Table 5 Recommendations on implementation and the number of publications they were mentioned in (n)

Category 1: Increase understanding of patient suitability ( n  = 3 recommendations)

 Understanding patient suitability

Understanding suitability

Determining for which patients VR treatment is fitting

6

[34, 38, 43, 52, 54, 58]

Functional limitations

Take patients’ functional limitations into account, such as mobility or communication skills, before referring patients to VR

2

[43, 54]

Not mandatory

Consider that not all patients want to use VR; it should not be mandatory to use

1

[62]

Category 2: Improve knowledge and skills on VR use ( n  = 17 recommendations)

 Learning how to use VR

Training programs

Offer training programs on technical skills for healthcare providers

7

[34, 35, 38, 39, 45, 48, 51]

Educational resources

Develop and disseminate quality educational and training activities and materials

5

[34, 39, 45, 48, 60]

Mentorship

Offer mentorship by colleagues experienced in VR use

4

[38, 48, 54, 59]

Multi-phased

Develop multi-phased strategies to address healthcare providers needs as they progress from novice to experienced VR users

3

[38, 43, 60]

Decision-making

Develop training on clinical decision-making and application competences of when to use VR and for whom

3

[38, 43, 48]

Frequently reassess

Frequently reassess multi-phased strategies to see if the strategies fit with the needs of healthcare providers and patients

3

[35, 43, 48]

Different formats

Use different formats in training (e.g., written documentation, video, online activities)

2

[13, 38]

Online vs. real-life

Combine online and real-life training on VR use for healthcare providers

2

[13, 38]

Individual vs. group

Combine individual and group learning on VR use for healthcare providers

2

[13, 38]

Train-the-trainer

Use the train-the-trainer model in which colleagues who have experience with VR train colleagues that are new to VR

2

[36, 43]

Comfortable

Make healthcare providers comfortable with VR use by letting them try out VR and experiment with colleagues

2

[50, 60]

Refresher sessions

Include refresher sessions between initial skills training and healthcare providers first use of VR with patients

1

[13]

 Information provision on VR

Knowledge gaps

Address healthcare providers’ knowledge gaps and misconceptions about VR and address the added value of VR

2

[34, 48]

Acceptability

Address acceptability and feasibility to aid adoption and sustained uptake

1

[34]

Theoretical background

Provide theoretical background on VR use and effect on treatment outcomes

1

[39]

Protocols

Develop guidelines and treatment protocols

1

[34]

 Available time

Support time

Management should support time for training, use and maintenance of VR

1

[48]

Category 3: Improve healthcare providers’ engagement with VR ( n  = 4 recommendations)

 Awareness and information on added value of VR

Benefits

Communicate possible benefits and the importance of VR and its possible contributions to treatment to healthcare providers and patients

4

[36, 49,50,51]

Evidence

Use example cases and supporting evidence of added value of VR from research

2

[36, 52]

Experience

Let healthcare providers experience VR to see the potential and increase motivation for use

1

[36]

Purpose

Inform about purpose of using VR

1

[45]

Category 4: Have support staff available ( n  = 3 recommendations)

 Support staff

Staff support

Hire staff to support VR use and maintenance

4

[36, 44, 49, 52]

Champions

Use other experienced healthcare providers or mentors to promote uptake and increase self-efficacy

3

[34, 38, 59]

 Motivation

Encouragement

Organization should provide encouragement to healthcare providers with regard to using VR and motivate them to expanding their skills

1

[49]

Category 5: Points of attention for developing VR treatment ( n  = 11 recommendations)

 Treatment considerations

Frequency of use

Use of VR in treatment ranging from daily to once a week

2

[42, 54]

When to use

Introduce VR early in treatment, but not at the first appointment, because the use of VR can be overwhelming

2

[42, 62]

Establish goals

Establish measurable goals for VR treatment

1

[43]

Match patient needs

VR treatment should match patient needs

1

[58]

Become familiar

Patients should spend sufficient time with VR technology before treatment starts to become familiar with the system

1

[39]

Step by step

Start step by step and slowly navigate within the virtual environment

1

[39]

 Safety

Freedom of movement

Treatment room should offer sufficient freedom of movement to keep risk of falling as low as possible

1

[54]

Switch off

VR systems should be able to switch off immediately, e.g., in case of dizziness

1

[54]

Infection control

Consider hygienic measures before implementing VR in practice

1

[52]

 Integration into workflow

Part of treatment

Offer VR as part of existing treatment

2

[48, 54]

Knowledge Translation intervention

Support clinical integration of VR by knowledge translation intervention

1

[38]

Category 6: Support functionality of VR hardware and software ( n  = 9 recommendations)

 Functionality

Clarify needs

Clarify functional needs of VR technology that are necessary in use according to healthcare providers

1

[36]

Works as intended

Check if technology works as intended

1

[36]

 Technical issues

Channels to report

Make sure that healthcare providers are aware of the official channels that they can use to report technical issues

1

[50]

 Software

Patient-appropriate

Create patient-appropriate content for VR software that fits patient needs

3

[39, 43, 52]

Setting-appropriate

Create setting-appropriate content for VR software that fits the setting

2

[52, 62]

Age-appropriate

Create age-appropriate content that fits patient age

1

[62]

 Hardware

Interaction

Interaction between healthcare provider and patient should still be possible with headset on

1

[62]

Relocatable

System has to be practical to set up in a treatment room and easy to relocate if necessary

1

[50]

Adaptable

System has to be able to adapt for limited mobility of patients

1

[62]

Category 7: Design and development of implementation ( n  = 4 recommendations)

 Using a theoretical framework

Guide development

Use a theoretical framework to guide development of relevant implementation strategies to enhance uptake

1

[34]

 Implementation intervention

Intervention

Use a multi-model and active implementation intervention to support needs of stakeholders and address barriers to VR use

2

[38]

 Engaging stakeholders

Key stakeholders

Engage key stakeholders during the design and development process of implementation

4

[34, 36, 50, 59]

 Integration of VR in workflow

Understanding needs

Understand clinical reasoning processes and treatment needs as means of informing features and functionality of VR systems that support integration in practice

2

[38, 59]