Assessing the feasibility of Behavioural Activation (BAPP-VR) to support people with Parkinson’s Disease enhanced by a virtual reality exercise programme

Abstract

Introduction:
Parkinson’s is a neurodegenerative disease with a variety of complex motor and non-motor progressive symptoms that changes lives for those diagnosed, and for their family members. Approximately 50% of people with Parkinson’s display symptoms of depression and 40% anxiety (Parkinson’s Foundation, 2024). Early intervention through regular exercise has been acknowledged to support physical symptoms such as tremors, freezing gait and frequent falls, and represents a key component of slowing down the progression of the disease. Access to rehabilitation services were significantly affected due to limited access to services during COVID-19. As a result of symptoms, adherence to exercise can be a challenge for people with Parkinson’s. Evidence-based talking therapy has been shown to support non-motor symptoms.

Aim:
To determine the feasibility and acceptability of a Behavioural Activation programme enhanced by a virtual reality exercise programme to support the mental well-being and physical rehabilitation of people with Parkinson’s.

Methods and Intervention Development:
Behavioural Activation for People with Parkinson’s enhanced by VR (BAPP-VR) was developed using the MRC framework for complex interventions (Skivington et al., 2021). This included a scoping review, Patient and Public involvement (PPI), an iterative process of each of the phases of BAPP-VR, as well as testing and feedback. The BAPP-VR intervention involved six group-based sessions, including one hour BA talking therapy, and a thirty-minute to one-hour virtual reality exercise programme. An introductory session was provided prior to the intervention at the hospice outpatient clinic.

Feasibility Study:
A mixed-methods, pre–post feasibility design was used to evaluate the feasibility of the BAPP-VR intervention within an outpatient unit at Marie Curie Hospice, Belfast in Northern Ireland. The target sample was 18-24 people with Parkinson’s using purposive and convenience sampling, to be allocated to three separate consecutively run groups of BAPP-VR over three time periods from May to October 2023. Purposive sampling was used to recruit family members, carers, and healthcare professionals. Validated outcome measures were used to screen for inclusion and pre and post test data. These included, Hoehn and Yahr scale (describes symptom progression), Berg Balance Scale (to determine balance ability), PHQ-9 (measures depression) and GAD-7 (measures severity of anxiety). The feasibility and acceptability of the study was determined using questionnaires and semi-structured interviews with 13 patients, 7 family members/carers and 3 healthcare staff who were directly involved in the intervention.

Results:
Thirteen participants were recruited to the BAPP-VR study. Recruitment was a challenge due to the geographical location of the clinic for some people who lived too far away, and medication changes which were not permitted based on rigid inclusion and exclusion criteria. The total attrition rate for the study was zero. Findings indicate some improvement in depression scores. However, these were not statistically significant, and improvements are preliminary. These indicate trends rather than definitive effects.

Conclusion:
BAPP-VR for people with Parkinson’s is broadly acceptable for patients, carers and healthcare staff, with some promising improvements in depression and balance. A larger trial would be feasible with some adjustments to the protocol.

Date of Award	Jul 2026
Original language	English
Awarding Institution	Queen's University Belfast
Sponsors	Northern Ireland Department for the Economy
Supervisor	Paul Best (Supervisor), Tracey McConnell (Supervisor), Audrey Roulston (Supervisor) & Joanne Reid (Supervisor)