Implementation of a Virtual Reality Intervention in Outpatient Physiotherapy for Chronic Pain: Protocol for a Pilot Implementation Study (Preprint)

Abstract

BACKGROUND Chronic pain is a global health issue that causes physical, psychological, and social disabilities for patients, as well as high costs for societies. Virtual Reality (VR) is a new treatment that provides an opportunity to narrow the gap between clinical practice and recommended care, especially in the outpatient physiotherapy setting. However, there is currently no implementation strategy to integrate VR treatments into this setting. OBJECTIVE This protocol outlines a pilot implementation study that aims to (1) identify barriers and facilitators for implementing a Virtual Reality (VR) intervention in outpatient physiotherapy care for people with chronic pain. And (2) to develop and pilot test an implementation strategy in five practices in Germany. METHODS The study consists of four phases. The first phase involves adapting the treatment protocol of the VR intervention to the local context of outpatient physiotherapy practices in Germany. The second phase includes the collection of barriers and facilitators via semisctructured interviews from physiotherapists and the development of a theory-driven implementation strategy based on the Theoretical Domains Framework (TDF) and the Behavior Change Wheel (BCW). This strategy will be applied in the third phase, which will also include a six-month span of using VR interventions in practices, along with a process evaluation. The fourth phase will be a final evaluation of the entire process and implementation strategy at the end of the of the study. RESULTS The recruitment process and phase 1, including the adaptation of the treatment protocol, have already been completed. We recruited five physiotherapy practices in Lower Saxony, Germany, where the VR intervention will be implemented. The collection of barriers and facilitators through semi-structured interviews is scheduled to begin in February 2024. CONCLUSIONS This pilot implementation study aims to develop a theory-driven implementation strategy for integrating a VR intervention into outpatient physiotherapy care for people with chronic pain. The identified barriers and facilitators, along with the implementation strategy, will serve as a starting point for future randomized controlled implementation studies in different settings to refine the implementation process and integrate VR interventions into the outpatient care of people with chronic pain. CLINICALTRIAL German Clinical Trials Register (ID: DRKS00030862)