JMIR Publications

ABSTRACT

Background:

Extended reality (XR) technologies have shown promising results in pediatric rehabilitation and are increasingly perceived as engaging and motivating tools for children and youth. Despite increasing evidence supporting their clinical potential, the integration of XR into routine pediatric rehabilitation practice remains limited.

Objective:

This action research study aimed to examine the implementation process of XR technologies in two pediatric rehabilitation centers, involving rehabilitation professionals and decision-makers. Specific objectives were to i) identify multilevel implementation determinants using the Consolidated Framework for Implementation Research (CFIR); and ii) examine which implementation strategies were selected, adapted, and applied in the two different contexts and why they were selected.

Methods:

The study used a qualitative multiple-case study design with two pediatric rehabilitation centers conceptualized as distinct cases (A and B). It was conducted as an action research based implementation study involving both rehabilitation professionals, such as physiotherapists and occupational therapists, and decision-makers in a collaborative process. The implementation process was carried out over five phases adapted from the Knowledge-to-Action framework. The Technotheque model was chosen due to its clinical relevance. Data were collected during the process through focus groups and interviews. A deductive content analysis guided by the CFIR was conducted to identify multilevel implementation determinants across cases.

Results:

Across both cases, XR was perceived as an engaging and adaptable rehabilitation tool that supported children’s motivation and participation. However, important contextual differences emerged regarding implementation determinants and support needs. The main difference between cases concerned access to knowledge and training. In Case A, XR technologies were perceived as more complex, and rehabilitation professionals reported lower self-efficacy. In contrast, rehabilitation professionals in Case B perceived XR as easier to integrate into practice. In both cases, rehabilitation professionals expressed concerns about screen exposure and anticipated family acceptability, while emphasizing the importance of XR technologies that are engaging, affordable, and accessible for use at home. Differences were also observed between rehabilitation professionals and decision-makers regarding training adequacy and facilitation needs. These determinants informed the selection, intensity (frequency of support), and operationalization of multilevel implementation strategies across cases. Although both cases received educational materials and workshops, Case A focused on in-person facilitation, clinician champions, and structured opportunities for XR testing, whereas Case B relied more on existing peer-support mechanisms and autonomous learning. Organizational adaptations improved access to XR devices within each center.

Conclusions:

XR implementation in pediatric rehabilitation is a dynamic, context-dependent process that requires tailored multilevel implementation strategies. Although similar implementation determinants were identified across sites, the intensity and operationalization of implementation strategies differed according to local needs, perceptions, and organizational realities. Access to knowledge, clinical decision-making support, organizational integration, and collaboration between rehabilitation professionals and decision-makers emerged as key implementation considerations. Clinical Trial: This study was registered at ClinicalTrial.gov under the identifier NCT06627049.