Barriers, Facilitators and Interventions to Support Virtual Reality Implementation in Rehabilitation: A Scoping Review

Abstract

Virtual reality and active video games (VR/AVGs) are promising rehabilitation tools because of their potential to facilitate abundant, motivating, and feedback-rich practice. However, clinical adoption remains low despite a growing evidence base and the recent development of clinically accessible and rehabilitation-specific VR/AVG systems. Given clinicians’ eagerness for resources to support VR/AVG use, a critical need exists for knowledge translation (KT) interventions to facilitate VR/AVG integration into clinical practice. KT interventions have the potential to support adoption by targeting known barriers to, and facilitators of, change. This scoping review of the VR/AVG literature uses the Theoretical Domains Framework (TDF) to (1) structure an overview of known barriers and facilitators to clinical uptake of VR/AVGs for rehabilitation; (2) identify KT strategies to target these factors to facilitate adoption; and (3) report the results of these strategies. Barriers/facilitators and evaluated or proposed KT interventions spanned all but 1 and 2 TDF domains, respectively. Most frequently cited barriers/facilitators were found in the TDF domains of Knowledge, Skills, Beliefs About Capabilities, Beliefs About Consequences, Intentions, Goals, Environmental Context and Resources, and Social Influences. Few studies empirically evaluated KT interventions to support adoption; measured change in VR/AVG use did not accompany improvements in self-reported skills, attitudes, and knowledge. Recommendations to target frequently identified barriers include technology development to meet end-user needs more effectively, competency development for end-users, and facilitated VR/AVG implementation in clinical settings. Subsequent research can address knowledge gaps in both clinical and VR/AVG implementation research, including on KT intervention effectiveness and unexamined TDF domain barriers.

Feasibility, acceptability and clinical implementation of an Immersive Virtual Reality intervention to address psychological wellbeing in children and adolescents with cancer

“…Importantly, despite the encouraging findings shown thus far, the feasibility and acceptability of VR technology in complex healthcare environments remains largely unexplored (Glegg & Levac, 2018). With VR implementation research at an early stage, there is demand for more research investigating its safe and effective application in these environments (Rizzo & Koenig, 2017) and more recently, factors influencing VR technology adoption as they directly impact intervention success (Bertrand & Bouchard, 2008;Glegg et al, 2013;Glegg & Levac, 2018;Markus et al, 2009). A notable limitation of nearly all current clinical VR research has been the lack of significant end user involvement from intervention design, to acceptance and implementation of VR technology.…”

“…A notable limitation of nearly all current clinical VR research has been the lack of significant end user involvement from intervention design, to acceptance and implementation of VR technology. Previous research has established that initial testing of technology innovations in healthcare settings, including the opportunity to trial and provide feedback is a crucial step in the development of relevant and effective interventions that meet the needs of patients and HCPs (Glegg & Levac, 2018;Langhan, Riera, Kurtz, Schaeffer, & Asnes, 2015;Lyon et al, 2016). This collaborative process also encourages "buy-in" from patients and HCPs, which has been shown to have a positive influence on adoption (i.e.…”

“…initial decision to use) and implementation (i.e. actual use) of new bedside technology in clinical care (Glegg & Levac, 2018;Langhan et al, 2015). Conversely, failure to engage key product end-users in this way may result in discrepancies between their needs and beliefs about what the new technology can offer, and risk intervention disuse (Glegg & Levac, 2018).…”

Movement Pattern Recognition in Physical Rehabilitation - Cognitive Motivation-based IT Method and Algorithms

“…These sensors are of great importance, mainly those that are operating based on optical principles because of their convenient usability. [20,21] The role of these IT solutions, serious games and frameworks that can be used in home environments is also significant in post-stroke rehabilitation. Many of these have been developed worldwide in the past years.…”

Virtual Reality in Rehabilitation—Using Technology to Enhance Function

“…Prahm and colleagues [17] have explored the role of VR based gaming interventions to encourage use of prosthetic upper limbs in persons with upper extremity amputations at different levels. Glegg and Levac [18] conducted a scoping review to identify the barriers and facilitators to the implementation on the use of VR in rehabilitation. Finally, Subramanian and Prasanna [19] assessed the effectiveness of a combination of task‐practice in VEs and provision of non‐invasive brain stimulation on upper limb motor improvement in individuals post‐stroke using a meta‐analysis and systematic review.…”