Feasibility of a culturally adapted virtual reality cognitive rehabilitation program (COVERT) delivered via a hybrid model for stroke survivors in Singapore: A pilot study

Abstract

Virtual reality (VR) is an emerging modality for cognitive rehabilitation, but evidence in Singapore is limited. This pilot study examined the feasibility and preliminary effectiveness of a localized cognitive VR-based training program (COVERT) for individuals with post-stroke cognitive impairment, delivered using a hybrid model. Nine participants (mean age = 54.0, SD = 10.0) were recruited from Hospital A and Hospital B over 19 months. Participants completed a 4-week VR program through tele-rehabilitation and conventional therapy. This single-arm feasibility pilot study assessed feasibility, cognitive function (Montreal Cognitive Assessment, Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), Trail Making Test (TMT)), health-related quality of life (EuroQol Five-Dimension Questionnaire), usability (System Usability Scale), and motivation (Intrinsic Motivation Inventory, Virtual Reality Neuroscience Questionnaire). Feasibility was high with 100% retention. RBANS total scores improved significantly (73.4–78.9, p  = 0.020), with all participants showing delayed memory gains. Processing speed improved (TMT-A) and there was a trend toward better executive function (TMT-B). EuroQuol-5D scores increased. Usability was moderate and declined with age, while motivation remained high. Recruitment was challenging. VR-based cognitive rehabilitation delivered through an experienced occupational therapy-led hybrid model is feasible and potentially effective for post-stroke cognitive impairment in Singapore. Larger trials are warranted to establish efficacy.