The Effectiveness of Virtual Reality–Based Training for Family Caregivers in Supporting Post-Stroke Recovery: A Quasi-Experimental Study
Abstract
Introduction: Stroke survivors in low-resource settings often rely on family caregivers to provide essential daily care after hospital discharge. However, many caregivers lack the necessary knowledge, skills, and confidence to perform safe and effective home-based care. Virtual Reality (VR) offers an immersive, interactive, and practical training method that may enhance caregiver preparedness and is associated with improved patient outcomes during post-stroke recovery. This study evaluated the effectiveness of a VR-based caregiver training program on functional, psychological, physiological, and cognitive outcomes among stroke survivors.
Methods: A quasi-experimental pre–post design was conducted with 60 caregiver–patient pairs recruited from a community health center in South Sumatra. Participants were assigned to either a VR-based training group or a control group receiving standard discharge education. The intervention consisted of five immersive VR modules simulating stroke-care scenarios, including hygiene, feeding, transfer techniques, positioning, suctioning, and range of motion exercises. Outcome measures included systolic blood pressure, functional independence (Barthel Index), anxiety and depression (HADS), and cognitive status (MoCA).
Results: Patients whose caregivers received VR-based training demonstrated significant improvements in patient outcomes compared with the control group. The intervention group showed greater reductions in systolic blood pressure (p = 0.021), increased functional independence (p = 0.041), reduced anxiety (p = 0.017) and depression (p = 0.011), and enhanced cognitive function (p = 0.032). Effect sizes ranged from moderate to large, indicating clinically meaningful improvements.
Conclusion: VR-based caregiver training is a feasible, low-cost, and effective strategy associated with improved patient outcomes following caregiver training. Its immersive design provides experiential learning that may support caregiving activities in community health settings with limited resources.
References
Feigin VL, Brainin M, Norrving B, Martins S, Sacco RL, Hacke W, et al. World Stroke Organization (WSO): Global Stroke Fact Sheet 2022. International Journal of Stroke. SAGE Publications Inc.; 2022;17(1):18–29. DOI: 10.1177/17474930211065917
WHO. [Internet]. 2024 Aug 7. The top 10 causes of death [cited 2025 Jun 28]. Available from: https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death
Murphy SJ, Werring DJ. Stroke: causes and clinical features. Medicine (United Kingdom). Elsevier Ltd; 2020;48(9):561–6. DOI: 10.1016/J.MPMED.2020.06.002
Deepradit S, Powwattana A, Lagampan S, Thiangtham W. Effectiveness of a family-based program for post-stroke patients and families: A cluster randomized controlled trial. Int J Nurs Sci. Elsevier; 2023;10(4):446–55. DOI: 10.1016/J.IJNSS.2023.09.020
Kemenkes RI. Laporan KInerja Kementrian Kesehatan. 2024 Feb.
Laver K. Hayre CM, Muller DJ, Scherer MJ, editors. Virtual reality for stroke rehabilitation. Virtual reality in health and rehabilitation. 1st ed. Boca Raton: taylorfrancis.com; 2020;43(2):10. DOI: 10.1201/9780429351365-3
Rosidin U, Shalahuddin I, Yamin A, Lukman M, Pristasari S. Improving Family Function in Modifying a Healthy Home Environment. ABDIMAS: Jurnal Pengabdian Masyarakat. LPPM Universitas Muhammadiyah Tasikmalaya; 2025;8(2):980–7. DOI: 10.35568/ABDIMAS.V8I2.6471
Mou H, Lam SKK, Chien WT. The effects of a family-focused dyadic psychoeducational intervention for stroke survivors and their family caregivers: A randomised controlled trial. Int J Nurs Stud. Pergamon; 2023;143:104504. DOI: 10.1016/J.IJNURSTU.2023.104504
Whitehead S, Baalbergen E. Post-stroke rehabilitation. South African Medical Journal. South African Medical Association; 2019;109(2):81–3. DOI: 10.7196/SAMJ.2019.V109I2.00011
Sultan B. Application of Betty Neuman Theory in Care of Stroke Patient. Vol. 5, Ann Nurs Pract 2018.
Fachrine A, Saqina A, Hudiyawati D. Correlation of Family Support on Physical Rehabilitation Compliance in Stroke Patients. Indonesian Journal of Global Health Research. 2024;6(S6):763–70. DOI: 10.37287/IJGHR.V6IS6.5018
Soto-Cámara R, González-Bernal JJ, González-Santos J, Aguilar-Parra JM, Trigueros R, López-Liria R. Knowledge on signs and risk factors in stroke patients. J Clin Med. MDPI; 2020;9(8):1–14. DOI: 10.3390/JCM9082557
Nurhidayah, Muadi, Marisa DE. Penerapan terapi Range of Motion (ROM) terhadap peningkatan kekuatan otot pada pasien Stroke Non Hemoragik (SNH) dengan gangguan mobilitas fisik. Jurnal Ilmiah Keperawatan (Scientific Journal of Nursing). 2025;11(3):408–12. DOI: 10.33023/JIKEP.V11I3.2618
Saputro H, Camo MI, Suraksono B. Analysis Support Families With Quality Of Life After Stroke Patients. STRADA Jurnal Ilmiah Kesehatan. Institut Ilmu Kesehatan STRADA Indonesia (STRADA Indonesia Health Sciences Institute); 2019;8(2):172–6. DOI: 10.30994/SJIK.V8I2.175
Laver KE, Lange B, George S, ... Virtual reality for stroke rehabilitation. Cochrane database …. cochranelibrary.com; 2017;11(11). DOI: 10.1002/14651858.CD008349.pub4
de Rooij IJM. Effect of Virtual Reality Gait Training on Participation in Survivors of Subacute Stroke: A Randomized Controlled Trial. Phys Ther. 2021;101(5). DOI: 10.1093/ptj/pzab051
WHO. [Internet]. 2025. Health Promotion [cited 2025 Feb 19]. Available from: https://www.who.int/teams/health-promotion/enhanced-wellbeing/first-global-conference
Li J, Yang L, Lv R, Kuang J, Zhou K, Xu M. Mediating effect of post-stroke depression between activities of daily living and health-related quality of life: meta-analytic structural equation modeling. Quality of Life Research. Springer Science and Business Media Deutschland GmbH; 2023;32(2):331–8. DOI: 10.1007/S11136-022-03225-9
Strini V, Piazzetta N, Gallo A, Schiavolin R. Barthel index: Creation and validation of two cut-offs using the BRASS index. Acta Biomedica. Mattioli 1885; 2020;91:19–26. DOI: 10.23750/ABM.V91I2-S.9226
Beekman E, Verhagen A. Clinimetrics: Hospital Anxiety and Depression Scale. J Physiother. Elsevier; 2018;64(3):198. DOI: 10.1016/J.JPHYS.2018.04.003
Culley D. How Should We Identify Patients at Risk for Postoperative Neurocognitive Disorder? Evidence-Based Practice of Anesthesiology. Elsevier; 2022;49–54. DOI: 10.1016/B978-0-323-77846-6.00006-9
Badran D, Abreu P, Restivo MT. Blood Pressure Measurement. Proceedings of the 2019 5th Experiment at International Conference, exp.at 2019. StatPearls Publishing; 2022;476–80. DOI: 10.1109/EXPAT.2019.8876538
Groop J, Ketokivi M, Gupta M, Holmström J. Improving home care: Knowledge creation through engagement and design. Journal of Operations Management. No longer published by Elsevier; 2017;53–56:9–22. DOI: 10.1016/J.JOM.2017.11.001
Brown K, Foronda C. Use of virtual reality to reduce anxiety and pain of adults undergoing outpatient procedures. Informatics. MDPI AG; 2020;7(3). DOI: 10.3390/INFORMATICS7030036
Brown A, Green T. Virtual reality: Low-cost tools and resources for the classroom. TechTrends. Springer; 2016; DOI: 10.1007/s11528-016-0102-z
Han SH, Jang HJ, Lee JW, Cheong JW, Kim YD, Nam HS, et al. The effect of virtual reality-based treadmill gait training on functional mobility and balance in chronic stroke patients: a randomized controlled trial. Front Neurol. Frontiers Media SA; 2025;16:1603233. DOI: 10.3389/FNEUR.2025.1603233/BIBTEX
Suksatan W, Collins CJ, Koontalay A, Posai V. Burdens among familial caregivers of stroke survivors: a literature review. Working with Older People. Emerald Publishing; 2022;26(1):37–43. DOI: 10.1108/WWOP-02-2021-0007
Rahayu TG. Analisis Faktor Risiko Terjadinya Stroke Serta Tipe Stroke. Faletehan Health Journal. Universitas Faletehan; 2023;10(01):48–53. DOI: 10.33746/FHJ.V10I01.410
Estheresia E. Systematic Review: Penggunaan Video Games dan Virtual Reality Dalam Memulihkan Fungsi Motorik Pasien Stroke. Syntax Literate ; Jurnal Ilmiah Indonesia. CV. Syntax Corporation Indonesia; 2023;7(9):16349–60. DOI: 10.36418/syntax-literate.v7i9.13947
Riva G. Virtual Reality in Clinical Psychology. Comprehensive Clinical Psychology, Second Edition. 2022;10:91–105. DOI: 10.1016/B978-0-12-818697-8.00006-6
Copyright (c) 2026 Media Publikasi Promosi Kesehatan Indonesia (MPPKI)

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Authors who publish with Media Publikasi Promosi Kesehatan Indonesia retain the copyright of their work. The journal applies a Creative Commons Attribution-ShareAlike 4.0 International License (CC BY-SA 4.0), which grants the following rights:
-
Copyright Retention: Authors retain the copyright of their work, maintaining full control over their intellectual property without restrictions.
-
Right of First Publication: Authors grant the journal the right of first publication of their work. This ensures that the work is initially published and credited in Media Publikasi Promosi Kesehatan Indonesia.
-
License to Share and Reuse: The work is licensed under CC BY-SA 4.0, allowing others to copy, distribute, remix, and build upon the work for any purpose, even commercially, as long as proper credit is given to the authors, and any new creations are licensed under the same terms.