Virtual Reality in Chronic Pain Management: A systematic Review of Barriers and Facilitators

To identify barriers and facilitators to the implementation of VR intervention in the treatment of people with chronic pain.

A scoping review was conducted to identify quantitative, qualitative, and mixed methods studies reporting on barriers and facilitators to the implementation of VR interventions for patients with chronic pain. Six databases were systematically searched. After screening, two independent reviewers (AE, ML) systematically extracted, coded and categorized all barriers and facilitators described in the identified studies. The Theoretical Domains Framework (TDF) was used as a basis for categorization.

After removing duplicates, the database search yielded 1864 records. From the 14 included studies, 30 barriers and 33 facilitators from the patients' perspective and 2 facilitators from the therapists' perspective were extracted. Patient-reported barriers were most common in the TDF domains of environmental context (60%) and skills (16.7%). Most facilitators were found in the areas of beliefs about consequences (30.3%) and emotions and environmental context (18.2% each), which were also reported by therapists.

Our findings provide a comprehensive overview of the barriers and facilitators to implementing VR interventions for people with chronic pain. Based on the identified barriers, the development of VR devices and VR interventions should consider the perspectives of both people with chronic pain and healthcare professionals. This could reduce language, cognitive, and physical barriers, which are common. Future research should focus on the perspective of healthcare professionals, as little is known about this important group when considering implementation. In addition, systematic and targeted implementation strategies can be developed through implementation studies based on the identified barriers and facilitators.

Based on the identified barriers and facilitators, systematic and targeted implementation strategies for VR interventions for the treatment of people with chronic pain can be developed. With the help of these strategies, the use of VR interventions in the physiotherapeutic treatment of chronic pain can be increased in a systematic process.