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

If you're not measuring satisfaction against 100% recovery you're using the tyranny of low expectations to disguise the fact YOU'RE A COMPLETTE FUCKING FAILURE AT STROKE RECOVERY!

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

Sarka Banikova^1,2,3Alice Najsrova²István Szegedi^2,4,5Kateřina Vitová¹Iva Fiedorová^1,3Jana Trdá⁶Ondrej Volny^2,4*

• ¹Department of Rehabilitation and Sports Medicine, University Hospital Ostrava, Ostrava, Czechia
• ²Centre for Clinical Neurosciences, Faculty of Medicine, University of Ostrava, Ostrava, Czechia
• ³Department of Rehabilitation and Sports Medicine, Faculty of Medicine, University of Ostrava, Ostrava, Czechia
• ⁴Department of Neurology, University Hospital Ostrava, Ostrava, Czechia
• ⁵Department of Neurology, University of Debrecen, Debrecen, Debrecen, Hungary
• ⁶VR LIFE Ltd., Ostrava, Czechia

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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-December 31, 2024, at 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). 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. Individual question analysis revealed highest ratings for information clarity (4.63 ± 0.96) and perceived rehabilitation benefit (4.37 ± 1.12), with 63.2% reporting no discomfort. Physiotherapists rated 31.6% of patients as showing better outcomes than expected with conventional therapy, while 52.6% showed similar outcomes. No serious adverse events were recorded. Conclusions: VR rehabilitation demonstrated high patient satisfaction and excellent tolerance in subacute stroke patients. Individual USEQ analysis revealed strong acceptance for system clarity and rehabilitation benefit. These findings support VR rehabilitation feasibility in clinical stroke care.

Keywords: virtual reality, stroke rehabilitation, Patient Satisfaction, Neurorehabilitation, subacute stroke

Received: 06 Jul 2025; Accepted: 31 Jul 2025.

Copyright: © 2025 Banikova, Najsrova, Szegedi, Vitová, Fiedorová, Trdá and Volny. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Ondrej Volny, Centre for Clinical Neurosciences, Faculty of Medicine, University of Ostrava, Ostrava, Czechia

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Implementing a Neurohospitalist Program Improves Stroke Care Metrics and Patient Satisfaction Scores

 You're measuring things wrong if patient satisfaction increased without getting to 100% recovery. You're biasing your patients by suggesting the tyranny of low expectations.  Measuring 'CARE' rather than results should be a  fireable offense. We get crapola like this because there is NO STROKE LEADERSHIP!

Implementing a Neurohospitalist Program Improves Stroke Care Metrics and Patient Satisfaction Scores

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Renée E. Pierre-Louis, PhD, MBA, MA, CHRC, ACRP-CP, Kelly Pannikodu, Maher Madhoun, MD, MMM,

First Published February 11, 2022 Research Article 

https://doi.org/10.1177/19418744211069272

Article information

Abstract

Objective

Compare the differences in health outcomes and patient satisfaction between a neurohospitalist model of care and a community-based neurologists model at a single community-based teaching hospital among in-patients diagnosed with a cerebrovascular accident (CVA).

Methods

Data was collected from the Stamford Hospital’s electronic medical records system. An assessment of patient health outcomes and satisfaction scores was conducted, comparing both discrete and continuous variables between the two time periods. An omnibus P-value of 0.05 (P < 0.05) was considered statistically significant.

Results

The sample consisted of 341 patients between the two periods, pre-period n = 168 (49.3%) post-period n = 173 (50.7%). Door to lab and door to tPA times decreased significantly between pre- and post-periods (P = 0.003 and P = 0.002, respectively) as did the number of MRIs (P < 0.001). In addition, statistically significant increases were found between pre-period and post-period percentages, all increasing over time: stroke education (P < 0.001), discharged on anticoagulant medication (P < 0.001), and discharged on anti-thrombolytic medication (P = 0.019). Patient satisfaction scores demonstrated mean gain across both periods for five of six items. Two items “Doctor’s Concern of my Questions/Worries” and “Skill of Doctors” demonstrated statistical significance (P = 0.020 and P = 0.029, respectively).

Conclusions

The introduction of a neurohospitalist service at a community-based teaching hospital improved patient health outcomes on time to intervention, stroke education, discharge medications as well as patient satisfaction. Therefore, it may be beneficial for hospitals to implement a neurohospitalist model of care for their patients presenting with CVA.

Keywords

Neurohospitalist, Quality Metrics, Door-to-Needle, Stroke, Outcomes Research

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Implementing a Neurohospitalist Program Improves Stroke Care Metrics and Patient Satisfaction Scores

But you blithering idiots aren't measuring 100% recovery metrics, so you don't give a shit about complete survivor recovery.   Without 100% recovery your patient satisfaction has to be zero, unless you are tipping the scale by biasing survivor responses by invoking your tyranny of low expectations.

Implementing a Neurohospitalist Program Improves Stroke Care Metrics and Patient Satisfaction Scores

 

Show all authors

Renée E. Pierre-Louis, PhD, MBA, MA, CHRC, ACRP-CP, Kelly Pannikodu, Maher Madhoun, MD, MMM,

First Published February 11, 2022 Research Article 

https://doi.org/10.1177/19418744211069272

Article information

Abstract

Objective

Compare the differences in health outcomes and patient satisfaction between a neurohospitalist model of care and a community-based neurologists model at a single community-based teaching hospital among in-patients diagnosed with a cerebrovascular accident (CVA).

Methods

Data was collected from the Stamford Hospital’s electronic medical records system. An assessment of patient health outcomes and satisfaction scores was conducted, comparing both discrete and continuous variables between the two time periods. An omnibus P-value of 0.05 (P < 0.05) was considered statistically significant.

Results

The sample consisted of 341 patients between the two periods, pre-period n = 168 (49.3%) post-period n = 173 (50.7%). Door to lab and door to tPA times decreased significantly between pre- and post-periods (P = 0.003 and P = 0.002, respectively) as did the number of MRIs (P < 0.001). In addition, statistically significant increases were found between pre-period and post-period percentages, all increasing over time: stroke education (P < 0.001), discharged on anticoagulant medication (P < 0.001), and discharged on anti-thrombolytic medication (P = 0.019). Patient satisfaction scores demonstrated mean gain across both periods for five of six items. Two items “Doctor’s Concern of my Questions/Worries” and “Skill of Doctors” demonstrated statistical significance (P = 0.020 and P = 0.029, respectively).

Conclusions

The introduction of a neurohospitalist service at a community-based teaching hospital improved patient health outcomes on time to intervention, stroke education, discharge medications as well as patient satisfaction. Therefore, it may be beneficial for hospitals to implement a neurohospitalist model of care for their patients presenting with CVA.

Keywords

Neurohospitalist, Quality Metrics, Door-to-Needle, Stroke, Outcomes Research

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ClarkeHopkinsClarke's biophilic design at the heart of new stroke unit

How can you get to 90% satisfaction when you never discuss 100% patient recovery? Unless of course you have bamboozled patients into accepting the tyranny of low expectations. 

ClarkeHopkinsClarke's biophilic design at the heart of new stroke unit

Several design features based on biophilic principles have been incorporated into the new Stroke and Neurology Unit at the Royal Melbourne Hospital to support patient recovery.
Stroke is one of Australia’s major causes of death and disability, which is why an exciting new treatment called Endovascular Clot Retrieval (ECR) offered exclusively at the Royal Melbourne Hospital, is making news with its ground-breaking impact on patient outcomes.
ECR is a time-critical, technically challenging, high-intervention rehabilitation treatment that starts within 24 hours of clot removal, restoring the patient’s blood flow and getting short-term, high-needs patients up and active early.
Designed by ClarkeHopkinsClarke Architects, Royal Melbourne Hospital’s bespoke Stroke and Neurology Unit uses biophilic design features such as abundant natural light, soft curved forms, timber joinery and rug-like flooring, serene blue and warm grey seating upholstery and feature walls, and cosy nooks where staff, patients and visitors can interact and clinicians can observe incidental rehab activities or write up clinical notes.
According to project architect Nicholas Simmonds, the resulting calming, informal interior with elements of home naturally supports brain stimulation, physical activity and social connectivity.
“The environment needs to strike just the right balance in terms of stimulation,” says Simmonds. “If a stroke patient is over-stimulated that can send them into stroke again.”
Some of the design highlights of the new Stroke Unit include patient rooms located around the outside of the unit to capture natural light; previously decentralised rehabilitation services and new clinical and caregiver support facilities accomodated in a central hub; rooms and rehab linked by a wide circular walkway dubbed ‘The Racetrack’; and operable glazed walls and windows in High-Dependency Unit bedrooms switchable from clear to opaque when privacy is required.
The Racetrack is designed to create a light-filled, sociable space lined with deliberately non-clinical upholstered timber joinery seating. This space is very popular among staff, patients and visitors for all kinds of interactions, family visits and incidental rehabilitation.
The Racetrack gives staff clear sight lines and subtle wall - and floor-markers to help unobtrusively monitor patients’ progress, says ClarkeHopkinsClarke heath partner Justin Littlefield.
“Initially a patient might get up from a room opposite and just walk across the corridor. Later they might take shortcuts through the middle - there’s another seat on the opposite side of this central zone, so there’s another 20 steps or so that gets them to the next spot. Eventually they might go for a whole loop of one of these ends, which all vary in distance. We actually had a lot of fun designing for these changing needs.”
The design improves links to other departments, introduces teaching, training and research facilities that support patient care and staff development, and includes a higher proportion of single-bed patient rooms.
Commenting on the ‘massive’ impact of the design on patient recovery, RMH director of Neurology and head of the new Stroke Unit Professor Mark Parsons says, “We’re seeing patient satisfaction surveys of over 90 percent each month, and more stroke patients being discharged directly home who would previously have had to go on to rehabilitation. For the same length of stay patients have a much better level of function than they did previously. They’re able to go home and look after themselves rather than need further rehabilitation to get them to an independent level.”
According to Parsons, higher patient satisfaction and better recovery outcomes are producing huge savings for the hospital and the broader community.
“If you save one stroke patient from going to a nursing home you’re saving the community around $200,000 in the first year and $100,000 thereafter.”

Factors Influencing the Overall Satisfaction in Patients With Severe Brain Injury With Physiotherapy Services During Inpatient Rehabilitation

The only way brain injury patients can be 'satisfied' with their recovery is because the medical staff set them up with the tyranny of low expectations.  The goal is 100% recovery, NOT whatever minimal crap your doctor and therapists expect. Screaming at them will be required to get them out of their comfort zones.
http://europepmc.org/abstract/med/29271787

(PMID:29271787)

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Leung J ¹ , 

Fereday S , 

Sticpewich B , 

Stroud K  

Affiliations

The Journal of Head Trauma Rehabilitation [21 Dec 2017]

Type: Journal Article
DOI: 10.1097/HTR.0000000000000364

Abstract

To determine what influences the satisfaction of rehabilitation inpatients and their relatives with physiotherapy after severe traumatic brain injury.A prospective purpose-designed survey of consecutive eligible patients discharged from a metropolitan brain injury unit.A total of 65 patients with severe traumatic brain injury and 32 relatives.The vast majority of patients (99%) and relatives (97%) reported being "satisfied" or "highly satisfied" with the service. Patients' overall satisfaction was influenced by the extent of actual and perceived improvement, satisfaction with certain aspects of service delivery, and quality of interaction with physiotherapy staff. Satisfaction with the amount of therapy was the key determinant for patients' overall satisfaction, whereas relatives' overall satisfaction was influenced primarily by how well they felt they were listened to by physiotherapy staff.The high satisfaction of the patients and relatives suggests that our brain injury unit provides physiotherapy that meets their expectations. Promoting recovery, providing high-quality care, and ensuring good interaction are ways to maintain high satisfaction of patients and relatives with the service. In addition, staff may have to pay particular attention to patients' satisfaction with the amount of therapy and ensure that relatives' needs are listened to.

Read Article at publisher's site

[Evaluation of patient satisfaction after stroke rehabilitation program. Validation study for the Spanish version of the Satisfaction Pound Scale]

Since only 10% of patients almost fully recover you should have a 90% dissatisfaction rate, or you are not measuring correctly or biasing the results.
https://www.ncbi.nlm.nih.gov/pubmed/27743593

[Article in Spanish]

Aguirrezabal Juaristi A¹, Ferrer Fores M², Marco Navarro E³, Mojal García S², Vilagut Saiz G², Duarte Oller E³.

Author information

Abstract

BACKGROUND AND OBJECTIVE:

The Satisfaction Pound Scale is a specific questionnaire to evaluate satisfaction with the rehabilitation program after a stroke. The aim of this study was to adapt this scale to Spanish and to evaluate its metric characteristics.

METHOD:

The adaptation included translation and back-translation methods. Metric characteristics were evaluated in 74 patients, all of whom were administered the Satisfaction Pound Scale and the Short Form 36 (SF-36). The statistical model was tested by confirmatory factor analysis (CFA). Reliability was determined through Cronbach alpha coefficient and a test-retest procedure. Construct validity was assessed by means of correlations between the satisfaction scale and the SF-36.

RESULTS:

Adjustment indicators in the CFA were very good. Reproducibility test showed correlations higher than 0.85, and all correlations between SF-36 dimensions and the satisfaction scale were lower than 0.2, in accordance with the hypotheses raised.

CONCLUSIONS:

The Spanish version of the Satisfaction Pounds Scale is reliable and valid, therefore it is a useful tool to assess satisfaction with the post-stroke rehabilitation program in our area.

Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

KEYWORDS:

Cuestionario; Estudio de validación; Ictus; Patient satisfaction; Questionnaire; Rehabilitación; Rehabilitation; Satisfacción del paciente; Stroke; Validation studies

PMID:

27743593

DOI:

10.1016/j.medcli.2016.07.021

Understanding the doublings - applied to stroke

Stroke patient satisfaction is going to be very very hard to accomplish. This Seth  Godin post explains why, stroke rehab hasn't even reached the starting point of pleasing 90% of your customers.  The goal has to be 100% recovery, not this crap of compensating for everything.

Understanding the doublings 

If you seek to please 90% of your potential customers, all you need to do is the usual thing.
To please half the remaining potential market, you're going to need to work at least twice as hard.
And to please the next half, twice as hard again. It's Zeno's paradox, an endless road to getting to the end.
So, a letter with a stamp gets you on time deliverability 90% of the time.
Priority mail gets you the next 5%, and if you want to be sure of reaching just about everyone in a trackable, reliable way, you're going to have to step up and pay for a courier service. (And note the expensive part... you often don't know which people need to be couriered, so you have to pay to do it for everyone).
The rules apply to more than fulfillment. They apply to bedside manner, to customer service, to effort and originality in the kitchen as well.
Cheap food, quickly served, will please 90% of the audience. You'll have to invest in quality, preparation and service to get the next half, and then double it again for the half after that... etc.
Health care works the same way. 90% of the patients will respond to a treatment, but the next 5% will cost twice as much, and on and on...
The very end of the curve, the .5%, might be unpleasable, uncurable, unreachable without insane effort. Which is why organizations that please everyone are so extraordinarily rare.
One approach, which some organizations use, is to redefine your usual systems so you are able to please most people without your team going through a Herculean sprint every day, and then (this is a key element as well), eagerly and regularly apologizing and giving refunds to the one in 150 where it just can't be done. Hell, our stroke professionals would have to apologize 90% of the time. You can't refund your loss of functionality. Money means nothing.
Perfect is nice, but you can't afford it. None of us can.

 

Satisfaction with care and rehabilitation among people with stroke, from hospital to community care

Why would you expect satisfaction when only 10% fully recover? And having rehab performed by a professional doesn't mean anything when they still don't know what they are doing.
The conclusion is wrong, you need to stop the neuronal cascade of death resulting is much less disability. They can't think outside their own silo.
http://onlinelibrary.wiley.com/doi/10.1111/scs.12116/abstract;jsessionid=20D81ED08D41E6B1BCC06E1CA1A6F803.f04t03?deniedAccessCustomisedMessage=&userIsAuthenticated=false

1. Helena Tholin MSc, RPT Physiotherapy Supervisor^1,2,*,
2. Anette Forsberg PhD, RPT Lecturer^1,3

Article first published online: 5 FEB 2014

DOI: 10.1111/scs.12116

© 2014 Nordic College of Caring Science

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Scandinavian Journal of Caring Sciences

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Keywords:

• stroke;
• quality of care;
• rehabilitation;
• patient participation;
• qualitative approaches;
• research in practice

Background

Despite recent improvements in Swedish stroke care some patients still experience a lack of support and follow-up after discharge from hospital. In order to provide good care according to the National Board of Health and Welfare, systematic evaluations of stroke care must be performed. Quality indicators in the national guidelines could be useful when measuring quality of care in all parts of the stroke care chain.

Aim

To investigate how people with stroke experienced their care, rehabilitation, support, and participation from hospital to community care.

Method

Qualitative interviews were performed with 11 people in 2009–2010 covering their experiences of care, rehabilitation, support, and participation. The interviews were analysed with qualitative content analysis.

Result

The interviewees were satisfied with their hospital care, but reported both positive and negative experiences of the continuing care. Most of them appreciated intense, specific, and professional rehabilitation, and had experienced these qualities in the rehabilitation they received in most parts of the stroke care chain. Those who received support from the community services expressed satisfaction with the staff, but also felt that autonomy was lost. Several did not feel involved in the health care planning, but instead relied on the judgement of the staff.

Conclusion

To ensure high quality throughout the whole stroke care chain, people with stroke must be invited to participate in the care and the planning of care. To offer evidence-based stroke rehabilitation, it is important that the rehabilitation is specific, intense, and performed by professionals, regardless of where the rehabilitation is performed. A changed view of the patient's autonomy in residential community services should be developed, and this process must start from the staff and residents.

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Just say no to linking patient satisfaction with dollars

I would have to disagree with these  doctors. How the hell are newer and better practices going to make it into clinical practice?  Something needs to be tried, especially in stroke rehab. My doctor should have not received any payment. It doesn't take much training to write a prescription of ET(Evaluate and Treat) to speech, physical and occupational therapists.

This is where if no goal/objectives are set at the beginning of the relationship/project you will never know when you have objectively met those requirements. I know this is the businessperson in me talking but I would like to have such a discussion when I start any relationship with my medical staff. None of my medical staff has ever asked what my goals are and for that reason would fail any satisfaction question.
Just say no to linking patient satisfaction with dollars

 U.S. Ties Hospital Payments to Making Patients Happy

Patient satisfaction: When a doctor’s judgment risks a poor rating

How patient satisfaction can kill