Heart Rate Variability Skills Training for Rehabilitation (HRV STAR): a feasibility and acceptability pilot study of a clinician training program

Background Heart rate variability biofeedback (HRVB) supports autonomic regulation, which has important implications for managing symptom clusters common in autonomic dysregulation, such as chronic pain, fatigue, and sleep disturbances. However, its integration into routine care is often hindered by training and workflow constraints. The HRV Skills Training for Autonomic Rehabilitation (HRV STAR) Program is a structured, clinical education model developed to facilitate HRVB implementation within existing clinical settings. This study used quantitative and qualitative methods to evaluate clinician perceptions of training acceptability, preparedness, and the feasibility of integrating HRV-based self-regulation into clinical practice. Methods Ten clinicians from diverse rehabilitation and mental health disciplines completed a core 4-session HRV STAR curriculum, with two optional sessions provided for additional support. Feasibility and acceptability were assessed via post-training Likert-scale surveys and inductive thematic analysis of qualitative feedback. Results Based on a 5-point scale, clinicians reported high confidence in guiding patients through HRVB (M = 4.40, SD = 0.50) and using nocturnal HRV (N-HRV) data for recovery planning (M = 4.20, SD = 0.40). Qualitative themes highlighted the value of a supportive, multi-instructor environment and hands-on practice. Areas for improvement included the delivery of the “intermediate to advanced” concepts, the timing of hands-on training, and the integration of technical troubleshooting. Conclusions The HRV STAR model is a feasible and well-received framework for interprofessional autonomic rehabilitation training for adaptability and parasympathetic health. To optimize clinical mastery and reduce cognitive load, future iterations should prioritize scaffolded, flipped classroom pre-work, adequate technical support, and mandatory personal immersion to ensure technical proficiency. These findings provide a foundation for evaluating longitudinal clinician uptake and patient-level outcomes.