Examining Implementation of a VR Intervention for Pediatric Chronic Pain: A Content Analysis

Background & Aims

The utility of Virtual Reality (VR) to support exposure to feared and painful (e.g., lumbar puncture) stimuli is well established, and VR has also demonstrated efficacy for supporting functioning and movement in adult chronic pain populations. Minimal research has been conducted evaluating the efficacy of VR for pediatric chronic pain populations, despite well-established fear of pain and movement in this population. A pilot study examining the use of VR in a pediatric chronic pain rehabilitation program supported the efficacy of VR in this population. As such, we initiated a randomized controlled trial to examine the effectiveness of VR for supporting youth with chronic pain engaging in outpatient physiotherapy. During implementation of the trial, considerable challenges arose prompting the current study which examined barriers and facilitators to implementing VR to support youth with chronic pain in the outpatient setting according to critical stakeholders in the study.

Methods

Semi-structured and informal interviews were conducted with youth participants, their caregivers, and collaborating clinicians. Interviews were recorded and transcribed verbatim and field notes taken. Youth participants and caregivers were asked about the importance of the intervention goals, acceptability of the procedures, and relevancy of the intervention outcomes. Clinician collaborators were asked about their experiences using VR, the impact on their patient care, and general feedback to improve uptake of the VR intervention. To analyze transcriptions, content analysis was employed. Consistent with content analysis, multiple rounds of analysis were completed, first using a deductive approach to code transcripts for barriers and facilitators to VR implementation. In the second round of analysis an inductive approach was used to identify emergent themes within each code category (i.e., barriers, facilitators).

Results

We completed interviews with N=20 participants including n=8 youth participants, n=5 caregivers, and n=7 clinician stakeholders. Results of the content analysis revealed several themes under each of the deductive codes (facilitators, barriers) related to implementation of the VR intervention. Themes that emerged within the barriers included: (a) participant identity and self-narrative inconsistent with the intervention, (b) system level, structural, constraints of healthcare, (c) research burden, (d) lack of guidance and leadership from clinicians around VR use, (e) treatment expectation violation and let-down, and (f) missing the optimal treatment window. Within the facilitators, primary themes included: (a) viewing VR as a bridge to achieving treatment goals, (b) having access to resources, (c) a sustained positive experience and immersion in the game, (d) alignment between identity and the intervention, and (e) champion collaborators.

Conclusions

Results indicate that to effectively translate VR interventions to the outpatient setting for chronic pain, consideration for implementation of the intervention is paramount. While VR can be an effective intervention to support engagement in feared or painful movements in the context of outpatient physiotherapy, direct translation of the intervention does not work for everyone or in every context. Findings of the current study highlight the need assess structural, social, and individual characteristics of the patient population and intervention setting to adequately tailor the VR intervention for optimal uptake. Adopting an implementation science lens to the field of VR for chronic pain is needed, particularly given the relatively low number of studies examining VR in this population and clinical context. The Consolidated Framework for Implementation Research (CFIR) model is an implementation science framework that may support systematic evaluation and guide intervention design.

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Presenting Author