Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jan 1;50(1):76-85.
doi: 10.1093/jpepsy/jsae056.

Navigating virtual realities: identifying barriers and facilitators to implementing VR-enhanced PT for youth with chronic pain

Nicole M Jehl  1 , Courtney W Hess  1 , Ellison S Choate  1 , Hannah T Nguyen  2 , Yerin Yang  2 , Laura E Simons  1
Affiliations

Navigating virtual realities: identifying barriers and facilitators to implementing VR-enhanced PT for youth with chronic pain

Nicole M Jehl et al. J Pediatr Psychol. .

Abstract

Objective: Virtual reality (VR) can enhance engagement in outpatient physical therapy (PT) through distraction and gamification of movement. This study assessed barriers and facilitators to VR-enhanced PT.

Method: Data were collected during a feasibility trial of VR-enhanced PT for youth with chronic musculoskeletal pain. Semistructured and informal interviews were conducted with youth participants, their caregivers, and collaborating physical therapists. To analyze transcriptions, content analysis was employed in multiple rounds. Barriers and facilitators to VR implementation were coded using a deductive approach, then an inductive approach was used to identify emergent themes within each deductive code category.

Results: We completed interviews with youth participants (n = 9), caregivers (n = 7), and clinician stakeholders (n = 5). Coded barriers included: (1) participant identity and self-narrative inconsistent with the intervention, (2) system-level, structural constraints of healthcare, (3) lack of guidance and leadership from clinicians around VR use, (4) research burnout, (5) expectation violation and disappointment, and (6) missing the optimal treatment window. Coded facilitators included: (1) viewing VR as a bridge to achieving treatment goals, (2) having access to resources, (3) sustained positive experience and immersion in the game, (4) alignment between identity and the intervention, and (5) champion-level collaborations.

Conclusions: This study highlights the importance of considering the VR technology, person using the VR, and the context in which VR is being implemented to optimize uptake and acceptability. Adopting an implementation science lens to the field of VR for chronic pain will enhance the applicability and scale of impact.

Keywords: chronic pain; implementation science; pain rehabilitation; pediatrics; physical therapy; qualitative research; virtual reality.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Interrelationships across theme domains. Theme domains are the individual (youth with chronic pain), innovation (the virtual reality technology), and context (outpatient physical therapy). Each theme is in its own circle that is connected by bidirectional arrows to indicate the bidirectional relationship between each of the developed themes. The individual and innovation are related through themes of participant identity, treatment expectations, and access to resources. The innovation and context are related through themes of rigidity of healthcare, research burden, and the importance of champion collaborators. The context and individual are related through themes of the optimal treatment window, need for sustained engagement, and need for guidance and leadership from PT.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Ajzen I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50(2), 179–211. 10.1016/0749-5978(91)90020-T - DOI
    1. Bonawitz K., Wetmore M., Heisler M., Dalton V. K., Damschroder L. J., Forman J., Allan K. R., Moniz M. H. (2020). Champions in context: Which attributes matter for change efforts in healthcare? Implementation Science, 15(1), 1–10. 10.1186/S13012-020-01024-9/TABLES/1 - DOI - PMC - PubMed
    1. Carl E., Stein A. T., Levihn-Coon A., Pogue J. R., Rothbaum B., Emmelkamp P., Asmundson G. J. G., Carlbring P., Powers M. B. (2019). Virtual reality exposure therapy for anxiety and related disorders: A meta-analysis of randomized controlled trials. Journal of Anxiety Disorders, 61, 27–36. 10.1016/J.JANXDIS.2018.08.003 - DOI - PubMed
    1. Crombez G., Eccleston C., Van Damme S., Vlaeyen J. W. S., Karoly P. (2012). Fear-avoidance model of chronic pain: The next generation. Clinical Journal of Pain, 28(6), 475–483. 10.1097/AJP.0B013E3182385392 - DOI - PubMed
    1. Dedoose Version 9.0.17, cloud application for managing, analyzing, and presenting qualitative and mixed method research data. (2021). SocioCultural Research Consultants, LLC. www.dedoose.com