3.2.1. Results of the Thematic Analysis
We extracted the themes that represented the participants’ experiences through analysis of the collected qualitative data, which included interviews, researchers’ notes, and personal letters. Four themes emerged: (1) patients’ perspectives regarding the OR2-LMC treatment, (2) facilitators and barriers related to OR2-LMC treatment adherence, (3) management and application of the OR2-LMC treatment, and (4) potential improvements to the treatment.
Patients’ Perspectives Regarding OR2-LMC Treatment:
All patients reported that the OR2-LMC treatment was not better at increasing their upper limb functionality than the conventional treatment (physiotherapy, occupational therapy, etc.). Patients showed that this new treatment did not replace conventional treatment, but rather complemented it. Some patients (P1, P2) argued that health professionals reinforced the importance of movement-oriented treatments and the avoidance of immobility. For some patients (P2, P4–P6), the new treatment was more of a mental challenge than a physical one. None of the patients spontaneously reported any improvements following OR2-LMC treatment. However, some did perceive improvements in their daily activities, such as eating, handling utensils, buying food, and checking tickets at home (P2–P4, P6). Additionally, some patients perceived improvements post-treatment when driving, looking at traffic lights on the street, and reading. Some patients also felt as though they improved coordination, joint movement, concentration, mental speed during activities, and the ability to overcome obstacles on the street.
Facilitators and Barriers Contributing to OR2-LMC Treatment Adherence:
Patients were asked to identify barriers and facilitators that contributed to their adherence to the OR2-LMC treatment.
Facilitators: (a) A sense of competition against the machine was perceived as a facilitator by all patients. Improvement of personal scores in the video games, as well as winning them, was seen as a stimulus to continue with therapy; winning was perceived as something that depended on their upper limb abilities. (b) One patient (P2) reported that overcoming these challenges made him feel closer to his family and more competent in his daily living activities. (c) A sense of frustration was felt when failing to overcome a challenge (P2–P6) and the treatment helped patients to identify their limits while striving to overcome them (P1–P6), which gave a greater sense of satisfaction (P4–P6). (d) The OR2-LMC treatment helped patients become more aware of situations that they had previously paid little attention to, such as picking up and manipulating small objects (P1, P4–P6). (e) The games helped patients to focus on their treatment and be more involved in it. (f) The treatment encouraged some patients (P2–P6) to compare their scores with each other and share their experiences with the therapy by discussing the challenges they overcame, supporting each other, and feeling that they were all facing these new games together.
Barriers: (a) Fatigue (P1, P6) from a sense of tension and nervousness from wanting to do their best in the video games (P1). (b) The short time interval available to become acquainted with the virtual world and perform the required activities (P1, P2, P5, P6). Some patients felt that their low scores did not accurately reflect their actual health status, and instead demonstrated their lack of prowess with VR (P1, P2, P5). (c) The monotony of the video game activities (P2–P4). (d) Fear of new challenges and activities involved in the therapy (P6), and the sense of frustration in failing to overcome a challenge (P4, P6). (f) The PD tremors interfered with their ability to perform the tasks (P4, P5).
Management and Application of the OR2-LMC Treatment:
There was a process of adaptation to the new treatment (P1–P6). At first, patients reported feeling awkward as they tried to adapt to the “virtual world”, although they did gradually become more comfortable and improved their performance. The patients reported that the treatment seemed inapplicable to the home setting (P1, P2, P4, P5), because the system requires a lot of physical space, is complex to assemble, demands previous knowledge and skills for use, and requires a lot of time and money. The patients also described feeling that the treatment should be administered by a qualified professional (P1, P2, P4–P6), in order to prepare and operate the equipment and resolve any unforeseen events that may occur. Moreover, one patient (P1) felt that a professional was required to monitor and track the results of the treatment. In contrast, another patient (P2) felt that a professional was needed to correct his actions and help guide him through the correct performance.
Regarding potential help from their families, some patients (P3–P6) preferred to be monitored by a professional, although they felt their families could help them if necessary. The reasons given for preferring professional help included a feeling of safety, as well as the inability to postpone treatment or falsify their results (P5). One patient (P2) justified the feeling that family members should not be responsible for applying the treatment with the following statement: “families already deal with enough seeing how we deteriorate a little more every day.”
Potential OR2-LMC Treatment Improvements:
The patients described improvements they felt could be included for newer versions of the treatment, including: (a) competition among the users, because the competition was perceived as a positive element of the treatment (P1); (b) conducting preparatory sessions to increase familiarity with VR before treatment (P1, P2); (c) expanding the catalogue of games and activities available to increase motivation (P2, P3) and help with the treatment of additional symptoms of PD, such as tremor (P2) and lack of balance (P3); (d) clearly explaining the treatment, its application, and realistic expectations of results during recruitment (P1, P2, P4, P5), because some patients either did not fully understand what the treatment involved (P2) or had unrealistic expectations of potential improvements (P3–P5); (e) including various levels of difficulty in the video games to stimulate continuous efforts (P2, P3); and (f) requiring treatment administrators to experience the treatment before applying it to gain the first-hand experience with the technology (P3).