Factors Associated With Virtual Reality Sickness in Head-Mounted Displays: A Systematic Review and Meta-Analysis

Comparative effectiveness of small group practice and 3D VR simulation on nursing students' PIVC skills, flow state, and learning satisfaction: A quasi-experimental study

BACKGROUND

PIVC (Peripheral intravenous catheterization) skills are highly challenging techniques frequently used in clinical settings. To prevent complications from intravenous catheterisation and to ensure patient safety, it is necessary to identify effective training methods.

AIM

This study aimed to evaluate the educational effects of 3D VR simulation practice versus small group practice on nursing students' skill performance, learning satisfaction, and flow state.

DESIGN

A quasi-experimental study was conducted using a nonequivalent control group time-lagged design.

PARTICIPANTS

A total of 158 fourth-year undergraduate nursing students participated, with 75 students assigned to the 3D VR group and 83 students to the small group practice group.

METHODS

Pre- and post-assessments were conducted to measure PIVC skills, and flow state, while learning satisfaction was compared only in the post-assessment. The study was conducted over three weeks. The 3D VR group participated in virtual reality practice sessions, completing a total of three 30-minute sessions. Meanwhile, the small group practice group conducted mannequin-based practice sessions, with a student-to-instructor ratio of 8-9 students per instructor, completing two 45-minute sessions. Statistical analysis was performed using SPSS 28.0, and ANCOVA and the Mann-Whitney U test were used to compare the effects between the two groups.

RESULTS

The small group practice showed significantly higher PIVC skill performance (F = 5.367, p = .022), while the 3D VR simulation group demonstrated significantly higher flow state (F = 6.002, p = .015). However, there was no significant difference in learning satisfaction between the two groups (z = -0.169, p = .866).

CONCLUSION

Small group practice was more effective for skill performance in PIVC, while flow state was higher with 3D VR. There was no difference in learning satisfaction between the two groups. These findings provide valuable evidence for selecting optimal teaching methods in nursing education based on learning objectives and educational outcomes.

Immersive insights: A qualitative systematic review and thematic synthesis of views, experiences, health and wellbeing of students and educators using virtual reality in nursing and midwifery education

BACKGROUND AND OBJECTIVES

As healthcare evolves with technology, the demand for a more skilled nursing and midwifery workforce has increased, making traditional learning alone insufficient. This has driven the adoption of virtual reality (VR) based simulation learning. While VR's effectiveness has been reviewed, student and educator experiences and well-being remain underexplored. This review examined the perspectives of nursing and midwifery students and educators using immersive VR, and its impact on health and well-being.

METHODS

A qualitative systematic review was conducted searching across seven databases, CINAHL, Embase, Education Resources Information Centre, MEDLINE, PsycINFO, Scopus, and Web of Science Core Collection, from January 2001 to March 2024. Qualitative evidence on midwifery and nursing students and educators using immersive VR, including head-mounted displays, were included. An adapted Critical Appraisal Skills Programme tool was used to assess study quality. Themes were developed using thematic synthesis.

FINDINGS

Forty-five studies from 14 countries were synthesised. VR topics covered skills, competencies, knowledge acquisition, and professional values. Seven analytical themes emerged: impact on health and well-being, constraints to VR use, unique selling points of VR, enhanced productivity in teaching and learning, perceptions of realism in VR, professional development and attitude shifts, and future considerations for VR use.

CONCLUSION

While VR provides significant benefits in nursing and midwifery education, its full integration is hindered by practical challenges, and concerns about health and well-being. Effective adoption requires dedicated educator support, student collaboration in content development, clear guidelines, increased institutional investment, and balanced use alongside traditional simulations. Future research should investigate learner and educator perspectives longitudinally to maximise VR's educational potential.

A new era for stress research: supporting user performance and experience in the digital age

Stress is both a driver of objective performance impairments and a source of negative user experience of technology. This review addresses future directions for research on stress and ergonomics in the digital age. The review is structured around three levels of analysis. At the individual user level, stress is elicited by novel technologies and tasks including interaction with AI and robots, working in Virtual Reality, and operating autonomous vehicles. At the organisational level, novel, potentially stressful challenges include maintaining cybersecurity, surveillance and monitoring of employees supported by technology, and addressing bias and discrimination in the workplace. At the sociocultural level, technology, values and norms are evolving symbiotically, raising novel demands illustrated with respect to interactions with social media and new ethical challenges. We also briefly review the promise of neuroergonomics and emotional design to support stress mitigation. We conclude with seven high-level principles that may guide future work.

Development of Virtual Reality Educational Content on Magnetic Resonance Imaging: A Pilot Study

Through virtual reality technology, users experience challenging situations in a virtual world without physical experiences. This study aims to develop educational content using virtual reality to help patients undergoing magnetic resonance imaging and evaluate its usability. This pilot study developed virtual reality educational content using the ADDIE (analysis, design, development, implementation, and evaluation) model. An educational needs assessment targeted 20 experts and patients at a tertiary hospital. The content developed included pre-magnetic resonance imaging nursing, the magnetic resonance imaging process, and post-magnetic resonance imaging nursing. In pre-magnetic resonance imaging nursing, patients completed consent forms and received preparation instructions. The magnetic resonance imaging process included the environment, vision, and noise experienced during the examination. Post-magnetic resonance imaging nursing included precautions. An additional 12 experts and patients subsequently participated in virtual reality implementation and evaluation. Virtual reality evaluation included survey and semistructured face-to-face individual interviews. It scored 96.5 points out of 100 in usability, with little difference between experts' and patients' evaluations. In the qualitative evaluation, virtual reality educational content was revealed to be a useful approach, and the final virtual reality educational content was completed by reflecting the improvements suggested by participants. The findings offer tangible benefits for both healthcare professionals and patients by addressing the challenges associated with magnetic resonance imaging procedures through innovative educational interventions using virtual reality technology. Virtual reality educational content can be used as a practical training method in clinical settings.

Comparing virtual reality with traditional methods in cognitive rehabilitation in PICS syndrome

INTRODUCTION

Post Intensive Care Unit Syndrome (PICS) manifests deficits in physical, cognitive, and mental functions following ICU hospitalization and complicates the recovery process.

AIM

The clinical trial aimed to assess the impact of neuropsychological rehabilitation on cognitive deficits arising from ICU hospitalization. Additionally, it sought to compare the effectiveness of VR-based rehabilitation with traditional methods and investigate the safety and feasibility of VR intervention.

METHODOLOGY

Thirty participants were divided into experimental and control groups. The experimental group underwent cognitive training using VR, while the control group utilized traditional methods. Neuropsychological assessments (Addenbrooke's Cognitive Examination-Revised (ACE-R), Frontal Assessment Battery (FAB), and Geriatric Depression Scale (GDS)) were conducted before and after a 12-session intervention (three times a week for four weeks).

RESULTS

Regardless of the intervention type, participants exhibited statistically significant improvements in general cognitive function (p = 0.02), attention (p = 0.016), visuospatial (p = 0.03), and executive functions (p = 0.011). The experimental group showed greater improvement in visuospatial function (p = 0.011), while the control group demonstrated enhanced language fluency (p = 0.019). Correlations between cognitive functions were observed in baseline measures and their differences. VR was found to be a safe, suitable, and enjoyable rehabilitation method, as indicated by Suitability Evaluation Questionnaire (SEQ) scores, with a mean of 60.7 (SD = 5.5).

DISCUSSION

These preliminary data suggest that VR can be effective in the rehabilitation of cognitive functions in ICU survivors with PICS, especially in visuospatial abilities. Large-scale longitudinal clinical trials involving diverse patient groups are needed to explore the long-term impact of VR interventions on cognitive functions.

Hybrid 3D augmented reality for image-guided therapy using autostereoscopic visualization

PURPOSE

During image-guided therapy, cardiologists use 2-dimensional (2D) imaging modalities to navigate the catheters, resulting in a loss of depth perception. Augmented reality (AR) is being explored to overcome the challenges, by visualizing patient-specific 3D models or 3D shape of the catheter. However, when this 3D content is presented on a 2D display, important depth information may be lost. This paper proposes a hybrid 3D AR visualization method combining stereo 3D AR guidance with conventional 2D modalities.

METHODS

A cardiovascular catheterization simulator was developed consisting of a phantom vascular model, a catheter with embedded shape sensing, and an autostereoscopic display. A user study involving interventional cardiologists ( n = 5 ) and electrophysiologists ( n = 2 ) was set up. The study compared the hybrid 3D AR guidance with simulated fluoroscopy and 2D AR guidance in a catheter navigation task.

RESULTS

Despite improvements in task time and traveled path length, the difference in performance was not significant. However, a reduction of 50% and 81% with 2D and hybrid 3D AR in the number of incorrect artery entries was found, respectively. The results of the questionnaires showed a reduced mental load and a higher confidence with the proposed hybrid 3D AR guidance. All but one participant indicated to feel comfortable looking at the hybrid 3D view.

CONCLUSION

The findings suggest that AR guidance, particularly in a hybrid 3D visualization format, enhances spatial awareness and reduces mental load for cardiologists. The autostereoscopic 3D view demonstrated superiority in estimating the pose and relationship of the catheter relative to the vascular model.

Investigating the role of vestibular function in motion sickness and visually induced motion sickness by multiple vestibular function tests

BACKGROUND

Motion sickness (MS) and visually induced motion sickness (VIMS) are vestibular system-related conditions affecting balance.

OBJECTIVES

To investigate the role of vestibular function and susceptibility in MS/VIMS in healthy college students and to evaluate the effectiveness of various vestibular function tests in detecting these disorders.

MATERIALS AND METHODS

Five hundred young adults, grouped by motion sickness susceptibility questionnaire-short (MSSQ-S) and visually induced motion sickness susceptibility questionnaire-short (VIMSSQ-S) questionnaires, were further analyzed via continuous linear regression to validate the grouping strategy. The participants completed a caloric test (CT), video head impulse test (vHIT), dynamic visual acuity (DVA), subjective visual vertical/horizontal (SVV/SVH), and sensory organisation tests (SOT). Analysis of the relationship between the results of the five tests and the MS/VIMS.

RESULTS

CT revealed significant differences in right cold slow-phase velocity (RC SPV) and left cold slow-phase velocity (LC SPV) among groups (p < 0.001), with strong correlations between these values and MS/VIMS susceptibility (p < 0.05). Among 52 subjects with abnormal CT results, significant differences were found in vHIT, DVA, and SOT (p < 0.001), while SVV/SVH showed a significant difference only in MSSQ-S scores (p = 0.034).

CONCLUSIONS AND SIGNIFICANCE

This study comprehensively assessed vestibular function in MS and VIMS susceptible individuals, confirming increased sensitivity and highlighting the need for targeted evaluation strategies.

Acceptability, Usability, and Insights Into Cybersickness Levels of a Novel Virtual Reality Environment for the Evaluation of Depressive Symptoms: Exploratory Observational Study

BACKGROUND

There is a clear need for enhanced mental health assessment, depressive symptom (DS) evaluation being no exception. A promising approach to this aim is using virtual reality (VR), which entails the potential of adding a wider set of assessment domains with enhanced ecological validity. However, whilst several studies have used VR for both diagnostic and treatment purposes, its acceptance, in particular how exposure to virtual environments affects populations with psychiatric conditions remains unknown.

OBJECTIVE

This study aims to report on the acceptability, usability, and cybersickness levels of a pilot VR environment designed for the purpose of differentiating between individuals with DSs.

METHODS

The exploratory study, conducted in Italy, included 50 healthy controls and 50 young adults with mild-to-moderate DSs (without the need for a formal diagnosis). The study used an observational design with approximately 30 minutes of VR exposure followed by a self-report questionnaire battery. The battery included a questionnaire based on the Theoretical Framework of Acceptability, the System Usability Scale as well as the Simulator Sickness Questionnaire.

RESULTS

Results indicate that the majority found VR acceptable for the purposes of mental health screening and treatment. However, for diagnostics, there was a clear preference for VR to be used by mental health professionals as a supplementary tool, as opposed to a stand-alone solution. In practice, following exposure to the pilot VR environment, generally, good levels of acceptability and usability were reported, but areas in need of improvement were identified (such as self-efficacy). Self-reported cybersickness levels were comparable to literature averages but were considerably higher among those with DSs.

CONCLUSIONS

These findings raise questions about the potential interplay between underlying somatic symptoms of depression and VR-induced cybersickness and call for more attention from the scientific community both in terms of methodology as well as potential clinical and theoretical implications. Conclusively, user support indicates a potential for VR to aid mental health assessment, but further research is needed to understand how exposure to virtual environments might affect populations with varying severity and other forms of psychiatric symptoms.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1186/ISRCTN16396369.

Is Boccia XR an enjoyable and effective rehabilitation exercise for older adults?

BACKGROUND AND OBJECTIVES

Maintaining activities of daily living (ADL) in older adults requires muscle strength and physical activity. However, exercise motivation often declines with age. Enjoyable activities can enhance motivation and effectiveness. Boccia is a recreational sport with rehabilitation potential but requires substantial space. This study evaluated the enjoyment and lower limb muscle activity of "Boccia XR," a virtual adaptation designed for limited spaces, comparing it with traditional Boccia and treadmill walking.

METHODS

Eighteen healthy older adults (mean age 73.3 ±  5.4 years) participated. Each performed Boccia XR, traditional Boccia, and treadmill walking in random order. Mood changes were assessed using the Profile of Mood States 2nd Edition (POMS2), and lower-limb muscle activity was measured via electromyography (EMG).

RESULTS

Both Boccia XR and traditional Boccia significantly improved positive mood (Vigor-Activity) and reduced negative mood (Total Mood Disturbance) as compared to treadmill walking. Muscle activity analysis revealed that Boccia XR and traditional Boccia imposed muscle loads comparable to treadmill walking. Rectus femoris activity exceeded that of treadmill walking, and medial gastrocnemius activation was sufficient for strengthening in sedentary older adults during Boccia tasks.

CONCLUSION

Boccia XR is an enjoyable and effective physical activity for older adults, requiring less space, than traditional Boccia while providing physical benefits similar to treadmill walking. It may enhance exercise adherence and overall function in space-limited settings.

Effectiveness of Technology-Based Intervention in Symptom Management in Pediatric Oncology Patients: A Systematic Review and Meta-Analysis

BACKGROUND

Technology-based interventions are increasingly integrated to improve symptom management of pediatric oncology patients. However, evidence for their effectiveness remains low across various studies characterized by different methodologies and patient populations. This study aimed to synthesize and analyze the effectiveness of technology-based intervention in symptom management in pediatric oncology patients.

METHODS

Six databases (PubMed, Web of Science, Cochrane Library, Ovid MEDLINE, CINAHL, and Scopus) were searched from January 1, 2014, to January 1, 2024. The methodological quality of the included studies was assessed using the Cochrane and JBI checklists. The PRISMA guidelines for systematic reporting were followed in this study. The search protocol has been registered with the PROSPERO International Prospective Register of Systematic Reviews (CRD42024516320).

RESULTS

Thirteen studies with 624 pediatric oncology patients were analyzed. Significant differences were found between intervention and control groups in pain (Hedge's g = -0.695, 95% CI: -0.994 to -0.396, p < 0.001), fear (Hedge's g = -0.737, 95% CI: -1.01 to -0.464, p < 0.001), anxiety, and nausea and vomiting (Hedge's g = -0.573, 95% CI: -0.912 to -0.235, p < 0.001).

CONCLUSION

The findings indicate that VR, iPad, humanoid robots, and Pain Squad reduce pain in pediatric oncology. VR, biofeedback-based VR, and iPads also alleviate fear, while all three plus humanoid robots mitigate anxiety. VR, interactive mobile apps, tablet games, text reminders, and iPads effectively decrease nausea and vomiting. More research is needed to evaluate the long-term effects of these interventions.

Virtual reality for MRI preparation: Participant perceptions from a feasibility study

INTRODUCTION

Undergoing a Magnetic Resonance Imaging (MRI) procedure remains a source of fear and concern for many. Providing adequate information beforehand is essential to ease concerns, yet traditional methods have limitations, often hindered by time constraints. The aim of this study is to explore the acceptability of a Virtual Experience (VE) as an alternative method to prepare patients, with a focus on participant feedback to inform future development.

METHODS

Feedback metrics and qualitative responses were captured as part of a wider experimental mixed methods feasibility study. Feedback scores were collated and described, whilst qualitative data underwent a process of thematic analysis.

RESULTS

15 participants underwent two exposures to the VE. The majority were female with an average age of 50, and a third having experienced virtual reality before. Feedback obtained supported perception of the VE to have been engaging, safe, and of benefit, with a willingness to use in the future. From the emerging themes, the experience was considered realistic, fostering acceptance and tolerance of the tool with a number of suggestions for improvement made. Participants would prefer use in a clinical setting with staff support, rather than at home, highlighting its potential to build trust with imaging staff away from pressurised scanning lists ahead of an actual scan.

CONCLUSION

Participants viewed the VE as a valuable preparatory tool, providing a realistic and acceptable means to familiarise themselves with the process. Their feedback highlights areas for improvement and supports its potential use in practice, underscoring the importance of the public's role in shaping acceptance and future enhancements.

IMPLICATIONS FOR PRACTICE

VR could become a commonplace means of patient preparation and help facilitate coping strategies before an actual scan.

Effectiveness of a mindfulness-based program with virtual reality to increase safe behaviors in workers of a mining company

Objectives

The development of safe behaviors is a transcendental issue, especially in organizations where jobs considered high risk, such as mining, are carried out. This study proposes a program aimed at increasing safe behavior through a mindfulness program supported by virtual reality techniques. The specific objective was to determine the effect of this program on safe behaviors, comparing with those produced with the BBS (Safety Based On Behavior) program in a sample of workers who performed high-risk activities in a mining company in southern Peru.

Method

Based on the determination of high-risk activities for the study, the study groups were randomly selected, forming two equivalent groups in terms of sex, age, education, and marital status. The study units were randomly assigned to one of the following 2 groups: 22 to the control group (BBS) and 22 to the experimental group (mindfulness) to whom record sheets of safe behaviors related to standard risk behaviors were applied for each activity on a weekly basis, according to the BBS system where the observers did not know the composition of the groups under study.

Results

Data analysis showed evidence of a significant improvement in the index of safe behavior thanks to the proposed mindfulness program, compared to the BBS program alone.

Conclusion

Evidence was found that the mindfulness-based program significantly reduces the number of risk behaviors likely to cause workplace accidents, maintaining that mindfulness is a very useful tool to reduce the number of incidents and/or accidents in workers. An organization, in this case, a mining company.

Experiences of People With Persistent Nonspecific Neck Pain Who Used Immersive Virtual Reality Serious Games in the Home Setting: A Qualitative Study

OBJECTIVE

The purpose of this study was to explore the experiences of individuals with persistent nonspecific neck pain who used immersive virtual reality (VR) serious games at home for 2 weeks.

METHODS

In this descriptive qualitative study, semi-structured one-on-one interviews were conducted at the participant's home after the 2-week period. Interviews were analyzed using qualitative content analysis. Sample size was determined using the information power concept (where "information power" refers to the amount of relevant information the sample provides for addressing the research question).

RESULTS

Eleven adults with continuous or recurrent nonspecific neck pain participated in the study. Three main categories were identified. The first revolves around the home environment, revealing that participants had mixed perceptions about being at home, yet held a positive perspective on the utilization of immersive VR in that setting. The second pertains to immersive VR as a novel technology, indicating its overall comfort, user-friendliness, and varying degrees of immersion and presence experienced by the participants. The third focuses on exercising in immersive VR, drawing comparisons with conventional exercises, exploring the facilitators and barriers to usage, and addressing various aspects of integrating this technology into rehabilitation.

CONCLUSION

Immersive VR was deemed comfortable for almost all participants and easy to use. Participants found exercising in immersive VR motivating and enjoyable, compared to conventional exercises. The home environment proved suitable for using immersive VR, though challenges included autonomy and reduced human contact. Participants highlighted facilitators and barriers in using immersive VR serious games, as well as immersive VR's rehabilitation potential. They also underscored the crucial role of physical therapists for guidance, remote supervision, and personalized treatment.

IMPACT

These findings could help clinicians to better understand the experiences of individuals with persistent nonspecific neck pain when using immersive VR, as well as its use at home. This understanding can improve patient care and optimize the effectiveness of immersive VR as a treatment method.

The Body Image Virtual Reality Assessment (BIVRA): Measuring the body representation through virtual reality

Our physical and psychological well-being is significantly influenced by how we perceive our body, in addition to our thoughts and emotions associated with it. Dysfunctional body perceptions and attitudes play a key role in the development and maintenance of severe conditions such as eating disorders in both males and females. Given its relevance, some attempts have been made to improve body image assessment methods in terms of perceptual accuracy and body satisfaction taking advantage of technological advances such as virtual reality. However, existing applications have mainly focused on women and clinical conditions. In this study, we presented the Body Image Virtual Reality Assessment (BIVRA), a virtual reality figure rating scale to assess body image in both male and female subjects. We tested BIVRA's ability to measure perceptual accuracy and compared its results with a standardized body satisfaction questionnaire. Additionally, we investigated gender differences. BIVRA was found to be effective in assessing body image. We observed that a perceptually based task successfully captured both low and high levels of body representations, shedding light on the significant gender differences. The association between BIVRA and the body satisfaction questionnaires was moderated by gender, with a stronger association for women. While further validation of BIVRA is needed to fully exploit its potential, our results suggest that the integration of virtual reality into the assessment of body image and related disorders may significantly enhance our understanding of individuals struggling with body image issues and has the potential to advance current methods and techniques.

The limitations and challenges in the assessment of executive dysfunction associated with real-world functioning: The opportunity of serious games

Nowadays, there is a broad range of methods for detecting and evaluating executive dysfunction ranging from clinical interview to neuropsychological evaluation. Nevertheless, a critical issue of these assessments is the lack of correspondence of the neuropsychological test's results with real-world functioning. This paper proposes serious games as a new framework to improve the neuropsychological assessment of real-world functioning. We briefly discuss the contribution and limitations of current methods of evaluation of executive dysfunction (paper-and-pencil tests, naturalistic observation methods, and Information and Communications Technologies) to inform on daily life functioning. Then, we analyze what are the limitations of these methods to predict real-world performance: (1) A lack of appropriate instruments to investigate the complexity of real-world functioning, (2) the vast majority of neuropsychological tests assess well-structured tasks, and (3) measurement of behaviors are based on simplistic data collection and statistical analysis. This work shows how serious games offer an opportunity to develop more efficient tools to detect executive dysfunction in everyday life contexts. Serious games provide meaningful narrative stories and virtual or real environments that immerse the user in natural and social environments with social interactions. In those highly interactive game environments, the player needs to adapt his/her behavioral performance to novel and ill-structured tasks which are suited for collecting user interaction evidence. Serious games offer a novel opportunity to develop better tools to improve diagnosis of the executive dysfunction in everyday life contexts. However, more research is still needed to implement serious games in everyday clinical practice.

Evaluation of a nature-based virtual reality intervention to support hospice caregivers: a pilot feasibility study

OBJECTIVES

Hospice family caregivers (CGs) may experience poor emotional health and diminished quality of life (QOL) secondary to stressors that accompany home-based end-of-life caregiving. Innovative flexible strategies are needed to support hospice CGs in their homes. Being outdoors in nature enhances well-being but is often not accessible to home-based CGs. The purpose was to evaluate the feasibility/acceptability, and preliminary emotional health and QOL outcomes of a 5-day nature-based virtual reality (VR) intervention.

METHODS

A pre-post design was used. Hospice CGs engaged in self-selected 10 min nature experiences via VR headset over 5 days. Preintervention surveys included demographics and the PROMIS-29 QOL measure (physical/social function, anxiety/depressive symptoms, fatigue, sleep and pain). Postintervention surveys included acceptability/feasibility surveys, PROMIS-29 and a VR-related symptom checklist. Data analysis included descriptives and paired t-tests.

RESULTS

15 CGs (mean 61.13±12.47 years; 12 females) completed the study. Findings demonstrated high acceptability (14.46±1.77; range 0-16); feasibility (13.93±2.43;range 0-16). Adverse VR symptoms were minimal. PROMIS-29 overall scores were significantly improved following the 5-day intervention (pre: 66.33±8.47; post: 61.07±7.83,p=0.01). Paired t-tests showed significant pre-post changes in anxiety (t=2.206, p<0.05) and favourable trends on other QOL dimensions.

CONCLUSIONS

Feasibility/acceptability and QOL data support further testing of VR nature immersive experiences in the home environment with larger more diverse representative samples.

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.

Virtual reality for assessment in undergraduate nursing and medical education - a systematic review

BACKGROUND

Virtual reality (VR) is increasingly used in healthcare education, offering immersive training experiences that are as effective as conventional methods, with benefits like cost-effectiveness, replicating complex scenarios, and reduced need for physical resources. However, the use of VR as an assessment tool is still emerging, particularly in nursing and medical education. The aim of this systematic review was to examine how immersive VR is used as an assessment tool for nursing and medical students.

METHODS

Embase, PubMed, PsycINFO, Cochrane, CINAHL, and ERIC were searched for articles that assessed nursing and/or medical students using immersive/HMD VR. The data was extracted, and content analysis was performed.

RESULTS

Twenty-six studies met the inclusion criteria, investigating VR assessments in various settings mostly emergencies. Assessments focused on core competencies Patient Care such as first triage, Interpersonal and Communication Skills (e.g., interprofessional communication), and Medical Knowledge (e.g., about coma), utilizing a range of assessment methods from knowledge to performance levels. VR was used either as an automated or supporting assessment tool. Practical considerations in VR implementation were also examined, such as hardware and software.

CONCLUSION

The use of VR in medical education assessment shows promise, particularly for emergency scenarios and performance-based tasks related to core competencies such as Patient Care, Interpersonal and Communication Skills, and Medical Knowledge. While this technology offers opportunities to automate assessments and reduce examiner workload, challenges related to software, costs, and feasibility must be addressed. Additionally, aligning learning objectives, teaching methods, and VR assessments through constructive alignment is essential to ensure effective implementation as both a teaching and evaluation tool.

Effectiveness and adverse effects of immersive technologies used for rehabilitation of patients with non-specific neck pain: a systematic review

OBJECTIVE

The aim of this study is to evaluate the effectiveness of immersive technologies in the rehabilitation of patients with non-specific neck pain and identify any potential side effects associated with their use.

DESIGN

Systematic review.

SUBJECTS/PATIENTS

Individuals with non-specific neck pain.

METHODS

A systematic literature search of randomized controlled trials was conducted using Medline (PubMed), Embase (Ovid), Scopus, Cochrane Database of Systematic Reviews, WHO, Pedro, and ClinicalTrials.gov. Risk of bias was assessed with Cochrane Risk of Bias tool.

RESULTS

Five studies with a total of 203 participants (129 women, 74 men) were included in the review. In most studies, both the virtual reality (VR) and control groups demonstrated improvement in pain, functioning related to neck pain, and range of motion. Two cases found the virtual reality group to demonstrate greater improvements in pain and range of motion (for some movements), but not in function. The studies analysed lack much information regarding the applicability of VR therapy.

CONCLUSION

The data are promising and suggest that VR therapy may have benefits in the rehabilitation of patients with non-specific neck pain. Data on the safety of therapy and adverse events are insufficient to draw any conclusions.

The Impact of Virtual Reality Content Characteristics on Cybersickness and Head Movement Patterns

Virtual reality (VR) technology has gained popularity across various fields; however, its use often induces cybersickness, characterized by symptoms such as dizziness, nausea, and eye strain. This study investigated the differences in cybersickness levels and head movement patterns under three distinct VR viewing conditions: dynamic VR (DVR), static VR (SVR), and a control condition (CON) using a simulator. Thirty healthy adults participated, and their head movements were recorded using the Meta Quest 2 VR headset and analyzed using Python. The Virtual Reality Sickness Questionnaire (VRSQ) assessed subjective cybersickness levels. The results revealed that the SVR condition induced the highest VRSQ scores (M = 58.057), indicating the most severe cybersickness symptoms, while the DVR condition elicited significantly higher values in head movement variables, particularly in the coefficient of variation (CV) and integral values of head position along the vertical axis, and mean velocity (p < 0.05). These findings suggest that VR content characteristics directly influence users' head movement patterns, closely related to cybersickness occurrence and severity. This study highlights the importance of analyzing head movement patterns in cybersickness research and provides insights for VR content design.

Virtual reality tolerability, sense of presence and usability in Huntington disease: a pilot study

INTRODUCTION

Several studies demonstrated the utility of immersive virtual reality (VR) as a complementary approach to conventional therapy for improving motor, psychological and cognitive impairment in some pathological conditions. Our pilot study aims to evaluate for the first time: 1) sense of presence, tolerability and usability of VR immersive experience in patients with early stages of Huntington disease (eHDp) compared to healthy controls (HC); 2) correlation between the use of technology/cybersickness and the variables of presence/usability; 3) correlation between clinical characteristics (genetic, motor, functional and cognitive) and VR's variables.

METHOD

We recruited 10 eHDp and 10 age, gender and education matched HC. Participants completed questionnaires about sense of presence, usability, tolerability and technology use profile. Subjects were exposed to different VR scenarios from a first-person perspective through a standalone VR headset.

RESULTS

Our results showed no significant statistical difference between eHDp and HC for the sense of presence (p=0.910), usability (p=0.744) and tolerability (p=0.730) during the VR experience. Familiarity with the use of technology was also comparable between groups (p=0.676). Regarding correlations in eHDp group, our results showed no correlations between use of technology/tolerability and the sense of presence/usability. Moreover, clinical characteristics of eHDp (genetic, motor, functional and cognitive scores) did not influence the sense of presence, tolerability and usability.

CONCLUSION

Our research presents preliminary evidence for the applicability of VR in eHDp. These results open up the possibility to explore future applications of this methodology in rehabilitation (i.e., cognitive training, physiotherapy), diagnosis and psychological support in Huntington disease patients.

Feasibility and Safety of Virtual Reality-Based Online Group Discussions Among Nursing Students: A Cross-Sectional Study

Objective Virtual reality (VR) has emerged as a potential tool for enhancing learning experiences in various fields, including nursing education. However, its feasibility, safety, and impact on online group discussions remain underexplored. This study aimed to assess the feasibility and safety of VR conferencing in basic education courses for nursing students. Methods This cross-sectional study was conducted with third-year nursing students at Mie University, Tsu, Japan. Participants were assigned non-randomly to either a VR discussion group using MetaQuest 3 and Horizon Workrooms or a video discussion group using Zoom meetings. The groups discussed challenges in the daily lives of patients with chronic shoulder pain and completed tasks, such as listing and ranking challenges. After the discussions, data on discussion drop rates, levels of understanding, teamwork, psychological safety, cybersickness, cognitive load, and impressions of VR and avatar usage were collected. All variables are summarized by the group as means and standard deviations, medians and interquartile ranges, or frequencies and percentages, as appropriate. Results A total of 36 nursing students participated in this study (VR group: n=17; video group: n=19). All participants completed the discussions without dropping out or experiencing cybersickness. The average discussion time was comparable between the groups (approximately 10 minutes). Both groups demonstrated an equivalent understanding of the topic. Both discussion methods had positive effects on teamwork and psychological safety. Cognitive load differences were mixed, with VR reducing some elements of task-related stress (e.g., understanding the overall discussion) but showing higher demands in others (e.g., the design for learning tasks). Participants in the VR group reported a high intention to continue using VR and noted that avatar customization (e.g., clothing and hairstyles) influenced the discussions. Conclusions Both VR and video groups engaged in discussions of similar quality and completed the discussion. As none of the participants had cybersickness or dropped out of the discussions, it was thought that the VR discussions were feasible. Carefully selecting discussion themes, evaluation items, and avatar conditions, as well as verifying the effectiveness of online discussion methods, are necessary.

Virtual Reality-Applied Home-Visit Rehabilitation for Patients With Chronic Pain: Protocol for Single-Arm Pre-Post Comparison Study

BACKGROUND

Pain inhibits rehabilitation. In rehabilitation at medical institutions, the usefulness of virtual reality (VR) has been reported in many cases to alleviate pain. In recent years, the demand for home rehabilitation has increased. Unlike in medical situations, the patients targeted for in-home rehabilitation often have chronic pain due to physical and psychosocial factors, and the environment is not specialized for rehabilitation. However, VR might be effective for in-home rehabilitation settings.

OBJECTIVE

This study aims to evaluate the feasibility of applying VR to home-visit rehabilitation for homebound patients with chronic pain.

METHODS

This study will test the feasibility of VR applied to home-visit rehabilitation for patients with chronic pain. A single-arm pre-post comparison will be conducted to evaluate its feasibility. Screening will be conducted on patients who have given consent to participate in the study, and those who have pain that persists or recurs for more than 3 months and receive home-visit rehabilitation will be enrolled in the study. Baseline measurements will be conducted on study participants before the start of the VR intervention. VR-applied home-visit rehabilitation will be conducted once a week for a total of 10 VR interventions. The primary endpoint is the change in pain from the baseline to the tenth intervention. Pain is a subjective symptom of the study participants and will be subjectively assessed by the Numerical Rating Scale of 11 levels from 0 to 10. Pain as the primary endpoint will be measured at 3-time points per rehabilitation session: before, during, and after the rehabilitation so that changes between time points can be evaluated. Secondary endpoints are heart rate variability, range of motion of the area in the musculoskeletal system where the pain occurs, motivation for rehabilitation, catastrophic thoughts of pain, mood state, quality of life, and interviews. Assessments will be conducted at the baseline, first, fifth, and tenth interventions. After completing the clinical study (10 VR interventions), patients will continue their regular home-visit rehabilitation as usual.

RESULTS

Recruitment of participants began on February 22, 2022, and data collection is ongoing as of November 2024. The research results will be published in international peer-reviewed journals and through presentations at national and international conferences.

CONCLUSIONS

This study will contribute to the development of novel rehabilitation-based solutions for homebound patients who have had difficulty obtaining adequate relief from chronic pain. Future studies will consider conducting randomized controlled trials as clinical trials to validate the efficacy of VR during home-visit rehabilitation for patients with chronic pain.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/58734.

Safety of Immersive Virtual Reality for the Management of Parkinson's Disease

Virtual reality (VR) has been used in research and clinical practice in the management of Parkinson's disease (PD), potentially enhancing physiotherapy. Adverse events (AEs) associated with VR applications in PD have been poorly explored. We conducted a randomized controlled trial to compare two 12-week interventions using physiotherapy and immersive VR, and analyzed the frequency and type of AEs occurring in 30 people with PD. We reported 144 AEs (8.4% of the sessions), predominantly classified as mild and unrelated to the interventions. Two were serious AEs, one leading to study discontinuation. Notably, discomfort/pain, motor fluctuations, and falls were the most frequently reported, accounting for 63% of the total AEs. Five falls were definitely associated with the 'sense of presence' provided by the fully immersive VR system, which underscores the necessity for careful game selection when designing interventions for PD. Motor fluctuations may have been associated with various factors, which merit further investigation. We also explored the role of SSQ as a measure of cybersickness in PD. In conclusion, it is important to closely monitor and characterize AEs to ensure safety and efficacy in clinical practice as AEs may be more common than previously recognized in VR interventions in PD.

Personalized Clustering for Emotion Recognition Improvement

Emotion recognition through artificial intelligence and smart sensing of physical and physiological signals (affective computing) is achieving very interesting results in terms of accuracy, inference times, and user-independent models. In this sense, there are applications related to the safety and well-being of people (sexual assaults, gender-based violence, children and elderly abuse, mental health, etc.) that require even more improvements. Emotion detection should be done with fast, discrete, and non-luxurious systems working in real time and real life (wearable devices, wireless communications, battery-powered). Furthermore, emotional reactions to violence are not equal in all people. Then, large general models cannot be applied to a multi-user system for people protection, and health and social workers and law enforcement agents would welcome customized and lightweight AI models. These semi-personalized models will be applicable to clusters of subjects sharing similarities in their emotional reactions to external stimuli. This customization requires several steps: creating clusters of subjects with similar behaviors, creating AI models for every cluster, continually updating these models with new data, and enrolling new subjects in clusters when required. An initial approach for clustering labeled data compiled (physiological data, together with emotional labels) is presented in this work, as well as the method to ensure the enrollment of new users with unlabeled data once the AI models are generated. The idea is that this complete methodology can be exportable to any other expert systems where unlabeled data are added during in-field operation and different profiles exist in terms of data. Experimental results demonstrate an improvement of 5% in accuracy and 4% in F1 score with respect to our baseline general model, along with a 32% to 58% reduction in variability, respectively.

Use of virtual reality in preoperative education of cardiac surgery patients - A feasibility study

OBJECTIVE

A Virtual Patient Tour (VPT) was developed to inform cardiac surgery patients about their hospitalization from the admission to their postoperative stay on the ward. The objective of our study was to assess the feasibility and acceptability of this VPT following the framework of the Virtual Reality Clinical Outcomes Research Experts Committee.

METHODS

In this single-centre cross-sectional study, adult patients admitted to the hospital for elective cardiac surgery were included. Acceptability, usability, and tolerability were measured by the validated questionnaires Unified Theory of Acceptance and Use of Technology (acceptability), System Usability Scale (usability), and Virtual Reality Sickness Questionnaire (tolerability). Descriptive statistics were used for the analysis.

RESULTS

Twenty-eight participants used the VPT. Results showed high acceptability (mean 16.7 ± 1.5), acceptable usability (mean 86.7 ± 9.3), and high tolerability (sickness score, median 7.1 % [0-17.1 %]).

CONCLUSION

The use of the VPT is a feasible and promising technique. The next step is to optimize the content and technique of the VPT based on the suggestions of the participants.

PRACTICE IMPLICATIONS

We recommend incorporating the VPT into preoperative patient education in addition to the routine information in cardiac surgery patients.

A telerehabilitation program to improve visual perception in children and adolescents with hemianopia consecutive to a brain tumor: a single-arm feasibility and proof-of-concept trial

Background

Brain tumor in children can induce hemianopia, a loss of conscious vision, profoundly impacting their development and quality of life, yet no effective intervention exists for this pediatric population. This study aimed to explore the feasibility, safety, and potential effectiveness of a home-based audiovisual stimulation in immersive virtual-reality (3D-MOT-IVR) to improve visual function and functional vision.

Methods

In a phase 2a, open-labeled, nonrandomized, single-arm study, conducted from July 2022 to October 2023 (NCT05065268), 10 children and adolescents with stable hemianopia were enrolled to perform 20-min sessions of 3D-MOT-IVR every other day for six weeks from home. We assessed feasibility by monitoring adoption, adherence and completion rates, remote data transfer and qualitative feedback. Safety was evaluated using validated cybersickness questionnaires. Comprehensive vision assessments following standardized low-vision evaluation procedures were conducted pre- and post-intervention, with follow-ups at 1- and 6 months.

Findings

The home-based 3D-MOT-IVR intervention proved both feasible and safe, with no reported adverse events. All participants completed the prescribed stimulations and the pre- and post-intervention assessment points, 90% completed the follow-ups. Nine out of ten participants showed clinically meaningful enhancement in visual function and/or functional vision, namely binocular visual field restoration and increased reading speed, but two showed concomitant deterioration in monocular visual field. These positive effects were sustained at the 6-month follow-up. Exploratory outcomes revealed a significant positive correlation between the performance at the 3D-MOT-IVR intervention and the visual perception at the binocular visual field test.

Interpretation

Our findings underscore the feasibility and safety of home-based audiovisual stimulation in immersive virtual-reality as a potential intervention for improving visual perception in children/adolescents with hemianopia consecutive to a pediatric brain tumor. These promising results lay a strong foundation for a larger randomized controlled trial, offering hope for a meaningful breakthrough in visual rehabilitation for this vulnerable population.

Funding

Meagan Bebenek Foundation and University Health Network Foundation.

Factors Influencing Virtual Reality Sickness in Emergency Simulation Training

Introduction

Virtual reality-based simulation is an educational tool that has been proven to increase participants' self-perceived, confidence, and skill. However, the use of VR is associated with virtual reality sickness (VRS). The purpose of this study is to determine related factors of VRS in an emergency setting simulation-based training, hence providing information and mitigation plan to enhance and optimize learning outcomes.

Method

We developed multiplayer VR simulation in Traumatic Brain Injury and Local Anaesthetic Systemic Toxicity emergency. Seventy-five medical doctors voluntarily partake in the VR simulation. Throughout the simulation and its aftermath, participants were carefully monitored and observed. Additionally, they were questioned regarding their experience of VRS using the Simulation Sickness Questionnaire (SSQ) instrument.

Result

The incidence of virtual reality sickness was found to be 57.3% and is significantly associated with male gender, myopia, astigmatism, and the use of stationary VR mode (p<0.05). The mean SSQ score for nausea, oculomotor, disorientation, and total score component is 5.97 (standard deviation (SD): 6.4), 6.26 (SD 6.5), 125.6 (SD 132), and 9.03 (SD 9.5), respectively. There were 16% of participant experiencing severe symptoms of VRS.

Conclusion

Male gender, myopia, astigmatism, and the use of stationary VR mode were related with incidence of virtual reality sickness. VR activities in either room-scale or walking mode and appropriate correction of any refractive disorders are pivotal to prevent VRS in VR simulation training.

Immersive collaborative virtual reality for case-based graduate student teaching in thoracic surgery: A piloting study

Background

In medical education various non-digital teaching methods are established. However, studies have proven that the immersive character of virtual reality (VR) applications positively impact the understanding of spatial relationships.This study outlines the development and pilot testing of a novel system for collaborative, case-based VR teaching, utilizing real-time volume rendered computed tomography (CT) data of thoracic cases among graduate students.

Methods

A system was configured and deployed to provide real-time volume rendered CT data in a collaborative, multiuser VR environment. A thoracic surgery VR course was implemented into the surgical graduate curriculum, which has subsequently been evaluated with questionnaires.

Results

Seventy students assessed the curriculum through a questionnaire. Usability was rated intuitive (77.14 %) while few students (5.71 %) reported cyber sickness.A vast majority (98.57 %) agreed VR improved their understanding of anatomy compared to traditional methods and most students found learning more effective. (88.57 %) and joy during participation was rated high (97,14 %). A majority of the students (61.43 %) believed VR could partly replace traditional methods. They supported integrating VR into preclinical (81.43 %) and clinical teaching (94.29 %) as well as taking VR courses from home (78.57 %). Most participants (90,72 %) encouraged the expansion of VR infrastructure.

Conclusion

The concept of a collaborative real-time VR-based educational program in medical graduate teaching has proven its technical feasibility and positive acceptance with a desire for more VR integration in surgical curricula. A two-armed study will be conducted to evaluate the objective impact as the expansion of VR environments for teaching continues.

Immersive virtual reality is more effective than non-immersive devices for developing real-world skills in people with intellectual disability

BACKGROUND

People with intellectual disability (ID) demonstrate persistent challenges around developing life skills. Immersive virtual reality (IVR) is gaining interest as a tool for training life skills as it enables individuals to engage in hands-on learning in a safe, controlled and repeatable environment. However, there are concerns about the potential drawbacks of IVR, such as cybersickness and practical challenges with using the equipment, which may hinder its widespread adoption in educational settings. The current study aimed to compare the effectiveness of training in IVR and a non-immersive virtual environment for improving real-world skills in people with ID.

METHODS

In the present study, 36 adults (16 female, 20 male) with ID were recruited from a disability organisation. Participants completed a real-world assessment of waste management skills before and after training in either the IVR or non-immersive group.

RESULTS

Consistent with our hypotheses, the IVR group scored significantly higher in the real-world assessment after virtual training (d = 1), and at the 1-week follow-up (d = 1.12), compared with the non-immersive group. Further analyses showed that the IVR group, but not the non-immersive group, significantly improved performance in the real-world assessment across timepoints.

CONCLUSIONS

The findings indicate that IVR was more effective for improving and retaining real-world waste management skills. This study supports IVR as a viable tool for professionals and caregivers to develop skills for independent living among people with ID.

Controlling Virtual Reality With Brain Signals: State of the Art of Using VR-Based Feedback in Neurofeedback Applications

The rapid progress of commercial virtual reality (VR) technology, open access to VR development software as well as open-source instructions for creating brain-VR interfaces have increased the number of VR-based neurofeedback (NF) training studies. Controlling a VR environment with brain signals has potential advantages for NF applications. More entertaining, multimodal and adaptive virtual feedback modalities might positively affect subjective user experience and could consequently enhance NF training performance and outcome. Nevertheless, there are certain pitfalls and contraindications that make VR-based NF not suitable for everyone. In the present review, we summarize applications of VR-based NF and discuss positive effects of VR-based NF training as well as contraindications such as cybersickness in VR or age- and sex-related differences. The existing literature implies that VR-based feedback is a promising tool for the improvement of NF training performance. Users generally rate VR-based feedback more positively than traditional 2D feedback, albeit to draw meaningful conclusions and to rule out adverse effects of VR, more research on this topic is necessary. The pace in the development of brain-VR synchronization furthermore necessitates ethical considerations on these technologies.

NEIVATECH pilot study: immersive virtual reality training in older amblyopic children with non-compliance or non-response to patching

Immersive virtual reality (VR) is recently being explored as a therapeutic alternative for the treatment of amblyopia. This pilot study aimed to evaluate the preliminary efficacy, safety, usability and satisfaction obtained with the use of a novel VR system (NEIVATECH) to provide binocular vision training in previously treated older amblyopic children with non-compliance or non-response to patching. A prospective, multicentre, open-label, single-arm, pilot study was conducted in which the intervention under study was 9 h of therapy with the NEIVATECH system, distributed in 18 half-hour sessions spread over 1 month. A comprehensive visual assessment was conducted before and after the intervention, and at the end of the intervention the safety and usability of the system and patient satisfaction were evaluated. After therapy, statistically significant differences were observed in the near best-corrected visual acuity (BCVA) of the dominant (p = 0.022) and non-dominant (p = 0.022) eye, in stereopsis based on the Binocular Function Score (p = 0.045) and in the break (p = 0.012) and recovery (p = 0.009) points of negative fusional vergence for distance vision. The safety and usability of the system and patient satisfaction with the therapy were adequate. These findings support further investigation of this treatment option in future studies incorporating a control group with which to compare the results obtained. Trial registration: NCT04819386.

An examination of scene complexity's role in cybersickness

This study explored the effects of scene complexity factor on cybersickness. In this between-subjects experiment, 44 participants played the Pendulum Chair VR game, half with a simple scene and half with a complex scene. The complex scene featured higher optic flow (lower-level perceptual factor) and higher familiarity (higher level factor). Dependent variables were cybersickness and task performance. Results were unexpected in that cybersickness did not differ significantly between the simple and complex scenes. These results suggest that the impact of optic flow and familiarity on cybersickness may be affected by each other or other factors, making them unreliable predictors of cybersickness if considered alone. Both lower level and higher-level factors would benefit from further research to deduce the conditions under which they affect cybersickness. VR designers could consider that optic flow and familiarity alone are not reliable factors when predicting the cybersickness-inducing effects of a new environment.

In rod we trust-The evaluation of a virtual rod and frame test as a cybersickness screening instrument

Although Virtual Reality (VR) holds massive potential, its applicability still faces challenges because some individuals experience cybersickness. This phenomenon includes general discomfort, disorientation, and/or nausea, and it threatens not only a pleasant user experience but also the user's safety. Thus, predicting a user's susceptibility without relying on screening questionnaires that focus on past experiences, would enable more pleasant, safer VR experiences, especially for first-time users. Hence, the current study uses the participant's controller input in a virtual Rod and Frame Test (RFT) as an effortlessly trackable performance measure. The RFT is an established method for measuring an individual's sense of verticality in visually displaced fields. It has been used in the context of simulator sickness and cybersickness. In line with the literature and the subjective vertical mismatch theory, a lower visual dependency is expected to be correlated positively with cybersickness. To evaluate the potential of the RFT as a screening method for cybersickness, a cybersickness-inducing virtual environment (the City) was deployed. In total, data from 76 participants were eligible for the statistical analysis. The study finds a positive correlation between lower visual dependency and cybersickness, but only for the group that took the RFT after experiencing the City and only for the post-RFT cybersickness ratings. As cybersickness symptoms were VR environment-specific, the predictive validity of the RFT considering the VR-specific attributes is limited. Further, other studies attributed different working mechanisms to explain the connection between visual dependence and cybersickness with conflicting evidence. Although the RFT is not applicable as a cybersickness screening method, the effect sizes suggest that the RFT could serve as an additional objective assessment of the individuals' current state during VR exposure. Future research should systematically explore interconnections between the various factors that contribute to cybersickness, pursuing the idea of open science for context sensitivity.

WEMAC: Women and Emotion Multi-modal Affective Computing dataset

WEMAC is a unique open multi-modal dataset that comprises physiological, speech, and self-reported emotional data records of 100 women, targeting Gender-based Violence detection. Emotions were elicited through visualizing a validated video set using an immersive virtual reality headset. The physiological signals captured during the experiment include blood volume pulse, galvanic skin response, and skin temperature. The speech was acquired right after the stimuli visualization to capture the final traces of the perceived emotion. Subjects were asked to annotate among 12 categorical emotions, several dimensional emotions with a modified version of the Self-Assessment Manikin, and liking and familiarity labels. The technical validation proves that all the targeted categorical emotions show a strong statistically significant positive correlation with their corresponding reported ones. That means that the videos elicit the desired emotions in the users in most cases. Specifically, a negative correlation is found when comparing fear and not-fear emotions, indicating that this is a well-portrayed emotional dimension, a specific, though not exclusive, purpose of WEMAC towards detecting gender violence.

The presence of an avatar can reduce cybersickness in Virtual Reality

Virtual Reality (VR) applications are increasingly being utilized for research, healthcare, and education. Despite their benefits, many VR users report motion sickness-like sensations (cybersickness), such as headache, disorientation, or nausea. Previous studies suggest that the sense of presence ("being there") in the virtual world may contribute to the severity of cybersickness; however, results have been contradictory, with some studies reporting a negative and some reporting a positive relationship between the two. The goal of the current study was to further investigate how presence and cybersickness are related. Participants (N = 54) were exposed to a VR scene presented on a head-mounted display showing a 15-minute-long passive movement through space. The level of presence was manipulated by including an avatar (astronaut suit with hand-tracking) or no avatar in the virtual environment. Results showed that the avatar group reported significantly less severe cybersickness compared to the no-avatar group. We also found significant, negative correlations between some of the presence metrics (immersion, sensory fidelity) and cybersickness, indicating that cybersickness severity decreased as the level of presence increased. These findings suggest that more immersive VR experiences using an avatar may potentially reduce the risk of experiencing cybersickness.

Preregistered test of whether a virtual nose reduces cybersickness

Recent findings suggest that adding a visual depiction of a nose to virtual reality displays (virtual nose) can reduce motion sickness. If so, this would be a simple intervention that could improve the experience of a variety of VR applications. However, only one peer-reviewed study has reported a benefit from a virtual nose, and the effect was observed in a single low-powered experiment. To further test the effectiveness of a virtual nose for mitigating motion sickness in VR, we performed a preregistered experiment with higher power and better control. Subjects were presented with simulated movement in a virtual environment using a head-mounted display, and the resulting motion sickness was measured using the Fast Motion Sickness Scale (FMS) and the Simulator Sickness Questionnaire (SSQ). Conditions with and without a virtual nose were tested in separate sessions on different days, and the mean habituation effects were removed analytically. Awareness of the manipulation was assessed with a funnel debriefing procedure. The sample size (n = 32) was chosen to have over 90% power to detect the estimated effect size based on previous data (dz = 0.6). We found no significant difference between motion sickness in conditions with and without the virtual nose. The estimated effect size was close to zero, dz = - 0.02, with a 95% credible interval [- 0.37, 0.33]. Results from a Bayesian analysis imply that any benefit from a virtual nose is unlikely to be more than a 26% reduction in FMS scores, and any cost is unlikely to be more than a 23% increase. Our results do not support the hypothesis that a virtual nose is a general and effective way to relieve motion sickness in virtual reality.

Mixing transcutaneous vagal nerve stimulation and galvanic cutaneous stimulation to decrease simulator adaptation syndrome

Purpose

Simulator Adaptation Syndrome arises from a perceptual discordance between expected and actual motion, giving rise to symptoms such as nausea and disorientation. This research focused on determining the benefit of Transcutaneous Vagal Nerve Stimulation (tVNS) and Galvanic Cutaneous Stimulation (GCS), where both were applied in conjunction, as compared to their administration in isolation, to decrease Simulator Adaptation Syndrome (SAS).

Method

A driving simulation study was proposed where SAS, body balance, and driving performance were measured. These measurements were taken during seven different stimulation scenarios with a baseline condition without stimulation compared against tVNS and GCS conditions.

Results

The main result showed that the combination of tVNS and GCS reduced SAS and improved body balance and driving performance more successfully than their administration in isolation.

Conclusion

Similar neuromodulation in the temporoparietal junction is proposed to mitigate SAS for GCS and tVNS (although additional explanations are discussed). Applying both techniques simultaneously is encouraged to decrease SAS in future interventions.

VisionCoach: Design and Effectiveness Study on VR Vision Training for Basketball Passing

Vision Training is important for basketball players to effectively search for teammates who has wide-open opportunities to shoot, observe the defenders around the wide-open teammates and quickly choose a proper way to pass the ball to the most suitable one. We develop an immersive virtual reality (VR) system called VisionCoach to simulate the player's viewing perspective and generate three designed systematic vision training tasks to benefit the cultivating procedure. By recording the player's eye gazing and dribbling video sequence, the proposed system can analyze the vision-related behavior to understand the training effectiveness. To demonstrate the proposed VR training system can facilitate the cultivation of vision ability, we recruited 14 experienced players to participate in a 6-week between-subject study, and conducted a study by comparing the most frequently used 2D vision training method called Vision Performance Enhancement (VPE) program with the proposed system. Qualitative experiences and quantitative training results are reported to show that the proposed immersive VR training system can effectively improve player's vision ability in terms of gaze behavior and dribbling stability. Furthermore, training in the VR-VisionCoach Condition can transfer the learned abilities to real scenario more easily than training in the 2D-VPE Condition.

Effects of Virtual Reality Motor-Cognitive Training for Older People With Cognitive Frailty: Multicentered Randomized Controlled Trial

BACKGROUND

Cognitive frailty refers to a clinical syndrome in which physical frailty and mild cognitive impairment coexist. Motor-cognitive training and virtual reality (VR) have been used to launch various therapeutic modalities to promote health in older people. The literature advocates that motor-cognitive training and VR are effective in promoting the cognitive and physical function of older people. However, the effects on older people with cognitive frailty are unclear.

OBJECTIVE

This study examined the effects of VR motor-cognitive training (VRMCT) on global cognitive function, physical frailty, walking speed, visual short-term memory, inhibition of cognitive interference, and executive function in older people with cognitive frailty.

METHODS

This study used a multicentered, assessor-blinded, 2-parallel-group randomized controlled trial design. Participants were recruited face-to-face in 8 older adult community centers. Eligible participants were aged ≥60 years, were community dwelling, lived with cognitive frailty, had no dementia, and were not mobility restricted. In the intervention group, participants received VRMCT led by interventionists with 16 one-hour training sessions delivered twice per week for 8 weeks. In the control group, participants received the usual care provided by the older adult community centers that the investigators did not interfere with. The primary outcome was global cognitive function. The secondary outcomes included physical frailty, walking speed, verbal short-term memory, inhibition of cognitive interference, and executive function. Data were collected at baseline (T0) and the week after the intervention (T1). Generalized estimating equations were used to examine the group, time, and interaction (time × group) effects on the outcomes.

RESULTS

In total, 293 eligible participants enrolled in the study. The mean age of the participants was 74.5 (SD 6.8) years. Most participants were female (229/293, 78.2%), had completed primary education (152/293, 52.1%), were married (167/293, 57.2%), lived with friends (127/293, 43.3%), and had no VR experience (232/293, 79.5%). In the intervention group, 81.6% (119/146) of participants attended >80% (13/16, 81%) of the total number of sessions. A negligible number of participants experienced VR sickness symptoms (1/146, 0.7% to 5/146, 3%). VRMCT was effective in promoting global cognitive function (interaction effect: P=.03), marginally promoting executive function (interaction effect: P=.07), and reducing frailty (interaction effect: P=.03). The effects were not statistically significant on other outcomes.

CONCLUSIONS

VRMCT is effective in promoting cognitive functions and reducing physical frailty and is well tolerated and accepted by older people with cognitive frailty, as evidenced by its high attendance rate and negligible VR sickness symptoms. Further studies should examine the efficacy of the intervention components (eg, VR vs non-VR or dual task vs single task) on health outcomes, the effect of using technology on intervention adherence, and the long-term effects of the intervention on older people with cognitive frailty at the level of daily living.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04730817; https://clinicaltrials.gov/study/NCT04730817.

TEAMs go VR-validating the TEAM in a virtual reality (VR) medical team training

BACKGROUND

Inadequate collaboration in healthcare can lead to medical errors, highlighting the importance of interdisciplinary teamwork training. Virtual reality (VR) simulation-based training presents a promising, cost-effective approach. This study evaluates the effectiveness of the Team Emergency Assessment Measure (TEAM) for assessing healthcare student teams in VR environments to improve training methodologies.

METHODS

Forty-two medical and nursing students participated in a VR-based neurological emergency scenario as part of an interprofessional team training program. Their performances were assessed using a modified TEAM tool by two trained coders. Reliability, internal consistency, and concurrent validity of the tool were evaluated using intraclass correlation coefficients (ICC) and Cronbach's alpha.

RESULTS

Rater agreement on TEAM's leadership, teamwork, and task management domains was high, with ICC values between 0.75 and 0.90. Leadership demonstrated strong internal consistency (Cronbach's alpha = 0.90), while teamwork and task management showed moderate to acceptable consistency (alpha = 0.78 and 0.72, respectively). Overall, the TEAM tool exhibited high internal consistency (alpha = 0.89) and strong concurrent validity with significant correlations to global performance ratings.

CONCLUSION

The TEAM tool proved to be a reliable and valid instrument for evaluating team dynamics in VR-based training scenarios. This study highlights VR's potential in enhancing medical education, especially in remote or distanced learning contexts. It demonstrates a dependable approach for team performance assessment, adding value to VR-based medical training. These findings pave the way for more effective, accessible interdisciplinary team assessments, contributing significantly to the advancement of medical education.

Transforming Sedentary Lifestyles: The impact of remote VR and flat-screen interventions on affective attitudes towards physical exertion, guided by avatar or human trainers

This study advances understanding of the impact of flat-screen and virtual reality (VR) remote exercise environments in a home setting on affective attitudes towards physical exertion, with either a human or an avatar trainer. Employing a two-by-two factorial design, we manipulated both the medium (flat screen vs. VR) and the type of trainer (human vs. avatar). A total of 108 participants engaged in the study using a custom VR application for the Oculus Quest 2 headset or training videos, both prepared specifically for this study. The participants underwent a 15-min high-intensity interval training (HIIT) regimen, completing six workouts in their homes within fourteen days. Data on their exercise experiences and their affective attitudes towards exercise were collected using the CAWI technique. These were next analysed using a model that presumes that exercise experiences can increase motivation to exercise. We also studied the roles of spatial presence and trainer relatedness. Our results show that VR physical training shifted affective attitudes towards exercise positively, in contrast to the flat-screen groups. Moreover, using a digital avatar as a trainer had no negative effect on this favourable change in attitude. The change in affective attitude was influenced primarily by baseline levels and the wellbeing experienced during training. The factors we added to the original model-relatedness to the trainer and spatial presence-also contributed significantly to wellbeing. Perception of competence was a critical determinant of wellbeing, while perceived exertion was largely irrelevant. The HIIT protocol in the study was suitable for VR exercise.

Virtual Reality Videos for Symptom Management in Hospice and Palliative Care

Objective

To learn more about the effect of virtual reality videos on patients' symptoms near the end of life, including which are most effective, how long the effect lasts, and which patients benefit the most.

Patients and Methods

We conducted a prospective study of 30 patients in a regional hospice and palliative care program from March 11, 2022, through July 14, 2023. Using a head-mounted display virtual reality, all participants viewed a 15-minute video of serene nature scenes with ambient sounds. Fifteen patients also participated in a second session of viewing bucket-list video clips they selected. Symptoms were measured with the revised Edmonton Symptom Assessment Scale before, immediately after, and 2 days after each experience. Participants rated their bucket-list selections by level of previous experience, strength of connection, and overall video quality. Functional status was also recorded.

Results

Nature scenes significantly improved total symptom scores (30% decrease, P<.001), as well as scores for drowsiness, tiredness, depression, anxiety, well-being, and dyspnea. The improved scores were not sustained 2 days later. Overall, bucket-list videos did not significantly improve symptoms. Neither previous experience with an activity nor a strong connection correlated with significant improvement; however, when patients rated video quality as outstanding, scores improved (31% decrease, P=.03). Patients with lower functional status tended to have more symptoms beforehand and improve the most.

Conclusion

Serene nature head-mounted display virtual reality scenes safely reduce symptoms at the end of life. Bucket-list experiences may be effective if they are high-quality. More infirm patients may benefit the most.

Application of virtual reality for supportive care in cancer patients: a systematic review

BACKGROUND

In recent years, virtual reality (VR) technology has been widely used to support cancer patients with physical, emotional, and functional needs. This systematic review aimed to investigate the application of VR in the supportive care of cancer patients.

METHOD

This systematic review was conducted in 2024. In this study, various databases including PubMed, Web of Science, Scopus, the Cochrane Library, Ovid, IEEE Xplore, and ProQuest were searched, and quantitative, qualitative, and mixed-method studies which were in English and published up to 20th May 2024 were included. The keywords consisted of "virtual reality," "supportive care," and "cancer". Studies were assessed in terms of quality and risk of bias using standard tools, and results were analyzed and reported narratively.

RESULTS

A total of 33 articles were reviewed. VR interventions, primarily using fully immersive head-mounted displays, were associated with significant reductions in anxiety, pain, and fatigue. VR also improved mood, relaxation, and overall quality of life, and some studies noted enhanced vital signs such as heart rate and blood pressure. This technology could be used along with other medical interventions. Both patients and healthcare providers reported high level of satisfaction with VR, and appreciated its ease of use and therapeutic benefits. However, some technical barriers, like inadequate visual performance and realism, were reported.

CONCLUSION

VR demonstrates substantial potential benefits as a supportive care tool for cancer patients, effectively addressing their psychological, physiological, psychosocial needs. Despite technical challenges, high level of user satisfaction and benefits underscore the need for further research to optimize VR interventions in cancer care.

Optokinetic stimulation in the rehabilitation of visually induced dizziness in people with vestibular disorders: A systematic review

OBJECTIVE

This systematic review and meta-analysis investigates the effects optokinetic stimulation in people with vestibular disorders, with a specific focus on people with visually induced dizziness.

DATA SOURCES

A systematic review was conducted using three electronic databases, CINAHL, PubMed and Physiotherapy Evidence Database (PEDro), from 2000 up to February 2024.

REVIEW METHODS

Randomised controlled trials were included, which compared: (a) adults above 18 years old with vestibular disorders, (b) the study evaluated interventions using optokinetic stimulation, (c) the intervention was compared with usual care; placebo or to no intervention, (d) the study included at least one outcome measure evaluating vestibular symptoms and (e) published in English. The methodological quality of the included studies was assessed using the PEDro scale and PROSPERO's registration number ID: CRD42021273382).

RESULTS

Eleven randomised control trials, reported in 12 records, fulfilled the inclusion criteria. All of the studies were considered to have 'good' methodological quality according to the PEDro scale. All studies showed significant improvement in vestibular symptoms in both the intervention and control groups. A meta-analysis performed on six of the records found a preference towards the addition of OKS to conventional vestibular rehabilitation helped to further reduce dizziness symptoms for patients, but the results were not statistically significant.

CONCLUSION

No optimal duration or frequency for OKS has been determined. The addition of OKS to conventional vestibular rehabilitation may be beneficial in further improving vestibular symptoms in patients with dizziness. OKS could help to improve enjoyment and adherence to vestibular rehabilitation.

Validation of a novel, low-fidelity virtual reality simulator and an artificial intelligence assessment approach for peg transfer laparoscopic training

Simulators are widely used in medical education, but objective and automatic assessment is not feasible with low-fidelity simulators, which can be solved with artificial intelligence (AI) and virtual reality (VR) solutions. The effectiveness of a custom-made VR simulator and an AI-based evaluator of a laparoscopic peg transfer exercise was investigated. Sixty medical students were involved in a single-blinded randomised controlled study to compare the VR simulator with the traditional box trainer. A total of 240 peg transfer exercises from the Fundamentals of Laparoscopic Surgery programme were analysed. The experts and AI-based software used the same criteria for evaluation. The algorithm detected pitfalls and measured exercise duration. Skill improvement showed no significant difference between the VR and control groups. The AI-based evaluator exhibited 95% agreement with the manual assessment. The average difference between the exercise durations measured by the two evaluation methods was 2.61 s. The duration of the algorithmic assessment was 59.47 s faster than the manual assessment. The VR simulator was an effective alternative practice compared with the training box simulator. The AI-based evaluation produced similar results compared with the manual assessment, and it could significantly reduce the evaluation time. AI and VR could improve the effectiveness of basic laparoscopic training.

Advancements in eye movement measurement technologies for assessing neurodegenerative diseases

Eye movements have long been recognized as a valuable indicator of neurological conditions, given the intricate involvement of multiple neurological pathways in vision-related processes, including motor and cognitive functions, manifesting in rapid response times. Eye movement abnormalities can indicate neurological condition severity and, in some cases, distinguish between disease phenotypes. With recent strides in imaging sensors and computational power, particularly in machine learning and artificial intelligence, there has been a notable surge in the development of technologies facilitating the extraction and analysis of eye movements to assess neurodegenerative diseases. This mini-review provides an overview of these advancements, emphasizing their potential in offering patient-friendly oculometric measures to aid in assessing patient conditions and progress. By summarizing recent technological innovations and their application in assessing neurodegenerative diseases over the past decades, this review also delves into current trends and future directions in this expanding field.

The Role of Virtual Reality in the Management of Football Injuries

Injuries represent a serious concern for football players, with a significant loss in terms of sport participation and long periods of rehabilitation. According to the 2019/20 UEFA Élite Club Injury Report, the average incidence of injuries during training is 2.8 per 1000 h of training, with an average absence from training of 20 days. In addition, injured athletes are 4 to 7 times more likely to relapse than uninjured athletes. High workloads and reduced recovery periods represent two of the most important modifiable risk factors. In this context, prevention and an adequate rehabilitation protocol are vital in managing injuries, reducing their incidence, and improving the return to competition. In recent years, technological development has provided new tools in rehabilitation, and Virtual reality (VR) has shown interesting results in treating neurologic and orthopedic pathologies. Virtual Reality (VR) technology finds application in the sports industry as a tool to examine athletes' technical movements. The primary objective is to detect the biomechanical risk factors associated with anterior cruciate ligament injury. Additionally, VR can be used to train athletes in field-specific techniques and create safe and controlled therapeutic environments for post-injury recovery. Moreover, VR offers a customizable approach to treatment based on individual player data. It can be employed for both prevention and rehabilitation, tailoring the rehabilitation and training protocols according to the athletes' specific needs.

The use of Virtual Reality (VR) to assess the impact of geographical environments on walking and cycling: a systematic literature review

BACKGROUND

Geographical environments influence people's active mobility behaviors, contributing to their physical and mental health. The use of Virtual Reality (VR) in experimental research can unveil new insights into the relationship between exposure to geographic environments and active mobility behaviors. This systematic review aims to (1) identify environmental attributes investigated in relation with walking and cycling, using VR, (2) assess their impacts on active mobility behaviors and attitudes, and (3) identify research gaps, strengths and limitations in VR-based experimental research.

METHODS

Articles published between January 2010 and February 2022 within five databases (PubMed, Scopus, EBSCO, IEEE Xplore, and Cochrane Library) were explored using three keywords and their synonyms: Virtual Reality, Active mobility behavior, and Geographical environments. Studies focusing on indoor environments, driving simulation, disease-specific groups, non-relevant disciplines (e.g. military, emergency evacuation), VR methodology/software optimization, and those with static participants' involvement were excluded. The full protocol is available from PROSPERO (ID = CRD42022308366).

RESULTS

Out of 3255 articles, 18 peer-reviewed papers met the selection criteria, mostly focusing on walking (83%). Most studies used head-mounted displays (94%) and relied on convenience sampling (72% below 100 participants). Both static (33%) and dynamic (45%) environmental attributes have been investigated, with only 22% of them simultaneously in the same virtual environment. Greenness and crowd density were the most frequent attributes, rather consistently associated with emotional states and movement behaviors. Few studies have taken into account participant's previous VR experience (33%) and cybersickness (39%) while both are likely to affect an individual's perception and behavior.

CONCLUSIONS

Future research should explore a broader range of environmental attributes, including static and dynamic ones, as well as a more complex integration of these attributes within a single experiment to mimic the effect of realistic environments on people's active mobility behaviors and attitudes. Larger and more diverse population samples are deemed required to improve result generalizability. Despite methodological challenges, VR emerges as a promising tool to disentangle the effect of complex environments on active mobility behaviors.