Barriers and facilitators to the implementation of virtual reality as a pain management intervention in outpatient physiotherapy practices: a qualitative analysis

BACKGROUND: Chronic pain is a leading global cause of disability. There is evidence supporting the efficacy of virtual reality (VR) interventions for improving pain and function in patients with chronic pain. However, use of VR in physiotherapy practice remains limited. This study examined the pre-implementation barriers and facilitators experienced by physiotherapists working in Germany when implementing VR for chronic pain management in outpatient settings. METHODS: Physiotherapists participating in a VR implementation study were interviewed using semi-structured interviews. The interviews were transcribed and analyzed using qualitative content analysis. The identified barriers and facilitators were categorized into domains of the Theoretical Domains Framework. RESULTS: Based on the interviews with nine physiotherapists, the pre-implementation key barriers included environmental barriers, such as time limitations and lack of insurance reimbursement, knowledge barriers in relation to chronic pain management and VR content, professional role barriers, such as VR being perceived as outside the scope of physiotherapy and decision-making barriers, such as patient selection. The primary facilitators were environmental opportunities, such as VR being a unique asset of the practice or a dedicated area for VR therapy. Additional facilitators included positive expectations for the rehabilitation process and the belief that VR is an opportunity of growth for physiotherapy as a profession. CONCLUSIONS: Physiotherapists recognize the therapeutic potential of VR, but anticipate significant implementation challenges related to environmental restrictions, knowledge gaps, and professional role conflicts. However, they also identified potential facilitators, such as VR's unique assets for practices and its benefits for patient empowerment and professional advancement. Successful adoption requires multifaceted strategies that address reimbursement policies, provide enhanced training in areas such as pain neuroscience and VR applications, and facilitate workflow integration. Future research should validate these findings across diverse healthcare systems to support the integration of VR in chronic pain care. TRIAL REGISTRATION: The study was registered with the German Clinical Trials Register on April 14, 2023 (ID: DRKS00030862).