ASPECT Study lessons learnt: Feasibility mixed methods RCT examining the effectiveness of virtual reality training and usual care, versus usual care alone on ataxia in children following surgical resection of posterior fossa tumour.:ASPECT Study lessons learnt

Background Ataxia is the most common movement problem in children with posterior fossa tumours (PFT). Physiotherapy may be of benefit; however, there is little evidence to guide the type, intensity, or duration of physiotherapy management. The aim of this study was to determine the feasibility of conducting a randomised control trial (RCT) examining the effectiveness of Xbox Kinect virtual reality training (VRT) and usual care (UC) versus UC alone for rehabilitation of ataxia in children following surgical resection of PFT. Methods A multi-site feasibility RCT adopting mixed methods examined VRT and UC, versus UC alone in children following PFT resection. VRT consisted of an 8-week intervention programme (four weeks as an outpatient, four weeks at home, three sessions per week). Feasibility focused on trial eligibility, acceptance, practicality, adherence and implementation. The embedded qualitative study explored children and parental perceptions of feasibility and acceptability. Results Twelve children (aged 4-17), one to three years following PFT resection and eleven parents (8 mothers and 3 fathers) participated. Eligibility was 29-50% (site dependent). Recruitment was low (0-45%, site dependent). No issues with willingness to randomisation were identified. Assessment timepoints were practical. Adherence to VRT varied (average 73% adherence to hospital-based intervention, average 62% adherence to home-based intervention). Conclusions The results suggest a definitive trial may be feasible although adapted recruitment strategies are likely to be necessary.