Evaluating the Effects of Clinician Prescribing and Implementation Materials on Adoption of Virtual Reality Therapeutics: Randomized Feasibility Pilot Study.
BACKGROUND: Virtual reality therapeutics (VRx) are emerging as a form of digital therapeutics (DTx) with growing evidence for improving symptoms such as anxiety, pain, and distress. However, real-world adoption remains limited because successful use depends not only on the therapeutic benefits but also on how the intervention is introduced, supported, and integrated into care, in addition to the therapeutic benefits. Existing literature has identified barriers related to clinician familiarity, prescribing pathways, onboarding, and independent use outside the clinic, but few studies have experimentally evaluated how implementation strategies influence early adoption outcomes. OBJECTIVE: This feasibility pilot study evaluated how different implementation strategies influence early adoption of a VRx intervention in a nonclinical setting by comparing unguided VRx use, self-directed VRx use with implementation materials, and VRx use with prescriber-led consultation and support. METHODS: An institutional review board-approved, 3-arm randomized feasibility pilot study was conducted following the Virtual Reality Clinical Outcomes Research Experts framework and reported using the CONSORT (Consolidated Standards of Reporting Trials) 2010 extension guidelines for pilot and feasibility studies. Participants were randomly allocated to 1 of 3 experimental conditions. Outcomes included technology acceptance, usability, fidelity, and tolerability. Quantitative measures were complemented by qualitative exit interviews. Analyses were exploratory, and the study was not powered for hypothesis testing. RESULTS: Across conditions, brief VRx exposure was associated with significant improvements in overall technology acceptance (P<.001), though postintervention scores remained in the neutral range, indicating early shifts rather than strong endorsement. Participants receiving provider-supported implementation demonstrated the most consistent pattern of favorable outcomes, including higher fidelity of use and significantly greater time-based adherence (P=.04). Usability scores were generally favorable across conditions. Tolerability was acceptable, with low levels of reported cybersickness and no discontinuations due to adverse effects. Qualitative findings highlighted the importance of guidance, expectation-setting, and perceived clinical legitimacy in shaping engagement. CONCLUSIONS: This study demonstrates that implementation strategy is a key determinant of adoption for virtual reality-based DTx. By experimentally isolating onboarding and provider support components, this work extends prior efficacy-focused research to address implementation design. Findings suggest that brief provider involvement and structured onboarding may enhance engagement and adherence, supporting future evaluation of scalable DTx implementation models in clinical and community settings.
