A Virtual Reality-Based Cognitive Restorative Intervention Using Nature to Improve Attention, Self-Care, and Health-Related Quality of Life in Heart Failure

BACKGROUND: Cognitive dysfunction is prevalent and predictive of worse health outcomes among people with heart failure (HF). OBJECTIVE: The purpose of this study was to test the preliminary efficacy of the newly developed virtual reality-based cognitive restorative intervention using nature environments (Nature-VR) on improving attention, HF self-care, and health-related quality of life (HRQL) compared with the active control condition using urban environments (Urban-VR). Intervention effects were explored on other cognitive domains. METHODS: A 2-group single-blind pilot randomized controlled trial design was used. Participants randomized to Nature-VR viewed spherical images of nature environments on a virtual reality headset for 10 minutes/day, 5 days/week for 4 weeks (200 images total). Participants randomized to Urban-VR viewed spherical images of urban environments matched to Nature-VR intervention delivery mode and time. Data were collected at baseline, 4, 8, 26, and 52 weeks. RESULTS: Of 73 participants, 68 (93%) completed the intervention or control condition. Fifty-one (70%) completed the study. Linear mixed models showed no significant group-by-time interactions on attention, HF self-care, or HRQL. Significant time effects were found on HF self-care (all scales, P < .001). Executive function measured by Verbal Fluency Test-Letter F improved more among participants in Nature-VR than those in Urban-VR at 4 weeks ( P = .041) after adjusting covariates. CONCLUSIONS: Preliminary efficacy of Nature-VR compared with Urban-VR was not demonstrated for attention, HF self-care, and HRQL. There was preliminary evidence of improved executive function at 4 weeks. Factors associated with intervention responsiveness and strategies to optimize cognitive interventions should be considered.