A multimodal group-based immersive virtual reality intervention for improving cognition and mental health in patients with post-covid-19 condition: A quasi-experimental design study. (Preprint)

Abstract

Adults with Post-COVID-19 Condition (PCC) may show cognitive impairments in attention, processing speed, memory, and executive function. Multimodal programs that combine cognitive training, physical activity and emotional tasks, such as mindfulness-based interventions (MBIs), may be a suitable alternative for improving PCC treatments. Immersive Virtual Reality (IVR) is a promising technology that can enhance traditional cognitive training, physical activity, and MBIs. The use of IVR technology may increase engagement with these interventions and potentially enhance the individual benefits of cognitive training, exercise and MBI.

The current study aims to evaluate the impact of a multimodal IVR intervention compared to a usual care control group to assess changes in cognition and mental health in adults with PCC. We also aim to assess user experience factors such as enjoyment, perceived improvement and fatigue following each multimodal IVR session within the experimental group.

Thirty-one participants with PCC symptoms were assigned to either the experimental group (IVR, n=15) or the control group (usual care, n=16) in a quasi-experimental design study. The multimodal IVR intervention consisted of MBI, cognitive training and physical exercise and was delivered in a 60-minute group session with 5 participants, twice a week for 8 weeks (16 sessions). Measures of global cognition, attention, processing speed, verbal episodic memory and subjective memory complaints (primary measures), and depressive and anxiety symptoms and fatigue (secondary measures) were assessed at baseline and after 8 weeks (post-intervention).

Mixed between-group (group) and within-group (pre-post assessments) ANOVAs revealed significant group*time interactions in global cognition, simple attention, processing speed, memory and depressive symptoms, with large effect sizes (P<.05; partial η2 > .14). There were marginally significant group*time interactions for executive function (P =.05) and selective attention (P =.059). Follow-up analyses comparing pre- and post-intervention outcomes for each group separately showed that the experimental group significantly improved in global cognition, processing speed, memory and depressive symptoms, while the control group showed no significant pre-post changes. Friedman tests showed a significant main effect of time (χ2(2) = 6.609, P = .04), with a gradual increase in enjoyment from the first, to the mid, to the final session. In addition, perceived improvement scores remained high throughout the intervention, and patients' reported fatigue levels did not fluctuate significantly throughout the intervention.

To our knowledge, there is no research that integrates cognitive training, physical exercise and MBI using an IVR paradigm in adults with PCC. Despite inherent limitations, our findings mark a pioneering step toward improving cognition and mental health outcomes in PCC through innovative use of technology and multimodal methods. This first study should be accompanied by larger and randomized clinical trials aimed at further exploring and refining these interventions.