JMIR Publications

ABSTRACT

Background:

Virtual reality (VR) platforms have demonstrated small-to-moderate effect sizes for motor, balance, and dual-task outcomes across neurological conditions, yet fewer than one-third of physical therapists regularly integrate VR into practice, citing limited space, inadequate training, and uncertainty about clinical utility. The Instrumented Multitask Assessment System (IMAS) is a compact VR platform combining a 360° omnidirectional walking surface, an immersive headset, and integrated biophysical sensors for real-time adaptive cognitive-motor dual-task training. Preliminary work demonstrated feasibility for dual-task assessment in military service members with mild traumatic brain injury, but clinician perspectives on acceptability and implementation for routine neurorehabilitation remain unexplored.

Objective:

This study explored practicing neurorehabilitation clinicians’ perceptions of the feasibility, acceptability, and implementation requirements of the IMAS platform. Guided by the Theoretical Framework of Acceptability (TFA), we sought to understand how clinicians perceive the coherence, burden, and potential effectiveness of the IMAS to inform iterative design modifications for subsequent patient-focused pilot testing.

Methods:

A qualitative descriptive design using semi-structured interviews was employed. Eighteen licensed neurorehabilitation clinicians (physical therapists, occupational therapists, and speech-language pathologists) with a minimum of 2 years’ experience treating adults with neurological disorders were recruited via purposive sampling across diverse US clinical settings. Interviews were conducted via videoconference. Data were analyzed using reflexive thematic analysis with 2 investigators independently coding transcripts and resolving discrepancies through structured consensus meetings. Reporting followed the Standards for Reporting Qualitative Research guidelines.

Results:

Participants were predominantly female (11/18, 61%), physical therapists (12/18, 67%), held professional doctorates (12/18, 67%), and worked in outpatient settings (11/18, 61%), with a mean of 11.11 (SD 9.05) years of neurorehabilitation experience. Saturation was reached by the sixteenth interview. Analysis yielded four themes: (1) System Design and Customization Needs, reflecting emphasis on principles of neuroplasticity and environmental customization as essential features; (2) Implementation Challenges and Barriers, encompassing learning curves, safety concerns, resource constraints, workflow considerations, and technical limitations as burden dimensions; (3) Perceived Benefits and Advantages, including enhanced therapeutic outcomes, patient safety, engagement through gamification, and immediate feedback; and (4) Training and Support Requirements, highlighting comprehensive hands-on training and tiered technical support as requisites for clinician self-efficacy.

Conclusions:

Clinicians perceived the IMAS as coherent with established neurorehabilitation principles and therapeutically promising; however, substantial barriers related to cost, space, workflow disruption, and technical reliability were identified as limiting factors for adoption. The TFA revealed that high coherence and perceived effectiveness alone cannot overcome high burden when organizational capacity, financial resources, and technical support remain inadequate. Successful implementation requires coordinated efforts to address safety, reduce costs, validate effectiveness through patient outcome studies, and embed comprehensive training within clinical settings.