Clinical Applicability and Therapists’ Acceptance of an Immersive Virtual Reality Application in Pediatric Gait Rehabilitation: Mixed Methods Study (Preprint)

BACKGROUND Immersive virtual reality (iVR) is a promising tool in pediatric neurorehabilitation, as active participation depends strongly on young patients’ motivation. Despite growing availability, clinical adoption remains limited due to technical challenges, lack of experience, and integration barriers. Knowledge translation (KT) strategies may help therapists acquire the competence and confidence needed for effective implementation. OBJECTIVE To implement an iVR application for practicing everyday walking activities in a neuropediatric rehabilitation setting and evaluate its clinical applicability, therapists’ acceptance, and adoption. METHODS In a longitudinal mixed-methods study, 18 therapists from a neuropediatric rehabilitation center participated in a KT intervention including interactive workshops, written guidance, and ongoing technical support to implement an iVR application specifically developed for practicing everyday walking activities. Over a 4-month implementation phase, quantitative data of patient and therapist characteristics, iVR session parameters, preparation times, usability after the first and fifth sessions (UMUX-Lite), and adverse events were collected. Qualitative semi-structured pre- and post-implementation interviews explored expectations, experiences, perceived barriers, and facilitators. Therapists’ continued use of iVR and therapist-reported issues were evaluated over an 18-month follow-up period. RESULTS During the 4-month implementation phase, 15 of the 18 therapists used the iVR application with 30 patients (mean 12.4, SD 2.6 years) with predominantly neuromotor and orthopedic diagnoses. On average, each therapist used the system 7.5 times (SD 3.6, range 3-14) and rated it as easy to use after 5 sessions. Preparation time was less than 5 minutes in 63% (72/114) of the sessions and decreased with therapists’ experience with the application. Active therapy duration mostly exceeded 20 minutes. UMUX-Lite ratings improved from the first to the fifth sessions, indicating increased perceived usability and usefulness. Therapists reported enhanced patient motivation and activity, greater movement variability, and reduced anxiety or pain during gait practice. Initial technical challenges diminished over time. No serious adverse events occurred. During the 18-month follow-up period, 18 therapists (including new staff members) performed 187 iVR sessions (range 1-49 per therapist) with 56 patients, indicating sustained, though variable, adoption. CONCLUSIONS The structured KT intervention supported safe and effective integration of iVR into neuropediatric gait rehabilitation. Therapists gained confidence and perceived clear therapeutic value, while patients demonstrated high engagement and intuitive interaction. Despite initial technical challenges, the application was clinically feasible, well accepted by therapists, and compatible with routine clinical workflows, with sustained use over 18 months. These findings support iVR as a valuable addition to conventional pediatric gait therapy and highlight the importance of tailored KT strategies.