Virtual Reality for Surgical Prehabilitation and Rehabilitation: A Qualitative Study of Breast Surgery Patients’ Experiences and Perspectives of Perioperative VR Physical Therapy

Introduction: Upper extremity functional morbidity is common after breast surgery. Physical therapy (PT) improves functional outcomes, but is underused due to lack of access. VR technology may mitigate these barriers by providing PT content in an engaging, scalable, and affordable way. Our aim was to identify preferences and potential barriers for VR-enabled PT. 

Methods: Participants experienced a VR-enabled PT session, followed by a semi-structured interview. Interview transcriptions were coded and subjected to inductive thematic analysis. 

Results: 9 of the 10 participants were women and the average age was 55. Interview analysis revealed 4 themes: lack of patient-provider alignment on the need for perioperative PT, subjective user experience with VR depends on how necessary patients perceived the VR platform to be, need for technology and coaching support to make VR feasible and engaging, and recognition of the potential strengths and limitations of VR for surgical patients. Participants found VR to be immersive in an enjoyable way, convenient, and potentially helpful in coping with perioperative anxiety. The limitations of VR-enabled PT were the lack of specific therapist feedback on proper form and the lack of hands-on manual therapy. 

Conclusion: VR is a promising method of delivering perioperative PT to breast surgery patients. Success of VR-enabled perioperative PT requires: education on the purpose of perioperative PT and personalized coaching for patient engagement, technology support for feasibility, and content that takes advantage of VR’s unique capabilities. These findings are critical to designing feasibility and effectiveness studies for VR-enabled PT in surgical patients.