Objectives: Virtual reality (VR) has been shown to facilitate rehabilitation at hospitals by distracting patients’ attention from pain and by providing a virtual environment favorable for motivating the patients to continue rehabilitation. However, the application of VR in a home-visit rehabilitation remains to be validated. Here, we report a case in which home-visit rehabilitation using immersive VR was effective for post-stroke hemiplegic shoulder pain.Case presentation: After treatment, at a general hospital, for the hypertensive hemorrhage in the right brain capsule that resulted in the residual attention deficit disorder and left hemiplegia, a 63-year-old woman was cared for with a home-visit rehabilitation in a rural area. The patient had persistent pain in her left shoulder, which increased during activities of daily living and during rehabilitation, and the pain precluded rehabilitation. A VR relaxation program was delivered to the patient to alleviate pain during rehabilitation. Her shoulder pain was successfully alleviated using VR during training for muscle stretching and passive joint mobilization.Conclusion: The application of VR to home rehabilitation in rural areas may augment the effectiveness of home rehabilitation by alleviating pain during the procedure and sustaining the motivation for home rehabilitation.

Objective: We conducted two workshops to encourage “Jinsei Kaigi” to discuss advance care planning (ACP) with family members or significant others during healthy times and evaluated whether the workshops were effectively motivated participants to engage in ACP. Methods: Two workshops were held with 171 welfare commissioners, and four surveys were conducted (T1-T4) before and after the workshops. The primary endpoint was the rate of “Jinsei Kaigi” implementation, and the secondary endpoints were the Japanese versions of the ACP Engagement Survey (ACPES-J), which measures readiness for ACP, and Death Attitude Inventory (DAI), which were compared before and after the intervention, with T1 VS. T4 as the primary analysis. Results: A total of 149 participants were analyzed, and the implementation rate was 38.3%, which was a significant increase from 6% before implementation (p<.001, w=.54). Self-efficacy, readiness, and ACPES-J total scores increased significantly (p<.001 to .031, d=.29 to .67, respectively), but there were no significant changes in DAI. Conclusion: Our results suggest that workshops provide opportunities to motivate engagement in “Jinsei Kaigi”.

Purpose: We held workshops (WSs) that recommend the use of advance care planning (ACP) for medical and health care professionals, and clarified whether or not these WSs motivated them to engage in their own ACP using two indicators: the proportion of professionals who wanted to conduct ACP and changes in the Death Attitude Inventory (DAI). Method: After the WS, we divided participants into two groups, depending on whether or not they wanted to have end-of-life discussions with their family and loved ones. The changes in the DAI brought about by the WSs and their impressions of the WS were compared between the groups. Results: A total of 91 participants were analyzed, of which 42 (46.2%) wanted to have end-of-life discussions with their family and loved ones. In both groups, “afterlife view” and “death anxiety and fear” in the DAI were significantly reduced after the WS when compared to attitudes from before the WS. In the group which wanted to have end-of-life discussions, “death avoidance” (effect size −0.42) and “sense of purpose in life” (effect size 0.51) changed significantly and positively. Conclusion: About half of the participants wanted to perform ACP after having attended the WSs, apparently due to an increased sense of purpose in life and a reduced death avoidance.