The Barriers and Facilitators to the Application of Non-Invasive Brain Stimulation for Injury Rehabilitation and Performance Enhancement: A Qualitative Study
Abstract
1. Introduction
2. Methods
2.1. Design
2.2. Reporting Criteria
2.3. Concepts of Interest
2.4. Research Team and Reflexivity
2.4.1. Personal Characteristics
2.4.2. Relationship with Participants
2.5. Study Design
2.5.1. Methodology
2.5.2. Participant Selection
2.6. Setting
2.7. Data Collection
2.8. Analysis
3. Results
3.1. Participant Characteristics
3.2. Themes
3.2.1. Impact of Musculoskeletal Injury on Health and Quality of Life
3.2.2. Performance and Injury-Recovery as Facilitators to Using tDCS
3.2.3. Barriers and Facilitators to tDCS Application
3.2.4. Design and Aesthetic Factors for a tDCS Device
4. Discussion
4.1. Future Research
4.2. Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Appendix A
- Could you please introduce yourself to us and the rest of the group? Please tell us your name, what persistent pains or injuries you are living with and what sort of treatments you have trialled so far to improve your condition.
- Now we’re moving into the main section of the focus group. We would like to know everything you know about the use of electrical stimulation to improve performance and rehabilitation outcomes. This can include devices like TENS, muscle stimulation or others like brain stimulation you may have used or heard about.
- What are your personal experiences and perceptions of these electrical brain stimulation techniques? Would you use them? Regardless of if you would or would not use them currently, what would entice you to using brain stimulation products?
- What would be the main barriers to not using brain stimulation technology to improve your rehabilitation outcomes and performance?
- I am now going to show you a series of designs on the power point, for each design I would like your feedback. Feel free to be brutal, if you think they are terrible and you would never use them tell us, and then also tell us why they are so bad. Or likewise, tell us why you think they are good. I specifically want you to consider how well these could be used during physical activity.
- Is there anything else about electrical brain stimulation to improve performance or rehabilitation timeframes you would like to add?
- Could you please introduce yourself to us and the rest of the group? Please tell us your name, what sport you participate in, what level you compete at and how long you have been competing at that level?
- Now we’re moving into the juicier section of the focus group. We would like to know everything you know about the use of electrical stimulation to improve performance and rehabilitation outcomes. This can include devices like TENS, muscle stimulation or others like brain stimulation you may have used or heard about.
- What are your personal experiences and perceptions of these electrical brain stimulation techniques? Would you use them? Regardless of if you would or would not use them currently, what would entice you to using brain stimulation products?
- What would be the main barriers to not using brain stimulation technology to improve your rehabilitation outcomes and performance?
- I am now going to show you a series of designs on the power point, for each design I would like your feedback. Feel free to be brutal, if you think they are terrible and you would never use them tell us, and then also tell us why they are so bad. Or likewise, tell us why you think they are good. I specifically want you to consider how well these could be used during physical activity.
- Is there anything else about electrical brain stimulation to improve performance or rehabilitation timeframes you would like to add?
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Interviewer | Credentials | Occupation | Gender | Experience and Training |
---|---|---|---|---|
Myles Murphy | PT, PhD | University Academic and Physiotherapist | Man | Has conducted several qualitative research studies, including supervising an honours student performing qualitative research. Is an experienced sport physiotherapist having worked in both elite sport and private clinical practice. |
Participant Characteristic | Count | |
---|---|---|
Highest level of education | Less than high school degree | 1 |
High school degree | 0 | |
Bachelor’s degree | 13 | |
Master’s degree | 1 | |
Doctoral degree | 0 | |
Professional degree (JD, MD) | 1 | |
Occupation | Academic | 1 |
Cleaner | 1 | |
Electrical Engineer | 1 | |
Graphic Designer | 1 | |
Medical Doctor | 1 | |
Police Officer | 1 | |
Physiotherapist | 4 | |
Student | 2 | |
Taxi driver | 1 | |
Teacher | 2 | |
Retired | 1 | |
Employment Status | Student | 2 |
Working part-time | 3 | |
Working full-time | 10 | |
Retired | 1 | |
Household Income | Between AUD $30,000–$49,999 | 1 |
Between AUD $49,999–$79,999 | 0 | |
Between AUD $80,000–$99,999 | 6 | |
Between AUD $100,000–$149,999 | 2 | |
Between AUD $150,000–$199,999 | 5 | |
More than AUD $200,000 | 2 | |
Medical Conditions | Depression | 1 |
Hypertension | 1 | |
Regions of pain and injury in the past 12 months | Ankles and Feet | 2 |
Knees | 5 | |
Hips/Thighs | 2 | |
Lower Back | 7 | |
Thoracic Spine | 0 | |
Neck | 3 | |
Shoulders | 5 | |
Elbows | 1 | |
Wrists and Hands | 2 | |
Moderate to vigorous physical activity at least three time weekly | No | 3 |
Yes | 13 |
Sub-Theme | Supporting Evidence |
---|---|
Musculoskeletal injuries have a negative impact on quality of life | “It changes the type of exercise that I can do. Like I actually I thought that my back hurting a little bit was normal for a long time.” “I am a fear avoidant of running. I used to do a lot of marathons, but probably a little bit like to stick to about 10 km” “It has impacted things, like my ability to just like go out to hike, like all those things” “It’s been quite a long journey since I haven’t been able to run until like the last two or three months. I run a lot and cycle as well, so thankfully I was able to get into cycling a little bit earlier. It’s part of the recovery process.” “I’ve been doing Brazilian Ju Jit Su for a long time as well, and running, you know, I love running. Yeah. So I tried to get into other things” |
Regardless of the region, injuries can be serious | “I’ve had a bunch of ankle issues, like rolled ankles. So now my ankles are super fat. And that’s just what they look like. I had surgery on one the other day and they took 13 pieces of little chips of bones and stuff out of it.” “I tore my right Achilles tendon in 2016” “I have fractured my left ankle in the past so now I have osteoarthritis, and I have chronic tendonitis” “I tore my right ACL in 2018, and after a year I tore my left ACL” “In my head. I’m like, I’ve never really been injured, but I’ve had four or five years of chronic back pain.” “I have always had a like weaker back as well. It’s always brought pain down the left side of my body.” |
Trialling numerous management strategies | “I had surgery for osteitis pubis when I was 18.” “I had a hamstring avulsion water skiing where they had to like screw the hip back on over the tendon, then stitch the muscle back together.” “One (injury) is a shoulder where I had a cyst removed surgically” “After surgery (I performed) physio recommendations and follow those exercise routines” |
Sub-Theme | Supporting Evidence |
---|---|
Facilitate recovery form injury | “I think I’d use it (tDCS) if I was at a doctors or a rehab facility.” “I wouldn’t do it (tDCS) from a television advertisement, but I’d do it from a doctor’s recommendations.” “If it (tDCS) meant reducing the pain (I would use it).” “I’d do it (tDCS) on a professional’s recommendation.” “You’d be really wanting to see someone for an assessment and have them advise whether or not they think it’s a good idea for you to be using it (tDCS).” “I would just go to the physio or doctor and if they recommended it, I would do it.” |
Improve athletic performance | “Honestly, as long as it improves my performance, I don’t really care that much because I know that it works. And I know that it will really help.” “But if you found it was working, I think then going to a gym and people see it’s working, they don’t care what you look like.” “Most athletes don’t really care. But some athletes, I would imagine, would be like if you’re going to give me a benefit I will wear it. Yeah. Like the athletes that I would deal with, they don’t care even about pain.” |
Brain stimulation can be scary | “Brain stimulation is, I think it’s scary for people.” “The horror that comes to mind is shock therapy where they used to for mental patients give them shock therapy and that had nothing but bad news and that was electrical currents.” “I think you have to gently educate people rather than just, because anything to do with brain stimulation is scary.” “Oh, well, we’re going to do some brain, you know, stimulation. You’re thinking, jeez, hang on a second.” “I think straight off, you know, you have a broken ankle. We’re going to do your brain. That’s a little scary for me anyway.” “(Can) you get people who are obsessive, and can you overcook yourself with this thing (tDCS)?” |
Sub-Theme | Supporting Evidence |
---|---|
Usability | “How easy/difficult will this be to replace parts/fix?” “I could do 20 min of wearing it around the house before the gym and then. Yeah, leave it at home. And do. Yeah. Drive into the gym.” “You’d need good instructions or something to be able to set it up yourself.” “Knowing like how much voltage I’m meant to be getting through, how much is too much or too little stuff like that.” “Is it easy to change the little sponges?” |
Discomfort | “If it is really firm against your skull, it’s probably going to cause you a headache when you’re running.” “How does it move when I’m like, you know, running, how does it shift around perspiration.” “I imagine it will feel like headphones, even though it might not. But I don’t like wearing headphones because of the weight of the headphones.” “The thing that bothers me the most is how comfortable it will be, especially if I’m running.” “Then (what) if you’re sweaty and then it slides down.” |
Hygiene | “So they (sponges) would have to be replaced disposable or something, wouldn’t they?” “If you used your own sponges, but if the clinic wiped it all over like they do with other sanitising, that would be fine.” “Couldn’t you have linings?” “As long as they (tDCS) have cleaning.” “Do they have a procedure for cleaning?” |
Sub-Theme | Supporting Evidence |
---|---|
Aesthetics | “People wearing it outside of being in like an actual physio gym or something like you want to be like, streamlined not bulky, something like hanging back more or like didn’t come down to the brow.” “I’ll be way less embarrassed to wear whatever it is if I think that anyone who looks at it can tell what it is.” “To make it more appealing to use in a gym could you integrate headphones in? Or just make them look like headphones.” “Incorporate into some sort of like hats or something, it doesn’t look too bad” “People wear hats when they play golf and everything, so it looks like if it’s more streamlined it’d like slot in a pretty easy.” |
Customisation | “If it just had the visor, you could just adjust it” “(In terms of adjustable fit) I want the option It’d be nice to have the option.” |
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© 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
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Haydock, C.; Timler, A.; Whife, C.; Tyler, H.; Murphy, M.C. The Barriers and Facilitators to the Application of Non-Invasive Brain Stimulation for Injury Rehabilitation and Performance Enhancement: A Qualitative Study. NeuroSci 2025, 6, 72. https://doi.org/10.3390/neurosci6030072
Haydock C, Timler A, Whife C, Tyler H, Murphy MC. The Barriers and Facilitators to the Application of Non-Invasive Brain Stimulation for Injury Rehabilitation and Performance Enhancement: A Qualitative Study. NeuroSci. 2025; 6(3):72. https://doi.org/10.3390/neurosci6030072
Chicago/Turabian StyleHaydock, Chris, Amanda Timler, Casey Whife, Harrison Tyler, and Myles C. Murphy. 2025. "The Barriers and Facilitators to the Application of Non-Invasive Brain Stimulation for Injury Rehabilitation and Performance Enhancement: A Qualitative Study" NeuroSci 6, no. 3: 72. https://doi.org/10.3390/neurosci6030072
APA StyleHaydock, C., Timler, A., Whife, C., Tyler, H., & Murphy, M. C. (2025). The Barriers and Facilitators to the Application of Non-Invasive Brain Stimulation for Injury Rehabilitation and Performance Enhancement: A Qualitative Study. NeuroSci, 6(3), 72. https://doi.org/10.3390/neurosci6030072