Feasibility and usability of mirror therapy in a virtual environment in phantom limb pain management: an exploratory mixed methods study

The interest in the use of mirrors and virtual reality techniques as a treatment to alleviate phantom limb pain has increased in the last few years. Our aim was to examine the feasibility and usability of using the mirror box technique in a virtual reality (VR) environment in comparison to traditional mirror therapy (MT) in adult individuals with an acquired amputation of the upper limb. A mixed methods design was used with the semi-structured interviews, feasibility measures and System Usability Scale (SUS). Topics within the semi-structured interviews were general impression, acceptability, demand, implementation and feedback. Three themes were generated from the interview data: (1) participants’ experiences and preferences with mirror therapy and virtual reality, (2) use in a home setting and (3) feedback/suggestions MT and VR. Descriptive statistics were applied and qualitative data were analysed using framework analysis. A total of 10 participants (9 men, median age of 50.5) were included. The Wilcoxon sign rank test between the SUS MT (median 82.5; IQR 9.4) and SUS VR (median 82.5; IQR 15.0) was not significant ( p = 0.67). Qualitative analysis identified three key themes: the participants’ experiences with traditional MT and VR, use in a home setting and suggestions for future use. Participants mentioned the intuitive usability and flexibility of VR for personalized treatment. However, limitations in perceptual realism were highlighted, particularly when compared to traditional MT. Although the usability of VR-based MT is promising, its feasibility for widespread implementation depends on addressing limitations in experiential realism. VR-based MT demonstrates adequate usability within rehabilitative contexts. Continued technical refinement integrating user feedback that enhances perceptual realism is proposed for future efficacy studies.