Virtual Walking System with Mood Evaluation for Individuals with Severe Mobility Impairments: Development and Feasibility Study

BackgroundIndividuals with severe mobility impairments (SMI) often experience significant psychological distress and chronic pain. Virtual walking (VW) presents an innovative rehabilitation approach to improve mood and alleviate pain. This study aimed to develop a home-based VW system with integrated mood and symptom tracking and to report on its feasibility and usability in a user study with individuals with SMI. MethodsA multidisciplinary, iterative frame-work guided the systems development. Following initial contextual research and design iterations, a user study was conducted with 11 participants with SMI. A repeated measures pre-post design was employed. Feasibility and usability were primarily assessed through post-study qualitative interviews, analyzed via content analysis. Changes in mood and symptoms were measured immediately before and after each session. Momentary mood was captured using an in-virtual reality (in-VR) two-dimensional (2D) affect grid, while embedded single-item state ratings were used to track anxiety, depressed mood, and pain. Daily mood changes and symptom trajectories were analyzed using logistic regression and generalized estimating equations (GEE), respectively. ResultsContextual research guided the system design towards enhancing accessibility, ergonomics, and therapeutic engagement. The final VW system featured three core modules: locomotion, multi-sensory feedback, and mood/symptom tracking. Qualitative analysis of the user study revealed high acceptance for the VW system, alongside challenges related to content variety and hardware ergonomics. Each intervention session was significantly associated with an immediate positive mood shift (odds ratio (OR) = 1.83), as measured by the affect grid. Furthermore, GEE models revealed a significant reduction in self-reported depression and anxiety symptoms over the intervention period (all P < 0.01). ConclusionsThis study confirms the feasibility and acceptability of the novel VW system for home-based use by individuals with SMI. The preliminary evidence suggests the system has high potential as a tool for improving mood and alleviating psychological distress. Future large-scale randomized controlled trials are warranted to establish its clinical efficacy. Trial registration numberNCT07073144-07/17/2025.