The Past, Present, and Future of Virtual and Augmented Reality Research: A Network and Cluster Analysis of the Literature

The acute effect of throwing training with virtual reality on boccia competitive performance in healthy adults

[Purpose] This study aimed to investigate the differences in the acute effects of virtual and actual throwing training on throwing performance. [Participants and Methods] Twenty healthy men and six women with no boccia experience were randomly divided into the virtual and non-virtual groups. The task involved throwing boccia balls at target sets of 2 (short), 5 (middle), and 9 m (long). Both the groups were trained in three rows for each condition. The distance from the ball to the target was calculated as throwing accuracy for both pre- and post-training. Confidence in throwing was measured using a visual analog scale pre-and immediately post-training. A two-way analysis of variance with a post-hoc Bonferroni test or t-test was conducted for throwing accuracy and confidence. [Results] For throwing accuracy, the post hoc test results showed that both groups improved after training, but only in the middle-distance throw. Throwing confidence improved after training in both groups. [Conclusion] Boccia-throwing training using virtual reality may have an acute training effect comparable to that of actual training.

Efficacy of virtual reality and augmented reality in anatomy education: A systematic review and meta-analysis

Anatomy is the cornerstone of medical education. Virtual reality (VR) and augmented reality (AR) technologies are becoming increasingly popular in the development of anatomy education. Various studies have evaluated VR and AR in anatomy education. This meta-analysis aims to evaluate the effectiveness of VR and AR in anatomical education. The protocol was registered in Prospero. Scopus, PubMed, Web of Science, and Cochrane Library databases were searched. From the 4487 articles gathered, 24 randomized controlled trials were finally selected according to inclusion criteria. According to the results of the meta-analysis, VR had a moderate and significant effect on the improvement of knowledge scores in comparison with other methods (standardized mean difference = 0.58; 95% CI = 0.22, 0.95; p < 0.01). Due to the high degree of heterogeneity (I2 = 87.44%), subgroup analyses and meta-regression were performed on eight variables. In enhancing the "attitude," VR was found to be more "useful" than other methods (p = 0.01); however, no significant difference was found for "enjoyable" and "easy to use" statements. Compared with other methods, the effect of AR on knowledge scores was non-significant (SMD = -0.02; 95% CI = -0.39, 0.34; p = 0.90); also, in subgroup analyses and meta-regression, the results were non-significant. The results indicate that, unlike AR, VR could be used as an effective tool for teaching anatomy in medical education. Given the observed heterogeneity across the included studies, further research is warranted to identify those variables that may impact the efficacy of VR and AR in anatomy education.

Exploring Adaptive Virtual Reality Systems Used in Interventions for Children With Autism Spectrum Disorder: Systematic Review

BACKGROUND

Adaptive systems serve to personalize interventions or training based on the user's needs and performance. The adaptation techniques rely on an underlying engine responsible for processing incoming data and generating tailored responses. Adaptive virtual reality (VR) systems have proven to be efficient in data monitoring and manipulation, as well as in their ability to transfer learning outcomes to the real world. In recent years, there has been significant interest in applying these systems to improve deficits associated with autism spectrum disorder (ASD). This is driven by the heterogeneity of symptoms among the population affected, highlighting the need for early customized interventions that target each individual's specific symptom configuration.

OBJECTIVE

Recognizing these technology-driven therapeutic tools as efficient solutions, this systematic review aims to explore the application of adaptive VR systems in interventions for young individuals with ASD.

METHODS

An extensive search was conducted across 3 different databases-PubMed Central, Scopus, and Web of Science-to identify relevant studies from approximately the past decade. Each author independently screened the included studies to assess the risk of bias. Studies satisfying the following inclusion criteria were selected: (1) the experimental tasks were delivered via a VR system, (2) system adaptation was automated, (3) the VR system was designed for intervention or training of ASD symptoms, (4) participants' ages ranged from 6 to 19 years, (5) the sample included at least 1 group with ASD, and (6) the adaptation strategy was thoroughly explained. Relevant information extracted from the studies included the sample size and mean age, the study's objectives, the skill trained, the implemented device, the adaptive strategy used, the engine techniques, and the signal used to adapt the systems.

RESULTS

Overall, a total of 10 articles were included, involving 129 participants, 76% of whom had ASD. The studies included level switching (7/10, 70%), adaptive feedback strategies (9/10, 90%), and weighing the choice between a machine learning (ML) adaptive engine (3/10, 30%) and a non-ML adaptive engine (8/10, 80%). Adaptation signals ranged from explicit behavioral indicators (6/10, 60%), such as task performance, to implicit biosignals, such as motor movements, eye gaze, speech, and peripheral physiological responses (7/10, 70%).

CONCLUSIONS

The findings reveal promising trends in the field, suggesting that automated VR systems leveraging real-time progression level switching and verbal feedback driven by non-ML techniques using explicit or, better yet, implicit signal processing have the potential to enhance interventions for young individuals with ASD. The limitations discussed mainly stem from the fact that no technological or automated tools were used to handle data, potentially introducing bias due to human error.

Benefits and Barriers of Using Virtual Reality in Teaching Undergraduate Nursing Students: A Scoping Review

BACKGROUND

Although studies have been conducted using virtual reality (VR) in nursing education, evidence distinguishing the benefits and barriers of adopting VR pedagogical methods to teach undergraduate nursing students is not well-defined in nursing literature.

PURPOSE

To identify current evidence on the benefits and barriers of adopting VR as a pedagogical method in nursing education.

METHODS

A scoping review of 6 databases using PRISMA-ScR reporting guidelines. Data were managed using Covidence® software. Table of Evidence illustrates the themes.

RESULTS

Seventeen articles identified 5 thematic benefits of VR (knowledge acquisition, student engagement, improved self-confidence, teaching strategy, and cost factors) and 4 barriers (physical discomfort, learning outcome challenges, challenges to integrating into curricula, and technology challenges).

CONCLUSIONS

VR is an effective teaching-learning strategy to reinforce nursing concepts and build competencies. It is not a substitute for clinical education.

Virtual reality as a treatment for chronic musculoskeletal pain syndromes

Chronic musculoskeletal pain syndromes, including fibromyalgia, are often resistant to conventional medications and invasive therapies. Central hypersensitization, neurotransmitter dysregulation, and autonomic nervous system abnormalities are key pathomechanisms, frequently resulting in widespread pain and a variety of psychosomatic symptoms. Virtual Reality (VR) applications have demonstrated effectiveness in reducing pain, both during and after interventions, and in chronic conditions such as fibromyalgia and back pain. The proposed mechanisms behind VR's effectiveness include distraction and immersion, coupled with cognitive behavioral therapy, which promote neuroplasticity and alter pain perceptions. Functional MRI studies have shown the impact of VR interventions on specific brain regions. Advances in hardware and software, potentially combined with treatments like biofeedback, could enhance VR's role in managing chronic pain. Currently, VR for musculoskeletal pain syndromes is primarily used within multimodal programs, but it is also available for home use as a standalone health application. Future research should focus on the 'drug-like' effects of VR, requiring controlled trials with comparable study populations and appropriate sham interventions.

Extended Reality in Revolutionizing Neurological Disease: A New Era for Chronic Condition Treatment

Extended reality (XR), which includes virtual reality (VR), augmented reality (AR), and mixed reality (MR), provides promising advancements in managing chronic neurological disorders such as Parkinson's disease (PD), multiple sclerosis (MS), Alzheimer's disease, and stroke. This review examines the impact of XR technologies on neurological care, highlighting their ability to create immersive, interactive environments that enhance rehabilitation through tailored motor and cognitive exercises. XR supports neuroplasticity by providing engaging, contextually relevant exercises and real-time feedback, offering innovative alternatives to traditional methods. The technical issues, clinical validation, and accessibility must be addressed despite the potential benefits. Future developments should focus on refining XR applications, integrating them with complementary technologies, and establishing robust policies to guide their effective and ethical use. XR is poised to revolutionize neurological rehabilitation, promising improved patient outcomes and transforming medical training.

Ego-depletion and motor skill performance under pressure-experimental effects of a short term virtual-reality based mindfulness breathing meditation with integrated biofeedback

Ego-depletion describes a state of mind, where the capacity for self-control is temporarily depleted after a primary self-control action. The aim of this study was to investigate whether a brief virtual reality-based mindfulness breathing meditation with integrated biofeedback can be considered an effective strategy to counteract the detrimental effects of ego depletion on motor skill performance under pressure. The study included two experiments, each of them designed as counterbalanced cross-over trials and based on an a priori sample-size calculation. Within each experiment, participants completed two appointments in a randomly assigned order, during which they were asked to perform 20 basketball free throws (N = 18; Experiment 1) or 20 penalty kicks at a football goal in four target squares (N = 16; Experiment 2) under pressure pre and post the following conditions: Stroop-test-induced ego depletion followed by a 15 min resting break, Stroop-test-induced ego depletion followed by a 15 min virtual reality-based mindfulness breathing meditation with integrated biofeedback. Results indicate that, in comparison to a resting break, a brief virtual reality-based mindfulness meditation with integrated biofeedback can counteract the detrimental effects of ego-depletion (Experiment 2) and enhance motor skill performance under pressure (Experiment 1, 2) Implications for researchers and practitioners are derived in light of the identified methodological limitations.

The Usefulness of Virtual Reality in Symptom Management during Chemotherapy in Lung Cancer Patients: A Quasi-Experimental Study

Background: Virtual reality (VR) emerges as a promising non-pharmacological intervention for managing symptoms and providing distraction during chemotherapy. This study aims to assess VR's effectiveness on cancer-related symptoms, vital signs, and the patients' perception of chemotherapy in lung cancer patients. Methods: A quasi-experimental study was conducted on 100 patients. Participants were allocated into an intervention group (n = 55), which experienced immersive VR, and a comparison group (n = 45), which received usual care. Data were collected through questionnaires and checklists, including feedback on the VR experience, pain, vital signs, and common cancer symptoms, assessed through the Edmonton Symptom Assessment Scale. Results: VR had a significant impact on reducing the perception of chemotherapy length. Patients reported high levels of satisfaction and tolerability. No adverse events were observed. VR did not have significant influence on pain intensity or vital signs. The only exceptions were oxygen saturation, where a significant difference (p = 0.02) was reported, and the perception of chemotherapy duration. Conclusions: As a non-pharmacological intervention, VR proves to be beneficial in minimizing the perceived length of chemotherapy sessions for lung cancer patients, enhancing their overall treatment experience. The intervention was found to be a safe, feasible, and well-accepted distraction technique. Future research should explore VR's potential effects on a wider range of symptoms and evaluate its impact on long-term outcomes.

Navigating the Metaverse: A New Virtual Tool with Promising Real Benefits for Breast Cancer Patients

BC, affecting both women and men, is a complex disease where early diagnosis plays a crucial role in successful treatment and enhances patient survival rates. The Metaverse, a virtual world, may offer new, personalized approaches to diagnosing and treating BC. Although Artificial Intelligence (AI) is still in its early stages, its rapid advancement indicates potential applications within the healthcare sector, including consolidating patient information in one accessible location. This could provide physicians with more comprehensive insights into disease details. Leveraging the Metaverse could facilitate clinical data analysis and improve the precision of diagnosis, potentially allowing for more tailored treatments for BC patients. However, while this article highlights the possible transformative impacts of virtual technologies on BC treatment, it is important to approach these developments with cautious optimism, recognizing the need for further research and validation to ensure enhanced patient care with greater accuracy and efficiency.

Effects of Immersive Technology-Based Education for Undergraduate Nursing Students: Systematic Review and Meta-Analysis Using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) Approach

BACKGROUND

The adoption of immersive technology in simulation-based nursing education has grown significantly, offering a solution to resource limitations and enabling safe access to clinical environments. Despite its advantages, there are still diverse reports regarding the effectiveness of immersive technology. It is crucial to verify the effectiveness of immersive technology in nursing education to inform future educational programs.

OBJECTIVE

This systematic review aimed to identify the contents of immersive technology-based education for undergraduate nursing students and evaluate the effectiveness of immersive technology compared to traditional teaching methods.

METHODS

A literature search was performed using 4 databases: PubMed, CINAHL, Embase, and Web of Science; the latest search was completed on January 19, 2023. The inclusion criteria were as follows: participants were undergraduate nursing students; studies were published in Korean or English; designs included randomized controlled trials (RCTs) or nonrandomized studies; and interventions involved virtual reality (VR), augmented reality (AR), mixed reality, or extended reality. Quality assessment was conducted using Cochrane Risk-of-Bias Tool version 2 for RCTs and the Risk-of-Bias Assessment Tool for Nonrandomized Studies. The main outcomes of the included studies were classified according to the New World Kirkpatrick Model (NWKM), ranging from level 1 (reaction) to level 4 (results). Meta-analysis was conducted using RevMan 5.4 software, and subgroup analysis was conducted due to heterogeneity of the results of the meta-analysis. The Grading of Recommendations, Assessment, Development, and Evaluation approach was adopted for assessing certainty and synthesizing results of the relevant literature.

RESULTS

A total of 23 studies were included, with participant numbers ranging from 33 to 289. Of these, 19 (82.6%) studies adopted VR to simulate various nursing scenarios, including disaster training, resuscitation, health assessments, and home health care; 4 (17.4%) studies used AR technologies; and 15 (65.2%) studies involved virtual patients in their scenarios. Based on the NWKM, the main outcome variables were classified as level 1 (usability and satisfaction), level 2 (knowledge, motivation, confidence, performance, attitude, and self-efficacy), and level 3 (clinical reasoning); level 4 outcomes were not found in the selected studies. Results of the subgroup analysis showed that immersive technology-based nursing education is more effective than traditional education in knowledge attainment (standard mean difference [SMD]=0.59, 95% CI 0.28-0.90, P<.001, I2=49%). Additionally, there were significant difference differences between the experimental and control group in confidence (SMD=0.70, 95% CI 0.05-1.35, P=.03, I2=82%) and self-efficacy (SMD=0.86, 95% CI 0.42-1.30, P<.001, I2=63%).

CONCLUSIONS

These findings support the effectiveness of immersive technology-based education for undergraduate nursing students, despite heterogeneity in methods and interventions. We suggest that long-term cohort studies be conducted to evaluate the effects of immersive technology-based nursing education on NWKM level 4.

Emerging Technologies and Open-Source Platforms for Remote Physical Exercise: Innovations and Opportunities for Healthy Population-A Narrative Review

The emergence of tele-exercise as a response to the impact of technology on physical activity has opened up new possibilities for promoting physical health. By integrating innovative technologies and open-source platforms, tele-exercise encourages people to stay active. In our latest analysis, we delved into the scientific literature surrounding the use of tele-exercise technologies in training healthy individuals. After conducting an extensive search on the PubMed database using the keywords "tele-exercise" and "physical activity" (from 2020 to 2023), we identified 44 clinical trials that were applicable to tele-exercise, but less than 10% of them were aimed at healthy individuals, precisely 9.09% (four out of forty-four studies analyzed). Our review highlights the potential of tele-exercise to help maintain physical fitness and psychological well-being, especially when traditional fitness facilities are not an option. We also underscore the importance of interoperability, standardization, and the incorporation of biomechanics, exercise physiology, and neuroscience into the development of tele-exercise platforms. Nevertheless, despite these promising benefits, research has shown that there is still a significant gap in the knowledge concerning the definition and evaluation of training parameters for healthy individuals. As a result, we call for further research to establish evidence-based practices for tele-exercise in the healthy population.

The impact of simulation-based training in medical education: A review

Simulation-based training (SBT) has emerged as a transformative approach in medical education, significantly enhancing healthcare professionals' learning experience and clinical competency. This article explores the impact of SBT, tracing its historical development and examining the various types of simulations utilized today, including high-fidelity mannequins, virtual reality environments, standardized patients, and hybrid simulations. These methods offer a safe and controlled environment for students to practice and hone technical and non-technical skills, ultimately improving patient safety and clinical outcomes. The benefits of SBT are manifold, including enhanced skill acquisition, error reduction, and the opportunity for repeated practice without risk to actual patients. Immediate feedback and structured debriefing further solidify learning, making Simulation an invaluable tool in medical education. However, the implementation of SBT is challenging. It requires substantial financial investment, specialized equipment, and trained faculty. Additionally, there are concerns about the realism of simulations and the transferability of skills to real-world clinical settings. Despite these challenges, numerous case studies and empirical research underscore the effectiveness of SBT compared to traditional methods. Looking ahead, advancements in technology, such as artificial intelligence and improved virtual reality applications, promise to enhance the efficacy and accessibility of simulation training. The integration of Simulation with other training modalities and its adoption in diverse global contexts highlight its potential to revolutionize medical education worldwide. This article affirms the crucial role of SBT in preparing the next generation of healthcare professionals and its ongoing evolution driven by technological innovations.

IAVRS-International Affective Virtual Reality System: Psychometric Assessment of 360° Images by Using Psychophysiological Data

Virtual Reality is an effective technique for eliciting emotions. It provides immersive and ecologically valid emotional experiences while maintaining experimental control. Recently, novel VR forms like 360° videos have been used successfully for emotion elicitation. Some preliminary databases of 360° videos for emotion elicitation have been proposed, but they tapped mainly into an emotional dimensional approach and did not include a concurrent physiological assessment of an emotional profile. This study expands on these databases by combining dimensional and discrete approaches to validate a new set of 360° emotion-inducing images. Twenty-six participants viewed 46 immersive images, and their emotional reactions were measured using self-reporting, psychophysiological signals, and eye tracking. The IAVRS database can successfully elicit a wide range of emotional responses, including both positive and negative valence, as well as different levels of arousal. Results reveal an important correspondence between the discrete and dimensional models of emotions. Furthermore, the images that exhibit convergence between the dimensional and discrete emotional models are particularly impactful regarding arousal and valence values. The IAVRS database provides insights into potential relationships between physiological parameters and emotional responses. This preliminary investigation highlights the complexity of emotional elicitation processes and their physiological correlates, suggesting the need for further research to deepen our understanding.

A review of published studies on virtual reality in sexuality research

INTRODUCTION

Virtual reality (VR) technology contributes to greater approach of methodological safety to make ecological validity more feasible and a growing interest in sexuality behaviors.

OBJECTIVES

The aim of this study was to show VR in the sexuality area by a comprehensive review of outcomes, offer a synthesis of the studies, and make a methodological quality assessment of finding results. A secondary goal was to investigate the effect of immersion on diverse sexual responses outcomes.

METHODS

We designed a review based on a systematic review strategy describing types of studies, participants, data collection and outcomes; searched in 4 electronic databases (PubMed, EMBASE, PsycINFO, and SciELO), and made a full-text screening process.

RESULTS

The study found 18 articles that met research criteria synthesized within 3 outcome groups: erection measures, level of immersion, and biomarker studies. Synthesis shows a lack of methodological aspects that impair results, such as description of methods from bias protection, randomization, or concealment. The literature still needs to improve its methodology, even though it already shows relevant data for intervention in sexual dysfunction, forensic psychiatry, sexual attraction, orientation, and use of pornography.

CONCLUSION

Current methodological issues need better design to highlight relevant issues in sexuality with stronger quality of design, opening boundaries to new diagnostic or interventional technologies to sexual health.

Comparison of subjective evaluations in virtual and real environments for soundscape researcha)

Emerging technologies of virtual reality (VR) and augmented reality (AR) are enhancing soundscape research, potentially producing new insights by enabling controlled conditions while preserving the context of a virtual gestalt within the soundscape concept. This study explored the ecological validity of virtual environments for subjective evaluations in soundscape research, focusing on the authenticity of virtual audio-visual environments for reproducibility. Different technologies for creating and reproducing virtual environments were compared, including field recording, simulated VR, AR, and audio-only presentation, in two audio-visual reproduction settings, a head-mounted display with head-tracked headphones and a VR lab with head-locked headphones. Via a series of soundwalk- and lab-based experiments, the results indicate that field recording technologies provided the most authentic audio-visual environments, followed by AR, simulated VR, and audio-only approaches. The authenticity level influenced subjective evaluations of virtual environments, e.g., arousal/eventfulness and pleasantness. The field recording and AR-based technologies closely matched the on-site soundwalk ratings in arousal, while the other approaches scored lower. All the approaches had significantly lower pleasantness ratings compared to on-site evaluations. The choice of audio-visual reproduction technology did not significantly impact the evaluations. Overall, the results suggest virtual environments with high authenticity can be useful for future soundscape research and design.

Telerehabilitation by Videoconferencing for Balance and Gait in People with Parkinson's Disease: A Scoping Review

Although supervised and real-time telerehabilitation by videoconferencing is now becoming common for people with Parkinson's disease (PD), its efficacy for balance and gait is still unclear. This paper uses a scoping approach to review the current evidence on the effects of telerehabilitation by videoconferencing on balance and gait for patients with PD. We also explored whether studies have used wearable technology during telerehabilitation to assess and treat balance and gait via videoconferencing. Literature searches were conducted using PubMed, ISI's Web of Knowledge, Cochrane's Library, and Embase. The data were extracted for study design, treatment, and outcomes. Fourteen studies were included in this review. Of these, seven studies investigated the effects of telerehabilitation (e.g., tele-yoga and adapted physiotherapy exercises) on balance and gait measures (e.g., self-reported balance, balance scale, walking speed, mobility, and motor symptoms) using videoconferencing in both assessment and treatment. The telerehabilitation programs by videoconferencing were feasible and safe for people with PD; however, the efficacy still needs to be determined, as only four studies had a parallel group. In addition, no study used wearable technology. Robust evidence of the effects of telerehabilitation by videoconferencing on balance and gait for patients with PD was not found, suggesting that future powered, prospective, and robust clinical trials are needed.

Extended reality navigation for pain procedures: a narrative review

BACKGROUND

Extended reality (XR) technology, encompassing virtual reality, augmented reality, and mixed reality, has been widely studied for procedural navigation in surgical specialties. Similar to how ultrasound transformed regional anesthesia, XR has the potential to reshape how anesthesiologists and pain physicians perform procedures to relieve pain.

OBJECTIVE

This narrative review examines the clinical benefits of XR for navigation in various pain procedures. It defines key terms and concepts related to XR technology and explores characteristics of procedures that are most amenable to XR-based navigation. Finally, it suggests best practices for developing XR navigation systems and discusses the role of emerging technology in the future of XR in regional anesthesia and pain medicine.

EVIDENCE REVIEW

A search was performed across PubMed, Embase, and Cochrane Central Register of Controlled Trials for primary literature investigating the clinical benefits of XR navigation for pain procedures.

FINDINGS

Thirteen studies using XR for procedural navigation are included. The evidence includes randomized controlled trials, retrospective studies, and case series.

CONCLUSIONS

Early randomized controlled trials show potential for XR to improve procedural efficiency, but more comprehensive research is needed to determine if there are significant clinical benefits. Case reports demonstrate XR's utility in generating patient-specific navigation plans when difficult anatomy is encountered. Procedures that facilitate the generation and registration of XR images are most conducive to XR navigation, whereas those that rely on frequent re-imaging will continue to depend on traditional modes of navigation.

Delivering clinical tutorials to medical students using the Microsoft HoloLens 2: A mixed-methods evaluation

BACKGROUND

Mixed reality offers potential educational advantages in the delivery of clinical teaching. Holographic artefacts can be rendered within a shared learning environment using devices such as the Microsoft HoloLens 2. In addition to facilitating remote access to clinical events, mixed reality may provide a means of sharing mental models, including the vertical and horizontal integration of curricular elements at the bedside. This study aimed to evaluate the feasibility of delivering clinical tutorials using the Microsoft HoloLens 2 and the learning efficacy achieved.

METHODS

Following receipt of institutional ethical approval, tutorials on preoperative anaesthetic history taking and upper airway examination were facilitated by a tutor who wore the HoloLens device. The tutor interacted face to face with a patient and two-way audio-visual interaction was facilitated using the HoloLens 2 and Microsoft Teams with groups of students who were located in a separate tutorial room. Holographic functions were employed by the tutor. The tutor completed the System Usability Scale, the tutor, technical facilitator, patients, and students provided quantitative and qualitative feedback, and three students participated in semi-structured feedback interviews. Students completed pre- and post-tutorial, and end-of-year examinations on the tutorial topics.

RESULTS

Twelve patients and 78 students participated across 12 separate tutorials. Five students did not complete the examinations and were excluded from efficacy calculations. Student feedback contained 90 positive comments, including the technology's ability to broadcast the tutor's point-of-vision, and 62 negative comments, where students noted issues with the audio-visual quality, and concerns that the tutorial was not as beneficial as traditional in-person clinical tutorials. The technology and tutorial structure were viewed favourably by the tutor, facilitator and patients. Significant improvement was observed between students' pre- and post-tutorial MCQ scores (mean 59.2% Vs 84.7%, p < 0.001).

CONCLUSIONS

This study demonstrates the feasibility of using the HoloLens 2 to facilitate remote bedside tutorials which incorporate holographic learning artefacts. Students' examination performance supports substantial learning of the tutorial topics. The tutorial structure was agreeable to students, patients and tutor. Our results support the feasibility of offering effective clinical teaching and learning opportunities using the HoloLens 2. However, the technical limitations and costs of the device are significant, and further research is required to assess the effectiveness of this tutorial format against in-person tutorials before wider roll out of this technology can be recommended as a result of this study.

Virtual reality, face-to-face, and 2D video conferencing differently impact fatigue, creativity, flow, and decision-making in workplace dynamics

Digital communication technologies are rapidly evolving, and understanding their impact on group dynamics and cognitive performance in professional settings becomes central. This study investigates the psychological impact of different interaction settings-two-dimensional Video Conferencing (VC), Face-To-Face (FTF), and Virtual Reality (VR)-on group dynamics, cognitive performance, and aspects of well-being in a professional context. Utilizing a sample of 40 participants from a large Italian electricity transmission company, the study employs a within-subjects design to explore various metrics, including flow, creativity, fatigue and aspects of interaction. The results indicate that FTF interactions are optimal for idea generation and task absorption. VR, although initially more fatiguing for first-time users, fosters a more collaborative and peaceful environment, encouraging participants to engage more openly with each other. VC was found to be the least fatiguing, but also the least engaging in terms of task absorption and idea generation. Additionally, age-related differences were observed, particularly in the perception of motivational and emotional fatigue in the VR setting. The study provides empirical evidence supporting the integration of VR in professional settings for specific types of meetings, while also highlighting the limitations and areas for future research. These findings have implications for organizational well-being, cognitive ergonomics, and the evolving landscape of remote work technologies.

Feasibility and Usability of Augmented Reality Technology in the Orthopaedic Operating Room

PURPOSE OF REVIEW

Augmented reality (AR) has gained popularity in various sectors, including gaming, entertainment, and healthcare. The desire for improved surgical navigation within orthopaedic surgery has led to the evaluation of the feasibility and usability of AR in the operating room (OR). However, the safe and effective use of AR technology in the OR necessitates a proper understanding of its capabilities and limitations. This review aims to describe the fundamental elements of AR, highlight limitations for use within the field of orthopaedic surgery, and discuss potential areas for development.

RECENT FINDINGS

To date, studies have demonstrated evidence that AR technology can be used to enhance navigation and performance in orthopaedic procedures. General hardware and software limitations of the technology include the registration process, ergonomics, and battery life. Other limitations are related to the human response factors such as inattentional blindness, which may lead to the inability to see complications within the surgical field. Furthermore, the prolonged use of AR can cause eye strain and headache due to phenomena such as the vergence-convergence conflict. AR technology may prove to be a better alternative to current orthopaedic surgery navigation systems. However, the current limitations should be mitigated to further improve the feasibility and usability of AR in the OR setting. It is important for both non-clinicians and clinicians to work in conjunction to guide the development of future iterations of AR technology and its implementation into the OR workflow.

A comprehensive overview of post-stroke depression treatment options

Nearly one-third of all stroke patients develop depression at any time after a stroke, and its presence is associated with unfavorable outcomes. This narrative review aims to provide a synopsis of possible pharmacological and non-pharmacological treatment modalities for post-stroke depression (PSD). Several studies have demonstrated the efficacy and safety of selective serotonin reuptake inhibitors in treating the symptoms of this clinical condition. The treatment of PSD has been recently enhanced by innovative approaches, such as cognitive-behavioral therapy, virtual reality, telehealth, repetitive transcranial magnetic stimulation, and non-conventional therapies, which might improve depression treatment in stroke survivors. Future high-quality randomized controlled trials are necessary to confirm this hypothesis.

Virtual Reality-Based Interventions to Improve Balance in Patients with Traumatic Brain Injury: A Scoping Review

INTRODUCTION

Virtual reality (VR)-based interventions to improve balance and mobility are gaining increasing traction across patient populations. VR-based interventions are believed to be more enjoyable and engaging for patients with traumatic brain injury. This scoping review aims to summarize existing studies from the literature that used VR to improve balance and mobility and determine the gap in VR-based balance literature specific to individuals with traumatic brain injury.

METHODS

Two authors independently searched the literature using the search terms "Virtual Reality Traumatic Brain Injury Lower Limb", "Virtual Reality Traumatic Brain Injury Balance", and "Virtual Reality Traumatic Brain Injury Gait".

RESULTS

A total of seventeen studies, specifically, three randomized controlled trials, one one-arm experimental study, two retrospective studies, two case studies, one feasibility/usability study, one cohort study, and seven diagnostic (validation) studies, met the inclusion criteria for this review. The methodological quality of the studies evaluated using the PEDro scale was fair.

DISCUSSION

Future studies should focus on large-scale clinical trials using validated technology to determine its effectiveness and dose-response characteristics. Additionally, standard assessment tools need to be selected and utilized across interventional studies aimed at improving balance and mobility to help compare results between studies.

The use of virtual reality as a perspective-taking manipulation to improve self-awareness in Alzheimer's disease

Lack of awareness of symptoms or having a condition referred to as anosognosia is a common feature of individuals with Alzheimer's Disease (AD). Previous literature on AD reported difficulties in evaluating self-abilities, often showing underestimation of limitations. There is increasing evidence that the perspective through which information is presented may moderate the performance appraisal and that anosognosia in AD might be a consequence of a deficit in assuming a third-person perspective. In this context, some studies showed that subjects may better recognize self-and other-difficulties when exposed to a third-person perspective. Considering the variety of approaches aiming to investigate the lack of awareness, there is still a scarcity of methods that provide great ecological validity and consider more than one facet of awareness, thus failing to offer more accurate evaluations of daily experiences. The present paper primarily addresses the theme of the multidimensional character of awareness of abilities in AD and the effect of perspective-taking on its trajectories. The focus turns to virtual reality as a promising tool for a greater evaluation of perspective-taking and self-awareness. Particularly, these systems offer the possibility to involve users in cognitive and sensorimotor tasks that simulate daily life conditions within immersive and realistic environments, and a great sense of embodiment. We propose that virtual reality might allow a great level of complexity, veracity, and safety that is needed for individuals with AD to behave according to their actual abilities and enable to explore the liaison between the subject's viewpoint, performance, and self-evaluation. In addition, we suggest promising clinical implications of virtual reality-based methods for individualized assessments, investigating specific impacts on subjects' life and possible improvements in their awareness.

Effects of Virtual Reality Therapy Combined With Conventional Rehabilitation on Pain, Kinematic Function, and Disability in Patients With Chronic Neck Pain: Randomized Controlled Trial

BACKGROUND

Neck pain is a common condition that leads to neck motor dysfunction and subsequent disability, with a significant global health care burden. As a newly emerging tool, virtual reality (VR) technology has been employed to address pain and reduce disability among patients with neck pain. However, there is still a lack of high-quality studies evaluating the efficacy of VR therapy combined with conventional rehabilitation for patients with chronic neck pain, particularly in terms of kinematic function.

OBJECTIVE

This study aims to investigate the effect of VR therapy combined with conventional rehabilitation on pain, kinematic function, and disability in patients with chronic neck pain.

METHODS

We conducted an assessor-blinded, allocation-concealed randomized controlled trial. Sixty-four participants experiencing chronic neck pain were randomly allocated into the experimental group that underwent VR rehabilitation plus conventional rehabilitation or the control group receiving the same amount of conventional rehabilitation alone for 10 sessions over 4 weeks. Pain intensity, disability, kinematic function (cervical range of motion, proprioception, and mean and peak velocity), degree of satisfaction, and relief of symptoms were evaluated at 3 timepoints (baseline, postintervention, and at 3 months follow-up). A 2*3 mixed repeated measures analysis of variance was utilized for analyzing the difference across indicators, with a significant difference level of .05.

RESULTS

Both groups demonstrated significant improvements in pain, disability, and kinematic functions (P<.05) at postintervention and at 3-month follow-up. The experimental group showed superior therapeutic outcomes compared to the control group in pain reduction (mean difference from the baseline: 5.50 vs 1.81 at posttreatment; 5.21 vs 1.91 at the 3-month follow-up, respectively; P<.001), disability improvement (mean difference from baseline: 3.04 vs 0.50 at posttreatment; 3.20 vs 0.85 at the 3-month follow-up, respectively; P<.001), and enhanced kinematic functions (P<.05). Moreover, participants in the experimental group reported better satisfaction and relief of symptoms than the control group (P<.05), with better initiative for exercising during the follow-up period. However, there was no between-group difference of improvement in proprioception. No adverse events were reported or observed in our research.

CONCLUSIONS

The findings of our study support the efficacy of combining VR therapy with conventional rehabilitation in alleviating pain, enhancing kinematic function, and reducing disability of patients with chronic neck pain. Future research should focus on refining the therapeutic protocols and dosages for VR therapy as well as on optimizing its application in clinical settings for improved convenience and effectiveness.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR2000040132; http://www.chictr.org.cn/showproj.aspx?proj=64346.

Perceptions and needs for a community nursing virtual simulation system for Chinese nursing students during the COVID-19 pandemic: A qualitative study

Background

Virtual simulation systems are being increasingly used in the field of nursing education. However, these systems are mostly designed based on the perspective of developers, and the needs of the end users are often neglected. The purpose of this study was to explore the perceptions and needs of Chinese undergraduate nursing students for the development of a community nursing virtual simulation system.

Methods

This was a descriptive qualitative study enrolling 12 undergraduate nursing students at a University in China. Data were collected through semi-structured interviews. The content analysis method was used for data analysis.

Result

Three themes and 15 sub-themes were extracted from this study: (1) Positive perceptions regarding virtual systems: a) Provides space for trials and errors, b) Not limited by time and space, c) Provides auxiliary tools; (2) Design and use requirements: a) Performance needs, b) Contents design needs, c) Appearance design needs, d) Support Needs; (3) Competency enhancement needs: a) Community nursing practice ability, b) Critical thinking ability, c) Independent thinking ability, d) Ability to deal with emergencies, e)Teamwork skills, f) Self-efficacy, g) Resilience, h)Interpersonal communication skills.

Conclusion

Designers and engineers should consider students' needs, aim to improve students' abilities, improve the diversity, the scientific and rigor of content, and enhance user immersion and interest. The system should be programmed to provide real-time feedback, timely technical and professional support, in order to optimize use experience of nursing students.

Digital holographic content manipulation for wide-angle holographic near-eye displays

In recent years, the development of holographic near-eye displays (HNED) has surpassed the progress of digital hologram recording systems, especially in terms of wide-angle viewing capabilities. Thus, there is capture-display parameters incompatibility, which makes it impossible to reconstruct recorded objects in wide-angle display. This paper presents a complete imaging chain extending the available content for wide-angle HNED of pupil and non-pupil configuration with narrow-angle digital holograms of real objects. To this end, a new framework based on the phase-space approach is proposed that includes a set of affine transformations required to account for all differences in capture-display cases. The developed method allows free manipulation of the geometry of reconstructed objects, including axial and lateral positioning and size scaling. At the same time, it has a low computational effort. The presented work is supported with non-paraxial formulas developed using the phase-space approach, enabling accurate tracing of the holographic signal, its reconstruction, and measuring appearing deformations. The applicability of the proposed hologram manipulation method is proven with experimental results of digital hologram reconstruction in wide-angle HNED.

Social Signal Processing in Affective Virtual Reality: Human-Shaped Agents Increase Electrodermal Activity in an Elicited Negative Environment

Prior research on affect elicitation indicates that stimuli with social content (pictures or videos) are more arousing than nonsocial stimuli. In particular, they elicit stronger physiological arousal as measured by electrodermal activity (EDA; i.e., social EDA effect). However, it is unclear how this effect applies to virtual reality (VR), which enables an enhanced sense of presence (SoP) and ecological validity. The study here approached this question from a social-emotional VR framework. A sample of N = 72 participants (55 percent women) experienced a set of six virtual environments (VEs) in the form of emotional parks specifically designed to elicit positive, negative, or neutral affectivity. Half of these VEs included human-shaped agents (social context) and the other half omitted these agents (nonsocial context). The results supported the social EDA effect, which in addition was amplified by the reported SoP. Importantly, the VE featuring a social negative content qualified this observed social EDA effect. The finding is discussed in the light of a negativity bias reported in affect literature, through which negative stimuli typically mobilize attention and bodily activation as a mechanism linked to stress responses. The study's implications extend to the use of VR in both research and practical applications, emphasizing the role of social content in influencing affective and physiological responses.

PTVR - A software in Python to make virtual reality experiments easier to build and more reproducible

Researchers increasingly use virtual reality (VR) to perform behavioral experiments, especially in vision science. These experiments are usually programmed directly in so-called game engines that are extremely powerful. However, this process is tricky and time-consuming as it requires solid knowledge of game engines. Consequently, the anticipated prohibitive effort discourages many researchers who want to engage in VR. This paper introduces the Perception Toolbox for Virtual Reality (PTVR) library, allowing visual perception studies in VR to be created using high-level Python script programming. A crucial consequence of using a script is that an experiment can be described by a single, easy-to-read piece of code, thus improving VR studies' transparency, reproducibility, and reusability. We built our library upon a seminal open-source library released in 2018 that we have considerably developed since then. This paper aims to provide a comprehensive overview of the PTVR software for the first time. We introduce the main objects and features of PTVR and some general concepts related to the three-dimensional (3D) world. This new library should dramatically reduce the difficulty of programming experiments in VR and elicit a whole new set of visual perception studies with high ecological validity.

Scientometric Analysis of the World Scientific Production on Augmented and Virtual Reality in Dental Education

AIM

The aim of this study was to perform a comprehensive bibliometric analysis of virtual reality (VR) and augmented reality (AR) applications in dental education.

MATERIALS AND METHODS

A cross-sectional research was carried out using a bibliometric methodology. This process entailed the assessment of metadata from scientific publications that are catalogued in the Scopus database, covering the period from January 2018 to August 2023. A variety of indicators were utilized to scrutinize scientific production and dissemination within the academic community. These encompassed elements such as the author, the publication itself, the number of citations, institutional and collaborative affiliations, geographical location, journal quartile ranking, h-index, Source Normalized Impact per Paper (SNIP), Field-Weighted Citation Impact (FWCI), SCImago Journal Rank (SJR), and the CiteScore.

RESULTS

Several institutions from different countries and their academic output were found. Beihang University stands out with 16 scholarly articles, followed by Stanford University with 16 articles and 170 citations. The Q1 quartile has experienced a steady increase, reaching 87 scientific articles. The top 10 authors in scientific production on augmented and VR in dentistry include Joe Amal Cecil, Avinash Gupta, and Miguel A Pirela-Cruz. In terms of co-authorship by country, the United States, Germany, and China are the most predominant in the clusters represented. However, other clusters also have a significant presence. By analyzing the explored trends and themes of keyword co-occurrence, four main clusters were identified. The yellow cluster contained the largest amount of research with the keyword "virtual reality." In addition, the blue cluster was found to be best related to the green "simulation," purple "virtual reality (VR)," and light blue "human-centered computing" clusters.

CONCLUSION

This study evidenced the availability and quality of the data used for the analysis. Future studies could consider the use of VR systems with integrated eye tracking and compare their effect in dentistry during dental procedures.

CLINICAL SIGNIFICANCE

The clinical importance of this study lies in its potential to improve dental education. The VR and AR can provide dental students with immersive, hands-on learning experiences, which can enhance their understanding and clinical skills. Furthermore, the translational value of this study extends beyond dental education. The insights gained from this research could be applicable to other fields of medical education where hands-on training is crucial. Thus, the findings of this study have the potential to influence the broader landscape of medical education, ultimately leading to improved healthcare outcomes. How to cite this article: Alvitez-Temoche D, Silva H, Aguila ED, et al. Scientometric Analysis of the World Scientific Production on Augmented and Virtual Reality in Dental Education. J Contemp Dent Pract 2024;25(4):358-364.

Assessing alexithymia: the proposal of a psychometric tool based on spheric videos

The present perspective introduces a novel psychometric tool designed to enhance the evaluation of alexithymia. Alexithymia, a condition marked by difficulties in recognizing and expressing emotions, along with a propensity to direct attention outside rather than toward one's own interior experiences, is commonly investigated through self-report questionnaires. These instruments assume that individuals have sufficient self-awareness and abstraction capabilities, which restricts the understanding of the underlying mechanisms of emotional recognition in individuals who do not possess these capacities. To address this lack, emerging technologies like virtual reality (VR) and 360° videos facilitate the recreation of immersive contexts, enabling subjects to engage with scenarios even remotely. Our innovative tool employs spherical video technology to recreate social and non-social scenarios that elicit emotions. Psychophysiological measures are collected during video observation; then, questions are asked to investigate how the subject consciously processes the emotions they experienced. This multimodal approach aims to capture both implicit and explicit emotion processing, providing a comprehensive assessment. Overall, the proposed psychometric tool offers the potential for a more nuanced understanding of alexithymic traits and their real-life impact, empowering clinicians to tailor treatment processes to individual needs based on a richer set of information.

Comparing Walking-Related Everyday Life Tasks of Children with Gait Disorders in a Virtual Reality Setup With a Physical Setup: Cross-Sectional Noninferiority Study

BACKGROUND

A frequent rehabilitation goal for children with gait disorders is to practice daily-life walking activities. Unfortunately, these are often difficult to practice in a conventional therapeutic setting. Virtual reality (VR) with head-mounted displays (HMDs) could be a promising approach in neurorehabilitation to train such activities in a safe environment. First, however, we must know whether obstacles in VR are indeed mastered as obstacles.

OBJECTIVE

This study aimed to provide information on whether VR is feasible and motivating to induce and practice movements needed to master real obstacles in children and adolescents with gait disorders. Furthermore, this project aims to evaluate which kinds of everyday walking activities are appropriate to be practiced in VR.

METHODS

In this cross-sectional study, participants stepped over a bar, crossed a gap, balanced over a beam, and circumvented stationary obstructions arranged in a course under real physical and virtual conditions wearing a VR HMD. We recorded the respective primary outcomes (step height, step length, step width, and minimal shoulder-obstacle distance) with motion capture. We then calculated the mean differences and 95% CI of the spatiotemporal parameters between the VR and physical setup and later compared them using noninferiority analysis with margins defined a priori by a clinical expert panel. Additionally, the participants responded to a standardized questionnaire while the therapists observed and evaluated their movement performance.

RESULTS

We recruited 20 participants (mean age 12.0, range 6.6-17.8 years) with various diagnoses affecting their walking ability. At 3.77 (95% CI 1.28 to 6.26) cm, the mean difference in step height of the leading foot in the overstepping task did not exceed the predefined margin of -2 cm, thus signifying noninferiority of the VR condition compared to mastering the physical obstacles. The same was true for step length (-1.75, 95% CI -4.91 to 1.41 cm; margin -10 cm), step width (1.05, 95% CI 0.20 to -1.90 cm; margin 3 cm), and the minimal shoulder-obstacle distance (0.25, 95% CI -0.85 to 0.35 cm; margin -2 cm) in the other tasks. Only the trailing foot in the overstepping task yielded inconclusive results.

CONCLUSIONS

Children with gait disorders perform everyday walking tasks like overstepping, crossing, balancing, or circumventing similarly in physical and VR environments, suggesting that VR could be a feasible therapeutic tool to practice everyday walking tasks.

XR and mental wellbeing: state of the art and future research directions for the Metaverse

Introduction

The purpose of this study is to provide an overview of extant research regarding XR technology and its effect on consumer wellbeing. With the hopes of informing marketing practitioners on XR consumer psychology, in preparation for the Metaverse.

Methods

To achieve the above aim, two types of analysis took place. Firstly, a bibliometric analysis was conducted which was then followed by a framework-based structured literature review. The latter entailed an analysis of 81 articles evaluated from a positive psychological approach.

Findings

Following the TCCM framework, the analysis revealed the most common psychological theories demonstrating potential avenues for XR to impact consumer wellbeing. Moreover, researchers found preliminary links between, theory, characteristics, and contexts. Giving a preliminary description of how theory manifests into reality. Finally, the overview of extant literature was used to propose new avenues for future research pertaining to marketing, the Metaverse, and consumer effects.

Conclusion

In conclusion, the paper provides stakeholder insights which can ensure minimal consumer risk and sustainable use of the XR technology and Metaverse. While addressing the need for more research that uncovers the psychological effects of emerging technologies, so to prepare for the Metaverse. This is especially important when considering the current upsurge of these technologies and the uncertainties associated with their novelty and the idea of an 'always on' consumer.

Systematic review of the effectiveness of innovative, gamified interventions for cognitive training in paediatric acquired brain injury

Effectiveness of innovative, gamified interventions (i.e., Augmented Reality, Computer-Based Cognitive Retraining [CBCR], and Virtual Reality [VR] in conjunction with a Serious Game) for cognitive training in paediatric ABI was evaluated. Studies were identified on PsycINFO, PubMed and Scopus; last searched 4 January 2022. Eligibility criteria were participants diagnosed with ABI and aged ≤ 18 years, experimental intervention to train cognition, cognition assessed pre- and post-intervention at: (1) The level of function, or (2) The level of activity, and written in English. ROB 2 and ROBINS-I were utilised to assess risk of bias. Extracted study characteristics were methods, participants, interventions, outcomes, and results. Seven studies were included, comprising six CBCR studies and one VR study, with 182 participants. Following CBCR: (1) Improvements were observed in several cognitive functions, but there was inconsistent evidence; (2) Improvements were reported in attention and executive functions (EF) at home and at school. Following VR: (1) Improvements were observed in attention and EF; (2) Not evaluated. Due to the small number of included studies with (relatively) small and heterogeneous samples, only a cautious interpretation of the evidence was provided. There is a need for carefully designed studies with more attention to inter-individual differences and generalisation to daily life.

Virtual Reality and Serious Videogame-Based Instruments for Assessing Spatial Navigation in Alzheimer's Disease: A Systematic Review of Psychometric Properties

Over the past decade, research using virtual reality and serious game-based instruments for assessing spatial navigation and spatial memory in at-risk and AD populations has risen. We systematically reviewed the literature since 2012 to identify and evaluate the methodological quality and risk of bias in the analyses of the psychometric properties of VRSG-based instruments. The search was conducted primarily in July-December 2022 and updated in November 2023 in eight major databases. The quality of instrument development and study design were analyzed in all studies. Measurement properties were defined and analyzed according to COSMIN guidelines. A total of 1078 unique records were screened, and following selection criteria, thirty-seven studies were analyzed. From these studies, 30 instruments were identified. Construct and criterion validity were the most reported measurement properties, while structural validity and internal consistency evidence were the least reported. Nineteen studies were deemed very good in construct validity, whereas 11 studies reporting diagnostic accuracy were deemed very good in quality. Limitations regarding theoretical framework and research design requirements were found in most of the studies. VRSG-based instruments are valuable additions to the current diagnostic toolkit for AD. Further research is required to establish the psychometric performance and clinical utility of VRSG-based instruments, particularly the instrument development, content validity, and diagnostic accuracy for preclinical AD screening scenarios. This review provides a straightforward synthesis of the state of the art of VRSG-based instruments and suggests future directions for research.

Virtual Reality-Based Exercise Rehabilitation in Cancer-Related Dysfunctions: Scoping Review

BACKGROUND

Virtual reality-based exercise rehabilitation (VRER) is a promising intervention for patients with cancer-related dysfunctions (CRDs). However, studies focusing on VRER for CRDs are lacking, and the results are inconsistent.

OBJECTIVE

We aimed to review the application of VRER in patients with CRDs.

METHODS

This scoping review was conducted following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist framework. Publications were included from the time of database establishment to October 14, 2023. The databases were PubMed, Embase, Scopus, Cochrane, Web of Science, ProQuest, arXiv, IEEE Xplore, MedRxiv, CNKI, Wanfang Data, VIP, and SinoMed. The population included patients with cancer. A virtual reality (VR) system or device was required to be provided in exercise rehabilitation as an intervention. Eligible studies focused on VRER used for CRDs. Study selection and data extraction were performed by 2 reviewers independently. Extracted data included authors, year, country, study type, groups, sample size, participant age, cancer type, existing or potential CRDs, VR models and devices, intervention programs and durations, effectiveness, compliance, satisfaction, and safety.

RESULTS

We identified 25 articles, and among these, 12 (48%) were randomized clinical trials, 11 (44%) were other experimental studies, and 2 (8%) were observational studies. The total sample size was 1174 (range 6-136). Among the 25 studies, 22 (88%), 2 (8%), and 1 (4%) included nonimmersive VR, immersive VR, and augmented reality, respectively, which are models of VRER. Commercial game programs (17/25, 68%) were the most popular interventions of VRER, and their duration ranged from 3 to 12 weeks. Using these models and devices, VRER was mostly applied in patients with breast cancer (14/25, 56%), leukemia (8/25, 32%), and lung cancer (3/25, 12%). Furthermore, 6 CRDs were intervened by VRER, and among these, postmastectomy syndromes were the most common (10/25, 40%). Overall, 74% (17/23) of studies reported positive results, including significant improvements in limb function, joint range of motion, edema rates, cognition, respiratory disturbance index, apnea, activities of daily living, and quality of life. The compliance rate ranged from 56% to 100%. Overall, 32% (8/25) of studies reported on patient satisfaction, and of these, 88% (7/8) reported satisfaction with VRER. Moreover, 13% (1/8) reported mild sickness as an adverse event.

CONCLUSIONS

We found that around half of the studies reported using VRER in patients with breast cancer and postmastectomy dysfunctions through nonimmersive models and commercial game programs having durations of 3-12 weeks. In addition, most studies showed that VRER was effective owing to virtualization and interaction. Therefore, VRER may be an alternate intervention for patients with CRDs. However, as the conclusions were drawn from data with acknowledged inconsistencies and limited satisfaction reports, studies with larger sample sizes and more outcome indictors are required.

An old approach to a novel problem: effect of combined balance therapy on virtual reality induced motion sickness: a randomized, placebo controlled, double-blinded study

BACKGROUND

The objective of this study was to investigate the impact of a rehabilitation program aimed at addressing vestibular and proprioceptive deficits, which are believed to underlie the pathophysiology of motion sickness.

METHODS

A total of 121 medical students with motion sickness participated in this study and were randomly divided into intervention (n = 60) and placebo control (n = 61) groups. The intervention group underwent combined balance, proprioception, and vestibular training three times a week for 4 weeks, while the control group received placebo training. The study assessed various measurements, including the Virtual reality sickness questionnaire (VRSQ), tolerance duration, enjoyment level measured by VAS, stability levels using Biodex, and balance with the Flamingo balance test (FBT). All measurements were conducted both at baseline and 4 weeks later.

RESULTS

There was no significant difference in pre-test scores between the intervention and control groups, suggesting a similar baseline in both groups (p > 0.05). The results showed a significant improvement in VRSQ, tolerance duration, VAS, Biodex, and FBT scores in the intervention group (p < 0.05). While, the control group showed a significant increase only in VAS scores after 4 weeks of training (p < 0.05). A statistically significant improvement was found between the groups for VRSQ (p < 0.001), tolerance duration (p < 0.001), VAS (p < 0.001), Biodex (p = 0.015), and FBT scores (p < 0.05), in favor of the intervention group.

CONCLUSIONS

A combined balance training program for motion sickness proves to be effective in reducing motion sickness symptoms, enhancing user enjoyment, and extending the usage duration of virtual reality devices while improving balance and stability. In contrast, placebo training did not alter motion sickness levels. These findings offer valuable insights for expanding the usage of virtual reality, making it accessible to a broader population.

Efficacy of virtual reality for pain relief in medical procedures: a systematic review and meta-analysis

BACKGROUND

Effective pain control is crucial to optimise the success of medical procedures. Immersive virtual reality (VR) technology could offer an effective non-invasive, non-pharmacological option to distract patients and reduce their experience of pain. We aimed to evaluate the efficacy of Immersive virtual reality (VR) technology in reducing patient's pain perception during various medical procedures by conducting a systematic review and meta-analysis.

METHODS

We searched MEDLINE, EMBASE, CENTRAL, CINAHL, and SIGLE until December 2022 for all randomised clinical trials (RCT) evaluating any type of VR in patients undergoing any medical procedure. We conducted a random effect meta-analysis summarising standardised mean differences (SMD) with 95% confidence intervals (CI). We evaluated heterogeneity using I 2 and explored it using subgroup and meta-regression analyses.

RESULTS

In total, we included 92 RCTs (n = 7133 participants). There was a significant reduction in pain scores with VR across all medical procedures (n = 83, SMD - 0.78, 95% CI - 1.00 to - 0.57, I 2 = 93%, p = < 0.01). Subgroup analysis showed varied reduction in pain scores across trial designs [crossover (n = 13, SMD - 0.86, 95% CI - 1.23 to - 0.49, I 2 = 72%, p = < 0.01) vs parallel RCTs (n = 70, SMD - 0.77, 95% CI - 1.01 to - 0.52, I 2 = 90%, p = < 0.01)]; participant age groups [paediatric (n = 43, SMD - 0.91, 95% CI - 1.26 to - 0.56, I 2 = 87%, p = < 0.01) vs adults (n = 40, SMD - 0.66, 95% CI - 0.94 to - 0.39, I 2 = 89%, p = < 0.01)] or procedures [venepuncture (n = 32, SMD - 0.99, 95% CI - 1.52 to - 0.46, I 2 = 90%, p = < 0.01) vs childbirth (n = 7, SMD - 0.99, 95% CI - 1.59 to - 0.38, I 2 = 88%, p = < 0.01) vs minimally invasive medical procedures (n = 25, SMD - 0.51, 95% CI - 0.79 to - 0.23, I 2 = 85%, p = < 0.01) vs dressing changes in burn patients (n = 19, SMD - 0.8, 95% CI - 1.16 to - 0.45, I 2 = 87%, p = < 0.01)]. We explored heterogeneity using meta-regression which showed no significant impact of different covariates including crossover trials (p = 0.53), minimally invasive procedures (p = 0.37), and among paediatric participants (p = 0.27). Cumulative meta-analysis showed no change in overall effect estimates with the additional RCTs since 2018.

CONCLUSIONS

Immersive VR technology offers effective pain control across various medical procedures, albeit statistical heterogeneity. Further research is needed to inform the safe adoption of this technology across different medical disciplines.

Effectiveness and User Experience of Virtual Reality for Social Anxiety Disorder: Systematic Review

BACKGROUND

Social anxiety disorder (SAD) is a debilitating psychiatric disorder that affects occupational and social functioning. Virtual reality (VR) therapies can provide effective treatment for people with SAD. However, with rapid innovations in immersive VR technology, more contemporary research is required to examine the effectiveness and concomitant user experience outcomes (ie, safety, usability, acceptability, and attrition) of emerging VR interventions for SAD.

OBJECTIVE

The aim of this systematic review was to examine the effectiveness and user experience of contemporary VR interventions among people with SAD.

METHODS

The Cochrane Library, Emcare, PsycINFO, PubMed, ScienceDirect, Scopus, and Web of Science databases were searched between January 1, 2012, and April 26, 2022. Deduplicated search results were screened based on title and abstract information. Full-text examination was conducted on 71 articles. Studies of all designs and comparator groups were included if they appraised the effectiveness and user experience outcomes of any immersive VR intervention among people with SAD. A standardized coding sheet was used to extract data on key participant, intervention, comparator, outcome, and study design items.

RESULTS

The findings were tabulated and discussed using a narrative synthesis. A total of 18 studies met the inclusion criteria.

CONCLUSIONS

The findings showed that VR exposure therapy-based interventions can generally provide effective, safe, usable, and acceptable treatments for adults with SAD. The average attrition rate from VR treatment was low (11.36%) despite some reported user experience difficulties, including potential simulator sickness, exposure-based emotional distress, and problems with managing treatment delivered in a synchronous group setting. This review also revealed several research gaps, including a lack of VR treatment studies on children and adolescents with SAD as well as a paucity of standardized assessments of VR user experience interactions. More studies are required to address these issues.

TRIAL REGISTRATION

PROSPERO CRD42022353891; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=353891.

The effect of augmented reality on preoperative anxiety in children and adolescents: A randomized controlled trial

BACKGROUND AND AIMS

Virtual reality has been shown to be an effective non-pharmacological intervention for reducing anxiety of pediatric patients. A newer immersive technology, that of augmented reality, offers some practical advantages over virtual reality, and also seems to show beneficial effects on anxiety. The main objective of this study was to determine whether augmented reality could reduce preoperative anxiety in pediatric patients undergoing elective day surgeries. A secondary outcome was to document the level of satisfaction from pediatric patients toward augmented reality intervention.

METHODS

Children and adolescents aged between 5 and 17 years old scheduled for elective day surgery under general anesthesia were randomly divided into two groups. Patients in the control group received standard care, whereas patients in the augmented reality group were accompanied by two virtual characters who taught them relaxation techniques and provided emotional and informational support. Anxiety was measured at the time of admission and at the time of induction using the short version of the modified Yale Preoperative Anxiety Scale.

RESULTS

The analysis included 37 pediatric patients in the augmented reality group and 64 in the control group. Anxiety scores were statistically significantly lower in the augmented reality group than those in the control group at the time of admission (median difference [95% CI]: 6.3 [0-10.4], p = .01), while no difference was observed between groups at the time of induction (median difference [95% CI]: -4.2 [-5.2-4.2], p = .58). Most patients in the augmented reality group wished to wear the glasses again and reported to be very satisfied with the intervention.

CONCLUSION

To our knowledge, this study is the first large randomized controlled trial to provide empirical evidence of reduction in anxiety for children and adolescents using augmented reality prior to induction of general anesthesia.

Virtual, augmented, and mixed reality: potential clinical and training applications in pediatrics

BACKGROUND

COVID-19 pandemic has significantly impacted the field of medical training, necessitating innovative approaches to education and practice. During this period, the use of novel technologies like virtual reality (VR), augmented reality (AR), and mixed reality (MR) has become increasingly vital. These technologies offer the advantage of transcending the limitations of time and space, thus enabling medical professionals to access various personalized programs for both education and service delivery. This shift is particularly relevant in the realm of pediatric medicine, where traditional training and clinical methods face unique challenges.

PURPOSE

The primary aim of this study is to explore the application of VR, AR, and MR technologies in pediatric medical settings, with a focus on both clinical applications and the training of pediatric medical professionals. We aim to comprehensively search and review studies that have utilized these technologies in the treatment of pediatric patients and the education of healthcare providers in this field.

METHODS

Peer-reviewed articles published in PubMed, the Cochrane Library, ScienceDirect, Google Scholar, and Scopus from January 1, 2018, to March 1, 2023, were comprehensively searched. The review was conducted according to the PRISMA (Preferred Reporting Items for Systematic review and Meta-Analyses) guidelines. Among the 89 studies, 63 investigated the clinical applications of VR (n=60) or AR (n=3) in pediatric patients, and 25 investigated the applications of VR (n=19), AR (n=5), or MR (n=1) for training medical professionals.

RESULTS

A total of 36 randomized controlled trials (RCTs) for clinical application (n=31) and medical training (n=5) were retrieved. Among the RCTs, 21 reported significant improvements in clinical applications (n=17) and medical training (n=4).

CONCLUSION

Despite a few limitations in conducting research on innovative technology, such research has rapidly expanded, indicating that an increasing number of researchers are involved in pediatric research using these technologies.

Use of Virtual Reality in Physical Therapy as an Intervention and Diagnostic Tool

Within the past decade, the integration of computer-generated virtual realities (VRs) has witnessed a significant rise in the field of healthcare, particularly in diagnosis and treatment applications. These VR systems have found extensive use in physical therapy, rehabilitation, research, and assessment. This narrative review article is aimed at providing a comprehensive overview of the literature regarding the implementation of VR in the physical therapy profession. The primary objective of this review is to provide information to clinicians about the diverse applications of VR and its potential advantages in intervening across various patient populations and diagnoses during rehabilitation therapy. Through in-depth discussions with experts and a thorough review of pertinent literature, several significant aspects of the topic were identified. Subsequently, we carried out an online search to investigate the prevalent utilization of VR systems within healthcare, both as assessment tools and for therapeutic interventions. Our examination encompassed a total of 56 articles, with supplementary references incorporated as required.

Effects of color cues on eye-hand coordination training with a mirror drawing task in virtual environment

Mirror drawing is a motor learning task that is used to evaluate and improve eye-hand coordination of users and can be implemented in immersive Virtual Reality (VR) Head-Mounted Displays (HMDs) for training purposes. In this paper, we investigated the effect of color cues on user motor performance in a mirror-drawing task between Virtual Environment (VE) and Real World (RW), with three different colors. We conducted a 5-day user study with twelve participants. The results showed that the participants made fewer errors in RW compared to VR, except for pre-training, which indicated that hardware and software limitations have detrimental effects on the motor learning of the participants across different realities. Furthermore, participants made fewer errors with the colors close to green, which is usually associated with serenity, contentment, and relaxation. According to our findings, VR headsets can be used to evaluate participants' eye-hand coordination in mirror drawing tasks to evaluate the motor-learning of participants. VE and RW training applications could benefit from our findings in order to enhance their effectiveness.

Exploring the potential role for extended reality in Mohs micrographic surgery

Mohs micrographic surgery (MMS) is a cornerstone of dermatological practice. Virtual reality (VR) and augmented reality (AR) technology, initially used for entertainment, have entered healthcare, offering real-time data overlaying a surgeon's view. This paper explores potential applications of VR and AR in MMS, emphasizing their advantages and limitations. We aim to identify research gaps to facilitate innovation in dermatological surgery. We conducted a PubMed search using the following: "augmented reality" OR "virtual reality" AND "Mohs" or "augmented reality" OR "virtual reality" AND "surgery." Inclusion criteria were peer-reviewed articles in English discussing these technologies in medical settings. We excluded non-peer-reviewed sources, non-English articles, and those not addressing these technologies in a medical context. VR alleviates patient anxiety and enhances patient satisfaction while serving as an educational tool. It also aids physicians by providing realistic surgical simulations. On the other hand, AR assists in real-time lesion analysis, optimizing incision planning, and refining margin control during surgery. Both of these technologies offer remote guidance for trainee residents, enabling real-time learning and oversight and facilitating synchronous teleconsultations. These technologies may transform dermatologic surgery, making it more accessible and efficient. However, further research is needed to validate their effectiveness, address potential challenges, and optimize seamless integration. All in all, AR and VR enhance real-world environments with digital data, offering real-time surgical guidance and medical insights. By exploring the potential integration of these technologies in MMS, our study identifies avenues for further research to thoroughly understand the role of these technologies to redefine dermatologic surgery, elevating precision, surgical outcomes, and patient experiences.

Best Practices for Research in Virtual and Augmented Reality in Dermatology

Virtual reality (VR) and augmented reality (AR) technologies have advanced rapidly in recent years. These cutting-edge technologies provide dermatology researchers, educators, proceduralists, and patients with opportunities in new scientific horizons. VR is a technology that facilitates immersive human experiences by allowing users to connect with various simulated environments through natural head and hand movements, whereas AR supplements a user's perception of their real environment with virtual elements. Despite technological advancements, there is limited literature on the methodological steps for conducting rigorous VR and AR research in dermatology. Effective storyboarding, user-driven design, and interdisciplinary teamwork play a central role in ensuring that VR/AR applications meet the specific needs of dermatology clinical and research teams. We present a step-by-step approach for their design, team composition, and evaluation in dermatology research, medical education, procedures, and habit formation strategies. We also discuss current VR and AR dermatology applications and the importance of ethical and safety considerations in deploying this new technology.

Feasibility of using virtual reality in geriatric psychiatry

OBJECTIVES

Virtual Reality-based interventions have become an important element of digital mental health, offering accessible and scalable treatment options. However, studies on VR-based approaches in elderly patients are scarce. This explorative study examined the feasibility of using Virtual Reality (VR) for elderly patients with psychiatric illness, focusing on the sense of presence as the primary outcome.

METHODS

The study included N = 30 patients between the ages of 59-92 years who were currently in geriatric psychiatric inpatient and day clinic treatment. Participants were assessed before, during and after a relaxing ten-minute VR experience. Attitude towards digital media and VR, subjective digital competence, and previous experience were examined using questionnaires. Motion sickness was measured repeatedly during the VR experience using the Fast Motion Sickness Scale (FMS). Patients rated their motion sickness and their general well-being in the virtual environment. Sense of presence in the virtual environment was quantified with the Igroup Presence Questionnaire (IPQ).

RESULTS

Participants reported a notable sense of presence (M = 0.41 ± 1.4) in the virtual environment, particularly in terms of spatial presence. Motion sickness was reported by a minority of patients. Three patients terminated the VR application before it was finished. The average well-being during the VR experience was reported as high (70/100). Sense of presence and motion sickness showed a significant negative correlation. Presence, motion sickness and well-being were not significantly correlated with age, nor did they differ significantly between groups.

CONCLUSIONS

This study underscores the potential of VR-based experiences in the treatment of elderly psychiatric patients and highlights their willingness and ability to engage with VR technology. While the results are promising, future research should explore more interactive VR scenarios and assess their safety and feasibility in elderly populations.

The effectiveness of nursing interventions for elderly dementia patients based on virtual reality technology: A systematic review and meta-analysis

OBJECTIVE

To systematically evaluate the effect of virtual reality technology-based nursing interventions to improve cognitive function, quality of life, activity of daily living, and negative emotions in patients with dementia.

METHODS

Computer searches of the VIP Chinese Science and Technology Journal Database, China National Knowledge Infrastructure Database, Wanfang Database, The Cochrane Library, Embase, PubMed, and Web of Science were conducted to include randomized controlled trials and class experimental studies of virtual reality technology-based nursing interventions for patients with dementia, with a search time frame from the date of database creation to March 31, 2023. Two investigators independently screened the literature according to inclusion and exclusion criteria, extracted data, performed risk bias evaluation, and then performed Meta-analysis on the extracted relevant data using Rev Man 5.4 software.

RESULTS

A total of 6 randomized controlled trials and 2 quasi-randomized controlled trial with 514 patients with dementia were included. Meta-analysis results showed that compared with conventional cognitive care interventions, virtual reality-based care interventions significantly improved cognitive function [MD = 1.61, 95% CI (0.99, 2.23), Z = 5.12, P < 0.00001], quality of life [SMD = 0.85, 95% CI (0.56, 1.14), Z = 5.70, P < 0.00001] and activity of daily living [MD = 3.75, 95% CI (1.22, 6.28), Z = 2.91, P = 0.004], and alleviate negative emotions [MD = -4.00, 95% CI (-7.26, -0.75), Z = 2.41, P = 0.02].

CONCLUSIONS

The current results suggest that virtual reality-based nursing interventions have a positive effect on improving cognitive function, quality of life, activities of daily living and alleviating negative emotions in patients with dementia. Due to the limitations of the quantity and quality of the included literature, the above findings are yet to be validated by more high-quality studies.

Bibliometric Analysis of Research in Pediatrics Related to Virtual and Augmented Reality: A Systematic Review

INTRODUCTION

The amount of research exploring the use of virtual reality (VR) and augmented reality (AR) technologies in health care has exploded. This has resulted in a massive body of work, making it difficult to obtain all of the research. The objective of this study was to map out and put together the scientific output of research and global trends in virtual and AR in pediatrics.

METHODS

Publications were collected from the Web of Science (WoS) database. The R tool was used to categorize and evaluate the research outputs, as well as the most productive and influential countries, journals, institutions, authors, articles, subject areas, and the latest research themes. The most utilized and co-occurring keywords were also examined. Texts, tables, and images were used to assess and describe the retrieval of findings.

RESULTS

The research was based on information from 7423 publications. The strongest growth in publications occurred in 2020. The most productive and influential country was the USA. The journal was Pediatrics, the author was G Riva, and the institution was the University of Washington. The most frequently occurring keywords were simulation, rehabilitation, and stroke. The main research themes were therapy, surgical education, and rehabilitation. Pain, stroke, anxiety, depression, fear, dementia, and neurodegenerative illnesses were all common medical issues investigated.

CONCLUSION

VR studies have mainly focused on surgical education or procedures, simulation technologies, and neurological conditions. Neurological conditions are linked to balance, gait, and rehabilitation, reflecting the prevalence of these disease groups. This article provides a thorough overview of VR and AR studies in the healthcare field. This work will allow academics, policymakers, and practitioners to gain a deeper understanding of the evolution of VR and AR studies in the healthcare field and its potential practical implications. Future VR and AR research should focus on bridging the gap between VR and AR healthcare research and clinical applications. Emerging trends in related fields, such as navigation, rehabilitation, stroke, dementia, and VR exposure therapy, should be given special attention.

Virtual reality interventions designed to support parents during and throughout the first year after birth: A scoping review

Objective

Virtual reality (VR) has become increasingly popular in clinical and health settings where it has been used for a wide range of purposes. A recent scoping review explored VR applications to assist pregnant women and found that VR was a useful method to be used for a range of different purposes in both pregnancy and labour. However, no such review exists for the period after birth.

Method

We aimed to search for studies that used VR to support parents during birth and in the first year postpartum (Population) in different settings (Context), and finally provided data on the characteristics, reported effectiveness and experience of VR interventions (Concept). Two hundred and fifty-one studies were identified, of which ten were eligible. Two authors independently extracted data including study design, participants and results.

Results

Findings indicate that VR has been used effectively in this context to alleviate depression anxiety, and multiple domains of pain and to improve childbirth satisfaction. The majority of the studies explored the use of VR technology on outcomes such as pain and anxiety during labour and birth. The studies included used a broad range of VR hardware and software. All of the studies reported positive experiences of using VR.

Conclusions

Across these studies, VR was found to be effective in terms of both physiological and psychological outcomes. There are many unexplored maternal and infant focused applications of VR which warrant further investigation as emerging evidence indicates this is becoming an increasingly accessible method to improve maternal and infant health outcomes from pregnancy through to parenthood.

Virtual Reality for the Rehabilitation of Acquired Cognitive Disorders: A Narrative Review

This review article explores the use of Virtual Reality (VR) technology in cognitive rehabilitation for individuals with neurological conditions, such as stroke, traumatic brain injury, and neurodegenerative diseases. The introduction highlights the challenges posed by cognitive impairments and the limitations of traditional rehabilitation methods. VR is presented as a transformative tool that immerses individuals in interactive environments, offering promising opportunities for enhancing cognitive functions and improving quality of life. This article covers the foundational principles of VR, its applications across different clinical conditions and cognitive domains, and evaluates empirical evidence supporting its efficacy. It also discusses the advantages, limitations, challenges, and ethical considerations in the use of VR for cognitive rehabilitation. This review concludes by exploring future developments, including advancements in VR technology, the integration of Augmented Reality (AR) and artificial intelligence (AI), and the importance of standardized assessment tools for the objective evaluation of rehabilitation outcomes.

Exocentric and Egocentric Views for Biomedical Data Analytics in Virtual Environments-A Usability Study

Biomedical datasets are usually large and complex, containing biological information about a disease. Computational analytics and the interactive visualisation of such data are essential decision-making tools for disease diagnosis and treatment. Oncology data models were observed in a virtual reality environment to analyse gene expression and clinical data from a cohort of cancer patients. The technology enables a new way to view information from the outside in (exocentric view) and the inside out (egocentric view), which is otherwise not possible on ordinary displays. This paper presents a usability study on the exocentric and egocentric views of biomedical data visualisation in virtual reality and their impact on usability on human behaviour and perception. Our study revealed that the performance time was faster in the exocentric view than in the egocentric view. The exocentric view also received higher ease-of-use scores than the egocentric view. However, the influence of usability on time performance was only evident in the egocentric view. The findings of this study could be used to guide future development and refinement of visualisation tools in virtual reality.