Effects of Adaptive Virtual Adventure Sport Tourism on Positive Affect and Well-Being in Adults With Spinal Cord Injury

To examine the effect of a four-week adaptive virtual adventure sport tourism intervention on SCI-specific positive affect and well-being in adults with spinal cord injury

Assessor-blinded, two-arm, parallel-group randomized controlled trial with 1:1 allocation and concealed computer-generated randomization

The study will be conducted at two specialist spinal cord injury rehabilitation centers in Tehran, Iran. Eligible participants will complete baseline assessments and will then be randomly assigned using the RAND function in Microsoft Excel to either the adaptive VR intervention or active control group. Interventions will be delivered in supervised sessions, and outcomes will be assessed at baseline, 24–72 hours after the four-week intervention, and at 30-day follow-up

Adults aged 18–65 years with SCI for ≥6 months and AIS grade A–D will be included. Major exclusions will be seizures, severe motion sickness, unstable medical conditions, active pressure injury, severe visual impairment, acute psychiatric crisis, cognitive impairment, or concurrent VR intervention

Intervention group: Participants will receive 12 supervised sessions of adaptive immersive VR adventure sport tourism over 4 weeks using Meta Quest 3. Activities will include virtual kayaking, hand-cycling, accessible trail navigation, seated sailing, and destination exploration, with individualized accessibility and comfort adaptations. Active control group: Participants will receive 12 matched sessions of two-dimensional travel videos without immersion, interaction, navigation, or adaptive challenge

SCI-specific positive affect and well-being measured by the SCI-QOL PAWB SF10a T-score

Participants will be randomized individually in a 1:1 ratio to the adaptive VR intervention or active control group using computer-generated permuted blocks of four and six. Randomization will be stratified by neurological level (tetraplegia vs paraplegia) and baseline positive affect and well-being score (below vs at or above the sample median). An independent researcher not involved in recruitment, intervention delivery, or outcome assessment will generate the allocation sequence. Group assignments will be placed in sequentially numbered, opaque, sealed envelopes and opened by the intervention coordinator only after completion of baseline assessment.

Participants and intervention personnel will not be blinded because of the visible differences between immersive VR and two-dimensional video viewing. Outcome assessments will be conducted by a research assistant who will not attend intervention sessions and will remain unaware of group allocation. Participants will be reminded not to disclose their assigned condition during assessments. For the primary analysis, groups will be coded as A and B, and the data analyst will remain blinded to group identity until the main analysis is completed.

Individual participant data will not be publicly shared to protect participant privacy and confidentiality

Study protocol and related study documents

After publication of the main study results

Qualified researchers upon reasonable request to the corresponding author

For academic and research purposes, subject to a reasonable request, approval by the study investigators, and compliance with ethical and confidentiality requirements

The corresponding author of the study

Requests will be submitted to the corresponding author and reviewed by the study investigators for scientific purpose, ethical compliance, and confidentiality requirements