A feasibility RCT of group social support in a virtual world for aphasia - feasibility met, no significant quantitative outcomes
How this was rated
Feasibility RCT (n=34) in aphasia. Not powered to detect effects on outcome measures; feasibility and qualitative components are the primary contributions.
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A waitlist randomized feasibility RCT with 34 recruited (29 completed, 85.3%). People with aphasia attended 14 EVA Park social group sessions over 6 months. Feasibility targets were met: recruitment achieved, 85.3% completion, all groups ran as planned. However, no significant change was observed on any quantitative outcome measure (wellbeing, communication, social connectedness, quality of life). Qualitative reports were positive. Trial registered NCT03115268.
A feasibility RCT (n=34 recruited, 29 completed) in aphasia. Feasibility demonstrated; no significant quantitative outcomes detected - the study was not powered for effects. Qualitative reports positive.
Key findings
- Feasibility met: recruitment target of 34 achieved; 85.3% completed; all 14 sessions ran; minimal fidelity drift; mean attendance 11.4/14 sessions (81.6% intended dose)
- No significant change observed on any quantitative outcome measure: wellbeing, communication, social connectedness, or quality of life
- Cost analysis: GBP 7,483-12,562 per group, varying with travel, volunteer contributions, and hardware loans
- Qualitative reports were positive - participants valued the social participation opportunities; quantitative measures showed no significant change
Background
Aphasia, typically arising after stroke, affects a person’s ability to use and understand language. Beyond the communication challenges, many people with aphasia experience significant social isolation, as everyday conversation becomes more effortful and opportunities for social participation diminish. Traditional speech and language support tends to focus on one-to-one sessions, leaving limited scope for practicing the group social interactions that characterize daily life.
EVA Park is a virtual world specifically designed for people with aphasia, offering a range of social spaces - cafes, gardens, and shops - where users can interact through personalized avatars. Marshall and colleagues explored whether this virtual environment could facilitate meaningful group social interaction.
What the researchers did
Marshall and colleagues conducted a waitlist randomized feasibility RCT (ClinicalTrials.gov NCT03115268) funded by The Stroke Association. 34 adults with aphasia were recruited and 29 completed (85.3%). EVA Park group sessions were delivered as 14 sessions over 6 months - considerably longer than the five-week period described in earlier summaries. Mean attendance was 11.4 of 14 sessions (81.6% intended dose). A health economic analysis was also conducted (by author Anita Patel, who is Director of a commercial health economics consultancy - a COI disclosed in the paper). Primary outcomes were wellbeing, communication, social connectedness, and quality of life, assessed with standardized measures.
What they found
Feasibility was comprehensively met: recruitment reached the 34 target, 85.3% of participants completed the full intervention, all planned groups ran with minimal fidelity drift, and mean attendance was high. These are important findings for implementation planning.
However, no significant change was observed on any quantitative outcome measure - wellbeing, communication, social connectedness, and quality of life all showed no significant difference between groups. The study was explicitly not powered to detect effects, so this is not evidence of ineffectiveness; it is evidence that a larger confirmatory RCT is needed.
Qualitative reports from participants were positive - people valued the social participation opportunities and described EVA Park as a less pressured environment for communication. Cost analysis showed GBP 7,483-12,562 per group depending on travel, volunteer contributions, and hardware loans.
Why this matters
This study is correctly characterized as a feasibility RCT, not a qualitative study. The combination of strong feasibility data and null quantitative outcomes is the expected profile for a feasibility trial - it tells us the intervention can be delivered but does not yet tell us whether it works on measured outcomes. The cost data provides practical information for commissioners considering group VR social support for aphasia.
Limitations
Not powered for quantitative effect detection. Single-waitlist control cannot rule out time effects. Author Anita Patel has a commercial health economics affiliation (disclosed). Long-term follow-up was not conducted.
Implications for practice
EVA Park group delivery over 6 months is feasible, and 85.3% completion with good session fidelity is a meaningful finding for implementation planning. Clinicians and commissioners should note that this study was not powered to detect effects and found no significant quantitative outcomes; it establishes that the approach can be delivered as planned, not that it outperforms alternatives on measurable outcomes. Cost data (GBP 7,483-12,562 per group) is available for service planning purposes.
Where this connects to Therapy withVR
The study above is independent research and does not endorse any product. The notes below are commentary from withVR on how the themes in this research relate to features of Therapy withVR. The research findings are not claims about Therapy withVR.
Speaking Circle
This study explored group social support in VR - Therapy withVR's Speaking Circle (2-12 chairs) creates the group interaction format this research used.
Multiple Avatar Placements
Place multiple avatars to simulate group conversations - building comfort with the multi-person social dynamics this study found beneficial.
Cite this study
If you reference this study in your work, the canonical citation formats are:
@article{marshall2020,
author = {Marshall, J. and Devane, N. and Talbot, R. and Caute, A. and Cruice, M. and Hilari, K. and MacKenzie, G. and Maguire, K. and Patel, A. and Roper, A. and Wilson, S.},
title = {A randomised trial of social support group intervention for people with aphasia: A Novel application of virtual reality},
journal = {PLOS ONE},
year = {2020},
doi = {10.1371/journal.pone.0239715},
url = {https://withvr.app/evidence/studies/marshall-2020}
}TY - JOUR
AU - Marshall, J.
AU - Devane, N.
AU - Talbot, R.
AU - Caute, A.
AU - Cruice, M.
AU - Hilari, K.
AU - MacKenzie, G.
AU - Maguire, K.
AU - Patel, A.
AU - Roper, A.
AU - Wilson, S.
TI - A randomised trial of social support group intervention for people with aphasia: A Novel application of virtual reality
JO - PLOS ONE
PY - 2020
DO - 10.1371/journal.pone.0239715
UR - https://withvr.app/evidence/studies/marshall-2020
ER - Know of research that should be in this hub? If a relevant peer-reviewed study is not listed here, send the reference to hello@withvr.app. The hub is kept up to date as the literature grows.
Funding & independence
The Stroke Association, Award Number TSA 2016/05. Disclosure: author Anita Patel is Director of Anita Patel Health Economics Consulting Ltd (commercial affiliation disclosed in paper). No withVR BV involvement in funding, study design, or authorship. Summary prepared independently by withVR using the published paper.