VR&R: Providing Caregiver Respite by Managing BPSDs and Improving QoL in People with Dementia Using Immersive VR-Therapy

Unpaid Caregivers: Short Zarit Burden Interview The Short Zarit Burden Interview tool will be completed by caregiver-participants and will be used to evaluate subjective feelings of caregiver burden associated with being a caregiver for the person with dementia. The Short Zarit Burden Interview is a 6-item questionnaire that employs a 5-point Likert scale. Total scores range from 0-24 where higher scores indicate greater feelings of caregiver burden.

Paid Caregivers: Professional Care Team Burden Scale The 10-item Professional Care Team Burden (PCTB) Scale is a validated tool designed to assess the burden experienced by professional caregivers working in dementia care settings such as nursing homes. It evaluates three dimensions of burden: subjective burden (individual emotional strain), organizational burden (workplace factors), and structural burden (systemic or institutional challenges).

The caregiver will be asked to take part in a pre- and post- intervention phone interview (approximately 15 minutes in length, audio-recorded). The interview will include open-ended questions to gather qualitative information on the impact of the VR intervention on the caregiver and PwD (i.e., whether there were any changes to baseline PwD & caregiver well-being/QoL, BPSD, caregiver burden, and caregiver respite following the intervention), as well as feedback on the VR mediums in terms of their ability to promote caregiver respite.

WHO-5 Well-Being Index will be administered to caregiver-participants to evaluate subjective wellbeing. The WHO (Five) is a 5-item questionnaire employing 6-point Likert scales. Calculated scores range from 0-25. A score of 0 represents the worst possible and a score of 25 represents the best possible quality of life. A score below 13 represents poor wellbeing. A change of 10% represents a significant change in wellbeing.

Caregivers will be asked to describe their time while the PwD was using VR in a paper-based log. This tool aims to capture if the caregiver was able to obtain additional respite, and the degree to which they were able to obtain respite (i.e., the degree to which caregivers were able to remain vigilant and at the same time detach and focus on their own task). Caregivers will also have the opportunity to record observations of the PwD's reactions to/experience with the VR intervention, as well as additional feedback and reflections of their own or from discussion with the PwD.

The 10-item Connor-Davidson Resilience Scale (CD-RISC) is a condensed version of the original 25-item scale, designed to efficiently measure resilience, the ability to adapt and thrive in the face of adversity. Each of its 10 items is rated on a 5-point Likert scale, with higher scores indicating greater resilience. The scale emphasizes key resilience traits such as adaptability, persistence, and emotional regulation. Validated across diverse populations, it has shown strong reliability, internal consistency, and construct validity. Its brevity and ease of use make it a valuable tool for both research and clinical settings, especially when time is limited.

The Neuropsychiatric Inventory-Questionnaire (NPI-Q) will be completed by the caregiver. The NPI-Q is a 12-item questionnaire that measures neuropsychiatric symptoms (e.g., related to related to mood, behavioural disturbance) as well as caregiver distress corresponding to reported symptoms.

Participants with dementia will be prompted to select from a set of eight faces displaying different emotions, immediately before and after each VR-therapy session. These include positive emotions (happy, joyful, relaxed) and negative emotions (anxious, sad, angry, confused, indifferent). These metrics will be collected before and after each intervention session (i.e., at a time-interval of approximately 30 minutes, depending on session length.)

The System Usability Scale (SUS) will be completed by the caregiver to evaluate device usability/ease-of-use of the VR intervention (head-mounted device and VR&R application) used during the study. The SUS is a 10-item questionnaire employing 5-point Likert scales. Calculated scores range from 0-100. Higher scores indicate better system usability.

The caregiver will take part in a semi-structured interview post-intervention. The interview will include open-ended questions to explore the acceptability and usability the 2 different VR-mediums, including suggestions for improvement.

During the initial home training (pre-intervention), the researcher will observe the participant's reactions to a brief "neutral" VR video (a nature scene). The researcher will then administer the Fast Motion Sickness Scale (FMS). The scale asks the participant to rate any feelings of motion sickness on a scale of 0 to 20 where 0 indicates no motion sickness and 20 indicates a great deal of motion sickness (on the brink of vomiting). Participants with a score of 15 or higher will be withdrawn from the study.

Immediately after each session, participants with dementia will be prompted to rate their experience on a visual analog "Star" scale (range of 1 to 5), where 1 indicates the worst possible experience and 5 indicates the best possible experience.

Caregivers will be asked to record any observations and feedback related to their their loved one's reactions to VR (e.g., enjoyment, relaxation, engagement, anxiety/apprehension; what did/did not go well). Caregivers will be asked to make these recordings immediately after intervention sessions.

This objective metrics of VR usage will be will be unobtrusively collected through the VR&R application for the duration of the study.

This objective metrics of VR usage will be will be unobtrusively collected through the VR&R application for the duration of the study.

The Mini Mental State Exam (MMSE) will be administered to the PwD at baseline. This is a widely used cognitive screening test consisting of 12 questions administered orally. Scores range from 0-30, with scores of 0-9 suggesting severe cognitive impairment/late stage dementia, scores of 10-19 suggesting moderate cognitive impairment/middle stage dementia, scores of 20-25 suggesting mild cognitive impairment/early stage dementia, and scores of 26-30 suggesting possibly normal cognition.

A short form of the Personality Attributes Questionnaire with 8 items (PAQ-8) used to assess femininity and masculinity, which has been found to be a valid screening measure to assess gender expression. Scores on each scale are range from 0-32. On the masculine and masculine-feminine subscales, higher scores indicate a greater level of masculinity. On the feminine subscale, a higher score indicates a greater level of femininity.