{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T16:33:13Z","timestamp":1786120393236,"version":"build-2736575974"},"reference-count":38,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR XR Spatial Comput"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Postoperative patients often face pain, reduced mobility, and motivational barriers, while health care systems increasingly struggle with shortages of physiotherapy staff, making the evaluation of digital rehabilitation tools highly relevant. In this context, virtual reality (VR)\u2013based rehabilitation has already shown promise in neurological and musculoskeletal settings, but evidence regarding its acceptance and usability in postoperative inpatient rehabilitation, particularly in surgical settings with potentially older, multimorbid patients, as well as the general acceptance and usability of VR-supported physiotherapy, is still insufficiently investigated.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This exploratory mixed methods study investigated the usability and acceptance of a VR-based rehabilitation application among postoperative patients and physiotherapists in a clinical setting. Secondary objectives were to gather initial data on potential differences in usability across age and gender groups and to explore patients\u2019 and physiotherapists\u2019 attitudes toward VR as a supplement or replacement for conventional physiotherapy.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This cross-sectional exploratory mixed methods study with prospective participant recruitment and data collection included 35 postoperative inpatients (17 female participants and 18 male participants; age groups: <40, 40\u201060, and >60 years) and 7 physiotherapists (4 female participants and 3 male participants) recruited from visceral surgery and orthopedic departments. Participants used a VR-based rehabilitation demonstrator (\u201cBeer Pong,\u201d apoQlar GmbH) delivered through a head-mounted display (Meta Quest 3) for a standardized 5-minute session involving upper-limb movements and squatting exercises. The System Usability Scale (SUS) and a self-developed questionnaire were used to assess the usability of the whole system and general attitudes toward VR-supported physiotherapy. Usability ratings were analyzed descriptively and using a 2-way ANOVA to test for effects of age group and gender. Descriptive statistics were used to summarize responses on motivation, distraction, supplementation, and preferences regarding VR use.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The overall mean SUS score was 73.21 (SD 13.74, 95% CI 68.49-77.93). No significant differences in usability ratings were found between age groups or genders. Most patients (29\/35, 83%) agreed that the VR scenario increases motivation, and 92% (32\/35) viewed VR exercises as a useful supplement to conventional physiotherapy. Physiotherapists reported an average SUS score of 74.64 (SD 10.04, 95% CI 65.35-83.93) and expressed positive attitudes toward VR implementation, as assessed using a self-developed questionnaire. However, only 20% (7\/35) of patients believed VR could replace traditional therapy entirely.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The results of this pilot study seem to indicate high acceptance of VR-based rehabilitation applications by patients and physiotherapists in the clinical context of a postoperative setting. As one of the first studies to evaluate VR usability specifically in early postoperative inpatient rehabilitation, this work extends existing evidence beyond previously studied rehabilitation domains. Taken together with the possible potential to increase patients\u2019 motivation while relieving work strain on physiotherapists, these findings support further investigation through larger controlled trials to assess long-term usability, clinical efficacy, and integration into routine postoperative clinical care, even for older people.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/82704","type":"journal-article","created":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T14:50:05Z","timestamp":1779807005000},"page":"e82704-e82704","source":"Crossref","is-referenced-by-count":0,"title":["User Acceptance of a Virtual Reality Beer Pong Intervention in Postoperative Rehabilitation: Exploratory Mixed Methods Study"],"prefix":"10.2196","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-6421-2570","authenticated-orcid":false,"given":"Tim","family":"Schneider","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-5051-2880","authenticated-orcid":false,"given":"Merle","family":"Schlender","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-5814-6083","authenticated-orcid":false,"given":"Verena","family":"Uslar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-3497-5856","authenticated-orcid":false,"given":"Sirko","family":"Pelzl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6820-3574","authenticated-orcid":false,"given":"Daniela","family":"Salzmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-9444-8487","authenticated-orcid":false,"given":"Nomi Anna","family":"Kre\u00df","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2414-2674","authenticated-orcid":false,"given":"Navid","family":"Tabriz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2660-625X","authenticated-orcid":false,"given":"Dirk","family":"Weyhe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,8,6]]},"reference":[{"issue":"4","key":"R1","doi-asserted-by":"publisher","first-page":"79","DOI":"10.3390\/surgeries6040079","article-title":"Postoperative rehabilitation and functional recovery after knee meniscectomy: an ambispective cohort study","volume":"6","author":"Mart\u00ednez-Fern\u00e1ndez","journal-title":"Surgeries"},{"issue":"1","key":"R2","doi-asserted-by":"publisher","DOI":"10.1186\/s12885-022-09586-1","article-title":"Effects of intensive physiotherapy on quality of life (QoL) after pancreatic cancer resection: a randomized controlled trial","volume":"22","author":"Weyhe","journal-title":"BMC Cancer"},{"key":"R3","doi-asserted-by":"publisher","DOI":"10.1016\/j.chb.2017.01.013","article-title":"A meta-analysis and systematic literature review of virtual reality rehabilitation programs","volume":"70","author":"Howard","journal-title":"Comput Human Behav"},{"issue":"2","key":"R4","doi-asserted-by":"publisher","first-page":"147","DOI":"10.2217\/pmt.10.15","article-title":"Virtual reality and pain management: current trends and future directions","volume":"1","author":"Li","journal-title":"Pain Manag"},{"issue":"2","key":"R5","doi-asserted-by":"publisher","DOI":"10.3390\/bioengineering12020106","article-title":"Usage of virtual reality technology in physiotherapy in Germany: results from a survey","volume":"12","author":"Elser","journal-title":"Bioengineering (Basel)"},{"issue":"1","key":"R6","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1007\/s10055-022-00654-2","article-title":"Virtual reality applied to physiotherapy: a review of current knowledge","volume":"27","author":"Brepohl","journal-title":"Virtual Real"},{"issue":"3","key":"R7","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1016\/j.jphys.2015.05.017","article-title":"Rehabilitation that incorporates virtual reality is more effective than standard rehabilitation for improving walking speed, balance and mobility after stroke: a systematic review","volume":"61","author":"Corbetta","journal-title":"J Physiother"},{"issue":"1","key":"R8","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph17010113","article-title":"Feasibility, safety and efficacy of a virtual reality exergame system to supplement upper extremity rehabilitation post-stroke: a pilot randomized clinical trial and proof of principle","volume":"17","author":"Norouzi-Gheidari","journal-title":"Int J Environ Res Public Health"},{"issue":"1","key":"R9","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1007\/s10055-021-00546-x","article-title":"Clinical effectiveness of virtual reality versus conventional clinic-based vestibular physical therapy on balance and function in active duty service members. A pilot randomized controlled trial","volume":"27","author":"Sessoms","journal-title":"Virtual Real"},{"issue":"6","key":"R10","doi-asserted-by":"publisher","first-page":"590584","DOI":"10.1155\/2015\/590584","article-title":"A novel study on natural robotic rehabilitation exergames using the unaffected arm of stroke patients","volume":"11","author":"Hoda","journal-title":"Int J Distrib Sens Netw"},{"key":"R11","doi-asserted-by":"crossref","unstructured":"Palaniappan SM Duerstock BS . Developing rehabilitation practices using virtual reality exergaming. Presented at: 2018 IEEE International Symposium on Signal Processing and Information Technology (ISSPIT); Dec 6-8, 2018:090-094; Louisville, KY, USA. [doi: 10.1109\/ISSPIT.2018.8642784]","DOI":"10.1109\/ISSPIT.2018.8642784"},{"key":"R12","doi-asserted-by":"publisher","DOI":"10.2147\/COPD.S223592","article-title":"Virtual reality rehabilitation in patients with chronic obstructive pulmonary disease: a randomized controlled trial","volume":"15","author":"Rutkowski","journal-title":"Int J Chron Obstruct Pulmon Dis"},{"issue":"4","key":"R13","doi-asserted-by":"publisher","first-page":"347","DOI":"10.2169\/internalmedicine.55.5275","article-title":"A feasibility study of virtual reality exercise in elderly patients with hematologic malignancies receiving chemotherapy","volume":"55","author":"Tsuda","journal-title":"Intern Med"},{"issue":"2","key":"R14","doi-asserted-by":"publisher","first-page":"181","DOI":"10.3109\/02699052.2013.860475","article-title":"Virtual reality-based therapy for the treatment of balance deficits in patients receiving inpatient rehabilitation for traumatic brain injury","volume":"28","author":"Cuthbert","journal-title":"Brain Inj"},{"issue":"1","key":"R15","doi-asserted-by":"publisher","DOI":"10.1186\/s12984-015-0035-3","article-title":"Efficacy of virtual reality-based intervention on balance and mobility disorders post-stroke: a scoping review","volume":"12","author":"Darekar","journal-title":"J Neuroeng Rehabil"},{"issue":"1","key":"R16","doi-asserted-by":"publisher","first-page":"191","DOI":"10.1186\/s12984-024-01492-w","article-title":"Effects of virtual reality rehabilitation after spinal cord injury: a systematic review and meta-analysis","volume":"21","author":"Wang","journal-title":"J Neuroeng Rehabil"},{"issue":"1","key":"R17","doi-asserted-by":"publisher","DOI":"10.1186\/s12984-023-01256-y","article-title":"Efficacy of virtual reality training on motor performance, activity of daily living, and quality of life in patients with Parkinson\u2019s disease: an umbrella review comprising meta-analyses of randomized controlled trials","volume":"20","author":"Yu","journal-title":"J Neuroeng Rehabil"},{"issue":"6","key":"R18","doi-asserted-by":"publisher","first-page":"458","DOI":"10.1016\/j.rehab.2019.11.008","article-title":"Active video games for knee osteoarthritis improve mobility but not WOMAC score: a randomized controlled trial","volume":"63","author":"Lin","journal-title":"Ann Phys Rehabil Med"},{"issue":"3","key":"R19","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1016\/j.ptsp.2013.08.004","article-title":"The effect of Xbox Kinect intervention on balance ability for previously injured young competitive male athletes: a preliminary study","volume":"15","author":"Vernadakis","journal-title":"Phys Ther Sport"},{"key":"R20","unstructured":"Brooke J . SUS: a \u201cquick and dirty\u201d usability scale. In: Usability Evaluation in Industry. CRC Press; 1996. ISBN: 9780429157011"},{"issue":"20","key":"R21","doi-asserted-by":"publisher","first-page":"1883","DOI":"10.1080\/10447318.2020.1801173","article-title":"Multi-language toolkit for the system usability scale","volume":"36","author":"Gao","journal-title":"Int J Hum Comput Interact"},{"key":"R22","volume":"13","author":"Lewis","journal-title":"J Usability Stud"},{"issue":"1","key":"R23","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-025-90698-6","article-title":"Design and usability evaluation of an immersive virtual reality mirrored hand system for upper limb stroke rehabilitation","volume":"15","author":"Hsieh","journal-title":"Sci Rep"},{"issue":"12","key":"R24","doi-asserted-by":"publisher","DOI":"10.1093\/ptj\/pzaf137","article-title":"Feasibility and usability of an omnidirectional treadmill-based virtual reality rehabilitation game: a mixed-methods feasibility study","volume":"105","author":"Quigley","journal-title":"Phys Ther"},{"issue":"1","key":"R25","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-024-07285-5","article-title":"Limited use of virtual reality in primary care physiotherapy for patients with chronic pain","volume":"25","author":"Slatman","journal-title":"BMC Musculoskelet Disord"},{"key":"R26","doi-asserted-by":"publisher","DOI":"10.2196\/72439","article-title":"Development and user experiences of a novel virtual reality task for poststroke visuospatial neglect: exploratory case study","volume":"2","author":"Danso","journal-title":"JMIR XR Spat Comput"},{"key":"R27","doi-asserted-by":"publisher","DOI":"10.1016\/j.glmedi.2025.100198","article-title":"Using thematic analysis in qualitative research","volume":"6","author":"Ahmed","journal-title":"J Med Surg Public Health"},{"issue":"11","key":"R28","doi-asserted-by":"publisher","first-page":"1773","DOI":"10.1080\/09638288.2022.2071484","article-title":"The efficacy of virtual reality interventions compared with conventional physiotherapy in improving the upper limb motor function of children with cerebral palsy: a systematic review of randomised controlled trials","volume":"45","author":"Alrashidi","journal-title":"Disabil Rehabil"},{"issue":"10","key":"R29","doi-asserted-by":"publisher","first-page":"2227","DOI":"10.1016\/j.arth.2016.03.066","article-title":"Day-of-surgery mobilization reduces the length of stay after elective hip arthroplasty","volume":"31","author":"Okamoto","journal-title":"J Arthroplasty"},{"issue":"11","key":"R30","doi-asserted-by":"publisher","first-page":"e209","DOI":"10.1016\/j.ijmedinf.2011.03.002","article-title":"Older adults: are they ready to adopt health-related ICT?","volume":"82","author":"Heart","journal-title":"Int J Med Inform"},{"key":"R31","doi-asserted-by":"publisher","DOI":"10.1080\/09638288.2026.2622898","article-title":"Knowledge, practices, and acceptance of physiotherapists regarding the use of immersive virtual reality in clinical practice: a cross-sectional online survey","author":"Luc","journal-title":"Disabil Rehabil"},{"key":"R32","doi-asserted-by":"publisher","DOI":"10.1371\/currents.dis.76fd9ebfd8689469452cc8c0c0d7cdce","article-title":"Development and implementation of the World Health Organization emergency medical teams: minimum technical standards and recommendations for rehabilitation","volume":"10","author":"Mills","journal-title":"PLoS Curr"},{"issue":"11","key":"R33","doi-asserted-by":"publisher","first-page":"2205","DOI":"10.1016\/j.apmr.2019.06.002","article-title":"Toward strengthening rehabilitation in health systems: methods used to develop a WHO package of rehabilitation interventions","volume":"100","author":"Rauch","journal-title":"Arch Phys Med Rehabil"},{"key":"R34","unstructured":"The World Health Report: health systems financing: the path to universal coverage. World Health Organization; 2010. URL: https:\/\/iris.who.int\/server\/api\/core\/bitstreams\/18e28fe3-d767-417f-811a-fd5f639a9ee4\/content [Accessed 04-08-2025]"},{"key":"R35","unstructured":"Rehabilitation 2030: meeting report, Geneva, Switzerland, 10\u201311 July 2023. World Health Organization; 2023. URL: https:\/\/iris.who.int\/server\/api\/core\/bitstreams\/34d3c289-87c3-4ba3-86dc-199a94bb3e88\/content [Accessed 30-05-2026]"},{"issue":"1","key":"R36","doi-asserted-by":"publisher","first-page":"49","DOI":"10.30621\/jbachs.1671406","article-title":"Perceived barriers and factors affecting postoperative mobilization and related outcomes in surgical patients","volume":"10","author":"K\u0131rt\u0131l","journal-title":"J Basic Clin Health Sci"},{"key":"R37","doi-asserted-by":"crossref","unstructured":"Lewis JR Sauro J . The factor structure of the system usability scale. In: Kurosu M , editor. Human Centered Design. Springer; 2009:94-103. [doi: 10.1007\/978-3-642-02806-9_12]","DOI":"10.1007\/978-3-642-02806-9_12"},{"key":"R38","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2019.02509","article-title":"Immersive versus non-immersive experience: exploring the feasibility of memory assessment through 360\u00b0 technology","volume":"10","author":"Ventura","journal-title":"Front Psychol"}],"container-title":["JMIR XR and Spatial Computing"],"original-title":[],"language":"en","deposited":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T20:47:03Z","timestamp":1786049223000},"score":1,"resource":{"primary":{"URL":"https:\/\/xr.jmir.org\/2026\/1\/e82704"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,6]]},"references-count":38,"URL":"https:\/\/doi.org\/10.2196\/82704","relation":{},"ISSN":["2818-3045"],"issn-type":[{"value":"2818-3045","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,6]]},"article-number":"v3i4e82704"}}