Anticipated Barriers and Facilitators to Engaging in a Novel Virtual Reality Program for Lower Phantom Limb Pain

While there is promising evidence to suggest certain virtual reality (VR) programs and graded motor imagery (GMI) can independently be administered to treat phantom limb pain (PLP) in people with lower limb amputations (LLAs), there are many barriers preventing their implementation. Long outpatient wait times prevent treatment access in the early postoperative period following amputation, when PLP is the most severe. The integration of GMI in VR offers the opportunity to improve PLP treatment access in the acute period by facilitating self-administration. Accordingly, the present multidisciplinary team used a multi-methods approach to assess a novel head-mounted VR GMI prototype and evaluate areas of improvement according to patient feedback. Twelve people with unilateral LLAs recruited from outpatient physiotherapist and prosthetic clinics were asked to trial the program in a single intensive session. Afterwards, participants completed a semi-structured interview to reflect on barriers and facilitators they expect would affect their use of the VR GMI program. They also completed psychometrically validated self-report questionnaires (including the User Engagement Scale and Presence Questionnaire) that inquired about the engagement and immersion facilitated by the program. Reflexive thematic analysis suggests VR and treatment expectations, in addition to individual priorities, motivation, and resources, may affect one's willingness to use the VR GMI program in the acute period following amputation. Meanwhile, descriptive analysis demonstrates that while the VR GMI program is considered immersive, more focused attention needs to be facilitated to increase engagement. In line with these findings, future development will prioritize embedding psychoeducation to prime realistic expectations about the intervention. These developments will improve the chances of implementing the VR GMI program in clinical settings following a larger study to assess its efficacy in the hospital following amputation. Results may be transferred to our broader understanding of how VR interventions may be implemented in acute postoperative settings.