By Amish Patel, MD, MBA

Founder & CEO, Verity XR | Board-Certified Anesthesiologist and Pain Management Physician

Over the course of my career in pain medicine, I have treated thousands of patients with spine and musculoskeletal conditions. We have become remarkably good at diagnosing structural problems and delivering increasingly sophisticated treatments. Surgery has advanced. Interventional procedures have advanced. Medications have advanced.

But there is a part of the recovery process that remains surprisingly difficult:

Getting patients to consistently participate in rehabilitation.

A successful procedure may correct a structural problem. An injection may decrease pain enough to allow someone to move. Medication may make symptoms more manageable. But none of these interventions by themselves restore strength, mobility, confidence, endurance, or function.

Ultimately, the patient still has to move.

For health systems investing heavily in orthopedic, spine, pain, and rehabilitation service lines, I believe this represents one of the largest remaining opportunities to improve the recovery experience.

The Procedure Is Only One Part of Recovery

Healthcare has traditionally been organized around encounters.

A patient sees a physician. They have an injection or surgery. They attend physical therapy. They return for follow-up.

Recovery, however, does not happen only during those encounters.

It happens during the hundreds of hours between them.

A physical therapist can prescribe an excellent rehabilitation program, but the effectiveness of that program depends in part on whether the patient actually performs it. A systematic review of randomized trials examining digital support for home rehabilitation found that adherence to prescribed home exercise remains a recognized problem; seven of ten included trials found significantly better adherence when a digital intervention was added, although longer-term effects were less certain.

A separate meta-analysis focused specifically on musculoskeletal conditions reached a similar conclusion. Across 11 trials involving 1,144 participants, digital rehabilitation improved therapeutic-exercise adherence at intermediate follow-up, while benefits were less clear at short- and long-term follow-up.

The message isn’t that digital rehabilitation has solved the problem.

The message is that engagement and adherence are problems worth solving.

Why Patients Disengage

In my practice, patients rarely tell me that they don’t care about getting better.

The barriers are more complicated.

Some patients are afraid that movement will worsen their injury. Others become discouraged because improvement is slow and difficult to see. Some find repetitive exercises boring. Others struggle to fit rehabilitation into their daily lives.

For patients with persistent pain, the problem becomes even more complex. Pain can lead to fear. Fear can lead to avoidance. Avoidance can lead to decreased movement, deconditioning and loss of confidence.

The fear-avoidance model has been studied extensively in musculoskeletal pain and describes how pain-related fear and avoidance can contribute to persistent disability in some patients.

More recent rehabilitation research also points to modifiable factors such as self-efficacy, social support and appreciation of the rehabilitation task as important determinants of home-exercise adherence and self-management.

This is why I don’t believe the rehabilitation problem can be solved simply by giving patients another sheet of exercises.

We need to address the person performing them.

Rehabilitation Needs to Address More Than Movement

Movement should remain the foundation of musculoskeletal rehabilitation.

But getting someone to move consistently may require addressing several interconnected barriers.

A patient who believes pain always means damage may need education before becoming comfortable moving.

A patient who has developed fear of bending after a back injury may need progressive exposure to movement.

A patient experiencing significant stress and muscle guarding may benefit from learning breathing, relaxation or mindfulness techniques.

And a patient who finds traditional exercise monotonous may benefit from a more engaging way of performing essentially the same therapeutic movements.

This is why I increasingly think of rehabilitation through three complementary components:

Behavioral rehabilitation → autonomic regulation → movement rehabilitation.

The destination is movement and function. The first two components can help some patients get there.

Engagement Should Become Part of the Health-System Conversation

Health systems routinely measure surgical complications, readmissions, length of stay, patient satisfaction and clinical outcomes.

I believe we should become equally interested in what happens during rehabilitation.

Did the patient participate?

How frequently?

Did they complete their prescribed activities?

Are they progressing?

Are they moving more?

Are they becoming more confident?

Can clinicians objectively see what happened between visits?

These questions become especially relevant as more rehabilitation moves outside traditional clinical settings.

A 2024 systematic review found that real-time video telerehabilitation produced patient satisfaction comparable to in-person physiotherapy and similar or better attendance and adherence across the included studies.

That doesn’t mean every patient should receive remote rehabilitation. It demonstrates something more fundamental: the location and delivery mechanism of rehabilitation can evolve.

The health system of the future should be able to extend rehabilitation from the hospital or therapy clinic into the patient’s daily environment while keeping the treating clinician connected to the recovery process.

Immersive Technology Creates Another Opportunity

Virtual reality is particularly interesting because immersion changes the patient’s relationship with an exercise.

Instead of being told to rotate the neck 10 times, reach a certain angle or perform another repetitive movement, the patient can accomplish that same movement while interacting with an immersive environment and receiving immediate feedback.

The clinical objective hasn’t changed.

The experience has.

Emerging evidence is encouraging but should be interpreted appropriately. A 2025 umbrella review synthesized 14 meta-analyses published between 2019 and 2024, representing more than 13,000 patients, and reported promising findings for VR across several musculoskeletal rehabilitation outcomes, while the strength and consistency of evidence varied by condition and outcome.

A separate systematic review of VR, augmented reality and sensor technologies in knee osteoarthritis found that immersive approaches showed potential to enhance rehabilitation engagement and adherence while sensor-based systems enabled real-time feedback.

I think this is where we need to be disciplined about the role of technology.

VR is not the treatment. Rehabilitation is the treatment.

Immersion is a tool that may make rehabilitation more engaging, interactive and measurable.

Where Verity Fits

This was the thinking behind Verity XR.

As a pain physician, I did not start Verity because I believed patients needed another piece of technology. I started it because I repeatedly saw patients receive appropriate medical treatment yet struggle with the behavioral and engagement components of recovery.

We designed Verity as an immersive, multimodal rehabilitation platform built around three interconnected pillars.

Behavioral Rehabilitation

Verity incorporates pain neuroscience education and behavioral concepts including graded exposure, activity pacing and self-management.

The goal is to help patients better understand pain and recovery, build confidence in movement and become more active participants in rehabilitation.

Autonomic Regulation

The platform incorporates guided breathing, relaxation, mindfulness and meditation experiences, with heart-rate feedback available in applicable configurations.

These modules are intended to help patients develop strategies for managing stress and physiologic arousal that can accompany pain and rehabilitation.

Movement Rehabilitation

Movement is ultimately the focus.

Verity uses immersive, gamified activities to facilitate clinician-directed range of motion, functional movement, balance, coordination and progressive rehabilitation while collecting objective performance information.

The treating clinician determines the rehabilitation plan and appropriate parameters. The technology provides another way to deliver and measure that plan.

Supporting Clinicians Rather Than Replacing Them

This distinction is particularly important for health systems.

I don’t believe the future of rehabilitation is replacing physical therapists with headsets.

Quite the opposite.

Technology should allow clinicians to extend their expertise.

A clinician should determine what the patient needs to accomplish. Technology can then help deliver those activities, collect objective information and create a more engaging patient experience—whether the patient is in the rehabilitation department or completing an assigned program at home.

That creates the possibility of a connected rehabilitation pathway:

Hospital or clinic → clinician-directed rehabilitation → home engagement → objective feedback → clinician review → progression.

The clinician remains at the center.

The Opportunity for Health Systems

For a hospital system, the value proposition for immersive rehabilitation should therefore be broader than purchasing a new rehabilitation device.

The opportunity is to explore whether a technology-enabled rehabilitation pathway can:

• improve patient engagement and satisfaction;
• extend rehabilitation beyond scheduled encounters;
• provide objective information about movement and participation;
• support standardized education and behavioral rehabilitation;
• complement existing PT, orthopedic, spine and pain programs;
• create a differentiated patient experience; and
• ultimately determine whether better engagement can contribute to better functional and economic outcomes.

Some of these benefits can be evaluated today. Others require prospective clinical validation.

We should be transparent about that distinction.

At Verity, our early work has focused on usability, patient and clinician preference, and feasibility. The next stage is building the evidence that connects engagement with meaningful clinical and healthcare outcomes.

Start With the Question, Not the Technology

When I speak with health systems, I don’t think the first question should be:

“Should we buy VR?”

The better questions are:

Where are patients disengaging from rehabilitation?

Which populations have difficulty completing conventional programs?

Where could clinicians benefit from objective information between encounters?

Could behavioral education, autonomic regulation and movement rehabilitation be delivered in a more integrated way?

And can we test whether doing so creates measurable value?

Those questions naturally lend themselves to focused pilot programs rather than large technology deployments.

Start with a patient population. Define engagement and functional metrics. Measure utilization. Ask patients and clinicians about the experience. Determine whether the workflow is sustainable.

Then decide whether it deserves to scale.

Looking Beyond the Procedure

Healthcare innovation has historically concentrated tremendous resources on what happens to the patient: the surgery, the injection, the medication, the device.

Rehabilitation is different.

Success depends heavily on what the patient does.

That is why I believe engagement deserves much more attention from health systems.

The next major advance in musculoskeletal care may not be another procedure. It may be finding better ways to help patients understand their recovery, overcome barriers to movement, participate consistently in rehabilitation and objectively see themselves getting better.

The procedure may start the recovery. The patient still has to complete it.

At Verity, that is the problem we are working to solve.

Selected References

Lang S, McLelland C, MacDonald D, Hamilton DF. Do digital interventions increase adherence to home exercise rehabilitation? A systematic review of randomised controlled trials. Archives of Physiotherapy. 2022.

Zhang ZY, et al. Digital Rehabilitation Programs Improve Therapeutic Exercise Adherence for Patients With Musculoskeletal Conditions: A Systematic Review With Meta-Analysis. Journal of Orthopaedic & Sports Physical Therapy. 2022.

Chester R, et al. Behaviour Change Techniques to promote self-management and home exercise adherence for people attending physiotherapy with musculoskeletal conditions. Musculoskeletal Science and Practice. 2023.

Leeuw M, et al. The fear-avoidance model of musculoskeletal pain: current state of scientific evidence. Journal of Behavioral Medicine. 2007.

Simmich J, Ross MH, Russell T. Real-time video telerehabilitation shows comparable satisfaction and similar or better attendance and adherence compared with in-person physiotherapy: a systematic review. Journal of Physiotherapy. 2024.