Virtual reality for brain injury rehabilitation : an evaluation of clinical practice, therapists' adoption and knowledge translation

Background: Acquired brain injury (ABI) affects considerable numbers of Canadians every year, resulting in a range of functional impairments requiring rehabilitation. Virtual reality (VR) is a relatively new treatment approach being used increasingly for this purpose. A lack of research documents current practice in VR use, along with the barriers, facilitators and support needs of therapists expected to adopt the technology. Purpose: This research aimed to describe how the GestureTek VR system was being used clinically in ABI rehabilitation, to outline preliminary work addressing the resource needs of clinicians, to examine factors influencing therapists’ adoption of VR and to evaluate the impact of a multi-faceted knowledge translation (KT) intervention at mediating these factors to facilitate VR implementation. Hypotheses: The KT intervention will be associated with improvements in therapists' perceived ease of use and self efficacy in using the technology, and an associated increase in their intentions to use VR. Methods: A single group pretest-posttest design was used to examine the determinants of VR adoption as proposed by the Decomposed Theory of Planned Behaviour and to evaluate change following KT. The intervention included interactive education, the provision of clinical protocols and technical and clinical support. Forty-two therapists from two health centres completed the ADOPT-VR outcome measure. Descriptive measures recorded the nature of therapists’ use of VR with 29 clients. Related-samples Wilcoxon signed ranks tests were used to evaluate pretest-posttest changes in hypothesis variables. Descriptive statistics and content analysis were used to analyse nominal and qualitative data, respectively. Results: Differences existed between clinical application and existing research in both treatment and client characteristics. Overall, therapists had positive attitudes and intentions to use VR. Increases in perceived ease of use and self efficacy, but not behavioural intention, were observed following KT. The most significant barriers to VR use included time and client factors, while primary facilitators included peer influence and organisational-level supports. Conclusion: Preliminary knowledge of current VR practice trends can assist in the design of clinically relevant ABI research. Barriers and facilitators can be targeted by management to support VR implementation. Therapists’ identified knowledge and support needs can inform future KT strategies.Medicine, Faculty ofGraduat