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Inclusion rate too low.
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Blunt chest trauma comprises over 10% of all trauma patients presenting to emergency departments worldwide and is the most frequent injury in polytrauma patients. It is associated with high risk (>10%) of pulmonary complications such as pneumonia. Pillars of treatment are adequate pain relief, respiratory function exercises and rapid mobilisation through physiotherapy. Inadequate pain control can result in restricted ventilatory function and in reduced mobility, both resulting in a higher risk of particularly pulmonary complications. Virtual Reality (VR) might be an easy to use, individualized, and harmless technique that can facilitate pulmonary recovery and aid in the prevention of complications through reducing pain and promoting exercising. The investigators hypothesize that VR improves respiratory function and mobilisation in the post-acute phase of blunt chest trauma by distracting patients from pain and stress, and by stimulating pulmonary and physical exercise.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Control | No Intervention | The control group will receive usual care. Patients will be instructed to perform respiratory exercises 8 times daily for 10 minutes and to extend these exercises 2 times daily with (sitting) physical exercises for an additional 10 minutes. Respiratory exercises include using incentive spirometry and exercises for deep breathing, huffing and coughing. Patients receive a leaflet with the exercises described and the exercises will be performed once daily under supervision of a physiotherapist. The other sessions will be unsupervised. | |
| Virtual Reality | Experimental | The intervention group will be instructed to perform the respiratory exercises using the VR-intervention 8 times daily for 10 minutes and to extend these exercises 2 times daily with (sitting) physical exercises for an additional 10 minutes. The respiratory exercises in VR are comparable to the exercises in usual care but performed in a virtual environment and without incentive spirometry. The physical exercises consist of several games through which patients are challenged to reach out to objects while engaging their core. Patients are allowed to continue these exercises or play some relaxation games for up to 30 minutes per session in total. The exercises will be performed once daily under supervision of a physiotherapist. The other sessions will be unsupervised. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Virtual Reality | Device | For all VR exercises a head mounted display (HMD), the PICO G2 4K (Barcelona, Spain) will be used. Together with SyncVRMedical (Utrecht, Netherlands) a VR dashboard has been created from which patients can chose the different exercises. |
| Measure | Description | Time Frame |
|---|---|---|
| Inspiration volume, mean change from baseline | Mean change from baseline in inspiration volume in ml, measured with an incentive spirometer (Voldyne) | From baseline to end of treatment at day 5. |
| Inspiration volume, repeated measures over 5 days | change in mean daily inspiration volume in mL, measured with an incentive spirometer (Voldyne) | Twice daily from enrollment to day 5 of treatment |
| Measure | Description | Time Frame |
|---|---|---|
| Time spent sitting or standing, mean change from baseline | Measured continuously using a wearable activity monitor, calculated as percentage of time spent sitting or standing. | Continuously from enrollment to end of treatment at day 5. |
| Length of hospital stay |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Radboud university medical center | Nijmegen | Gelderland | 6525 GA | Netherlands |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 39652866 | Derived | Groenveld TD, Smits IG, Scholten N, de Vries M, van Goor H, Stirler VM. Pulmonary and Physical Virtual Reality Exercises for Patients With Blunt Chest Trauma: Randomized Clinical Trial. JMIR Serious Games. 2024 Dec 9;12:e54389. doi: 10.2196/54389. |
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Non-identifiable patient characteristics, questionnaire data, diaries and measurements will be shared in a pseudonimised manner in DANS EASY under restricted access
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| ID | Term |
|---|---|
| D014947 | Wounds and Injuries |
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Length of hospital stay in days |
| At end of follow-up, 30 days after discharge |
| Pulmonary complications during admission | Number and type of pulmonary complications during admission | At end of follow-up, 30 days after discharge |
| Transfers to ICU | Participant transferred to ICU during admission yes/no? | At end of follow-up, 30 days after discharge |
| Readmission within 30 days | Participant readmitted within 30 days, yes/no | At end of follow-up, 30 days after discharge |
| Pain score during breathing exercise using Visual Analogue Score (VAS) | VAS pain score during breathing exercise (0-100mm). A higher score means a worse outcome. | Daily from baseline to end of treatment at day 5. |
| Powerless in Daily living questionnaire | Powerless in Daily living questionnaire (0-21), a higher score means a worse outcome. | Daily from baseline to end of treatment at day 5. |
| Quality of Recovery-15 questionnaire | Quality of Recovery-15 questionnaire (0-150), a higher score means a better outcome. | Daily from baseline to end of treatment at day 5. |