VR-READY: Qualitative co-production and intervention development

Context
Post intensive care syndrome (PICS) is common following a stay in an intensive care unit (ICU) and can be significantly debilitating. There are several well-described interventions used in ICU to prevent PICS, however there is no standardised approach post-discharge. The lack of adequate post-ICU rehabilitation has serious consequences for individuals and health services requiring research into alternative strategies to deliver therapeutic interventions to improve recovery. One potential method is using immersive virtual reality (VR) which has shown promise in a range of clinical areas.

Aim and Methods
This study aims to co-design an accessible and inclusive home-based VR-mediated intervention to aid recovery from critical illness. We ran a series of focus groups with survivors, family members and healthcare professionals. We facilitated creative elicitation tasks to map patient journeys, clinical pathways, and identify recovery and rehabilitation priorities and outcomes important to survivors. their family and healthcare professionals. We incorporated brokered dialogue between different stakeholder groups to clarify the character and range of differences in perspectives and seek consensus. We conducted thematic analysis feeding results into prototyping new VR content.

Results
We identified critical components underpinning recovery and facilitators and barriers affecting these. Key themes included self-motivation, goal-setting, realisation of illness severity, long-term physical and psychological sequelae, lack of support stepping down to ward then home, insufficient staff and resources, involvement of family. There was a high level of agreement between different stakeholders on challenges and priorities for recovery and brokered dialogue enabled validation of findings in an iterative process with participants throughout co-production.

Conclusions
The next phase of research will examine the feasibility and acceptability of a co-designed VR intervention in patients leaving ICU. If this intervention can help reduce the incidence or severity of PICS, benefits for individuals, families and health and social care services could be significant.