REVI Pilot Feasibility Trial in Long-Term Care

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.

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.