Concurrent validation of an immersive virtual reality version of the box and block test, the 360° turn test, and the five times sit-to-stand test to assess the functional status of stroke patients
2 Department of Physical Medicine and Rehabilitation, University of Health Sciences İstanbul Training and Research Hospital, İstanbul, Türkiye
3 Iottech Inc., Software Engineer, İstanbul, Türkiye
4 Department of Physical Medicine and Rehabilitation, Beykent University, İstanbul, Türkiye DOI : 10.5606/tftrd.2026.16467 Objectives: This study aims to develop immersive virtual reality (VR) versions of the box and block test (BBT), the 360° turn test, and five times sit-to-stand (5TSTS) test to evaluate functional status within a VR-mediated gamified environment and assess their concurrent validity.
Patients and methods: Thirty participants (18 males, 12 females; mean age: 59.9±11.9 years; range, 25 to 82 years) with a stroke diagnosis were included in the prospective study between February 2024 and August 2024. Each participant completed the BBT, 360° turn test, and 5TSTS test three times using both VR-based and traditional methods. Concurrent validity was examined by analyzing the correlations between VR-mediated and traditional test results. The test-retest reliability of the VR-based assessments was evaluated using intraclass correlation coefficients (ICCs). The usability of the developed software was also assessed using the System Usability Scale.
Results: Strong correlations were found between VR-based and traditional assessment methods for the affected side in the BBT (r=0.562; p<0.001), in the 360° turn test (r=0.838; p<0.001), and 5TSTS (r=0.733; p<0.001). Interrater reliability was high and statistically significant across all tests (ICC >0.80, p<0.001). The usability of the developed software was rated as good (mean System Usability Scale score: 70.8±15.6).
Conclusion: The VR-based versions of the BBT, 360° turn test, and 5TSTS are valid, reliable, and user-friendly tools for assessing functional status in stroke patients. These assessments show promise for integration into clinical settings and remote rehabilitation programs.
Keywords : Balance, gamification, lower limb, stroke, upper limb, virtual reality