Supporting virtual reality and active video game use in pediatric rehabilitation: Protocol for a mixed-methods feasibility study

BackgroundVirtual reality (VR) and active video game (AVG) systems that offer repetitive practice and multimodal feedback in engaging environments are attractive pediatric rehabilitation intervention options. Evidence supports their effectiveness to improve functional outcomes in multiple pediatric populations. However, VR/AVG integration into clinical practice faces multiple barriers, including limited access to these often-expensive technologies, a rapid development sector resulting in frequent obsolescence, and insufficient educational resources to help clinicians select appropriate games that match childrens therapeutic objectives. Knowledge translation initiatives that primarily target clinician knowledge and attitudes about VR/AVG use have shown limited success in facilitating adoption. To address these challenges, we used the Consolidated Framework of Implementation Research (CFIR) to structure development of the Technotheque, a multi-faceted VR/AVG support initiative at our large pediatric rehabilitation centre. The Technotheque addresses both access- and knowledge-based barriers to VR/AVG use via a dedicated gameplay space staffed by knowledge brokers who directly support clinicians in VR/AVG implementation in therapy sessions and provide education towards independent VR/AVG use. ObjectiveTo evaluate the feasibility of the Technotheque as a knowledge translation initiative to enhance VR/AVG use at our pediatric rehabilitation centre, as measured by demand, acceptability, adaptation, and implementation criteria. MethodsConvergent mixed-methods design. We will use convenience and snowball sampling strategies to recruit clinicians (physiotherapists, occupational therapists, speech therapists, special educators, and neuropsychologists) to participate in this 4-month study. Following informed consent, participants will complete a modified Assessing the Determinants of Prospective Take-up of Virtual Reality (ADOPT-VR2) instrument. Participants can then request individualized training and/or clinical implementation support with our knowledge brokers at a self-determined frequency and duration, and with their choice of clientele. Participants will be free to begin and end their study participation at any point during the four months. Data collection will include study-specific Technotheque pre-session objective and post-session feedback forms, a post-study ADOPT-VR reassessment, a CFIR-based satisfaction questionnaire, and individual semi-structured interviews. Quantitative analyses will examine demand (participant demographics, usage patterns, correlations between usage and ADOPT-VR2 scores), acceptability (satisfaction scores in relation to usage patterns and ADOPT-VR2 changes), adaptation (variety of professions, client populations, and clinical objectives), and implementation (pre-post ADOPT-VR2 changes and patterns of support needs over time). Qualitative data will be deductively analysed using the four feasibility criteria as a coding framework. Quantitative and qualitative results will be integrated to identify areas of alignment and/or divergence. ResultsResearch Ethics Board approval has been obtained. ConclusionsThe Technotheque initiative is designed to address both access and knowledge barriers to VR/AVG use in pediatric rehabilitation. Study results will inform subsequent research efforts to evaluate the effectiveness of VR/AVG as a rehabilitation intervention and to examine the impact of this initiative on sustained VR/AVG use.