a scientist (OT) and an IT-developer, who was also responsible for the subsequent realization of the user requirements for the design, led an online expert workshop. The topics of the workshop were: type and quality of home information needed for the respective duties in the discharge process, discussion of technical tools currently known from the literature to support the performance of pre-discharge home visits, presentation and discussion of the initial concept of the prototype (mock-up stage) together with the exploration of specific technical requirements for the latter, and the prioritization of demands. The workshop was audio-recorded and transcribed verbatim.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAs the use of VR is not very common yet and none of the workshop participants had ever tried VR goggles, we sent VR goggles to three HCPs and asked them to try several applications to become accustomed to using them. In each online session with the IT-developer and one researcher, we discussed views on usability and ideas for functionality regarding the planned home assessment tool.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe initial and overarching user demands on functionality to perform a VR PDHA while the patient stays in the clinic were:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eTo gain a general impression of the home environment.\u003c/li\u003e\n \u003cli\u003eTo measure the home and objects within it.\u003c/li\u003e\n \u003cli\u003eTo take notes within the system.\u003c/li\u003e\n \u003cli\u003eAll generated data (surveys and notes) should be exportable for further use.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eIn the next stage, the IT-expert developed a prototype to conduct virtual home visits at the patient`s real home by using the virtual twin of this home. The prototype system comprised the production of a 3D model of the home, the data processing of this model and the representation of the model in VR and 3D on the screen as well as a user desktop application with an interface to operate the data from each dataset.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Software (ReTHo) was developed to access, navigate and measure the virtual twin of the home on screen interface and in VR using VR goggles. Furthermore, we implemented features to note measurements by default and any other information as free access options into each \u0026ldquo;customer\u0026rdquo; account on the therapist\u0026acute;s user interface.\u003c/p\u003e\n\u003cp\u003eDuring the development phase from November 2020 to September 2021, a new smartphone model (I-Phone 12pro) with LIDAR technology \u0026nbsp; and various, partly freely available LIDAR apps \u0026nbsp; \u0026nbsp;(e.g. Toolbox AI) for scanning the rooms could be integrated into our technical system and ReTHo was interconnected with a Data Management System to process and organize 3D scans of patients\u0026acute; homes in a data-backend.\u0026nbsp;\u003c/p\u003e\n\u003ch3\u003ePretesting\u003c/h3\u003e\n\u003cp\u003eOnce the initial system was conceptualized and the initial software was set up, one research team member pretested each form of technology in the system and gave feedback to the IT-developer about the perspectives for usability and usefulness of the technologies: 1) conducting the scan, 2) operating the data management system 3) operating ReTHo and 4) operating and using representations via VR goggles and on the 3D desktop application.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDuring this pretesting phase, different options of scan-apps, designs of the user interface and functions for measuring and moving in VR and 3D models were tested. Additionally, from the researcher\u0026acute;s view, evidence from studies about usability aspects in virtual pre-discharge home assessment tools was included in the feedback. The main usability problems were the calibration of the immersive VR environment (leading to motion sickness) and the different performance qualities in mobile LIDAR-apps for scanning different textures and surfaces (e.g. reflecting surfaces like tiles in bathrooms and kitchens could not be scanned in good quality and these rooms are important for participation at home).\u003c/p\u003e\n\u003ch3\u003eUsability testing groups\u003c/h3\u003e\n\u003cp\u003eThe goal was to identify any problems in functionality and usability regarding operating data representation, measurement functions and the use of ReTHo. Therefore, we conducted six user-testing groups. Field notes\u0026nbsp;were taken during usability tests.\u0026nbsp;The IT-developer iteratively solved problems and implemented users\u0026acute; preferences.\u003c/p\u003e\n\u003cp\u003eExpert interviews\u003c/p\u003e\n\u003cp\u003eTo achieve the best possible fit of the study intervention to the specific implementation context, the study intervention was adapted to the ward setting.\u0026nbsp;Interviews with two leading therapists and one social worker from an inpatient rehabilitation clinic were conducted by telephone. Strategies to implement the intervention in clinical processes were discussed. These interviews were underlined by SOP documents reflecting clinical discharge preparation processes.\u0026nbsp;\u003c/p\u003e\n\u003ch3\u003eResults of intervention development\u0026nbsp;\u003c/h3\u003e\n\u003cp\u003eA total of 45 individual user demands for necessary functions or aspects of user friendliness were derived from pretesting, from the expert workshop and usability testing groups. The main themes in user demands are displayed in an additional file (Additional File 2). \u0026nbsp;All technologies in the system, IT-infrastructures and implemented functions are shown in Table 1 Technical infrastructure and functions of the VR-based PDHA-tool. Figure 2 illustrates the concept and user scenario of the tool.\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;1\u0026nbsp;Technical infrastructure and functions of the system\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.620689655172413%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSystem technology\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"44.13793103448276%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHardware/software/IT-infrastructure\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.241379310344826%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFunctions\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.620689655172413%\" valign=\"top\"\u003e\n \u003cp\u003eProduce a 3D home scan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"44.13793103448276%\" valign=\"top\"\u003e\n \u003cp\u003e- Smartphone with LIDAR-technology\u003c/p\u003e\n \u003cp\u003e- Smartphone application to produce 3D scans\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.241379310344826%\" valign=\"top\"\u003e\n \u003cp\u003e- Scan room by room\u003c/p\u003e\n \u003cp\u003e- Export anonymous 3D data to cloud\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.620689655172413%\" valign=\"top\"\u003e\n \u003cp\u003eBackend to process and organize data (technical writer role)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"44.13793103448276%\" valign=\"top\"\u003e\n \u003cp\u003e- Ability to transmit data digitally to a content management system\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e- Ability to store data (on a server from the Martin-Luther-University)\u003c/p\u003e\n \u003cp\u003e- Ability to perform technical writing (secured with password)\u003c/p\u003e\n \u003cp\u003e- Own data model to present data of each patient and to collect newly generated data while using the end-use application\u003c/p\u003e\n \u003cp\u003e- Interface to retrieve data from server and collect newly generated data from end-use application\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.241379310344826%\" valign=\"top\"\u003e\n \u003cp\u003e- Log in with password for technical writer role\u003c/p\u003e\n \u003cp\u003e-Creating a new patient folder with folder ID-number\u003c/p\u003e\n \u003cp\u003e-Apply individual number of \u0026nbsp;spaces for room data to the folder\u003c/p\u003e\n \u003cp\u003e-Import scan data from cloud to backend\u003c/p\u003e\n \u003cp\u003e-Assign scan data of rooms to each space and name the room\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.620689655172413%\" valign=\"top\"\u003e\n \u003cp\u003eReTHo desktop application\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"44.13793103448276%\" valign=\"top\"\u003e\n \u003cp\u003e- External WLAN router (insufficient internet resources in clinic)\u003c/p\u003e\n \u003cp\u003e- Laptop, mouse\u003c/p\u003e\n \u003cp\u003e- User interface for organizing data, operable on the screen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.241379310344826%\" valign=\"top\"\u003e\n \u003cp\u003e- Downloading data at clinic\u003c/p\u003e\n \u003cp\u003e- Selecting subject account with respective list of scanned rooms\u003c/p\u003e\n \u003cp\u003e- Automatic appearance of measurement data, listed in the currently named room-based organizational interface\u003c/p\u003e\n \u003cp\u003e- Manual labelling and commenting of the list\u0026rsquo;s measurement data \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e- Select relevant hazards from a clinic-based pre-configured checklist and add to the room-based data list.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.620689655172413%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eReTHo application to represent 3D models on a screen or in VR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"44.13793103448276%\" valign=\"top\"\u003e\n \u003cp\u003e- Additional large screen\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.241379310344826%\" valign=\"top\"\u003e\n \u003cp\u003e- Show rooms as 3D model and as floor plan on a screen\u003c/p\u003e\n \u003cp\u003e- Navigate through the rooms on the screen by moving the 3D model on the screen in three dimensions\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e-\u0026nbsp;Measure with virtual folding rule in 3D model and floor plan\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"54.23728813559322%\" valign=\"top\"\u003e\n \u003cp\u003e- VR goggles with external sensors\u003c/p\u003e\n \u003cp\u003e- Use of controllers\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45.76271186440678%\" valign=\"top\"\u003e\n \u003cp\u003e- Immersive VR- representation of rooms\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e- Navigate through the rooms in VR (physically move on the playing ground or \u0026quot;beam\u0026quot; in the VR room with controllers)\u003c/p\u003e\n \u003cp\u003e- Measure with two different measuring tools: distance meter (\u0026quot;laser meter\u0026quot;) and virtual folding rule\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eImplementation strategies of the study intervention\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eClinical outcome measures and routine data collection were checked for suitability for study data collection and integrated, if possible, to keep the burden for study therapists low. There were two therapists formally appointed as study therapists responsible for data collection on site. There were no formally appointed \u0026ldquo;intervention therapists\u0026rdquo;. Prior to the start of the study, one researcher informed all the therapeutic staff about the intervention and trained them in its implementation (n=29). Implementation strategies that had been applied before and during the pilot study were evaluated (an overview of the strategies is displayed in Additional File 3).\u003c/p\u003e\n\u003cp\u003eIntervention procedure\u003c/p\u003e\n\u003cp\u003eThe home scan was performed in the patients\u0026acute; homes by the first author or carers/family in the presence of the author. After completing the scan, the data were uploaded into the backend. The therapists downloaded 3D data and performed a virtual pre-discharge home visit during the rehabilitation period with patients and other participants or alone. The therapists could perform the home assessment once or repeat it, if necessary.\u003c/p\u003e\n\u003cp\u003eDuring the virtual home visit, the therapists took individual, relevant home measurements. Notes could be entered as free text on the user interface. Every data input item (measure or hazard or individual miscellaneous note) was required to be commented with a corresponding recommendation (e.g., for home modifications /aid installation or elimination of hazard or activity adaptation). Data could be exported as Excel spreadsheets with room-based lists of measurements and/or detected home hazards and/ or individual\u0026nbsp;miscellaneous notes with corresponding recommendations.\u003c/p\u003e\n\u003cp\u003eThe intervention is described in detail according to the TIDieR checklist (T. C. Hoffmann et al., 2014) and presented in the Additional File 4.\u003c/p\u003e\n\u003cp\u003eTo focus process evaluation, a process-oriented logic intervention model was developed in accordance with the guideline by Rohwer et al. (Rohwer et al., 2016). The logic model of the intervention (figure 3) displays the a priori mechanisms of intervention activities that influence the intervention outcomes.\u003c/p\u003e\n\u003ch2\u003ePhase 2 Feasibility testing\u003c/h2\u003e\n\u003ch3\u003eDesign\u0026nbsp;\u003c/h3\u003e\n\u003cp\u003eThe study was designed as an exploratory single-arm feasibility study to evaluate the acceptance and suitability of the underlying logic intervention model as well as the implementation of the intervention. Furthermore, we wanted to test the feasibility of the study procedures (including outcome measures, data collection procedures and recruitment process) to prepare a larger-scale study and to improve the intervention design.\u003c/p\u003e\n\u003cp\u003eThe evaluation of the study processes was based on the MRC framework as an overarching research approach (Moore et al., 2015; Skivington et al., 2021). Since intervention stakeholders were therapists and patients, this process evaluation focused on the experiences and perspectives of both. Barriers and facilitators regarding delivering and receiving the intervention were analyzed following the Consolidated Framework for advancing Implementation Research (CFIR) (Damschroder et al., 2022).\u0026nbsp;\u003c/p\u003e\n\u003ch3\u003eParticipants and Setting\u003c/h3\u003e\n\u003cp\u003eRecruitment and implementation of the intervention took place in an inpatient rehabilitation clinic in a rural area in Germany with a large catchment area of up to 400 km. Recruitment was carried out at MEDIAN Saale Klinik Bad K\u0026ouml;sen II, in the Departments of Neurology and Geriatrics, each of which was managed and staffed independently.\u003c/p\u003e\n\u003ch3\u003eEligibility Criteria\u003c/h3\u003e\n\u003cp\u003ePatients were included in the trial according to the following criteria: (i) age at least 18 years, (ii) neurological diagnosis or geriatric syndrome (defined as \u0026ldquo;multimorbidity with impending risk of loss of autonomy in activities of daily living\u0026rdquo;), (iii) anticipated persistent functional limitation(s) associated with increased risk of falls in the home environment and/or need for environmental adaptations, and (iv) discharge destination home or uncertain.\u003c/p\u003e\n\u003cp\u003ePatients were excluded according to the following criteria: (i) not able to understand the goal of the intervention (e.g., due to severe aphasia or severe cognitive impairment), (ii) not able to give consent and their legal care was not taken over by relatives, (iii) lethal course of disease, (iv) living outside a catchment area of 100 km distance from the rehabilitation facility, (v) patient or relatives did not consent.\u003c/p\u003e\n\u003cp\u003eTo increase the number of eligible patients four weeks after the start of recruitment, the eligibility criteria were adapted to (iv) living outside the defined catchment area of 150 km distance from the rehabilitation facility. Furthermore, \u0026ldquo;geriatric diagnoses or stroke only\u0026rdquo; was changed to \u0026ldquo;geriatric diagnoses or any neurological diagnoses\u0026rdquo;.\u003c/p\u003e\n\u003ch3\u003eIdentification and recruitment\u003c/h3\u003e\n\u003cp\u003eAfter admission, all patients were screened for eligibility by the study therapists. After the eligible participants had been provided with comprehensive information by the study therapists, they could consent to participate. If other persons lived in the same home with the patient, a consent from this person was necessary for the study intervention and had to be obtained. The recruitment of patients and their relatives who were willing to participate in a problem-centered interview for process evaluation took place at the time when the research team conducted the standardized telephone follow-up, two weeks after discharge (T3).\u003c/p\u003e\n\u003cp\u003eFor process evaluation, HCPs were interviewed who either had implemented the intervention or were present during the intervention. Furthermore, HCPs were interviewed who potentially could have used the intervention or could have been affected by the output of the intervention. All the recruited patients were invited to participate in an interview for process evaluation. \u0026nbsp;\u003c/p\u003e\n\u003ch3\u003eData collection procedures\u003c/h3\u003e\n\u003cp\u003eAn overview of the research questions, data collection instruments and the analysis plan is displayed in Additional File 5.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePre-screening list\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo specify future inclusion criteria for an RCT, study therapists in each department recorded reasons for exclusion, using a standardized pre-screening list for every patient after admission.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipant description\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo describe the participants, baseline data collection from routine documentation was recorded, including: sociodemographic data, comorbidities, functional status (ability to walk; Functional Ambulation Categories (FAC) (Martin \u0026amp; Cameron, 1996; Mehrholz et al., 2007; Park \u0026amp; An, 2016) fall events, paralysis; Motricity Index (Collin \u0026amp; Wade, 1990), ADL status; Barthel Index (BI) (Collin et al., 1988) ) and patient assistive devices.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProcess outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe number of recommendations and identified issues/hazards was collected, as well as the rates of installed aids/adaptations and elimination of issues/hazards after discharge.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFeasibility and acceptance\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFidelity and dosage in delivering the intervention were collected using standardized process data on the use of technology during the virtual assessment as well as during interviews. Therapists rated satisfaction in usability and usefulness of the tool by answering four questions at the time point of performing the VR assessment (NRS 0-10). Satisfaction with the tool was explored regarding feeling supported by technology when discussing home issues with the patient and pursuing therapeutic goals. Furthermore, the perceived overall effort in using the tool as well as the level of enjoyment when using the technology was rated. Problem-centered semi-structured interviews were used to obtain the participants\u0026apos; experiences of the intervention as well as factors affecting the delivery/reception of the intervention as well as the process and patient outcomes. Interview guidelines were agreed on by the research team prior to use.\u0026nbsp;Interviews with HCPs were conducted face to face and interviews with patients via telephone, one time each, and were carried out exclusively by one researcher (UKH) who was trained and involved in the project. Further information about the researcher\u0026acute;s personal characteristics according to CORREQ (Tong et al., 2007) is provided in the Additional File 6. The duration of each interview should not exceed 30 minutes taking the time constraints of the participants into consideration. Interviews were audio-recorded and transcribed verbatim.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;(Guidelines can be requested from the authors.)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatient outcome measures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn preparation for a subsequent effectiveness study, survey procedures and instruments were already tested to measure the effectiveness of the intervention. To assess performance and satisfaction with performance in client-identified daily activities in the individual home environment, we used the Canadian Occupational Performance Measure (COPM) (Law et al., 1990). Furthermore, the number of falls and fear of falling were measured.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eQuantitative data were collected after admission (t0), at the time of intervention (t1), at discharge (t2) and two weeks after discharge (t3), by telephone or with self-administered questionnaires, respectively.\u0026nbsp;\u003c/p\u003e\n\u003ch3\u003eSample size\u003c/h3\u003e\n\u003cp\u003eAs this was a feasibility study, there was no formal sample size calculation. The target number of participants was based on clinical estimates of the likely number of patients who fit the inclusion criteria and could be enrolled during the enrollment period.\u003c/p\u003e\n\u003cp\u003eThe feasibility study was planned with a sample of 30 participants (15 each in the Department of Geriatrics and Department of Neurology).\u003c/p\u003e\n\u003ch3\u003eData analysis\u003c/h3\u003e\n\u003cp\u003eAs part of the feasibility study, quantitative data were analyzed and presented descriptively. Continuous characteristics are presented as the mean and standard deviation, and categorical variables are presented as absolute and percentage frequencies.\u003c/p\u003e\n\u003cp\u003eQualitative data from the problem-centered interviews and group discussions were analyzed using a mixed deductive-inductive approach based on the structured approach of directed content analysis (Malterud, 2012). For this purpose, audio interviews were pseudonymously transcribed. Transcripts were not returned to the participants before analysis. MAXQDA software and Excel were used for the analysis. The themes and categories of the coding guideline were based on the mechanisms of impact and acceptance outcomes derived from the logical model defined a priori, also allowing for emerging themes.\u003c/p\u003e\n\u003cp\u003eTwo members of the research team coded interviews independently in the first two stages of the analysis. Codes were condensed and synthesized by one researcher alone under the supervision of another researcher from the team.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTo evaluate the study processes, the implementation and fit of the intervention within the setting and to develop the intervention further, context factors were extracted and structured according to the Consolidated Framework for Implementation Research based on user feedback (Damschroder et al., 2022). Possible recommendations for future intervention designs were derived from the lessons learned here.\u003c/p\u003e"},{"header":"Results","content":"\u003ch2\u003eFeasibility of recruitment process\u003c/h2\u003e\n\u003ch3\u003eReach and retention\u003c/h3\u003e\n\u003cp\u003eRecruitment of participants was planned from October 2020 to December 2020 and was prolonged for another two months due to a low recruitment rate. Of the 152 eligible patients 19 consented to be enrolled in the study (recruitment rate of 12.5%).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOne hundred and thirty-three of the eligible patients did not provide informed consent (87.5%).\u003c/p\u003e\n\u003cp\u003eOf the 19 patients who consented, a total of 12 patients were enrolled in the study and received the intervention. Eleven patients had neurological diagnoses and one patient had a geriatric diagnosis. Reasons for non-enrollment in the study intervention after consenting were as follows: One inpatient no longer met the inclusion criteria due to a deterioration of his condition, and in six cases, the relatives did not consent to study participation. Figure 4 shows the consort diagram for participant flow.\u003c/p\u003e\n\u003cp\u003eIn the expert interviews, therapists reported that geriatric patients showed a decreased willingness to participate in the study compared to neurologic patients. Therapists assumed that - in contrast to inpatients with a stroke who experienced a sudden change in their health condition - geriatric patients adapted to the functional limitations due to the chronic course of disease. Another reason stated was that patients feared burdening their relatives too much by carrying out the room scan or by opening the door to the study team. Therapists stated that geriatric patients would often live with spouses who were also in need of care.\u003c/p\u003e\n\u003ch3\u003eParticipant description\u003c/h3\u003e\n\u003cp\u003eParticipant characteristics are shown in Table 2. The study participants were on average 68.83 years old, 57.1% men. Half of the participants (50%) lived at home alone. Half of the participants (50%) had a diagnosis of stroke with symptomatic hemiparesis or hemiplegia. After extending the inclusion criteria, five additional individuals with paraparesis were included (41.7%). One person was included with a geriatric diagnosis.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eTable 2 Participant characteristics\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"562\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"50.08912655971479%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.768270944741534%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.142602495543674%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDischarge\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50.08912655971479%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003eAge (SD) (range)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.768270944741534%\" valign=\"top\"\u003e\n \u003cp\u003e68.83 (10.61) (51-80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.142602495543674%\"\u003e\n \u003cp\u003en. a.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50.08912655971479%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003eMale (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.768270944741534%\" valign=\"top\"\u003e\n \u003cp\u003e8 (57.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.142602495543674%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50.08912655971479%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003eLiving alone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.768270944741534%\" valign=\"top\"\u003e\n \u003cp\u003e6 (50.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.142602495543674%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50.08912655971479%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003eMain diagnose\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.768270944741534%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.142602495543674%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"4.45632798573975%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45.632798573975045%\" valign=\"top\"\u003e\n \u003cp\u003eStroke with hemiplegia/hemiparesis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.768270944741534%\" valign=\"top\"\u003e\n \u003cp\u003e6 (50.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.142602495543674%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"4.45632798573975%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45.632798573975045%\" valign=\"top\"\u003e\n \u003cp\u003eParaparesis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.768270944741534%\" valign=\"top\"\u003e\n \u003cp\u003e5 (41.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.142602495543674%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"4.45632798573975%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45.632798573975045%\" valign=\"top\"\u003e\n \u003cp\u003eGeriatric syndrome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.768270944741534%\" valign=\"top\"\u003e\n \u003cp\u003e1 (8.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.142602495543674%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50.08912655971479%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eMotricity Index, mean (SD)**\u003csup\u003e$\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.768270944741534%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.142602495543674%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"4.45632798573975%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45.632798573975045%\" valign=\"top\"\u003e\n \u003cp\u003eSum score left side\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.768270944741534%\" valign=\"top\"\u003e\n \u003cp\u003e75.64 (16.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.142602495543674%\" valign=\"top\"\u003e\n \u003cp\u003e85,45 (12.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"4.45632798573975%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45.632798573975045%\" valign=\"top\"\u003e\n \u003cp\u003eSum score right side\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.768270944741534%\" valign=\"top\"\u003e\n \u003cp\u003e90.40 (10.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.142602495543674%\" valign=\"top\"\u003e\n \u003cp\u003e95.27 (5.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50.08912655971479%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eFalls pre-admission (6 months)/during rehabilitation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.768270944741534%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.142602495543674%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"4.45632798573975%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45.632798573975045%\" valign=\"top\"\u003e\n \u003cp\u003eNo falls\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.768270944741534%\" valign=\"top\"\u003e\n \u003cp\u003e5 (41.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.142602495543674%\" valign=\"top\"\u003e\n \u003cp\u003e10 (83.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"4.45632798573975%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45.632798573975045%\" valign=\"top\"\u003e\n \u003cp\u003eOne fall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.768270944741534%\" valign=\"top\"\u003e\n \u003cp\u003e5 (41.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.142602495543674%\" valign=\"top\"\u003e\n \u003cp\u003e1 (8.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"4.45632798573975%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45.632798573975045%\" valign=\"top\"\u003e\n \u003cp\u003eTwo falls\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.768270944741534%\" valign=\"top\"\u003e\n \u003cp\u003e2 (16.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.142602495543674%\" valign=\"top\"\u003e\n \u003cp\u003e1 (8.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50.08912655971479%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eFear of falling (VAS 0 to 10)* \u0026nbsp;(mean)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.768270944741534%\" valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.142602495543674%\" valign=\"top\"\u003e\n \u003cp\u003e3.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50.08912655971479%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eFAC ** \u003csup\u003e\u0026sect;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.768270944741534%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.142602495543674%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"4.45632798573975%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45.632798573975045%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.768270944741534%\" valign=\"top\"\u003e\n \u003cp\u003e2 (14.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.142602495543674%\" valign=\"top\"\u003e\n \u003cp\u003e1 (8.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"4.45632798573975%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45.632798573975045%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.768270944741534%\" valign=\"top\"\u003e\n \u003cp\u003e1 (7.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.142602495543674%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"4.45632798573975%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45.632798573975045%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.768270944741534%\" valign=\"top\"\u003e\n \u003cp\u003e5 (35.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.142602495543674%\" valign=\"top\"\u003e\n \u003cp\u003e5 (41.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"4.45632798573975%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45.632798573975045%\" valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.768270944741534%\" valign=\"top\"\u003e\n \u003cp\u003e4 (28.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.142602495543674%\" valign=\"top\"\u003e\n \u003cp\u003e1 (8.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"4.45632798573975%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45.632798573975045%\" valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.768270944741534%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.142602495543674%\" valign=\"top\"\u003e\n \u003cp\u003e3 (25.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"4.45632798573975%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45.632798573975045%\" valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.768270944741534%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.142602495543674%\"\u003e\n \u003cp\u003e2 (16.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50.08912655971479%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eBarthel-Index, mean (SD)**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.768270944741534%\" valign=\"top\"\u003e\n \u003cp\u003e56.26 (12.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.142602495543674%\"\u003e\n \u003cp\u003e63,33 (10.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e* lower score indicates better outcome\u003c/p\u003e\n \u003cp\u003e** higher score indicates better outcome\u003c/p\u003e\n \u003cp\u003e\u003csup\u003e$\u0026nbsp;\u003c/sup\u003eperformed for patients with paresis/plegia only (n=11)\u003c/p\u003e\n \u003cp\u003e\u003csup\u003e\u0026sect;\u003c/sup\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003eFAC\u0026nbsp;: 0=Not capable, needs two or more therapists, 1=Needs constantly help from one person for walking, 2=Patient needs intermittent help from one person, 3=Patient needs verbal help, 4=Patient walks independently on level ground, still little help needed, e.g. when climbing stairs or on difficult ground, 5=patient is capable of walking\u003c/p\u003e\n \u003cp\u003en. a.= not applicable\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ch3\u003eFidelity and dosage\u003c/h3\u003e\n\u003cp\u003e\u003cstrong\u003eScan\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn total, the intervention was conducted 12 times, once per participating patient. A study team member performed each living room scan. In three cases, relatives performed the scan in the team member\u0026acute;s presence. Each room was scanned within a few minutes (3 minutes to 10 minutes). An average of 8.67 rooms per patient were scanned. The entire scanning process for all rooms took between 40 and 90 minutes each time.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eVirtual-based home assessment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEach of the patients (n=12) received the intervention once.\u003c/p\u003e\n\u003cp\u003ePer VR-home visit, an average of 7.76 (SD 1.97) rooms were assessed and 12.3 (SD 5.02) recommendations were entered in the application interface during the assessment.\u003c/p\u003e\n\u003cp\u003eTherapy sessions took 43.67 (SD 10.52, range from 25 to 65) minutes in total. The time between the start of the therapy session and the start of using the tool for the virtual visit took on average 11.17 (SD 5.57, range from 5 to 20) minutes. However, the VR-based part of the home assessment took 23.33 minutes (SD 9.31, range 13 to 42).\u003c/p\u003e\n\u003cp\u003eThe intervention was delivered in different constellations of participants with PTs, OTs, patients, one relative and one rehabilitation technician (see Additional File 7 for details). In most cases the therapists used the VR headset and the 3D screen (n=9), or only the screen (n=3). The rehabilitation patients did not put the VR headset on, but used the screen to view the home (n=11).\u003c/p\u003e\n\u003ch3\u003eFeasibility of data collection procedures\u003c/h3\u003e\n\u003cp\u003eMost data collection procedures were feasible with only minor implications for improvement, such as the use of symbols instead of numbers for visual analog scales to improve the self-assessment of the participants.\u0026nbsp;Instead of assessing\u0026nbsp;activities of daily living (ADL)\u0026nbsp;with the COPM during or after the virtual-based home assessment (as required by the intervention protocol), therapists conducted the COPM prior\u0026nbsp;to the intervention. The items were used during the\u0026nbsp;virtual-based home assessment\u0026nbsp;session for guiding the assessment.\u003c/p\u003e\n\u003cp\u003eApart from that, the target activity items had to be formulated as precisely as possible during the\u0026nbsp;virtual-based home assessment\u0026nbsp;to estimate the level of target achievement at the end of the intervention period. For example, \u0026quot;climbing stairs in the house\u0026quot; should be specified in the first assessment with \u0026quot;climbing stairs in the house without a person to help me\u0026quot; or \u0026quot;climbing stairs in the house without any aids\u0026rdquo;.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eRecommendations\u003c/h2\u003e\n\u003cp\u003eA total of 149 recommendations were derived during the virtual assessment interventions.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOn average 12.42 (SD 5.02) recommendations per patient were given, and on average 36% (SD 21%) of them were ongoing two weeks after discharge. (See Additional File 8 for details.)\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003e\u0026nbsp;Acceptance\u003c/h2\u003e\n\u003cp\u003e\u003cem\u003eCharacteristics of the interviewed persons\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eA total of nine HCPs participated in the interviews at the end of the intervention period. The majority were female (n=8). There were OTs (n=5), PTs (n=3) and one rehabilitation technician who was not an employee of the rehabilitation facility but worked closely with the therapists.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA total of nine patients reported on their experiences with the intervention in expert interviews. Relatives took part in the interviews in some cases (n=4).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eInterviewee characteristics (HCPs and patients) are shown in detail in Additional File 6.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAcceptance: Therapists\u0026acute; and patients\u0026acute; views\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTherapists rated satisfaction in usability and usefulness of the tool overall as very good. Satisfaction with regard to feeling supported by technology in discussing home issues with the patient was rated on average\u0026nbsp;9.83 (SD 0.58)\u0026nbsp;and in pursuing therapeutic goals with\u0026nbsp;9.67 (SD 0.78). Satisfaction with the perceived overall effort in using the tool was rated\u0026nbsp;8.25 (SD 2.34)\u0026nbsp;and the level of enjoyment in using the technology was rated 9.5 (SD 0.90).\u003c/p\u003e\n\u003cp\u003eAccording to the predefined process-oriented logic intervention model, certain process outcomes should generate acceptance and health outcomes. Corresponding comments from HCPs from interviews are presented below.\u003c/p\u003e\n\u003cp\u003e1. Tailored recommendations and advice on home modifications/aids and fall prevention.\u003c/p\u003e\n\u003cp\u003eThe intervention was perceived as supportive by therapists for all participating inpatients. Reliable information about the home environment helped to prepare the discharge. \u0026nbsp;\u003cem\u003e\u0026ldquo;Therefore, for me as a therapist, it is simply the best possible way to prepare the patient for discharge at home. [\u0026hellip;.] That\u0026rsquo;s because it (standard approach) is only about a verbal piece of information, right? And the intervention here had a solid foundation because you saw the situation at home. The right things were prescribed and given.\u0026rdquo; (Therapist)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e2. Increasing patients\u0026rsquo; acceptance of recommendations\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe visualization of the home supported a trustful discussion between therapists and patients in some cases. \u0026ldquo;So just having a conversation, like \u0026quot;Gee, but you have a nice carpet.\u0026quot; Simply to build up a basis of trust about it. That works out great.\u0026rdquo; (Therapist)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFrom the patients\u0026acute; point of view, the virtual-based home assessment facilitates the discussion because some things are difficult to explain and sketches can be challenging as well. \u003cem\u003e\u0026ldquo;And that it is easier for me to imagine my home. Because that was also difficult for the therapists to comprehend with the stairs and stuff. You cannot explain all that at all. I would have had to make sketches or something.\u0026rdquo; (Patient).\u003c/em\u003e Most of the patients found virtual- based home assessment to be supportive because of the recommendations and aid prescription and home modifications. Patients mentioned the measurement function and visualization as helpful here and felt better prepared when facing discharge. \u003cem\u003e\u0026ldquo;After you have been discharged, you are on your own. And then it is a good feeling, looking ahead, that things can work at home where you previously thought: \u0026quot;No, man, that cannot work at all.\u0026quot; Yes?\u0026rdquo; (Patient).\u0026nbsp;\u003c/em\u003eOne patient could not return to his old home, and a new home was furnished by relatives. He stated: \u0026ldquo;\u003cem\u003eI was informed beforehand about what it would look like. I was able to anticipate it and see what might need to be modified.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThere were two participants who were not very satisfied with the intervention. One patient stated that she generally lacked imagination based on any abstract room representations. \u003cem\u003e\u0026ldquo;We have built a lot at home, and it is always better when you can stand inside and imagine it in nature. However, I\u0026apos;m a person who has to see it in the real world. So my husband, who used to be a technical draftsman, made a sketch of it. Well, I could always imagine very little about that.\u0026rdquo; (Patient)\u003c/em\u003e Another patient experienced the virtual-based home assessment as an emotional stressful situation, being aware that returning home might not be possible: \u003cem\u003e\u0026ldquo;You get too worked up again and you know you cannot handle it. Have to let it all go.\u0026rdquo; (Patient)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e3. Therapists and patients find improved activity goals (tailored, participation-oriented and operationalized).\u003c/p\u003e\n\u003cp\u003eThe assessment supported the goal-setting process for activity training. One therapist stated \u003cem\u003e\u0026ldquo;And so you could at least say, \u0026quot;Okay, you might have to practice with them in that direction.\u0026quot; Yes, all of us have the goal that the patients should be able to cope independently at home again, if possible. And that\u0026apos;s why that was important to us.\u0026rdquo;\u003c/em\u003e Another therapist illustrated that being able to set goals with patients related to everyday life: \u003cem\u003e\u0026ldquo;We want to be able to walk from the living room to the kitchen, right? And we are now recreating that in the therapy room. Then it\u0026apos;s no longer just: \u0026quot;We\u0026apos;ll walk down the hall in the clinic,\u0026quot; but: \u0026quot;We\u0026apos;ll walk from the kitchen to the living room. And now I\u0026apos;m going to put something in between and you have to step over the edge.\u0026quot; (Therapist)\u0026nbsp;\u003c/em\u003eOne therapist pointed at the creation of\u003cem\u003e\u0026nbsp;\u003c/em\u003ehope and motivation for patients\u003cem\u003e: \u0026quot;And that gives a boost to the therapy, so that the patient once again knows what they are doing it for and what they still need to practice specifically.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eHaving the real furniture dimensions, the therapists started to simulate home activities in training sessions, such as getting in and out of the shower tub,\u0026nbsp;lifting the leg to the necessary height or climbing narrow stairs.\u003cem\u003e\u0026nbsp;\u0026ldquo;We discussed it with the therapist, for the first four or five steps, I can walk up by pulling on the the handrail. And where the spiral staircase begins, I walk a bit on all fours. And then, when it\u0026apos;s straight again, I stand back up. (...) And that\u0026apos;s what we practiced. We simulated it, so to speak.\u0026rdquo; (Patient)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e4. Better information flow and communication with stakeholders in the discharge preparation process.\u0026nbsp;\u003cbr\u003e\u0026nbsp;It was planned to use Excel spreadsheets to pass on information within the clinic digitally or in print form to support the information flow. However, this function could not be used because the tool had not been integrated into the clinic IT system. Therefore, information data from the assessments were transferred to other HCPs within the clinic manually or verbally. In one case, a rehabilitation technician (RT) attended the VR-home assessment. She appreciated that having information about dimensions enables her to order suitable technical aids immediately. Furthermore, she anticipated that it might be useful to pass on 3D photographs to health insurance providers who pay for installations.\u003c/p\u003e\n\u003cp\u003eThere are some adaptations to the intervention design that might improve the intervention.\u003c/p\u003e\n\u003cp\u003eThe RT suggested that additional visual representation of technical aids within the tool would be helpful to further increase acceptance of necessary aids: \u003cem\u003e\u0026ldquo;So that they can imagine that it does not look so bad after all. Because the grab rails are now available in white, chrome and black, right?\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eFurthermore, an interface between tool\u0026ndash;software infrastructures and IT devices in the facility must be provided to enable a data output within the clinic (e.g., to store or print Excel sheets or share sheets or photographs via e-mail). Furthermore, an interface between the software of the IT system and the local software could connect the electronic patient documentation.\u003c/p\u003e\n\u003ch3\u003ePatient outcomes\u003c/h3\u003e\n\u003cp\u003eBefore discharge, the Canadian Occupational Performance Measure (COPM) subscale execution rated an average of 4.41 (SD 1.82) out of 10 possible points which increased slightly to 5.3 (SD 1.87) after discharge. The COPM subscale satisfaction was rated 4.53 (SD 2.24) points before discharge and 4.90 (SD 2.00) after discharge.\u003c/p\u003e\n\u003cp\u003eThe Barthel Index (BI) declined from baseline with an average of 56.3 (SD 12.99) points to an average of 44.92 (SD 11.74) points after discharge. The lowest Barthel Index scores were caused by a deterioration of the condition due to a COVID-19 infection and due to another stroke.\u003c/p\u003e\n\u003cp\u003eSeven participants reported single or multiple falls at baseline, and three reported falls within two weeks after discharge.\u003c/p\u003e\n\u003cp\u003eThe extent of fear of falling perceived by participants remained consistent across all survey time points (VAS 4.00 (SD 2.7) at baseline, VAS 3.17 (SD 2.65) before discharge and VAS 3.08 (SD 3.40) after discharge in seven (58.3%) participants who had fear of falling). A detailed overview of the outcome measures is shown in Additional File 9.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis paper investigated the use of a newly developed technical application to perform a home assessment using digital data to provide a three-dimensional representation of the patient's home during inpatient rehabilitation in a clinical setting. The intervention comprised a virtual remote representation of the VR twin of the patient\u0026rsquo;s real home, which could be entered immersively in virtual reality or in 3D models on a screen interface.\u003c/p\u003e \u003cp\u003eThe focus of the feasibility study was to evaluate the intervention design and study processes. In this regard, information was obtained on how the HCPs delivered the intervention, to what extent the intervention was accepted by patients and therapists and which factors might affect delivery and outcomes.\u003c/p\u003e \u003cp\u003eThe first phase of the study aimed to identify the requirements defined by HCPs regarding the necessary kind and quality of functions of the VR-based PDHA system to represent and use home data before discharge. The development was carried out with the intensive involvement of the end users (HCP) and IT-developers, resulting in iterative improvements of a screen-based interface to organize patient home assessment data and an additional representation of the patients\u0026acute; home as an immersive or non-immersive environment. Therapists were satisfied with usability regarding with regard to the functions. The appearance of the interface or operation of devices to navigate or take measurements were not seen as difficult in the clinical test phase (phase 2). Being able to take measurements, to identify and discuss barriers resulted in high satisfaction from being able to tailor recommendations for home modifications and goal setting in inpatient training.\u003c/p\u003e \u003cp\u003eWith the help of the VR PDHA, training and participation targets for life at home can be realistically adapted to the functional abilities of the patient and the requirements of the home environment. This enables an individual participation-oriented goal setting for the inpatient rehabilitation period. Using the true-to-scale visualization of the home, the therapists felt that recommendations for aids and home adaptations could be made and discussed with the patients in a more precise manner. The therapists highlighted that having measurements (such as room size and height of steps) enables advice that is more reliable. Therefore, a VR solution might be superior to any other ward-based PDHA that relied only on patients\u0026rsquo; or relatives\u0026acute; information about the home, especially where measurements were concerned.\u003c/p\u003e \u003cp\u003eAnother researcher group, Guay et al., also had the idea of using room scans for therapeutic assessments. While we developed our prototype, they published the development of a mobile app to scan rooms and produce a 3D model. They also developed a special software tool to take measurements from the virtual model of rooms and tested usability (Guay et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). We implemented some additional technical innovations: Software to enter, navigate and measure the virtual twin of the living space not only on the screen interface but also in VR using VR goggles. Furthermore, we implemented functions to notice measurements by default and any other information as free entry option in each \u0026ldquo;customer\u0026rdquo; account on the therapist\u0026acute;s user interface.\u003c/p\u003e \u003cp\u003eOur results showed that, from a therapist's point of view, being able to discuss recommendations with the patients is in line with Guay et al., who found that therapists perceived a better understanding and ability to facilitate and explain recommendations when using the visual support (Guay et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eResults of a previous review indicated that the use of visualization as a joint basis for discussion of home modifications might be a facilitator to include patients in the decisions about home modifications and aids (Kirchner-Heklau et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Giving them a chance to give immediate feedback on proposed changes leads to shared decision-making and thus appropriate visualization should be provided (Kirchner-Heklau et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eResults showed that the joint assessment with patients and therapists supported the mutual discussion of recommendations. Two patients, who were recommended not to return home, reported a negative emotional reaction. It is known from literature on traditional PDHA that these might provoke anxiety, if patients viewed the assessment as a test that they might fail (Atwal et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2008\u003c/span\u003e; Atwal et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). This strain might not be preventable by any kind of ward-based PDHA. A patient, being confronted with handicaps that restrict independent living in the familiar home - whether in VR or in reality - always requires the communicative support of the therapist carrying out the PDHA.\u003c/p\u003e \u003cp\u003eImplementing the performance of the home scan in clinical processes might be a challenge in the future use of scenarios. Our findings confirmed Guay et al.\u0026acute;s concerns regarding conducting the scan in the clinical setting, especially in the geriatric setting. Indeed, relatives of geriatric patients in particular rejected being involved in providing a home scan.\u003c/p\u003e \u003cp\u003eConducting the scan by a staff member needed a physical home visit and its related resources. This, of course, does not meet the virtual home assessment goal of saving resources by avoiding physical home visits. This study focused on the feasibility testing of ward-based data use. However, in a next step, performing the scan efficiently should be tested. In the future intervention design, people who are available at home (e.g., relatives) could therefore perform the home scan. There is some evidence of good feasibility in using smartphone technology for taking and submitting photos for the therapeutic assessment for those in community dwelling (Leung \u0026amp; Brandis, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). However, only adults under 75 years of age in the community were recruited for this purpose. We agree with Guay et al.\u0026acute;s considerations that relatives, a government employee, or a healthcare professional could perform the scan. In the process of preparing the home before transition, not only generating the home scan might involve helpers and structures such as outpatient care services: With regard to the realization of the recommendations for home adaptations, inpatients living alone need help at home while they are still in the rehabilitation facilities.\u003c/p\u003e \u003cp\u003eIn this study, patients and relatives were not involved in the development, as we focused on the ward-based therapeutical use of ReTHo and they were therefore not identified as the main user group, but rather as stakeholders attending the assessment and providing the home data to be assessed. In the future development of the intervention design, relevant stakeholders to perform the scan should be involved. These people will primarily be relatives and carers. However, outpatient RTs and care services as well as OTs and PTs are also involved in providing care at home. This care is already initiated as part of the inpatient discharge preparation. In the future, possible temporal and organizational interfaces between the processes in the clinic and the aforementioned outpatient stakeholders should be identified when developing intervention processes.\u003c/p\u003e \u003cp\u003eThe duration of the intervention (excluding the scan) did not exceed the duration of a regular therapy session and is likely to be well below the effort and duration of a physical home assessment visit, which could take up to 4 hours in total (Lanfranchi et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). The virtual assessment could be delivered in clinical processes without straining therapists. A good fit between clinical routine and study intervention processes was integrated into the intervention design. The therapists could always access the scan in time to carry out the virtual PDHA during the rehabilitation interval, which often lasts just three weeks.\u003c/p\u003e \u003cp\u003eReTHo was equipped with one potential interface for data transfer by providing the opportunity to export data in Excel sheets and transfer them by mail or cloud or via a USB-slot as a data storage medium. However, these did not fit the clinical IT structures and processes. For future use, the fit between IT-Systems should be provided and tested.\u003c/p\u003e \u003cp\u003eStrengths and limitations\u003c/p\u003e \u003cp\u003eIn our study, some therapists who were involved in the development of the intervention were also interview partners for the evaluation of the acceptance. The strict separation of participants for development and evaluation could possibly facilitate the objectivity of the evaluation. The instruments for measuring outcomes themselves were feasible. In our study, validated outcome measures were mainly used, and the participants were defined and represented the intended user group of the innovative tool within the intervention. Therefore, our study demonstrates a certain methodological strength compared to other studies investigating information and communication technology in the context of occupational home assessments as described in Ninnis et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2019\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eOverall, fewer patients than anticipated were recruited. However, the follow-up interview was possible for many of them, so that the patient's perspective on the intervention was well represented.\u003c/p\u003e \u003cp\u003ePatients with severe aphasia and severe cognitive impairment were excluded from the intervention. It is not precluded that these patients may benefit from the intervention and this should be investigated in the future. One inclusion criterion was \u0026ldquo;anticipated persistent functional limitation(s) associated with increased risk of falls in the home environment and/or need for environmental adaptations\u0026rdquo;. However, it cannot be precluded that less severely impaired persons could also benefit from more participation-oriented therapy planning and education on fall prevention in terms of satisfaction with the therapy.\u003c/p\u003e \u003cp\u003eWe used customized questions to evaluate satisfaction. There are validated measures for this purpose, which should be used, especially in studies with many participants.\u003c/p\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003ePotential for development and next steps\u003c/h2\u003e \u003cp\u003eHCPs expressed that the implementation of visual representations of aids would be helpful. This was one of several user demands from the expert workshop, which was not realized or implemented in the tool. There are recent publications on aid representations using augmented reality applications (Aoyama \u0026amp; Aflatoony, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). These findings inspire us to implement aid avatars in VR in the future. For this purpose, functions could be built into the application that supports the selection of aids. In this regard, there are already ideas for further developments. For example, in 2014 Atwal et al. evaluated a 3D application in terms of usability that included a furniture catalog with an occupational therapy object library (Atwal et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2014\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSince the virtual PDHA is ward-based, it should also be possible to invite experts in the field of assistive technology (such as RTs who are responsible for equipping patients with home modification and aids in the German healthcare system) synchronously to consult about and order aids and home modifications immediately. For our study intervention, we found the exchange of information between one local rehabilitation technician and therapists during the home assessment to be a facilitator (which might be common in clinical settings). It would seem to be a good idea to include the actual providers of aids and home modifications in future technical applications for PDHA.\u003c/p\u003e \u003cp\u003eOnce it is clear that aids and modifications are needed, this could be discussed with all the stakeholders, and the rehabilitation technician could take steps to proceed. Even relevant stakeholders from the broader context of home modification remodeling, such as architects or builders, could be included early and start work. Moreover, it is important to involve relatives and patients in the process of providing aids and home modifications to meet the capabilities, needs and wishes (Harper et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Lo Bianco et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Despite the positive effects of the VR-based home visit on tailored advice, training and patient acceptance of recommendations, there were ongoing issues e.g. in aids provision after discharge. A tool incorporating the above-suggested elements of connecting stakeholders and focusing on aids provision could improve such outcomes.\u003c/p\u003e \u003cp\u003eIn the future, a large-scale study should investigate how the VR-PDHA affects the frequency with which PDHAs are performed in rehabilitation facilities and the amount of resources required (e.g. time, costs).\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe present study demonstrates the clinical feasibility of the ReTHo desktop application to perform VR PDHA. The system used goes beyond previously known functions of other applications for the purpose of home assessment.\u003c/p\u003e \u003cp\u003eIt interconnects the scan of the real patient\u0026rsquo;s home via mobile phone, data processing and structuring in the backend, manual data enrichment and structuring via the user interface, and measurement of rooms and objects in the 3D model of the virtual twin of the patient's home on screen or in VR with VR goggles. Administering the intervention was easy to integrate into daily clinical practice.\u003c/p\u003e \u003cp\u003eThus, the application helped therapists and patients by counseling on meaningful participation-oriented training goals as well as counseling on aids that fit into the home and necessary home modifications.\u003c/p\u003e \u003cp\u003eTo promote not only counseling but also the actual provision of aids and modifications to patients, other relevant stakeholders (primarily RTs and relatives) should be involved in the intervention design and processes.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCOPM: Canadian Occupational Performance Measure; HCP: healthcare professionals, OT: occupational therapist, PT: physical therapist, RT: rehabilitation technician, VR: virtual reality\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eThe study was planned, conducted and evaluated in accordance with the Good Clinical Practice Guidelines and the ethical principles of the Declaration of Helsinki (\u003cem\u003eWMA Declaration of Helsinki \u0026ndash; Ethical Principles for Medical Research Involving Human Subjects \u0026ndash; WMA \u0026ndash; the World Medical Association)\u003c/em\u003e. A study registration took place in a publicly accessible study register (DRKS) under the number DRKS00025836 before inclusion of the first study participant, and a vote of the ethics committee of Martin Luther University Halle-Wittenberg was obtained before the start of the study (processing number (2021-130 from August 8\u003csup\u003eth\u003c/sup\u003e 2021).\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eAll participants provided written consent for the publication of their anonymous data.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are available by contacting the corresponding author.\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eResearch reported in this publication was funded by the German Federal Ministry of Education and Research (BMBF), Funding code: 03WIR3103A. The funding body had no impact on the design of the study, collection, analysis and interpretation of data, or writing of the manuscript.\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; contributions\u003c/p\u003e\n\u003cp\u003eSS wrote the study protocol and supervised the intervention development and writing of this manuscript. UKH developed the logical intervention model, collected and analyzed the data used for intervention development and pilot study evaluation. The manuscript was prepared by UKH. All the authors have read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003eAcknowledgments\u003c/p\u003e\n\u003cp\u003eWe acknowledge the therapists of the Median Saale Rehabilitation Clinic Bad K\u0026ouml;sen II for the recruitment of the patients and the performance of the intervention. Furthermore, we would like to thank the IT-developer codemacher for their cooperative work. Furthermore, we thank the head of the institute Gabriele Meyer for her general support.\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; information\u003c/p\u003e\n\u003cp\u003eSS has a professorship as a physical therapist, and UKH is an occupational therapist and doctoral candidate.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eAoyama, H., \u0026amp; Aflatoony, L. (2021). Occupational Therapy Meets Design: An Augmented Reality Tool for Assistive Home Modifications. In \u003cem\u003eOzCHI \u0026rsquo;20, Proceedings of the 32nd Australian Conference on Human-Computer Interaction\u0026nbsp;\u003c/em\u003e(pp.\u0026nbsp;426\u0026ndash;436). Association for Computing Machinery. https://doi.org/10.1145/3441000.3441016\u003c/li\u003e\n \u003cli\u003eAtwal, A., McIntyre, A., Craik, C., \u0026amp; Hunt, J. (2008). 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Neuroscience\u003c/em\u003e, \u003cem\u003e6\u003c/em\u003e(4), 332\u0026ndash;339. https://doi.org/10.1038/nrn1651\u003c/li\u003e\n \u003cli\u003eSkivington, K., Matthews, L., Simpson, S. A., Craig, P., Baird, J., Blazeby, J. M., Boyd, K. A., Craig, N., French, D. P., McIntosh, E., Petticrew, M., Rycroft-Malone, J., White, M., \u0026amp; Moore, L. (2021). A new framework for developing and evaluating complex interventions: Update of Medical Research Council guidance. \u003cem\u003eBMJ (Clinical Research Ed.)\u003c/em\u003e, \u003cem\u003e374\u003c/em\u003e, n2061. https://doi.org/10.1136/bmj.n2061\u003c/li\u003e\n \u003cli\u003eThreapleton, K., Newberry, K., Sutton, G., Worthington, E., \u0026amp; Drummond, A. (2017). Virtually home: Exploring the potential of virtual reality to support patient discharge after stroke. \u003cem\u003eBritish Journal of Occupational Therapy\u003c/em\u003e, \u003cem\u003e80\u003c/em\u003e(2), 99\u0026ndash;107. https://doi.org/10.1177/0308022616657111\u003c/li\u003e\n \u003cli\u003eTong, A., Sainsbury, P., \u0026amp; Craig, J. (2007). Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. \u003cem\u003eInternational Journal for Quality in Health Care: Journal of the International Society for Quality in Health Care\u003c/em\u003e, \u003cem\u003e19\u003c/em\u003e(6), 349\u0026ndash;357. https://doi.org/10.1093/intqhc/mzm042\u003c/li\u003e\n \u003cli\u003eToolbox AI, I. \u003cem\u003eScaniverse-LiDAR 3D-Scanner\u003c/em\u003e. https://scaniverse.com/\u003c/li\u003e\n \u003cli\u003eTsai, C.‑Y., Miller, A. S., Huang, V., Escalon, M. X., \u0026amp; Bryce, T. N. (2019). The feasibility and usability of a mobile application for performing home evaluations. \u003cem\u003eSpinal Cord Series and Cases\u003c/em\u003e, \u003cem\u003e5\u003c/em\u003e, 76. https://doi.org/10.1038/s41394-019-0219-3\u003c/li\u003e\n \u003cli\u003eVenkatesh, V., \u0026amp; Hillol, B. (2008). Technology Acceptance Model 3 and a Research Agenda on Interventions. \u003cem\u003eDecision Sciences\u003c/em\u003e, \u003cem\u003e29\u003c/em\u003e(2), 273\u0026ndash;315.\u003c/li\u003e\n \u003cli\u003eWhitehead, P., Fellows, K., Sprigg, N., Walker, M., \u0026amp; Drummond, A. (2014). Who should have a pre-discharge home assessment visit after a stroke? A qualitative study of occupational therapists\u0026apos; views. \u003cem\u003eBritish Journal of Occupational Therapy\u003c/em\u003e, \u003cem\u003e77\u003c/em\u003e(8), 384\u0026ndash;391. https://doi.org/10.4276/030802214X14071472109752\u003c/li\u003e\n \u003cli\u003e\u003cem\u003eWMA Declaration of Helsinki \u0026ndash; Ethical Principles for Medical Research Involving Human Subjects \u0026ndash; WMA \u0026ndash; The World Medical Associatio\u003c/em\u003e\u003cem\u003en\u003c/em\u003e. https://www.wma.net/policies-post/wma-declaration-of-helsinki-ethical-principles-for-medical-research-involving-human-subjects/\u003c/li\u003e\n \u003cli\u003eWorld Health Organization. (2023). \u003cem\u003eRehabilitation\u003c/em\u003e. https://www.who.int/news-room/fact-sheets/detail/rehabilitation\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Pre-discharge home visit, home assessment, rehabilitation, participation, virtual reality, 3D imaging, digital healthcare","lastPublishedDoi":"10.21203/rs.3.rs-3787670/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3787670/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePre-discharge home assessments (PDHA) aim to identify environmental barriers to patients’ activities, to recommend and provide aids and home modifications and to assess activity performance within “real life conditions”. PDHA are time consuming. Virtual approaches might overcome these obstacles.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAim\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study aimed to develop a technical system (ReTho) supporting ward-based PDHA within the virtual twin of the real patients´ home and to evaluate the feasibility of the Virtual Reality (VR)-PDHA within clinical processes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eReTho was developed within 11 months involving users (workshops, pre-pilot testing, usability testing groups, interviews) to achieve usability and fit of the intervention to the context. ReTho comprised a smartphone-home scan, a data backend with interface to organize data and applications to measure the home as a 3D model on desktop and immersively in VR. Feasibility and acceptance of the intervention and feasibility of study processes were testet as single-arm study in an inpatient rehabilitation clinic.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTwelve patients (neurological diagnoses n=11, geriatric diagnosis n=1) received the intervention. The scan took between 40 and 90 minutes per patient. Per PDHA, on average 7.76 (SD 1.97) rooms were assessed. Therapy sessions took 43.67 (SD 10.52, range from 25 to 65) minutes in total. On average 12.42 (SD 5.02) recommendations per patient were given, and on average 36% (SD 21%) of them were ongoing two weeks after discharge. Data collection procedures were feasible with minor implications for improvement.\u003c/p\u003e\n\u003cp\u003eTherapists rated satisfaction in usability and usefulness of the tool overall as very good. ReTho had the potential to enable tailored recommendations and advice on home modifications/aids, to increase patients’ acceptance of recommendations and to improve activity goals. Information flow and communication within the discharge preparation process was not enhanced due to misssing interfaces between the system and the clinic IT. Performance and satisfaction with activities increased slightly after discharge (4.41 to 5.3 and 4.53 to 4.90). The fear of falling remained consistent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study demonstrates the clinical feasibility of ReTho. The system goes beyond functions of other previously known applications for PDHA. Further intervention development concerns the connection of process stakeholders in the rehabilitation context inside and outside the ward setting.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial Registration:\u003c/strong\u003e Study registration of the pilot study occurred prior to inclusion of the first study participant as DRKS00025836 in a publicly accessible study registry (German Clinical Trials Register).\u003c/p\u003e","manuscriptTitle":"Virtual reality-based pre-discharge home assessment (ReTHo) to improve participation-focused patient transition from rehabilitation to home: development and feasibility testing.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-20 08:59:24","doi":"10.21203/rs.3.rs-3787670/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"cf659852-3a63-4e43-91b1-9b3e2b119237","owner":[],"postedDate":"March 20th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-10-03T13:16:12+00:00","versionOfRecord":[],"versionCreatedAt":"2024-03-20 08:59:24","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3787670","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3787670","identity":"rs-3787670","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}