Virtual Reality in Patients With Pulmonary Hypertension: A Randomized Controlled Trial

Lower and upper extremity strength: Measurement is performed by having the person being tested exert maximum effort against the device during the measurement, and the person conducting the test respond with maximum force in the opposite direction to prevent movement. The tests are repeated three times, and the average of the values is recorded in Newtons (N).

The tests will be repeated three times, and the average of the values will be recorded in kilograms of force (kgF).

Six Minute Walking Test: Participants will be asked to walk as fast as possible at their own pace for 6 minutes on a 30-meter course. The distance walked by the patient will be recorded in meters.

Six Minute Pegboard and Ring Test: A wooden platform with bars will be used during the test. Two bars will be placed at shoulder level and the other two 20 cm above shoulder level. Ten rings, each weighing 14 grams, will be placed on the lower bars: ten on the right and ten on the left, for a total of 20 rings. Patients will be asked to place as many rings as possible from the lower bars to the upper bars and then back to the lower bars using both hands for 6 minutes. At the end of this time, the number of rings moved will be recorded as the the total score, and the resting time will be recorded in seconds.

Short Physical Performance Battery: The test consists of 3 tests: walking 4 meters, standing up from a chair, and standing balance test.

Each test is scored between 0-4. The scores obtained by the participants, ranging from 1-4, indicate the progressive performance required to complete the test according to the specified times.

Walking test: Participants will be asked to walk 4 meters in a pre-marked corridor, and the time will be recorded and scored. The use of walking aids will be permitted, and saturation monitoring will be performed.

Standing up from a chair test: Participants will be asked to stand up once from a seated position with their arms crossed over their chest. Patients who can do this will be asked to stand up and sit down five times as quickly as possible, and the time will be recorded.

Standing balance test: 3 positions will be used; feet side-by-side and together, tandem, and half-tandem.

Modified Medical Research Council Dyspnea Scale: This scale was developed to assess the level of dyspnea in patients. The scale evaluates how much difficulty patients experience in daily life activities due to dyspnea. Individuals indicate the degree of shortness of breath with a score between 0 and 4. Higher scores indicate a greater perception of dyspnea.

International Physical Activity Questionnaire - Short Form: This is a 7-question questionnaire developed to determine physical activity levels, covering the past week. The questionnaire examines activities under the headings of vigorous physical activity, moderate physical activity, and walking. All activities are recorded in terms of frequency (days/week) and duration (minutes/day). A score in MET-min/week is calculated for all categories using a defined metabolic equivalent (MET) per activity, and the sum of these scores gives the total IPAQ-SF score. Standard MET values are accepted as 3.3 for walking, 4.0 for moderate activity, and 8.0 for vigorous activity. Sitting is assessed with a separate question and is not included in the total IPAQ-SF score.

Fatigue Severity Scale: The scale consists of 9 questions, each rated between 1 (strongly disagree) and 7 (strongly agree). The total value is divided by 9 to obtain the final score. An increased score indicates greater fatigue severity. A score of <2.8 indicates no fatigue, while a score >6.1 indicates chronic fatigue.

EmPHasis 10: Developed for assessing quality of life in patients diagnosed with pulmonary hypertension, the EmPHasis-10 includes inquiries about significant consequences of the disease, such as shortness of breath, fatigue, and lack of energy, which can also affect social life. The scale consists of 10 questions, each a Likert-type question scored between 0 and 5. The total score of the scale ranges from 0 to 50 points. A high score indicates a poor quality of life due to symptoms.

Hospital Anxiety and Depression Scale: The scale consists of 14 questions in total. The Likert-type scale includes 7 questions to assess anxiety levels and 7 questions to assess depression levels. Scores for both sub-assessments range from 0 to 21. Higher scores indicate a worse level. For both sub-assessments, scores of 0-7 indicate a normal level, 8-10 indicate borderline mood disorder, and ≥11 indicate a mood disorder.

Simulator Sickness Questionnaire: This is a scale that assesses the safety of experiences that alter the perception of reality, such as virtual reality, and the symptoms of motion sickness. It consists of 16 items grouped into 3 subscales (oculomotor symptoms, disorientation, nausea). Each item is rated on a four-point scale (0 = I feel nothing, 1 = somewhat, 2 = moderate, and 3 = very), and the total score is the sum of the scores of the three subscales.