Perspectives of people living with Axial Spondyloarthritis on virtual reality rehabilitation: A qualitative interview study

Abstract Background Axial spondyloarthritis (axSpA) is a chronic inflammatory disease associated with pain, stiffness, fatigue, and reduced mobility. Exercise is recommended as part of axSpA self-management, but engagement during flares can be difficult because of pain, symptom exacerbation concerns and fear of movement. Virtual reality (VR) may offer an interactive and distracting way to support movement; however, its acceptability among people with axSpA remains unclear. This study explored patients’ perspectives of VR exercise as a potential rehabilitation intervention during flares. Methods Fifteen adults diagnosed with axSpA took part in semi-structured online interviews conducted using Microsoft Teams. Participants were recruited through UK rheumatology charities and had experienced at least one flare in the previous six months. Before the interviews, participants completed demographic questions and the Tampa Scale for Kinesiophobia (TSK). Interviews explored flare experiences, mobility, fear of movement and views on using VR exercise during flares. Interviews were transcribed and analysed using thematic analysis. Results All participants reported high kinesiophobia, with TSK scores ranging from 39 to 50. Four VR-focused themes were generated: 1. Acceptance of VR as a potential management tool during flare, 2. Symptom-related concerns about using VR during flares, 3. Safety and home-based use, and 4. Gamified activity preferences. Participants were generally open to trying VR and viewed it as a possible non-pharmacological support for pain distraction and maintaining activity. Concerns included headset weight, fatigue, session duration, standing tolerance, balance, disorientation and risk of injury at home. Participants requested an introductory training session. Purposeful and sport-like activities were preferred over simulated daily tasks. Conclusions Participants expressed openness towards VR exercise to support physical activity and pain management during flares. Patient concerns regarding headset comfort, fatigue, balance, home safety, session duration, and game preferences should be considered when designing future studies using VR during flare in axSpA population.