REVI Pilot Feasibility Trial in Long-Term Care

Universidad de Almeria18 enrolled

Overview

This pilot study evaluates the feasibility, safety, and acceptability of an immersive virtual reality (VR) intervention designed to promote psychological well-being in older adults living in a long-term care facility. The study examines whether an eight-session VR program can be delivered safely and comfortably, whether participants tolerate and engage with the sessions, and whether the intervention shows preliminary signals of benefit in emotional well-being and subjective experience of presence. The results will inform the design and implementation of a larger, ongoing study using the same protocol.

This pilot feasibility study evaluates the implementation of "REVI," a personalized immersive virtual reality (IVR) protocol designed for cognitively intact older adults living in long-term care. The intervention consists of eight individually guided IVR sessions delivered twice weekly over four weeks, using Meta Quest 2 head-mounted displays and browser-based WebXR environments developed to ensure accessibility and comfort. The protocol is explicitly grounded in Ryff's multidimensional model of psychological well-being and the Dignity-by-Design framework, emphasizing personalization, meaningful choice, and user agency as core design principles. Each session targets specific facets of eudaimonic well-being through structured activities such as avatar creation, motor-skills training, immersive visits to personally meaningful places, cooperative tasks, and a life-narrative exercise. The study uses a three-arm design to compare an Active IVR condition (full REVI protocol), a Passive IVR condition (non-interactive exposure to immersive environments), and a usual-care Control group. All IVR sessions are supervised one-on-one by a trained guide who monitors safety, provides technical support, and facilitates grounding and orientation when needed. The primary focus of this pilot is to assess feasibility (recruitment, retention, procedural consistency) and safety (adverse events, tolerability), as well as acceptability through observer-rated engagement and qualitative in-session feedback. Secondary measures include presence and structured emotional responses collected after immersion sessions. Exploratory outcomes include both state-level indicators aligned with the targeted psychological well-being dimensions and trait-level scores assessed at baseline and one week post-intervention. The study is designed as an early-stage evaluation of a theory-driven IVR protocol in a real-world residential care setting. Its purpose is to determine whether REVI can be delivered safely, comfortably, and consistently, and whether participants engage meaningfully with the personalized activities. Findings from this feasibility phase will inform refinements to the protocol and guide the development of a future definitive trial.

Interventions

Active IVRBEHAVIORAL

Participants complete eight individually guided immersive virtual reality sessions delivered twice weekly over four weeks. Sessions include structured interaction with immersive virtual environments, guided experiential tasks, and presence-enhancing activities aligned with the psychological well-being model.

Passive IVRBEHAVIORAL

Participants complete eight immersive virtual reality sessions delivered twice weekly over four weeks. Sessions consist of passive exposure to immersive virtual environments without guided experiential tasks or structured interaction. Participants view the VR scenarios while remaining seated and without engaging in presence-enhancing activities.

Eligibility

Sex: ALLMin age: 65 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * Residents of long-term care facilities. * Age 65 years or older. * Full functional independence (Barthel Index = 100). * Adequate balance and gait to safely participate in VR sessions (Berg Balance Scale \> 45). * Absence of significant cognitive impairment (MMSE ≥ 25 or CAMCOG-R ≥ 80). * Absence of clinically significant depressive symptoms (GDS-SF ≤ 5). * No prior experience with immersive virtual reality. * Able to provide informed consent or have a legal representative who can do so. * Able to remain seated for approximately 20 minutes per session. * Willing to participate in eight VR sessions over four weeks. Exclusion Criteria: * Cognitive impairment that prevents understanding instructions or interacting with VR content. * Depressive symptoms above the screening threshold established in the inclusion criteria. * Balance or gait limitations judged by clinical staff to pose a safety risk during VR use. * Medical or neurological conditions that contraindicate VR exposure (e.g., uncontrolled epilepsy, severe motion sickness). * Acute medical instability or conditions requiring urgent clinical intervention. * Any condition judged by clinical staff to pose a safety risk during VR immersion.

Outcomes

Primary Outcomes

Recruitment Rate

Recruitment rate is defined as the proportion of eligible participants who enroll in the study during the recruitment period.

Time frame: At the end of the recruitment period (March 13, 2026).

Retention Rate

Retention rate is defined as the proportion of enrolled participants who complete all scheduled assessments and sessions during the 4-week intervention period.

Time frame: From enrollment through completion of the 4-week intervention period.

Adverse Events

Adverse events are monitored throughout the intervention period and recorded after each session, including discomfort, cybersickness, or any unexpected negative reactions.

Time frame: From the first session through the final session of the 4-week intervention period.

Acceptability (NPT-ES)

Acceptability is assessed after each session using the adapted Non-Pharmacological Therapy Experience Scale (NPT-ES), which evaluates perceived usefulness, comfort, satisfaction, and willingness to continue the activity.

Time frame: Immediately after each session during the 4-week intervention period.

Secondary Outcomes

Psychological Well-Being (Ryff Scales)

Psychological well-being is assessed using the Ryff Scales of Psychological Well-Being, which evaluate autonomy, environmental mastery, personal growth, positive relations, purpose in life, and self-acceptance. The full scale is administered at baseline and after the four-week intervention period, and selected subscales are administered at intermediate time points during the intervention to capture short-term changes in specific dimensions of well-being.

Time frame: From baseline assessment before starting the intervention through intermediate session assessments during the 4-week program and the post-intervention assessment at 4 weeks.

Sense of Presence (Presence Questionnaire)

Sense of presence is assessed after each immersive session using an adapted version of the Presence Questionnaire (Witmer \& Singer, 1998), which evaluates the participant's subjective feeling of being physically and psychologically located within the virtual environment.

Time frame: Immediately after each immersion session during the 4-week intervention period.

Emotional Reactions (Session Questionnaire)

Emotional reactions are assessed after each session using a brief structured questionnaire that evaluates affective responses to the immersive experience, including comfort, enjoyment, and emotional engagement.