Cybersickness Variability by Race: Findings From 6 Studies and a Mini Meta-analysis

Impact of cybersickness and presence on treatment satisfaction and clinical outcomes in virtual reality-based biofeedback for depression and anxiety

Virtual Reality-Biofeedback (VR-BF) has emerged as a novel digital intervention for reducing anxiety and depressive symptoms. This study aimed to assess the relationship between cybersickness, presence, treatment satisfaction, and symptom change following VR-BF. In this prospective clinical study, 80 drug-naive adults were enrolled and classified into two groups: those with subclinical depressive and anxiety symptoms (n = 40) and healthy controls (n = 40). All participants completed three sessions of a self-developed VR-BF intervention over four weeks. Clinical outcomes related to depression and anxiety symptoms were assessed using established psychological scales, along with post-intervention evaluations of presence, cybersickness, and treatment satisfaction. Higher presence was associated with greater reductions in anxiety (ΔSTAI: β = -0.24, SE = 0.06, P < 0.001), stress (ΔVAS: β = -0.37, SE = 0.13, P = 0.008), and depressive symptoms (ΔPHQ-9: β = -0.07, SE = 0.02, P = 0.008), and with greater treatment satisfaction (β = 0.07, SE = 0.01, P < 0.001). Cybersickness was inversely correlated with presence (ρ = -0.38, P < 0.001) and satisfaction (β = -0.11, SE = 0.04, P = 0.013) and was associated with smaller improvements in anxiety (ΔSTAI: β = 0.62, SE = 0.30, P = 0.044) and depressive symptoms (ΔPHQ-9: β = 0.28, SE = 0.12, P = 0.019). Female sex and older age were associated with greater clinical improvement and higher satisfaction. These findings underscore the relevance of experiential process factors in VR-BF and support further development of user-centered, tolerable, and clinically effective VR-based interventions.

Effects of Virtual Reality on Pain, Anxiety and Fear Among Emergency Department Patients: A Meta-Analysis of Randomized Controlled Trials

OBJECTIVES

To explore the effects of virtual reality (VR) interventions in reducing pain, anxiety, and fear in child and adult emergency departments (EDs).

DESIGN

A meta-analysis of randomized controlled trials.

DATA SOURCES

Articles were searched from PubMed, Embase, The Cochrane Library, and Web of Science (up to 18 October 2024).

METHODS

The quality of the studies was assessed using the risk of bias tool recommended by the Cochrane Collaboration Risk of Bias Tool, and the Revman version 5.4 software was used to assess the risk of bias in the included studies. Two researchers independently screened eligible articles. The effects of VR on pain, anxiety, or fear in ED patients were estimated with a standardized mean difference (SMD) and 95% confidence interval (CI). Egger's test and the funnel plot were used to evaluate the publication bias. All data analysis was conducted utilizing STATA software version 18.0.

RESULTS

Sixteen randomized controlled trials (RCTs) involving 1449 participants were included. In this meta-analysis, VR reduced the severity of pain (SMD = -0.82; 95% CI: -1.11 to -0.53; p < .001), anxiety (SMD = -1.13; 95% CI: -1.74 to -0.52; p < .001), and fear (SMD = -0.82: 95% CI: -1.51 to -0.12; p = .022).

CONCLUSIONS

The results of this meta-analysis indicate that VR can effectively reduce pain, anxiety, and fear in ED patients. Therefore, VR shows promise as a valuable complementary pain, anxiety, and fear management intervention for ED patients.

Cultural Reflections in Virtual Reality: The Effects of User Ethnicity in Avatar Matching Experiences on Sense of Embodiment

Matching avatar characteristics to a user can impact sense of embodiment (SoE) in YR. However, few studies have examined how participant demographics may interact with these matching effects. We recruited a diverse and racially balanced sample of 78 participants to investigate the differences among participant groups when embodying both demographically matched and unmatched avatars. We found that participant ethnicity emerged as a significant factor, with Asian and Black participants reporting lower total SoE compared to Hispanic participants. Furthermore, we found that user ethnicity significantly influences ownership (a subscale of SoE), with Asian and Black participants exhibiting stronger effects of matched avatar ethnicity compared to White participants. Additionally, Hispanic participants showed no significant differences, suggesting complex dynamics in ethnic-racial identity. Our results also reveal significant main effects of matched avatar ethnicity and gender on SoE, indicating the importance of considering these factors in VR experiences. These findings contribute valuable insights into understanding the complex dynamics shaping VR experiences across different demographic groups.

Multicenter, randomized, controlled comparative-effectiveness study comparing virtual reality to sedation and standard local anesthetic for pain and anxiety during epidural steroid injections

Background

The use of sedation during interventional procedures has continued to rise resulting in increased costs, complications and reduced validity during diagnostic injections, prompting a search for alternatives. Virtual reality (VR) has been shown to reduce pain and anxiety during painful procedures, but no studies have compared it to a control and active comparator for a pain-alleviating procedure. The main objective of this study was to determine whether VR reduces procedure-related pain and other outcomes for epidural steroid injections (ESI).

Methods

A randomized controlled trial was conducted in 146 patients undergoing an ESI at 6 hospitals in Thailand and the United States. Patients were allocated to receive immersive VR with local anesthetic, sedation with midazolam and fentanyl plus local anesthetic, or local anesthetic alone. The primary outcome was procedure-related pain recorded on a 0-10 scale. Other immediate-term outcome measures were pain from a standardized subcutaneous skin wheal, procedure-related anxiety, ability to communicate, satisfaction, and time to discharge. Intermediate-term outcome measures at 4 weeks included back and leg pain scores, function, and success defined as a ≥2-point decrease in average leg pain coupled with a score ≥5/7 on a Patient Global Impression of Change scale.

Findings

Procedure-related pain scores with both VR (mean 3.7 (SD 2.5)) and sedation (mean 3.2 (SD 3.0)) were lower compared to control (mean 5.2 (SD 3.1); mean differences -1.5 (-2.7, -0.4) and -2.1 (-3.3, -0.9), respectively), but VR and sedation scores did not significantly differ (mean difference 0.5 (-0.6, 1.7)). Among secondary outcomes, communication was decreased in the sedation group (mean 3.7 (SD 0.9)) compared to the VR group (mean 4.1 (SD 0.5); mean difference 0.4 (0.1, 0.6)), but neither VR nor sedation was different than control. The trends favoring sedation and VR over control for procedure-related anxiety and satisfaction were not statistically significant. Post-procedural recovery time was longer for the sedation group compared to both VR and control groups. There were no meaningful intermediate-term differences between groups except that medication reduction was lowest in the control group.

Interpretation

VR provides comparable benefit to sedation for procedure-related pain, anxiety and satisfaction, but with fewer side effects, superior communication and a shorter recovery period.

Funding

Funded in part by grants from MIRROR, Uniformed Services University of the Health Sciences, U.S. Dept. of Defense, grant # HU00011920011. Equipment was provided by Harvard MedTech, Las Vegas, NV.

Investigating Personalization Techniques for Improved Cybersickness Prediction in Virtual Reality Environments

In recent cybersickness research, there has been a growing interest in predicting cybersickness using real-time physiological data such as heart rate, galvanic skin response, eye tracking, postural sway, and electroencephalogram. However, the impact of individual factors such as age and gender, which are pivotal in determining cybersickness susceptibility, remains unknown in predictive models. Our research seeks to address this gap, underscoring the necessity for a more personalized approach to cybersickness prediction to ensure a better, more inclusive virtual reality experience. We hypothesize that a personalized cybersickness prediction model would outperform non-personalized models in predicting cybersickness. Evaluating this, we explored four personalization techniques: 1) data grouping, 2) transfer learning, 3) early shaping, and 4) sample weighing using an open-source cybersickness dataset. Our empirical results indicate that personalized models significantly improve prediction accuracy. For instance, with early shaping, the Deep Temporal Convolutional Neural Network (DeepTCN) model achieved a 69.7% reduction in RMSE compared to its non-personalized version. Our study provides evidence of personalization techniques' benefits in improving cybersickness prediction. These findings have implications for developing personalized cybersickness prediction models tailored to individual differences, which can be used to develop personalized cybersickness reduction techniques in the future.

Effectiveness of Virtual Reality in Symptom Management of Cancer Patients: A Systematic Review and Meta-Analysis

CONTEXT

Although the survival rate of cancer patients has been increasing, such patients often experience severe physical and psychological burdens due to the effects of the disease and therapy. Multiple virtual reality (VR)-based interventions have been used to help improve physical and psychological symptoms and quality of life in cancer patients.

OBJECTIVE

This study aimed to assess the effects of VR-based interventions on anxiety, pain, depression, fear, distress, and quality of life in cancer patients.

METHODS

We conducted systematic searches in the PubMed, Web of Science, CINAHL, EMBASE, Cochrane Library, Scopus and APA PsycINFO databases from their inception to August 16, 2022. Two reviewers independently selected studies and extracted articles that met strict inclusion and exclusion criteria. Quality assessments of the included studies were performed according to the Cochrane risk assessment tool, and data analysis was performed using RevMan 5.4 software.

RESULTS

A total of 12 studies including 425 participants in the intervention group and 400 participants in the control group were selected for the final analysis. The results showed a significant difference between the VR and control groups for anxiety (standard mean difference [SMD] =-0.83, 95% CI -1.25 to -0.42, P < 0.001), SMD = pain (SMD =-0.86, 95% CI -1.36 to -0.35, P < 0.001), depression (SMD = -0.46, 95% CI -0.74 to -0.18, P = 0.001), fear (MD = -0.82, 95% CI -1.60 to -0.03, P = 0.04), and distress (SMD = -1.16, 95% CI -1.96 to -0.37, P = 0.004). However, no significant difference was observed in quality of life (SMD = 1.01, 95% CI -0.67 to 2.70, P = 0.24).

CONCLUSIONS

VR interventions were effective in improving physical and psychological symptoms in cancer patients. Due to the limited number of studies, small sample sizes, and moderate to high heterogeneity, these results should be interpreted with caution. More rigorous, comprehensive and high-quality randomized controlled trials (RCTs) are needed to validate the results of this study.

TRIAL REGISTRATION

PROSPERO International Prospective Register of Systematic Reviews CRD42022304931;https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=304931.