{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T17:55:41Z","timestamp":1791568541370,"version":"4.3.4"},"reference-count":76,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T00:00:00Z","timestamp":1791504000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec101\">\n                    <jats:title\/>\n                    <jats:p>Stroke is a leading cause of long-term disability, with a disproportionate burden in low- and middle-income countries (LMICs), where upper limb impairment emerges as one of its most prevalent and debilitating consequences. Upper limb impairment significantly limits independence and community participation, and this makes rehabilitation a critical priority. While conventional therapy is essential, its effectiveness is often limited by challenges in patient engagement and adherence. To address these barriers, immersive virtual reality (imVR) offers a promising modality for enhancing upper limb rehabilitation. This study examined the feasibility, acceptability, safety, and upper extremity outcomes of the AdaptRehab VR system in Ethiopia with the aim of informing future randomized controlled trials. A mixed-methods design was used, including quantitative assessments of upper extremity function, usability, user experience, and cybersickness, alongside qualitative interviews and focus group\u00a0discussion (FGD). The study was conducted at Jimma University Teaching Hospital, Ethiopia, and enrolled 20 adults aged \u226518 years with subacute or chronic stroke. Eighteen participants completed nine AdaptRehab VR sessions over three weeks. Physiotherapists collected baseline and post-intervention data. In addition, 18 participants (interview) and 6 physiotherapists (FGD) provided qualitative feedback. The study followed CONSORT guidelines for pilot and feasibility studies. Feasibility was excellent, with 93% adherence. System Usability Scale scores indicated good usability (mean 76.2\u2009\u00b1\u200912.1). User Experience Questionnaire ratings were positive across attractiveness (1.92\u2009\u00b1\u20090.84), pragmatic quality (1.78\u2009\u00b1\u20090.79), and hedonic quality (1.84\u2009\u00b1\u20090.81). Cybersickness was minimal, with mild transient symptoms (sweating: n\u2009=\u20096; fatigue and headache: n\u2009=\u20093). Significant improvements were observed in the Action Research Arm Test (33.0\u2009\u00b1\u200913.2 to 48.6\u2009\u00b1\u200913.1, p\u2009&lt;\u2009.001), and Box and Block Test (medians of 21.5 to 29, p\u2009&lt;\u2009.001). Qualitative findings confirmed high acceptability, motivation, and perceived functional gains. The AdaptRehab VR system demonstrated strong feasibility, acceptability, and safety for upper limb stroke rehabilitation in Ethiopia. Positive user experiences and functional improvements support its potential in LMICs settings, warranting a fully powered randomized controlled trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec001\">\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>\n                      ClinicalTrials.gov\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\/ct2\/show\/NCT07412899\" xlink:type=\"simple\">NCT07412899<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0360216","type":"journal-article","created":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T17:24:14Z","timestamp":1791566654000},"page":"e0360216","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Feasibility, acceptability, and preliminary efficacy of AdaptRehab VR, an immersive virtual reality system for upper limb stroke rehabilitation: A mixed-methods study in Ethiopia"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1573-2928","authenticated-orcid":true,"given":"Chala Diriba","family":"Kenea","sequence":"first","affiliation":[{"name":"Jimma University","place":["Jimma, Oromia, Ethiopia"],"department":["Department of Information Science, Faculty of Computing and Informatics, Jimma Institute of Technology"]},{"name":"University of Hasselt","place":["Diepenbeek, Belgium"],"department":["REVAL Rehabilitation Research Center, Technology-Supported and Data-Driven Rehabilitation, Data Science Institute, Faculty of Rehabilitation Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teklu Gemechu","family":"Abessa","sequence":"additional","affiliation":[{"name":"University of Hasselt","place":["Diepenbeek, Belgium"],"department":["REVAL Rehabilitation Research Center, Technology-Supported and Data-Driven Rehabilitation, Data Science Institute, Faculty of Rehabilitation Sciences"]},{"name":"Jimma University","place":["Jimma, Oromia, Ethiopia"],"department":["Department of Special Needs and Inclusive Education"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dheeraj","family":"Lamba","sequence":"additional","affiliation":[{"name":"Jimma University","place":["Jimma, Oromia, Ethiopia"],"department":["Department of Physiotherapy, Faculty of Medical Sciences, Institute of Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7729-4700","authenticated-orcid":true,"given":"Bruno","family":"Bonnech\u00e8re","sequence":"additional","affiliation":[{"name":"University of Hasselt","place":["Diepenbeek, Belgium"],"department":["REVAL Rehabilitation Research Center, Technology-Supported and Data-Driven Rehabilitation, Data Science Institute, Faculty of Rehabilitation Sciences"]},{"name":"PXL University of Applied Sciences and Arts","place":["Hasselt, Belgium"],"department":["Department of PXL\u2014Healthcare"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,10,9]]},"reference":[{"issue":"6","key":"pone.0360216.ref001","doi-asserted-by":"crossref","first-page":"1543","DOI":"10.1161\/STROKEAHA.123.044827","article-title":"Global, regional, and national burdens of stroke in children and adolescents from 1990 to 2019: A population-based study","volume":"55","author":"H Sun","year":"2024","journal-title":"Stroke"},{"key":"pone.0360216.ref002","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2018\/3238165","article-title":"Stroke in the 21st century: A snapshot of the burden, epidemiology, and quality of life","volume":"2018","author":"ES Donkor","year":"2018","journal-title":"Stroke Res 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