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Purpose: To evaluate the impact of knowledge translation (KT) on factors influencing virtual reality (VR) adoption and to identify support needs of therapists., Hypotheses: Intervention will be associated with improvements in therapists' perceived ease of use and self-efficacy, and an associated increase in intentions to use VR., Method: Single group mixed-methods pre-test-post-test evaluation of convenience sample of physical, occupational and rehabilitation therapists (n=37) from two brain injury rehabilitation centres. ADOPT-VR administered pre/post KT intervention, consisting of interactive education, clinical manual, technical and clinical support., Results: Increases in perceived ease of use (p=0.000) and self-efficacy (p=0.001), but not behavioural intention to use VR (p=0.158) were found following KT, along with decreases in the frequency of perceived barriers. Post-test changes in the frequency and nature of perceived facilitators and barriers were evident, with increased emphasis on peer influence, organisational-level supports and client factors. Additional support needs were related to clinical reasoning, treatment programme development, technology selection and troubleshooting., Conclusions: KT strategies hold potential for targeting therapists' perceptions of low self-efficacy and ease of use of this technology. Changes in perceived barriers, facilitators and support needs at post-test demonstrated support for repeated evaluation and multi-phased training initiatives to address therapists' needs over time. Implications for Rehabilitation Therapists' learning and support needs in integrating virtual reality extend beyond technical proficiency to include clinical decision-making and application competencies spanning the entire rehabilitation process. Phased, multi-faceted strategies may be valuable in addressing therapists' changing needs as they progress from novice to experienced virtual reality users. The ADOPT-VR is a sensitive measure to re-evaluate the personal, social, environmental, technology-specific and system-level factors influencing virtual reality adoption over time.

Purpose: Therapists use motor learning strategies (MLSs) to structure practice conditions within stroke rehabilitation. Virtual reality (VR)-based rehabilitation is an MLS-oriented stroke intervention, yet little support exists to assist therapists in integrating MLSs with VR system use. Method: A pre-post design evaluated a knowledge translation (KT) intervention incorporating interactive e-learning and practice, in which 11 therapists learned how to integrate MLSs within VR-based therapy. Self-report and observer-rated outcome measures evaluated therapists’ confidence, clinical reasoning and behaviour with respect to MLS use. A focus group captured therapists’ perspectives on MLS use during VR-based therapy provision. Results: The intervention improved self-reported confidence about MLS use as measured by confidence ratings (p <0.001). Chart-Stimulated Recall indicated a moderate level of competency in therapists’ clinical reasoning about MLSs following the intervention, with no changes following additional opportunities to use VR (p = .944). On the Motor Learning Strategy Rating Instrument, no behaviour change with respect to MLS use was noted (p = 0.092). Therapists favoured the strategy of transferring skills from VR to real-life tasks over employing a more comprehensive MLS approach. Conclusion: The KT intervention improved therapists’ confidence but did not have an effect on clinical reasoning or behaviour with regard to MLS use during VR-based therapy. [ABSTRACT FROM AUTHOR]

Background: Despite increasing evidence for the effectiveness of virtual reality (VR)-based therapy in stroke rehabilitation, few knowledge translation (KT) resources exist to support clinical integration. KT interventions addressing known barriers and facilitators to VR use are required. When environmental barriers to VR integration are less amenable to change, KT interventions can target modifiable barriers related to therapist knowledge and skills. Methods: A multi-faceted KT intervention was designed and implemented to support physical and occupational therapists in two stroke rehabilitation units in acquiring proficiency with use of the Interactive Exercise Rehabilitation System (IREX; GestureTek). The KT intervention consisted of interactive e-learning modules, hands-on workshops and experiential practice. Evaluation included the Assessing Determinants of Prospective Take Up of Virtual Reality (ADOPT-VR) Instrument and self-report confidence ratings of knowledge and skills pre- and post-study. Usability of the IREX was measured with the System Usability Scale (SUS). A focus group gathered therapist experiences. Frequency of IREX use was recorded for 6 months post-study. Results: Eleven therapists delivered a total of 107 sessions of VR-based therapy to 34 clients with stroke. On the ADOPT-VR, significant pre-post improvements in therapist perceived behavioral control (p = 0.003), self-efficacy (p = 0.005) and facilitating conditions (p =0.019) related to VR use were observed. Therapist intention to use VR did not change. Knowledge and skills improved significantly following e-learning completion (p = 0.001) and was sustained 6 months post-study. Below average perceived usability of the IREX (19th percentile) was reported. Lack of time was the most frequently reported barrier to VR use. A decrease in frequency of perceived barriers to VR use was not significant (p = 0.159). Two therapists used the IREX sparingly in the 6 months following the study. Therapists reported that client motivation to engage with VR facilitated IREX use in practice but that environmental and IREX-specific barriers limited use. Conclusions: Despite increased knowledge and skills in VR use, the KT intervention did not alter the number of perceived barriers to VR use, intention to use or actual use of VR. Poor perceived system usability had an impact on integration of this particular VR system into clinical practice. [ABSTRACT FROM AUTHOR]

BACKGROUND: Virtual reality (VR) is a relatively new treatment tool with emerging evidence supporting its use in neurorehabilitation, although no information exists about how therapists use VR clinically. OBJECTIVE: This study's purpose was to document current practice in GestureTek VR use for inpatient acquired brain injury (ABI) rehabilitation as a benchmark for clinicians integrating the approach into practice, and to inform future research to improve its clinical applicability. METHODS: As part of a larger study examining barriers and facilitators to VR use, participating therapists at two rehabilitation centres documented descriptive data about client demographics and VR treatment programme characteristics for 29 ABI clients on their caseloads over eight months. RESULTS: Differences between the clinical population and published research samples were apparent. Treatment characteristics and several outcomes of interest paralleled those in the literature; however, novel outcome areas were identified as research gaps. By study's end, more than half of clients' VR programmes had been discontinued, for reasons consistent with documented barriers to VR use. CONCLUSIONS: These findings can help bridge the knowledge-to-action gap by informing the design of research that has high clinical relevance, and by providing a point of reference for clinicians incorporating VR into their practices. [ABSTRACT FROM AUTHOR]

Virtual reality (VR) is an important emerging technology that is increasingly being introduced in health centers as a rehabilitation intervention. Quantitative research is needed to identify the factors influencing therapists' adoption of VR for brain injury rehabilitation, including barriers and facilitators to VR use, in order to inform successful implementation strategies. A measure based on the Decomposed Theory of Planned Behavior (DTPB) was developed and administered to 42 therapists; early psychometric properties are reported. Mean or median composite scores and correlations were calculated for each DTPB construct. Overall, therapists had positive attitudes toward VR, perceived it as being useful, and had positive intentions to use it more in the future. The self-efficacy composite yielded the lowest scores. The most significant barrier to adoption was time, while social influences and knowledge were the primary facilitators. Future research will explore the impact of knowledge translation interventions on these mediators of VR adoption. [ABSTRACT FROM AUTHOR]