Patient satisfaction and tolerance of virtual reality rehabilitation in subacute ischemic stroke: a pilot study

Background Virtual reality (VR) rehabilitation represents a promising technological approach in post-stroke neurorehabilitation, offering immersive, engaging therapy environments. However, limited data exist on patient satisfaction and tolerance in clinical practice, particularly during the subacute phase of stroke recovery. Objective To evaluate patient satisfaction and tolerance of VR rehabilitation in patients with subacute ischemic stroke and assess physiotherapist perceptions of treatment outcomes compared to conventional rehabilitation. Methods A prospective pilot study was conducted from January 1, 2024, to December 31, 2024, at the Department of Neurology, University Hospital Ostrava, Czech Republic. Patients in the subacute phase of ischemic stroke (≤2 weeks post-stroke) underwent VR rehabilitation using the MDR-certified VR Vitalis® Pro system. Patient satisfaction was measured using the User Satisfaction Evaluation Questionnaire (USEQ) with individual question analysis. Physiotherapists assessed treatment outcomes on a 5-point scale compared to conventional rehabilitation. Vital signs were monitored pre- and post-intervention. Results Nineteen patients (mean age 67.7 ± 11.2 years, 52.6% female) completed VR rehabilitation. The mean USEQ satisfaction score was 25.0 ± 6.8 points (range 7–30). High satisfaction (≥25 points) was achieved in 68.4% of patients, with only 5.3% reporting low satisfaction (15 points). Individual question analysis revealed highest ratings for information clarity (4.63 ± 0.96) and perceived rehabilitation benefit (4.37 ± 1.12), with excellent tolerability as 63.2% reported no discomfort. Physiotherapists rated 31.6% of patients as showing better outcomes than expected with conventional therapy, while 52.6% showed similar outcomes and 15.8% showed worse outcomes. The mean number of VR sessions per patient was 4.2 ± 4.1. No serious adverse events were recorded. Conclusions VR rehabilitation demonstrated high patient satisfaction and excellent tolerance in subacute stroke patients. Individual USEQ analysis revealed particularly strong acceptance for system clarity and rehabilitation benefit. These findings support the feasibility and acceptability of VR rehabilitation in clinical stroke care.