A map of every reason VR succeeds or stalls in rehabilitation clinics
How this was rated
Comprehensive scoping review with explicit framework (Theoretical Domains Framework). Reflects the state of the field at time of publication; individual study quality varies. The core pattern - awareness exceeds use - has been replicated in subsequent work.
Ratings use a simplified four-tier scheme (High, Moderate, Low, Very Low) informed by the GRADE working group. Learn more about how studies are rated.
A scoping review of barriers, facilitators, and knowledge-translation interventions for VR and active-video-game (VR/AVG) implementation in rehabilitation. Used the Theoretical Domains Framework to structure findings across all but 1 of 14 TDF domains; 24 articles were included, ~75% from neurologic rehabilitation (stroke, CP, ABI). A consistent awareness-to-use gap was documented: many clinicians know of VR/AVG but few use it routinely. The review's contribution is procedural and implementation-focused - it does NOT review specific VR therapy efficacy.
Successful VR implementation is not a technology problem - it is a training, guidelines, and workflow problem. Teams introducing VR should plan for protected training time, clinician co-design, context-specific barrier assessment, and organizational support from day one. Without these, even well-evidenced VR tools stall at the awareness stage.
Key findings
- Barriers and facilitators spanned 13 of 14 Theoretical Domains Framework domains
- Most frequent barrier/facilitator domains: Knowledge, Skills, Beliefs About Capabilities, Environmental Context and Resources, Social Influences, Beliefs About Consequences, Intentions, and Goals
- Large awareness-to-use gap: US survey ~76% ever used VR/AVG clinically, ~31% current use; Scottish data 18% current use; Canadian data 50% ever used VR/AVG, 12% current use
- VR/AVG scope: review covers Virtual Reality AND Active Video Games (including Wii Fit, Xbox Kinect) - not limited to immersive VR; 24 articles included, 75% neurologic rehabilitation (stroke, CP, ABI)
- Only 4 studies empirically tested knowledge translation interventions; those that existed improved knowledge and self-efficacy but showed limited behavior change in real adoption
- Recommendations: engineer-clinician collaboration, barrier assessments before implementation, competency frameworks, knowledge brokers
Background
VR technology has been available to rehabilitation clinicians for decades. Yet adoption has lagged behind awareness - a pattern noted by individual surveys but not systematically synthesized until this review. Glegg and Levac set out to map what actually explains the gap: the barriers, the facilitators, and what interventions have been tried to close it.
What the researchers did
A scoping review using the Theoretical Domains Framework (TDF) - a validated framework for understanding behavior change in clinical settings. Studies examining VR implementation barriers, facilitators, or interventions across rehabilitation disciplines were extracted and coded against TDF domains.
What they found
Obstacles and supports appeared in 13 of 14 TDF domains. The most frequently cited were Knowledge (understanding what VR does), Skills (how to use it), Beliefs About Capabilities (feeling competent), Environmental Context and Resources (space, time, budget), and Social Influences (team, management, peer support). Adoption surveys showed a consistent pattern: most clinicians know VR exists, far fewer have used it, and fewer still use it currently. Of the studies that tested knowledge translation interventions, most improved knowledge and confidence but did not translate into sustained clinical behavior change.
Why this matters
For any team introducing VR - including VR speaking-situation tools in SLP practice - this review is a planning document, not just a research summary. The barriers are predictable and addressable if named upfront. Knowledge-only interventions (webinars, handouts) reliably fail to change behavior; what works is context-specific adaptation, protected practice time, and supportive management.
Limitations
Scoping reviews map evidence rather than evaluating it. The included studies vary in quality. SLP-specific implementation is under-represented; most evidence comes from physiotherapy, occupational therapy, and rehabilitation medicine. Published 2018 - the technology landscape has shifted since.
Implications for practice
Before introducing VR into a service, audit which TDF domains are weakest - often skills and environmental context. Budget protected time for training, not just equipment purchase. Pair enthusiastic early adopters with skeptical colleagues to surface real implementation barriers. Without these steps, VR often becomes a cupboard tool.
Implications for research
Empirical tests of knowledge translation interventions in VR rehabilitation remain sparse. Studies that evaluate not just knowledge change but sustained clinical behavior change are needed. Context-specific implementation frameworks tailored to SLP practice would extend the mainly physiotherapy- and occupational therapy-weighted evidence.
Cite this study
If you reference this study in your work, the canonical citation formats are:
@article{glegg2018,
author = {Glegg, S. M. N. and Levac, D. E.},
title = {Barriers, Facilitators and Interventions to Support Virtual Reality Implementation in Rehabilitation: A Scoping Review},
journal = {PM&R},
year = {2018},
doi = {10.1016/j.pmrj.2018.07.004},
url = {https://withvr.app/evidence/studies/glegg-2018}
}TY - JOUR
AU - Glegg, S. M. N.
AU - Levac, D. E.
TI - Barriers, Facilitators and Interventions to Support Virtual Reality Implementation in Rehabilitation: A Scoping Review
JO - PM&R
PY - 2018
DO - 10.1016/j.pmrj.2018.07.004
UR - https://withvr.app/evidence/studies/glegg-2018
ER - Know of research that should be in this hub? If a relevant peer-reviewed study is not listed here, send the reference to hello@withvr.app. The hub is kept up to date as the literature grows.
Funding & independence
No withVR BV involvement in funding, study design, or authorship. Summary prepared independently by withVR using the published paper.