Barriers and Facilitators to the Implementation of Virtual Reality as a Pain Management Intervention in Outpatient Physiotherapy Practices: A Qualitative Analysis

Background Chronic pain is a leading global cause of disability. There is evidence supporting the efficacy of virtual reality (VR) interventions for improving pain and function in patients with chronic pain. However, use of VR in physiotherapy practice remains limited. This study examined the pre-implementation barriers and facilitators experienced by physiotherapists working in Germany when implementing virtual reality (VR) for chronic pain management in outpatient settings. Methods Physiotherapists participating in a VR implementation study were interviewed using semi-structured interviews. The interviews were transcribed and analyzed using qualitative content analysis. The identified barriers and facilitators were categorized into TDF domains. Results Based on the interviews with nine physiotherapists, the pre-implementation key barriers included environmental barriers, such as time limitations and lack of insurance reimbursement; knowledge barriers in relation to chronic pain management and VR content; professional role barriers, such as VR being perceived as outside the scope of physiotherapy; and decision-making barriers, such as patient selection. The primary facilitators were environmental opportunities, such as VR being a unique asset of the practice or a dedicated area for VR therapy. Additional facilitators included positive expectations for the rehabilitation process and the belief that VR is an opportunity of growth for physiotherapy as a profession. Conclusions Although physiotherapists recognize the therapeutic potential of VR, they anticipate significant implementation challenges related to environmental restrictions, knowledge gaps, and professional role conflicts. Successful adoption requires multifaceted strategies that address reimbursement policies, provide enhanced training in areas such as pain neuroscience and VR applications, and facilitate workflow integration. Future research should validate these findings across diverse healthcare systems to support the integration of VR chronic pain care. Trial registration The study was registered with the German Clinical Trials Register on April 14, 2023 (ID: DRKS00030862).