Rhythms of Recovery: Patient-Centered Virtual Reality Exergame for Physical Rehabilitation in the Intensive Care Unit

Early mobilization is a structured protocol designed to facilitate motor recovery in intensive care unit (ICU) patients with ICU-acquired weakness. This process is typically implemented by an interdisciplinary team of nurses, physical therapists, and other healthcare professionals. However, its application is often constrained by the patients' critical conditions, limited mobility, and the challenges of coordinating care within resource-intensive ICU environments. In this study, we developed a patient-centered virtual reality (VR) exergame through an interdisciplinary design process involving clinicians and therapists, tailored to the constraints of critical care. The exergame incorporates progressive mobility levels that mirror early mobilization practices, and includes an embodied avatar to provide guidance and motivation. Using Meta Quest 3 body tracking, the system captures and visualizes patients' movements, thereby providing motivational engagement and quantifiable mobility metrics. We evaluated the exergame in two stages: a dual-user study involving healthy participants and healthcare professionals or students (N = 13), and a subsequent study with cardiothoracic ICU patients (N = 18) to assess feasibility, design validity, and clinical acceptance. Across both studies, participants reported high enjoyment and engagement without discomfort or stress. Furthermore, patients demonstrated increases in movement speed, range of motion, and workspace volume of the upper body across game levels. Physiological monitoring further indicated that the exergame elicited exertion without inducing excessive cardiovascular responses. These findings highlight the feasibility of VR exergames as a clinically acceptable and engaging adjunct to early mobilization in critical care, offering a novel pathway to improve rehabilitation outcomes for ICU patients.