Development and Preliminary Content Validation of Dual-Perspective Virtual Reality Acceptability Questionnaires for Stroke Rehabilitation

Abstract

Immersive virtual reality (IVR) is increasingly investigated in stroke rehabilitation. However, its clinical implementation remains limited by the absence of standardized, theory-driven instruments assessing acceptability from both patient and therapist perspectives. This study aimed to develop two parallel Virtual Reality Acceptability Questionnaires for Stroke Rehabilitation: a patient version (VRAQ-SR-P) and a therapist version (VRAQ-SR-T), based on the Theoretical Framework of Acceptability (TFA), and to evaluate their preliminary expert-based content validity. A methodological instrument-development study was conducted. Two 14-item questionnaires were developed through a theory-driven process informed by the seven TFA constructs and contextualized for IVR-based stroke rehabilitation. Content validity was evaluated by nine Occupational Therapists (OTs) with expertise in stroke rehabilitation and technology-based interventions. Experts rated item relevance using a four-point scale, and item-level (I-CVI), scale-level (S-CVI/Ave), and modified kappa coefficients were calculated, while qualitative feedback informed item refinement. The VRAQ-SR-P demonstrated an S-CVI/Ave of 0.841, and the VRAQ-SR-T demonstrated an S-CVI/Ave of 0.826. Both exceeded the prespecified threshold of 0.80. Expert feedback identified construct overlaps, insufficient contextual specificity, ambiguity in ethicality items, and therapist-perspective issues, resulting in the revision of 12 of the 28 items, while no items were deleted. These findings provide preliminary evidence of acceptable scale-level content validity based on expert ratings and establish a theory-informed foundation for future psychometric evaluation.