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The present study aims to develop and validate an evidence-based functional balance task library for Augmented Reality-Functional Integrated Training (AR-FIT), incorporating standardized real-object integration through expert consensus and pilot usability testing. Furthermore, the study seeks to determine the effects of AR-FIT on balance and functional mobility in stroke survivors in comparison to conventional Augmented Reality & task oriented training over an eight-week intervention period. In addition, it intends to evaluate participant motivation, engagement, and perceived task realism during AR-FIT using structured questionnaires and post-intervention interviews, thereby examining both clinical effectiveness and user-centered experience outcomes.
Stroke remains a leading cause of long-term disability, with its burden rising sharply in low- and middle-income countries such as Pakistan. Despite advances in acute care, many survivors continue to experience persistent balance and mobility impairments that limit independence. While augmented reality (AR) based rehabilitation has shown promise in improving motor recovery and engagement, current AR systems often emphasize generalized or gamified tasks, offering limited opportunities for practicing functionally relevant, real-world movements. Therefore, the current study introduces an Augmented Reality-Functional Interactive Training (AR-FIT), designed to evaluate the feasibility and effectiveness of combining AR-guided feedback with real-object manipulation for post-stroke balance training. The objectives are threefold: first, to determine the feasibility and usability of AR-FIT as a balance training platform; second, to assess its impact on postural control, balance, and functional mobility compared to conventional AR training; and third, to explore patient motivation and engagement associated with tangible, ecologically valid tasks. By enhancing realism, sensory engagement, and functional relevance, this approach is expected to bridge the existing gap between digital rehabilitation technologies and the real-world demands of stroke recovery.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| AR Functional Integrated Training (AR-FIT) Group | Experimental | In Augmented Reality-Functional Integrated Training (AR-FIT) Group, participants will perform structured functional balance tasks integrating augmented reality with standardized real objects (e.g., chair, step, cup, basket, Swiss ball). Exercises will target lower limb motor control, dynamic balance, trunk stability, and task-oriented mobility. The task library will consist of progressively graded functional balance tasks. |
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| AR Generic Balance Training (AR-GBT) Group | Active Comparator | In the AR- based Generic AR Balance Training Group, participants will undergo augmented reality-based balance training without real-object integration. The intervention will include AR-guided weight shifting, virtual stepping, diagonal reaching, trunk control tasks, and tool-based stability exercises (e.g., virtual ball reaching, wobble-board simulations). Exercises will be selected from a structured pool of balance and mobility activities and will be progressed through virtual task difficulty, speed modulation, range of motion, and repetition parameters tailored to the participant's functional level. |
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| Conventional Balance Training (CBT) Group | Active Comparator | In the Conventional Training Group, participants will receive therapist-guided task-oriented balance training based on standard neurorehabilitation principles. Exercises will include sit-to-stand practice, stepping and step-up training, weight shifting, lunges, trunk rotation, reaching activities, and functional mobility drills using real objects without augmented reality support. Task selection and progression will be individualized according to the participant's baseline motor function and clinical progress, with adjustments made in task complexity, repetitions, external support, and environmental challenge. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Augmented Reality-Functional Integrated Training (AR-FIT) Group | Other | Each participant will receive a standardized intervention program consisting of 24 supervised training sessions delivered over 8 consecutive weeks (3 sessions per week, approximately 45 minutes per session). All sessions will follow a structured format including a 5-7 minute warm-up phase, a 30-35 minute task-specific training phase, and a 5-6 minute cool-down period. In Augmented Reality-Functional Integrated Training (AR-FIT) Group, participants will perform structured functional balance tasks integrating augmented reality with standardized real objects (e.g., chair, step, cup, basket, Swiss ball). Exercises will target lower limb motor control, dynamic balance, trunk stability, and task-oriented mobility. The task library will consist of progressively graded functional balance tasks. |
| Measure | Description | Time Frame |
|---|---|---|
| Berg Balance Scale (BBS) | The Berg Balance Scale (BBS) is a widely used performance-based clinical measure for assessing functional balance in individuals with neurological conditions, including stroke. It consists of 14 tasks that evaluate static and dynamic balance abilities during common functional activities such as sitting, standing, reaching, turning, and transfers. Each item is scored on a 5-point ordinal scale ranging from 0 (unable to perform) to 4 (independent performance), with a maximum total score of 56 indicating better balance performance. The BBS demonstrates strong validity and high inter-rater and test-retest reliability and is commonly used to assess balance impairment and monitor rehabilitation outcomes in stroke populations. | Baseline-4 Weeks-8 Week-3 Months Follow Up |
| Timed Up & Go (TUG) | The Timed Up and Go Test (TUG) is a simple and widely used clinical test for assessing functional mobility and dynamic balance. The test measures the time (in seconds) required for an individual to stand up from a chair, walk 3 meters, turn around, walk back to the chair, and sit down. Shorter completion times indicate better functional mobility. Typical interpretation suggests that <10 seconds represents normal mobility, 10-20 seconds indicates variable mobility, and ≥14 seconds is commonly considered a threshold for increased fall risk in individuals with stroke. The TUG has demonstrated strong test-retest and inter-rater reliability in stroke populations and is frequently used in rehabilitation research to evaluate mobility and fall risk. Instrumented versions of the TUG (iTUG) have also shown improved predictive capabilities and good psychometric properties. | Baseline-4 Weeks-8 Week-3 Months Follow Up |
| Balance Evaluation Systems Test (Mini-BESTest) | The Mini-BESTest (Mini Balance Evaluation Systems Test) is a performance-based clinical assessment used to evaluate dynamic balance and postural control. It assesses four key balance control systems: anticipatory postural adjustments, reactive postural control, sensory orientation, and dynamic gait. The test consists of 14 items scored on a 3-point ordinal scale (0-2), with a maximum score of 28 indicating better balance performance. The Mini-BESTest has demonstrated good construct validity and excellent inter-rater and test-retest reliability in individuals with neurological conditions, including stroke, and is widely used to assess balance impairments and monitor rehabilitation outcomes. |
| Measure | Description | Time Frame |
|---|---|---|
| User Engagement Questionnaire (UEQ) | The User Engagement Questionnaire (UEQ) is a standardized self-report instrument used to assess user engagement and overall user experience with interactive systems and digital applications. The questionnaire evaluates multiple dimensions of engagement, including usability, attractiveness, efficiency, stimulation, and novelty of the system. Items are rated on a Likert-type scale, and scores are analyzed to determine users' perceived satisfaction, motivation, and interaction quality with the technology. The UEQ has been widely used in digital health and rehabilitation technology research to evaluate user acceptance, engagement, and usability of technology-based interventions. |
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Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Arshad Nawaz Malik, PhD Rehab | Contact | 03334503754 | arshad.nawaz@riphah.edu.pk |
| Name | Affiliation | Role |
|---|---|---|
| Abrish Habib Abbasi, Phd* Rehab | Riphah International Unversity | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Railway General Hospital, Rawalpindi | Rawalpindi | Punjab Province | 44000 | Pakistan |
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| Augmented Reality-Generic Balance Training (GBT) Group | Other | In the AR- based Generic AR Balance Training Group, participants will undergo augmented reality-based balance training without real-object integration. The intervention will include AR-guided weight shifting, virtual stepping, diagonal reaching, trunk control tasks, and tool-based stability exercises (e.g., virtual ball reaching, wobble-board simulations). Exercises will be selected from a structured pool of balance and mobility activities and will be progressed through virtual task difficulty, speed modulation, range of motion, and repetition parameters tailored to the participant's functional level. |
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| Conventional Balance Training (CBT) Group | Other | In the Conventional Training Group, participants will receive therapist-guided task-oriented balance training based on standard neurorehabilitation principles. Exercises will include sit-to-stand practice, stepping and step-up training, weight shifting, lunges, trunk rotation, reaching activities, and functional mobility drills using real objects without augmented reality support. Task selection and progression will be individualized according to the participant's baseline motor function and clinical progress, with adjustments made in task complexity, repetitions, external support, and environmental challenge. |
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| Baseline-4 Weeks-8 Week-3 Months Follow Up |
| FUGL Meyer (Lower limb) | The Lower Extremity component of the Fugl-Meyer Assessment Lower Extremity (FMA-LE) is a stroke-specific, performance-based clinical assessment used to evaluate motor recovery of the lower limb following stroke. It measures key domains including voluntary movement within and out of synergy patterns, coordination, and reflex activity. The scale consists of multiple items scored on a 3-point ordinal scale (0 = cannot perform, 1 = performs partially, 2 = performs fully), with a maximum score of 34 indicating better lower extremity motor function. The instrument demonstrates strong construct validity and excellent reliability (r ≈ 0.99) for assessing post-stroke motor impairment and is widely used in clinical and research settings to monitor motor recovery and treatment outcomes. | Baseline-4 Weeks-8 Week-3 Months Follow Up |
| 8 Weeks |
| Stroke Impact Scale (SIS v3.0) | The Stroke Impact Scale is a stroke-specific, patient-reported outcome measure used to assess the multidimensional impact of stroke on health-related quality of life. The instrument evaluates eight domains including strength, hand function, mobility, activities of daily living (ADL/IADL), memory and thinking, communication, emotion, and participation. Items are rated on a 5-point Likert scale, with scores transformed to a 0-100 scale, where higher scores indicate better perceived function and quality of life. The SIS v3.0 has demonstrated strong validity, responsiveness, and high reliability in individuals with stroke and is widely used in clinical research to evaluate patient-centered outcomes following rehabilitation interventions. | Baseline-4 Weeks-8 Week-3 Months Follow Up |
| ID | Term |
|---|---|
| D020521 | Stroke |
| ID | Term |
|---|---|
| D002561 | Cerebrovascular Disorders |
| D001927 | Brain Diseases |
| D002493 | Central Nervous System Diseases |
| D009422 | Nervous System Diseases |
| D014652 | Vascular Diseases |
| D002318 | Cardiovascular Diseases |
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| ID | Term |
|---|---|
| D044382 | Population Groups |
| ID | Term |
|---|---|
| D003710 | Demography |
| D011154 | Population Characteristics |
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