Establishing Medical Extended Reality Labs Within Healthcare Institutions: A Nationwide Perspective.

Approximately 70% of people with lower limb amputations (LLAs) experience phantom limb pain (PLP), where stabbing, burning, or throbbing pain is felt in the missing limb despite its absence. There are two promising nonpharmacological interventions for PLP: graded motor imagery (GMI) and virtual reality (VR) programs. GMI is an evidence-based approach involving mental visualization of the phantom limb through three tasks: left/right discrimination, explicit motor imagery, and mirror therapy (which is typically delivered by specialized health care professionals in outpatient settings). VR programs have also shown potential for PLP relief by providing virtual visual feedback similar to mirror therapy, which uses a mirror to create an illusion of the missing limb by reflecting the existing one. Additionally, VR offers gamification opportunities that can enhance patient engagement in phantom limb movement exercises. Both GMI and VR can increase patients’ sense of agency over their phantom limb, a critical factor in reshaping the brain’s response to amputation and reversing the maladaptive rewiring of the sensorimotor cortex implicated in PLP. VR’s immersive qualities may further enhance treatment efficacy and patient motivation. A recent meta-analysis suggests that implementing nonpharmacological interventions such as VR and/or GMI could yield more effective PLP relief than medication alone. Despite the potential of VR and GMI, studies exploring their clinical feasibility are limited. Early research highlights several barriers to their use in outpatient settings, including patients’ doubts about treatment efficacy, lack of in-home equipment, time demands, limited technical support, financial constraints, and clinician dependence. Accessibility challenges, such as travel difficulties and navigating outpatient care, further hinder PLP treatment access for people with LLAs. In Canada, the average wait time for outpatient pain specialists is over 6 months. Given that PLP is the most severe and responsive to intervention within 1 year following LLA, these treatment delays and barriers may have adverse consequences for PLP recovery. For PLP treatment to be accessible and utilized effectively, barriers to its implementation need to be recognized and mitigated. To provide accessible, timely PLP care, our research team developed an innovative VR program that incorporates GMI principles, enabling individuals with LLAs to self-administer PLP treatment. This study aimed to refine our VR GMI prototype based on feedback from persons with lived experience and represents the first empirical investigation of a novel VR program embedding GMI. Our primary objective used qualitative methods to explore potential barriers and facilitators for using the VR GMI program at home and in the hospital (i.e., immediately postamputation, when the VR GMI intervention is intended for initial implementation). Our secondary objective used quantitative methods to assess participant engagement and immersion in the VR GMI program.