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. 2025 Nov 17:8:100443.
doi: 10.1016/j.pecinn.2025.100443. eCollection 2026 Jun.

The effect of physiotherapists' explanation of therapeutic virtual reality on treatment expectations in healthy people and people with chronic musculoskeletal pain: Two online RCTs

Syl Slatman  1   2 , Wim van Lankveld  1 , J Bart Staal  1   3 , Harry van Goor  4 , Raymond Ostelo  5   6 , Janine Westendorp  7 , Jesper Knoop  1   5
Affiliations

The effect of physiotherapists' explanation of therapeutic virtual reality on treatment expectations in healthy people and people with chronic musculoskeletal pain: Two online RCTs

Syl Slatman et al. PEC Innov. .

Abstract

Objectives: Chronic musculoskeletal pain (CMP) is a disabling condition, for which physiotherapy is a common treatment. Therapeutic virtual reality (VR) is an emerging treatment modality in physiotherapy care for patients with CMP. Treatment expectations of patients regarding therapeutic VR influence its effectiveness and could possibly be enhanced by the therapist by using positive language about therapeutic VR. The aim of the current studies was to explore the effect of physiotherapists explaining VR using positive versus neutral language, on treatment expectations of healthy participants (study 1) and patients with CMP (study 2).

Methods: Two web-based, double-blinded RCTs were conducted with two groups (healthy participants and patients with CMP), that were randomly allocated to a video explaining therapeutic VR using positive language or neutral language. The primary outcome measures were treatment credibility and expectancy, assessed at baseline and post-intervention. Between-group differences and within-group changes were respectively analyzed using simple linear regression analyses and repeated measures ANOVAs. All analyses were performed separately for healthy participants and patients with CMP.

Results: In total, 127 healthy participants (study 1) and 115 patients with CMP (study 2) were included and randomized. We found no between-group difference in treatment expectations between positive versus neutral language videos, neither in healthy participants nor patients with CMP. We found significant within-group changes for treatment expectations in both conditions (positive and neutral language) in healthy participants, and in the positive language condition only in the CMP group.

Conclusions: The studies show that any explanation of therapeutic VR (both using positive or neutral language) seems to improve treatment expectations. Unexpectedly, using positive language was not superior to using neutral language. Future research should examine strategies for healthcare providers to set optimal treatment expectations on therapeutic VR in patients with CMP.

Practice implications: A brief verbal explanation about therapeutic VR improves treatment expectations in both healthy participants and patients with CMP.

Keywords: Chronic musculoskeletal pain (CMP); Physiotherapy; Randomized controlled trial; Therapeutic communication; Virtual reality (VR).

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Conflict of interest statement

The authors declare they have no competing interests.

Figures

Fig. 1
Fig. 1
Still image from one of the VR explanation videos.
Fig. 2
Fig. 2
Study procedures.
Fig. 3
Fig. 3
CONSORT diagram flow of healthy participants.
Fig. 4
Fig. 4
CONSORT diagram flow of patients with CMP.
See this image and copyright information in PMC

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