## 1 Introduction  
Initially, virtual reality (VR) applications in healthcare predominantly focused on pain distraction during acute procedures, such as managing burn patients [1]. Its use for chronic pain received less attention, likely due to the persistent nature of chronic pain, making continuous VR use seem impractical [2]. This may explain why VR research for chronic pain lags behind its application for acute pain. Similarly, the development of VRfor musculoskeletal rehabilitation has progressed more slowly compared to its adoption in neurological rehabilitation [3]. One potential reason is that VR was initially considered more suitable for neurological patients due to its ability to facilitate cortical reorganization and potentially restore motor function [4]. Although motor function improvement is also an important focus in musculoskeletal rehabilitation, the field often emphasizes goals such as enhancing range of motion, increasing muscle strength, and managing pain. At first glance, it may seem that these objectives would not significantly benefit from VR compared to traditional non-VR interventions, raising questions about its cost-effectiveness for widespread adoption in the musculoskeletal field. Accordingly, a recent scoping review identified financial costs as one of the barriers to the implementation of VR in healthcare [5]. However, it appears that in the field of chronic musculoskeletal conditions, VR may be cost-saving compared to non-VR interventions [6]. In addition, for patients with these conditions, the use of VR goes beyond mere distraction from immediate pain. Recovery success in patients with musculoskeletal pain, regardless of chronicity, can be hindered by various psychosocial factors [7; 8; 9; 10; 11; 12; 13], which can be addressed through VR. VR can benefit patients with kinesiophobia by providing distraction from fear, facilitating movement [14], or through gradual exposure to feared movements, enabling desensitization and reducing fear responses over time [15]. A fun, engaging, and interactive form of therapy is offered through VR, enhancing patient motivation for rehabilitation [16; 17; 18]. By enabling patients to develop skills for the self-regulation of pain through interactive and sensory-augmented experiences, such as controlling unpleasant virtual elements via biosensor feedback or practicing deep breathing techniques in gamified environments, it also serves as a tool to improve self-efficacy [19]. Additionally, it facilitates embodiment, allowing users to perceive the virtual body as their own [20; 21]. Consequently, during and after VR interventions, users exhibit attitudes or behaviors aligned with the characteristics of the virtual avatar, a phenomenon known as the Proteus effect [22; 23]. By leveraging embodiment in virtual avatars, VR can help address altered body image [24; 25], which is often particularly pronounced in cases of chronic pain [26] and can contribute to dysfunctional pain-coping strategies, such as movement avoidance [27]. Furthermore, meta-analyses have increasingly highlighted the significant benefits of VR in managing musculoskeletal conditions and associated chronic pain [28; 29; 30; 31; 32; 33; 34; 35; 36], underscoring its potential as a valuable tool for integration into healthcare to effectively address these conditions. However, likely due to the relatively recent expansion of VR research in healthcare, particularly in the rehabilitation of musculoskeletal conditions, the field faces notable challenges. These challenges include inconsistent terminology, a lack of specialized software solutions, and an overwhelming variety of hardware options, most of which are not primarily designed for healthcare use. Such factors can make it difficult for healthcare professionals without technical expertise to identify the most suitable tools for clinical practice.