Concurrent validation of an immersive virtual reality version of the box and block test, the 360° turn test, and the five times sit-to-stand test to assess the functional status of stroke patients

Objectives: This study aims to develop immersive virtual reality (VR) versions of the box and block test (BBT), the 360 degrees turn test, and five times sit-to-stand (5TSTS) test to evaluate functional status within a VR-mediated gamified environment and assess their concurrent validity. Patients and methods: Thirty participants (18 males, 12 females; mean age: 59.9 +/- 11.9 years; range, 25 to 82 years) with a stroke diagnosis were included in the prospective study between February 2024 and August 2024. Each participant completed the BBT, 360 degrees turn test, and 5TSTS test three times using both VR-based and traditional methods. Concurrent validity was examined by analyzing the correlations between VR-mediated and traditional test results. The test-retest reliability of the VR-based assessments was evaluated using intraclass correlation coefficients (ICCs). The usability of the developed software was also assessed using the System Usability Scale Results: Strong correlations were found between VR-based and traditional assessment methods for the affected side in the BBT (r=0.562; p<0.001), in the 360 degrees turn test (r=0.838; p<0.001), and 5TSTS (r=0.733; p<0.001). Interrater reliability was high and statistically significant across all tests (ICC >0.80, p<0.001). The usability of the developed software was rated as good (mean System Usability Scale score: 70.8 +/- 15.6). Conclusion: The VR-based versions of the BBT, 360 degrees turn test, and 5TSTS are valid, reliable, and user-friendly tools for assessing functional status in stroke patients. These assessments show promise for integration into clinical settings and remote rehabilitation programs.