A virtual reality-based vocational training system (VRVTS) for people with schizophrenia in vocational rehabilitation

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A virtual reality-based vocational training system (VRVTS) for people with schizophrenia in vocational rehabilitation


Author: Tsang, Mei-yi
Title: A virtual reality-based vocational training system (VRVTS) for people with schizophrenia in vocational rehabilitation
Degree: M.Phil.
Year: 2012
Subject: Vocational rehabilitation.
Schizophrenics -- Rehabilitation.
Virtual reality therapy.
Hong Kong Polytechnic University -- Dissertations
Department: Dept. of Rehabilitation Sciences
Pages: xvi, 133 leaves : col. ill. ; 30 cm.
Language: English
InnoPac Record: http://library.polyu.edu.hk/record=b2507349
URI: http://theses.lib.polyu.edu.hk/handle/200/6509
Abstract: Background: During the recovery journey in people with psychiatric disabilities, employment is one of the most indispensable and essential elements that provide people with a positive identity and hope. However, in Hong Kong, the employment rate for people with psychiatric disabilities is around 30%. Apart from the typical psychiatric symptoms, cognitive impairments in attention, memory and executive functioning were also suggested to slow down the progress in work rehabilitation. Minimizing the effects of these cognitive factors was thus hypothesized to improve work rehabilitation outcomes and ultimately employability in people with schizophrenia. The present study adopted theory-driven training strategies enhanced by the use of virtual reality (VR), a cutting-edge computer technology, as the intervention tool. Virtual reality has the advantage of providing a virtual work environment with the potential for infinite repetitions of the same work-skill training task. It also enables sensory presentations, task complexity and response requirements, and the nature and pattern of feedback can be easily modified according to patient impairments before they enter the more demanding and complicated real work environment. Aims and objectives: The study aimed to develop and evaluate the effectiveness of a new virtual reality-based vocational training system (VRVTS) through a randomized control trial (RCT). Methodology: A single-blinded, pre-test/post-test RCT was adopted for the study. A total of 75 in-patients with schizophrenia, aged 18-55 years and of both genders, who had received vocational workshop training in a local mental hospital, were recruited. They were randomly divided between each of a virtual reality-based training group (VRG, n=25), a therapist-administered group (TAG, n=25) and a control group (CG, n=25). Except for the CG, all patients in the training groups received a 5-week, 10-session, individualized vocational-based cognitive training program. The two training programs (virtual reality based or therapist administered) were similar in content and structure but different in their delivery modes. The primary outcomes measures included the Brief Neuropsychological Cognitive Examination (BNCE), the Digit Vigilance Test (DVT), the Rivermead Behavioural Memory Test (RBMT), the Wisconsin Card Sorting Test Computer Version 4 (WCST-CV4) and the Vocational Cognitive Rating Scale (VCRS). Other outcome measures included a self-designed work-related self-efficacy score and on-site tests that assessed the patients' work-related knowledge and skills. In addition, vocational outcomes such as job status were recorded after training and at the 1-month and 3-month follow-ups.
Date analysis and results: Descriptive statistics were used to present the demographic data of the recruited participants. Training effects in both VRG and TAG were further analyzed by comparing the pre-test and post-test scores of the outcome measures with those of the CG using repeated measures ANOVA. Univariate ANOVA was used to investigate the differences in post-test outcome measures between the three groups. A post-hoc comparison of Turkey’s Honestly Significant Difference (HSD) was used to compare group differences. The results of the present study showed that patients in the VRG were found to perform better than patients in the TAG and CG in executive functioning, as shown by the WCST-percentage of error (F (2, 72) = 7.146, p<0.001) and the WCST-percentage of conceptual level response (F (2, 72) = 8.722, p<0.001). The post-hoc test revealed that the patients in VRG showed a better performance than patients in both TAG (p=0.03) and CG (p<0.001) in the WCST-percentage of error. The VRG also showed a better performance than patients in both TAG (p=0.01) and CG (p<0.001) in the WCST-percentage of conceptual level response. Besides this, the VRG showed a better performance in the self-efficacy score compared to patients in the CG (p= 0.04). Both VRG (p= 0.03) and TAG (p<0.01) patients showed a better work performance after training, as reflected by the on-site tests. However, due to the maintained hospitalization status of patients during the study period, the vocational outcomes could not be effectively analyzed. Conclusion: Improvements in cognitive ability, the acquisition of work skills and self-efficacy were initially supported by the results of this study. Regarding cognitive aspects, VRVTS can enhance cognitive functioning, especially in the area of executive functioning in schizophrenia. Regarding the work aspect, VRVTS can enhance work skills, since the transfer of skills to the real environment was demonstrated. When work-related self-efficacy was considered, it was found that the percentage change in self-efficacy in VRG was significantly greater than in CG. Further studies on the use of VR in schizophrenia rehabilitation and for vocational success are discussed.

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