{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,28]],"date-time":"2026-06-28T11:45:19Z","timestamp":1782647119651,"version":"3.54.5"},"reference-count":17,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T00:00:00Z","timestamp":1782432000000},"content-version":"unspecified","delay-in-days":25,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003196","name":"Italian Ministry of Health","doi-asserted-by":"crossref","award":["20225JEHW8"],"award-info":[{"award-number":["20225JEHW8"]}],"id":[{"id":"10.13039\/501100003196","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,6,11]]},"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Cognitive impairment is prevalent among adults with kidney failure treated with haemodialysis (HD). It affects multiple cognitive domains and contributes to suboptimal quality of life and clinical outcomes. Virtual reality (VR)-based cognitive training has shown benefits in various conditions including older adults without kidney failure; however, its feasibility in people receiving HD is unknown. This trial aims to evaluate the feasibility and acceptability of immersive VR cognitive training in adults undergoing maintenance HD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>The VIRTUAL trial is a multicentre, randomised, open-label feasibility study enrolling 60 adult patients (aged 18\u201375 years) undergoing thrice-weekly high-flux HD or haemodiafiltration for at least 90 days. Participants will be randomly assigned in a 1:1 ratio to receive standard care or standard care plus a 12-week VR cognitive training intervention delivered during dialysis sessions. The intervention consists of gamified tasks targeting memory, attention and processing speed via the Enhance VR platform.<\/jats:p>\n                    <jats:p>Primary outcomes include recruitment and retention rates, adherence to the intervention, acceptability of trial procedures and quality of life. Secondary outcomes include the completion rates of cognitive and patient-reported assessments and adverse event reporting. Feasibility thresholds will guide recommendations for a future definitive trial.<\/jats:p>\n                    <jats:p>Results will be disseminated through peer-reviewed publications, presentations at scientific meetings and communication with stakeholders. This feasibility study will inform the design of a future randomised trial evaluating the efficacy of VR-based cognitive training in this population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics, consent to participate and consent to publish declarations<\/jats:title>\n                    <jats:p>The study was approved by the Comitato Etico Campania 2 (AOU Universit\u00e0 della Campania \u2018Luigi Vanvitelli\u2019) following review at the meeting held on 25 July 2024, with formal favourable opinion issued on 31 July 2024 (Protocol: VIRTUAL PRIN20225JEHW8, (protocol number 0020792\/i)). The study was conducted in accordance with Good Clinical Practice and applicable regulations. Written informed consent was obtained from all participants prior to enrolment.<\/jats:p>\n                    <jats:p>Informed consent was obtained from all individual participants included in the study.<\/jats:p>\n                    <jats:p>Written informed consent was obtained from the patients\/participants for publication of their data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT06739187\">NCT06739187<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-120700","type":"journal-article","created":{"date-parts":[[2026,6,28]],"date-time":"2026-06-28T11:25:48Z","timestamp":1782645948000},"page":"e120700","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Virtual reality training for cognitive impairment in adults treated with haemodialysis (VIRTUAL): protocol for a multicentre, randomised, open-label feasibility trial"],"prefix":"10.1136","volume":"16","clinical-trial-number":[{"clinical-trial-number":"nct06739187","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct06739187","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Davide","family":"Viggiano","sequence":"first","affiliation":[{"name":"Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, Caserta, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Pellegrino","sequence":"additional","affiliation":[{"name":"Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J), University of Bari Aldo Moro, Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrizia","family":"Natale","sequence":"additional","affiliation":[{"name":"Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J), University of Bari Aldo Moro, Bari, Italy"},{"name":"School of Public Health, University of Sydney, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veronica","family":"Buonincontri","sequence":"additional","affiliation":[{"name":"Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, Caserta, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Gigliotti","sequence":"additional","affiliation":[{"name":"Nephrology and Dialysis Unit, Eboli Hospital, Eboli, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raffaele","family":"Genualdo","sequence":"additional","affiliation":[{"name":"Nephrology and Dialysis Unit, \u201cVecchio Pellegrini\u201d Hospital, Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felice","family":"Nappi","sequence":"additional","affiliation":[{"name":"Nephrology and Dialysis Unit, \u201cSanta Maria della Piet\u00e0\u201d Hospital, Nola, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"De Nicola","sequence":"additional","affiliation":[{"name":"Department of Advanced Medical and Surgical Sciences, Universit\u00e0 degli Studi della Campania Luigi Vanvitelli, Napoli, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmela","family":"Iodice","sequence":"additional","affiliation":[{"name":"Nephrology and Dialysis Unit, \u201cA. Cardarelli\u201d Hospital, Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariarosaria","family":"Iannuzzi","sequence":"additional","affiliation":[{"name":"Nephrology and Dialysis Unit, \u201cA. 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