The Effectiveness of Virtual Reality Exercise on Individual's Physiological, Psychological and Rehabilitative Outcomes: A Systematic Review

A behavioral economics approach to enhancing HIV preexposure and postexposure prophylaxis implementation

PURPOSE OF REVIEW

The 'PrEP cliff' phenomenon poses a critical challenge in global HIV PrEP implementation, marked by significant dropouts across the entire PrEP care continuum. This article reviews new strategies to address 'PrEP cliff'.

RECENT FINDINGS

Canadian clinicians have developed a service delivery model that offers presumptive PEP to patients in need and transits eligible PEP users to PrEP. Early findings are promising. This service model not only establishes a safety net for those who were not protected by PrEP, but it also leverages the immediate salience and perceived benefits of PEP as a natural nudge towards PrEP use. Aligning with Behavioral Economics, specifically the Salience Theory, this strategy holds potential in tackling PrEP implementation challenges.

SUMMARY

A natural pathway between PEP and PrEP has been widely observed. The Canadian service model exemplifies an innovative strategy that leverages this organic pathway and enhances the utility of both PEP and PrEP services. We offer theoretical insights into the reasons behind these PEP-PrEP transitions and evolve the Canadian model into a cohesive framework for implementation.

Effects of Multimodal Exercise With Augmented Reality on Cognition in Community-Dwelling Older Adults

OBJECTIVES

This study aims to investigate the effects of an exercise intervention using multimodal exercise with augmented reality and multimodal exercise-only on cognitive function in older adults living in a community dwelling.

DESIGN

Quasi-experimental research study.

SETTING AND PARTICIPANTS

In this control study, 78 participants were divided into 2 experimental groups (with sessions 3 times a week for 12 weeks) and a control group (CG).

METHODS

EG1 participated in a multimodal exercise-only intervention program, EG2 participated in a multimodal exercise program with augmented reality exergames, and CG continued its usual activities. Participants were assessed at baseline and postintervention after 12 weeks.

RESULTS

Comparison between baseline and postintervention at 12 weeks showed significant improvements in executive functions, verbal fluency, choice reaction time, and dual task in EG1, whereas there were improvements in general cognition, executive functions, verbal fluency, discrimination reaction time, and depression in EG2 (P ≤ .05). The clinical effect sizes of the interventions were large for overall cognition, executive functions, and reaction time on single- and dual-task reaction time in EG1 and for overall cognition, executive functions, and verbal fluency in EG2.

CONCLUSION AND IMPLICATIONS

The intervention programs showed significant improvements in several cognitive domains. The multimodal exercise-only showed improvements in more variables than the multimodal exercise with augmented reality, but the augmented reality group showed greater changes between baseline and postintervention.

Enhancing Physical Activity with Immersive Virtual Reality: A Systematic Review

The aim of this article is to review how immersive virtual reality-enhanced physical activity (IVR-PA) can be used to improve psychological, physiological, and performance outcomes linked to exercising and to compare it with non-immersive virtual reality-enhanced physical activity (nIVR-PA) and with traditional physical activity (TR-PA). We also aimed to explore the effectiveness of IVR-PA in promoting psychological well-being and engagement in physical activity. A systematic literature review (Prospero CRD42022330572) was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. OVID (including Medline, Embase, GlobalHealth, and APA PsychInfo), Web of Science, and Sport Discuss were searched. The quality of the studies was assessed using the Effective Public Health Practice Project Quality Assessment. The search identified 26,548 titles. After screening, 20 studies (the total number of participants was 798) published between 2009 and 2023 were included in this systematic review. The quality of the studies was rated as weak (n = 9), moderate (n = 10), or strong (n = 1). Overall, the reviewed studies indicated that, compared with TR-PA and nIVR-PA, IVR-PA was associated with an increase in enjoyment of physical activity, a reduction in perceived exertion, and increased rates of self-efficacy, intrinsic motivation, and exercise intention. Furthermore, some studies showed higher muscular strength and aerobic increase after an IVR-PA intervention compared with TR-PA. The findings suggest that IVR-PA can improve psychological, physiological, and performance outcomes linked to exercising, as well as improving psychological well-being and engagement in physical activity. However, owing to the methodological limitations of the reviewed studies, further research is encouraged.

Application of immersive virtual reality in the training of wheelchair boxers: evaluation of exercise intensity and users experience additional load- a pilot exploratory study

BACKGROUND

Over the last few years, there has been a growing interest in workout apps and active virtual reality video games (AVRGs), which provide entertainment and enable users to undertake various forms of physical activity (PA) at home. Presumably, these types of exercises can be particularly useful for people with physical disabilities, who experience problems with access to sports and leisure facilities due to architectural and communication barriers. However, it is interesting whether the intensity of PA in VR is high enough to provide users with health benefits, as it is mainly based on arm movements.

OBJECTIVE

The main aim of the study was to evaluate the intensity of physical exercise of wheelchair boxers during a boxing training session using the FitXR app in immersive VR in light of health-related PA recommendations. The effect of Velcro-fastened hand-held weights (HHWs) on the intensity of PA undertaken by people in VR was also examined, and the attractiveness of virtual exercise were assessed in the opinion of users.

METHODS

PA intensity was evaluated using a heart rate monitor based on the percentage of maximal heart rate (% HRmax) and the Borg's rating of perceived exertion (RPE 6-20). The attractiveness perceived during exercise by users were evaluated using the Physical Activity Enjoyment Scale (PACES 1-7 scale).

RESULTS

The study shows that the exercise intensity of the athletes during wheelchair boxing training in VR is at a beneficial moderate level for health (HRave=68.98% HRmax). The use of HHWs (0.5 kg) does not significantly increase the PA intensity of the individuals during virtual exercise. Users with disabilities highly rated the attractiveness (6.32 ± 0.79 points) of PA during virtual boxing training.

CONCLUSIONS

Boxing exercises in VR can be an attractive and health-related form of PA for wheelchair boxers and a supplement to their conventional training.

Development and feasibility assessment of a virtual reality-based aerobic exercise program with real-time pulse rate monitoring on hemodynamic and arterial stiffness in healthy people: a pilot study

Introduction

Virtual reality (VR) exercises are reportedly beneficial as a physical activity tool for health promotion and rehabilitation, and can also help individuals exercise under professional supervision. We developed and investigated the potential feasibility of a VR-based aerobic exercise program using the XBOX ONE console and Kinect sensor with real-time pulse rate monitoring. The VR setting consisted of two-dimensional (2D) environments via computer, laptop, or television screens. In addition, the study investigated the potential feasibility of the VR-based exercise program on hemodynamic response and arterial stiffness in healthy participants of various ages.

Methods

Healthy participants (n = 30) aged > 18 years were enrolled in the VR exercise-based program. All participants were required to wear a polar heart rate (HR) monitor set for moderate-intensity exercise, targeting 40%-59% of their HR reserve. Hemodynamic and arterial stiffness (pulse wave velocity) were noninvasively measured. The Borg scale rate of perceived exertion (RPE) was also assessed.

Results

Following a VR-guided exercise routine, all participants performed moderate-intensity exercise with no adverse health outcomes during or after the exercise. The effects of VR-based aerobic exercise extended beyond enhanced central hemodynamic and arterial stiffness. However, neither hemodynamic nor arterial stiffness showed significant differences before and after the VR exercise, except for a higher RPE response following the exercise program.

Conclusion

VR-based aerobic exercise with pulse rate monitoring is a promising physical activity tool to induce physiological changes and impact dyspnea scales and is also feasible for administration to healthy populations.

Impact of Exergames on the Rehabilitation of Cancer Patients Undergoing Major Abdominal Surgery: A Randomized Controlled Trial

BACKGROUND

Exergames can be an appealing strategy that is integrated into post-abdominal surgery rehabilitation.

OBJECTIVE

The aim of this study was to assess the effectiveness of exergame rehabilitation in improving independence in activities of daily living (ADLs) and patient balance after abdominal cancer surgery.

METHODS

A randomized control-group study was carried out in an oncological hospital in Portugal. Seventy postoperative patients were included, and data collection took place between January 2023 and May 2023. The patients were randomly assigned to either an exergame rehabilitation program (n = 35) or a traditional rehabilitation program (n = 35). The assessed outcomes were the Barthel and Berg scales, and data collection occurred at 3 different time points: admission, 48 hours postoperatively, and on the seventh day after surgery.

RESULTS

At the third assessment, a statistically significant difference was observed between the 2 groups for both indicators, ADLs and balance.

CONCLUSIONS

There was an improvement in ADLs and balance in the exergames group. By the seventh day after surgery, the intervention group showed improvement in balance and ADLs compared with the control group.

IMPLICATIONS FOR PRACTICE

The use of exergames can be a solution to the challenges of traditional rehabilitation methods after abdominal surgery for cancer for postoperative patients. This is the first study carried out in this specific population.

The value of audiovisual sexual stimulation with virtual reality in diagnosing erectile dysfunction

Background

The traditional audiovisual sexual stimulation (AVSS) test may experience limitations including low erectile response rate and lack of unified diagnostic criteria.

Aim

We aimed to explore the clinical value of AVSS with virtual reality (VR-AVSS) test in assessing erectile function and diagnosing erectile dysfunction (ED).

Methods

Participants 18 to 60 years of age were screened for analysis in 3 clinical centers from June 2020 to March 2022. Demographic data, 5-item International Index of Erectile Function (IIEF-5), erectile hardness score (EHS), and self-reported symptom questions were collected. The ED patients and control patients were confirmed according to the IIEF-5 and EHS. All subjects watched a 60-minute erotic video by VR device during RigiScan recording. The parameters including tip average rigidity, tip effective erectile duration (duration of rigidity ≥60%, tip effective erectile duration), base average rigidity, and base effective erectile duration were evaluated.

Outcomes

The main outcome of interest was the application of VR immersion technology to improve the traditional AVSS test.

Results

A total of 301 ED cases and 100 eligible control patients were included for final analysis. Compared with control patients, ED cases had significantly lower IIEF-5 scores, EHS, positive response rate, and erectile rigidity and duration. The positive response rate of ED and control patients were 75.5% and 90.9%, respectively. The cutoff points of tip average rigidity, tip effective erectile duration, base average rigidity, and base effective erectile duration were 40.5% (sensitivity: 77.6%, specificity: 70.2%; P < .001), 4.75 minutes (sensitivity: 75.9%, specificity: 75.4%; P < .001), 48.5% (sensitivity: 77.6%, specificity: 75.1%; P < .001), and 7.75 minutes (sensitivity: 79.3%, specificity: 75.7%; P < .001).

Clinical Implications

The technological superiority of VR will enable the VR-AVSS immersion test to be a more accurate detection than traditional AVSS modes.

Strengths and Limitations

Our study applied VR immersion technology to establish the standard operation procedure for the AVSS test, which could effectively reduce the interference of adverse factors and minimize the detecting errors. However, the test data only included positive response subjects, so the true erectile status of men with a negative response to the AVSS test cannot be obtained.

Conclusions

The VR-AVSS test can effectively improve the diagnostic accuracy of ED. The average rigidity and effective erectile duration were the optimal diagnostic parameters for excluding ED.

Effect of immersive virtual reality-based cognitive remediation in patients with mood or psychosis spectrum disorders: study protocol for a randomized, controlled, double-blinded trial

BACKGROUND

Cognitive impairments are prevalent across mood disorders and psychosis spectrum disorders, but there is a lack of real-life-like cognitive training programmes. Fully immersive virtual reality has the potential to ensure motivating and engaging cognitive training directly relevant to patients' daily lives. We will examine the effect of a 4-week, intensive virtual reality-based cognitive remediation programme involving daily life challenges on cognition and daily life functioning in patients with mood disorders or psychosis spectrum disorders and explore the neuronal underpinnings of potential treatment efficacy.

METHODS

The trial has a randomized, controlled, double-blinded, parallel-group design. We will include 66 symptomatically stable outpatients with mood disorders or psychosis spectrum disorders aged 18-55 years with objective and subjective cognitive impairment. Assessments encompassing a virtual reality test of daily life cognitive skills, neuropsychological testing, measures of daily life functioning, symptom ratings, questionnaires on subjective cognitive complaints, and quality of life are carried out at baseline, after the end of 4 weeks of treatment and at a 3-month follow-up after treatment completion. Functional magnetic resonance imaging scans are performed at baseline and at the end of treatment. The primary outcome is a broad cognitive composite score comprising five subtasks on a novel ecologically valid virtual reality test of daily life cognitive functions. Two complete data sets for 54 patients will provide a power of 80% to detect a clinically relevant between-group difference in the primary outcome. Behavioural data will be analysed using linear mixed models in SPSS, while MRI data will be analysed with the FMRIB Expert Analysis Tool (FEAT). Treatment-related changes in neural activity from baseline to end of treatment will be investigated for the dorsal prefrontal cortex and hippocampus as the regions of interest.

DISCUSSION

The results will provide insight into whether virtual reality-based cognitive remediation has beneficial effects on cognition and functioning in symptomatically stable patients with mood disorders or psychosis spectrum disorders, which can aid future treatment development.

TRIAL REGISTRATION

ClinicalTrials.gov NCT06038955. Registered on September 15, 2023.

Virtual Exercise in Medicine: A Proof of Concept in a Healthy Population

BACKGROUND

Science is beginning to establish the benefits of the use of virtual reality (VR) in health care. This therapeutic approach may be an appropriate complementary treatment for some mental illnesses. It could prevent high levels of morbidity and improve the physical health of patients. For many years, the literature has shown the health benefits of physical exercise. Physical exercise in a VR environment may improve the management of mild to moderate mental health conditions. In this context, we developed a virtual environment combined with an ergocycle (the augmented physical training for isolated and confined environments [APTICE] system).

OBJECTIVE

This study aims to investigate the impact of physical exercise in a VR environment.

METHODS

A total of 14 healthy participants (11 men and 3 women; mean age 43.28, SD 10.60 years) undertook 15 minutes of immersive physical exercise using the system. Measures included mindfulness and immersion disposition, subjective perceptions of sensory information, user experience, and VR experience (ie, psychological state, flow, and presence).

RESULTS

First, the APTICE system appears to be a useful tool because the user experience is positive (subscales in the AttrakDiff questionnaire: pragmatic quality=0.99; hedonic quality-stimulation=1.90; hedonic quality-identification=0.67; attractiveness=1.58). Second, the system can induce a positive psychological state (negative emotion, P=.06) and an experience of flow and presence (P values ranging from <.001 to .04). Third, individual immersive and mindful disposition plays a role in the VR experience (P values ranging from <.02 to .04). Finally, our findings suggest that there is a link between the subjective perception of sensory information and the VR experience (P values ranging from <.02 to .04).

CONCLUSIONS

These results indicate that the device is well accepted with positive psychological and exteroceptive outcomes. Overall, the APTICE system could be a proof of concept to explore the benefits of virtual physical exercise in clinical medicine.

Being in Virtual Reality and Its Influence on Brain Health-An Overview of Benefits, Limitations and Prospects

BACKGROUND

Dynamic technological development and its enormous impact on modern societies are posing new challenges for 21st-century neuroscience. A special place is occupied by technologies based on virtual reality (VR). VR tools have already played a significant role in both basic and clinical neuroscience due to their high accuracy, sensitivity and specificity and, above all, high ecological value.

OBJECTIVE

Being in a digital world affects the functioning of the body as a whole and its individual systems. The data obtained so far, both from experimental and modeling studies, as well as (clinical) observations, indicate their great and promising potential, but apart from the benefits, there are also losses and negative consequences for users.

METHODS

This review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) framework across electronic databases (such as Web of Science Core Collection; PubMed; and Scopus, Taylor & Francis Online and Wiley Online Library) to identify beneficial effects and applications, as well as adverse impacts, especially on brain health in human neuroscience.

RESULTS

More than half of these articles were published within the last five years and represent state-of-the-art approaches and results (e.g., 54.7% in Web of Sciences and 63.4% in PubMed), with review papers accounting for approximately 16%. The results show that in addition to proposed novel devices and systems, various methods or procedures for testing, validation and standardization are presented (about 1% of articles). Also included are virtual developers and experts, (bio)(neuro)informatics specialists, neuroscientists and medical professionals.

CONCLUSIONS

VR environments allow for expanding the field of research on perception and cognitive and motor imagery, both in healthy and patient populations. In this context, research on neuroplasticity phenomena, including mirror neuron networks and the effects of applied virtual (mirror) tasks and training, is of interest in virtual prevention and neurogeriatrics, especially in neurotherapy and neurorehabilitation in basic/clinical and digital neuroscience.

Immersive virtual reality in orthopaedics-a narrative review

PURPOSE

This narrative review explores the applications and benefits of immersive virtual reality (VR) in orthopaedics, with a focus on surgical training, patient functional recovery, and pain management.

METHODS

The review examines existing literature and research studies on immersive VR in orthopaedics, analyzing both experimental and clinical studies.

RESULTS

Immersive VR provides a realistic simulation environment for orthopaedic surgery training, enhancing surgical skills, reducing errors, and improving overall performance. In post-surgical recovery and rehabilitation, immersive VR environments can facilitate motor learning and functional recovery through virtual embodiment, motor imagery during action observation, and virtual training. Additionally VR-based functional recovery programs can improve patient adherence and outcomes. Moreover, VR has the potential to revolutionize pain management, offering a non-invasive, drug-free alternative. Virtual reality analgesia acts by a variety of means including engagement and diverting patients' attention, anxiety reduction, and specific virtual-body transformations.

CONCLUSION

Immersive virtual reality holds significant promise in orthopaedics, demonstrating potential for improved surgical training, patient functional recovery, and pain management but further research is needed to fully exploit the benefits of VR technology in these areas.

A psychosocial investigation of exercise preferences in real and virtual environments

Three studies explored exercise preferences in real-world and virtual environments, and their relationship with social physique anxiety (SPA), social comparison, and self-presentational efficacy (SPE). In Study 1 (N = 230), real-world exercise preferences were explored. Study 2 (N = 228) measured preferences for real-world and virtual reality (VR) exercise, and Study 3 (N = 249) investigated preferences for avatar embodiment and virtual companions within VR. Results revealed that participants who preferred home-based exercise had lower exercise behaviour, more negative fitness-related social comparisons, or lower SPE expectancy and outcome value (Study 1). Individuals with lower exercise behaviour, more negative fitness-related social comparisons, lower SPE expectancy, or higher SPA were also more likely to choose VR than real-world exercise (Study 2). In a VR exercise setting, participants with higher SPA and more negative social comparisons also preferred to embody a non-human and fantasy avatar more than a realistic avatar. A heightened threat of negative social comparison when imagining exercise with a physically superior virtual companion resulted in the strongest preference to embody a fantasy avatar (Study 3). The results suggest that individuals who place high importance on self-presentation and have low belief in their capacity to project an image of competence to others, are more likely to prefer exercise contexts that minimise physique- and fitness-related evaluation. Moreover, VR may afford a less psychosocially threatening context for individuals who feel self-conscious or comparatively inferior to others during exercise.

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.

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.

Anonymizing at-home fitness: enhancing privacy and motivation with virtual reality and try-on

Introduction

This study aimed to address privacy concerns associated with video conferencing tools used in home-based exercise training. To that end, a method that could anonymize participants' appearances and exercise environments during at-home fitness sessions was proposed.

Methods

This method combines virtual reality for 3-D human-model rendering using key-points tracking with a virtual try-on system enhanced by UV mapping and instance segmentation. To validate the proposed method, we conducted a user study by recruiting participants to assess effectiveness of virtual reality and virtual try-on in terms of privacy protection, self-confidence, and coaching satisfaction.

Results

Experimental results demonstrated the effectiveness and improved user experience of using virtual reality or virtual try-on in remote fitness, particularly in enhancing privacy protection and self-confidence with statistical significance. However, no significant differences were noted in coaching satisfaction.

Discussion

These findings confirmed the efficacy of our proposed approach. We believe that the proposed approach can significantly contribute to the future of remote fitness training, offering a more secure and engaging environment for users, thereby potentially increasing adherence to fitness regimens and overall physical wellbeing.

Virtual reality applications based on instrumental activities of daily living (iADLs) for cognitive intervention in older adults: a systematic review

BACKGROUND

In recent years, the use of virtual reality (VR) as a complementary intervention in treating cognitive impairment has significantly increased. VR applications based on instrumental activities of daily living (iADL-VR) could offer a promising approach with greater ecological validity for intervention in groups with cognitive impairments. However, the effectiveness of this approach is still debated.

OBJECTIVE

This systematic review aims to synthesize the effects of iADL-VR interventions to rehabilitate, train, or stimulate cognitive functions in healthy adults and people with mild cognitive impairment (MCI) and different types of dementia.

METHODS

A systematic search was performed in the Scopus, PubMed, IEEE Xplore, Web of Science, and APA PsycNet databases until September 2022 and repeated in April 2023. The selected studies met the search terms, were peer-reviewed, included an iADL-VR intervention, and were written in English. Descriptive, qualitative studies, reviews, cognitive assessment, non-intervention studies, those unrelated to VR or iADL, those focused on motor aspects, and non-degenerative disorders were excluded. The PEDro scale was used to assess the methodological quality of the controlled studies. To present and synthesize the results, we organized the extracted data into three tables, including PEDro scores, participant characteristics, and study characteristics.

RESULTS

Nineteen studies that met the inclusion and exclusion criteria were included. The total sample reached 590 participants, mostly women (72.67%). Approximately 30% were diagnosed with Alzheimer's disease or dementia, and 20% had mild cognitive impairment. Variables such as authors and year of publication, study design, type of intervention and VR applied, duration of the intervention, main findings, and conclusions were extracted. Regarding demographic characteristics, the sample size, age, sex, years of education, neurological diagnosis, dropouts, and the city and country where the intervention took place were recorded. Almost all studies showed improvements in some or all the outcomes after the intervention, generally greater in the iADL-VR group than in the control group.

CONCLUSION

iADL-VR interventions could be beneficial in improving the performance of cognitive functions in older adults and people with MCI and different types of dementia. The ecological component of these tasks makes them very suitable for transferring what has been learned to the real world. However, such transfer needs to be confirmed by further studies with larger and more homogeneous samples and longer follow-up periods. This review had no primary funding source and was registered with PROSPERO under registration ID: 375166.

Effects of digital-based interventions on muscular strength in adults: a systematic review, meta-analysis and meta-regression of randomized controlled trials with quality of evidence assessment

BACKGROUND

In the last three decades, both medical and sports science professionals have recognized the considerable potential of digital-based interventions (DBI) to enhance the health-related outcomes of their practitioners.

OBJECTIVES

This study aimed to investigate the effectiveness and potential moderators of DBI on measures of muscular strength.

METHODS

Six databases (PubMed/MEDLINE, Web of Science, SportDiscus, Embase, Cochrane Register of Controlled Trials and Google Scholar) were searched for eligible studies up to June 2022. The GRADE, PEDRO, and TIDieR checklists were used to assess the quality of evidence, methodology, and completeness of intervention descriptions, respectively.

RESULTS

A total of 56 studies were included in the meta-analysis (n = 2346), and participants were classified as healthy (n = 918), stroke survivors (n = 572), diagnosed with other neurological disorders (n = 683), and frail (n = 173). The DBI showed a small effect (standardized mean difference [SMD] = 0.28, 95% CI 0.21 to 0.31; p < 0.001) on strength, regardless of the type of intervention, control group, or tested body part. More specifically, while splitting the studies into different subgroups, a meta-analysis of 19 studies (n = 918) showed a small effect (SMD = 0.38, 95% CI 0.12 to 0.63; p = 0.003) on strength in the asymptomatic population. Similarly, small but positive effects of DBI were observed for stroke survivors (SMD = 0.34, 95% CI 0.13 to 0.56; p = 0.002), patients diagnosed with other neurological disorders (SMD = 0.17, 95% CI 0.03 to 0.32; p = 0.021), and the frail population (SMD = 0.25, 95% CI 0.0 to 0.5; p = 0.051). Sub-group analysis and meta-regression revealed that neither variable modified the effects of the DBI on measures of strength.

CONCLUSIONS

Overall, DBI may serve as an effective method to improve measures of strength in adults, regardless of their health status as well as the type of digital device, the presence of human-computer interaction, and the age of participants. In addition, the DBI was found to be more effective than traditional training or rehabilitation methods.KEY MESSAGESDigital-based intervention (DBI) is effective in improving measures of muscular strength in adults regardless of participants' health statusDBIs were equally effective for strength improvements in lower and upper limbsAlthough, DBIs were found to be effective in improving muscular strength, most studies did not follow strength training guidelines when prescribing the interventions.

Effects of Nonimmersive Virtual Reality Intervention on Children With Spastic Cerebral Palsy: A Meta-analysis and Systematic Review

ABSTRACT

This review aimed to assess the effectiveness of nonimmersive virtual reality intervention compared with traditional rehabilitation in improving the functions of the upper and lower limbs, balance, and social participation among children with spastic cerebral palsy. We used librarian-designed searches of 10 databases to identify research articles on randomized controlled trials that assessed the effectiveness of nonimmersive virtual reality in intervening spastic cerebral palsy patients up to April 15, 2023. Independent evaluation was conducted by two trained investigators using the evaluation criteria of randomized controlled trial quality indicated in the Cochrane Manual of Assessment "risk-of-bias tool." The Physical Therapy Evidence Database scale was used to evaluate the method and quality of the literature. Twenty-one research articles involving 779 patients with spastic cerebral palsy were included. Significant differences between the nonimmersive virtual reality rehabilitation and traditional rehabilitation groups were observed in all indicators, except for the Jebsen-Taylor Hand Function Test. Nonimmersive virtual reality intervention is effective in improving the function of the lower extremity, balance, and social participation in children with spastic cerebral palsy, but its effect on upper limb function is still controversial.

Exploring the efficacy of virtual reality-based rehabilitation in stroke: a narrative review of current evidence

BACKGROUND

Stroke rehabilitation presents a complex challenge, necessitating innovative approaches to optimise functional recovery. Virtual Reality-Based Rehabilitation (VRBR) has emerged as a promising intervention that capitalises on immersive technology to engage stroke survivors in their recovery journey. This review aims to examine the efficacy of VRBR in stroke rehabilitation, focusing on its advantages and challenges.

METHODS

A comprehensive search of relevant literature was conducted to gather evidence on the efficacy of VRBR in stroke survivors. Studies that investigated the impact of VRBR on patient engagement, functional recovery, and overall rehabilitation outcomes were included. The review also assessed the ability of VRBR to simulate real-life scenarios and facilitate essential daily activities for stroke survivors.

RESULTS

The review highlights that VRBR offers a unique immersive experience that enhances patient engagement and motivation during rehabilitation. The immersive nature of VRBR fosters a sense of presence, which can positively impact treatment adherence and outcomes. Moreover, VRBR's capacity to replicate real-world scenarios provides stroke survivors with opportunities to practice vital daily activities, promoting functional independence. In contrast, conventional rehabilitation methods lack the same level of engagement and real-world simulation.

CONCLUSION

VRBR holds promise as an efficacious intervention in stroke rehabilitation. Its immersive nature enhances patient engagement and motivation, potentially leading to better treatment adherence and outcomes. The ability of VRBR to simulate real-life scenarios offers a unique platform. However, challenges such as cost, equipment, patient suitability, data privacy, and acceptance must be addressed for successful integration into stroke rehabilitation practice.

Motivating older adults through immersive virtual exercise (MOTIVE): A randomized pilot study

BACKGROUND

This study aimed to: 1) determine the feasibility of a virtual reality physical activity intervention among older adults and 2) test the preliminary effectiveness of the intervention at increasing physical activity and 3) decreasing depressive symptoms.

METHODS

We included 10 older adults randomized into the Motivating Older Adults Through Immersive Virtual Exercise (MOTIVE) intervention group and 10 randomized into the physical activity education only control group. We analyzed the data using descriptive statistics and linear mixed models, testing the interaction of time and the treatment condition.

RESULTS

Participants in the intervention group attended an average of 15 out of the 16 sessions. A total of 90% of MOTIVE intervention group participants "completely agreed" that the intervention was acceptable, (compared to 30% of education control group participants).

CONCLUSION

This study supports testing the effectiveness of the intervention at improving physical activity and depressive symptoms in a larger sample of older adults.

Effects of Virtual Reality Pilates Training on Duration of Posture Maintenance and Flow in Young, Healthy Individuals: Randomized Crossover Trial

BACKGROUND

This study explored the use of virtual reality (VR) technology to enhance the effectiveness and duration of low-intensity movements and postures in Pilates-derived exercises. We postulate that by leveraging the flow state in VR, individuals can engage in these exercises for longer periods while maintaining a high level of flow.

OBJECTIVE

The purpose of this study was to compare differences in posture maintenance and flow between VR Pilates training and conventional Pilates training, and the correlation between the 2 factors.

METHODS

The 18 participants in each group received either VR training or conventional training and were switched to the other training type after a 2-day wash-out period. Each group performed Pilates movements in a VR environment and a conventional environment, divided into 4 types. After training sessions, participants were evaluated for flow using a self-report questionnaire. In addition, a sports video analysis program was used to measure the duration of posture maintenance in 2 video-recorded sessions. Repeated-measures ANOVA and correlation analysis were performed on the measured duration of posture maintenance and flow scores. In all cases, the statistical significance level was set at P<.05.

RESULTS

Results for the duration of posture maintenance verification by type showed that simple behavior (F1,16=17.631; P<.001), upper body-arm coordination behavior (F1,16=6.083; P=.04), upper body-leg coordination behavior (F1,16=8.359; P<.001), and whole-body coordination behavior (F1,16=8.426; P<.001) all showed an interaction effect at P<.05. Flow (F1,16=15.250; P<.001) also showed an interaction effect. In addition, significant correlations were determined between duration of all types of posture maintenance and flow in the VR training group at P<.05.

CONCLUSIONS

Our results indicate that VR Pilates training may be more useful than conventional Pilates training in improving the duration of posture maintenance and that it promotes a significantly higher degree of flow when compared with conventional Pilates training.

Perspectives in Wearable Systems in the Human-Robot Interaction (HRI) Field

Due to the advantages of ease of use, less motion disturbance, and low cost, wearable systems have been widely used in the human-machine interaction (HRI) field. However, HRI in complex clinical rehabilitation scenarios has further requirements for wearable sensor systems, which has aroused the interest of many researchers. However, the traditional wearable system has problems such as low integration, limited types of measurement data, and low accuracy, causing a gap with the actual needs of HRI. This paper will introduce the latest progress in the current wearable systems of HRI from four aspects. First of all, it introduces the breakthroughs of current research in system integration, which includes processing chips and flexible sensing modules to reduce the system's volume and increase battery life. After that, this paper reviews the latest progress of wearable systems in electrochemical measurement, which can extract single or multiple biomarkers from biological fluids such as sweat. In addition, the clinical application of non-invasive wearable systems is introduced, which solves the pain and discomfort problems caused by traditional clinical invasive measurement equipment. Finally, progress in the combination of current wearable systems and the latest machine-learning methods is shown, where higher accuracy and indirect acquisition of data that cannot be directly measured is achieved. From the evidence presented, we believe that the development trend of wearable systems in HRI is heading towards high integration, multi-electrochemical measurement data, and clinical and intelligent development.

Prediction of Gait Kinematics and Kinetics: A Systematic Review of EMG and EEG Signal Use and Their Contribution to Prediction Accuracy

Human-machine interfaces hold promise in enhancing rehabilitation by predicting and responding to subjects' movement intent. In gait rehabilitation, neural network architectures utilize lower-limb muscle and brain activity to predict continuous kinematics and kinetics during stepping and walking. This systematic review, spanning five databases, assessed 16 papers meeting inclusion criteria. Studies predicted lower-limb kinematics and kinetics using electroencephalograms (EEGs), electromyograms (EMGs), or a combination with kinematic data and anthropological parameters. Long short-term memory (LSTM) and convolutional neural network (CNN) tools demonstrated highest accuracies. EEG focused on joint angles, while EMG predicted moments and torque joints. Useful EEG electrode locations included C3, C4, Cz, P3, F4, and F8. Vastus Lateralis, Rectus Femoris, and Gastrocnemius were the most commonly accessed muscles for kinematic and kinetic prediction using EMGs. No studies combining EEGs and EMGs to predict lower-limb kinematics and kinetics during stepping or walking were found, suggesting a potential avenue for future development in this technology.

Effects of Virtual Reality Exercises on Chronic Low Back Pain: Quasi-Experimental Study

BACKGROUND

Low back pain is a common health problem globally. Based on the duration of pain, it is classified as acute, subacute, or chronic low back pain. Different treatment strategies are available to reduce chronic low back pain. Virtual reality (VR) is a novel approach in back pain rehabilitation.

OBJECTIVE

This study aimed to compare the effects of VR games on chronic low back pain.

METHODS

This quasi-experimental study was conducted among 40 patients with chronic low back pain. The data were collected using a nonprobability, convenient sampling technique. Patients visiting the Department of Physiotherapy, Government Services Hospital, Lahore, Pakistan, were recruited and equally divided into 4 groups. Group A received the Reflex Ridge game; group B received the Body Ball game; group C combined the 2 games without back-strengthening exercises; and group D combined the 2 games with back-strengthening exercises. The participants received 8 treatment sessions, with 3 sessions/wk. The outcomes were pre- and posttest measurements of pain intensity, low back disability, and lumbar range of motion. The repeated measurement ANOVA was used for inter- and intragroup comparison, with significance at P≤.05.

RESULTS

The study comprised a sample of 40 patients with low back pain; 12 (40%) were female and 28 (60%) were male, with a mean age of 37.85 (SD 12.15) years. The pre- and posttest mean pain scores were 7.60 (SD 1.84) and 4.20 (SD 1.62) in group A, 6.60 (SD 1.776) and 5.90 (SD 1.73) in group B, 6.90 (SD 1.73) and 5.40 (SD 1.07) in group C, and 7.10 (SD 1.53) and 3.60 (SD 0.97) in group D, respectively. The mean pain score differences of group D (combining the Reflex Ridge and Body Ball games with back-strengthening exercises) compared to groups A, B, and C were -.60 (P=.76), -2.30 (P<.001), and -1.80 (P=.03), respectively. Regarding the range of motion, the forward lumbar flexion mean differences of group D compared to groups A, B, and C were 3.80 (P=.21), 4.80 (P=.07), and 7.40 (P<.001), respectively. Similarly, the right lateral lumbar flexion mean differences of group D compared to groups A, B, and C were 2.80 (P=.04), 5.20 (P<.001), and 4.80 (P<.001), respectively. The left lateral lumbar flexion mean differences of group D compared to groups A, B, and C were 2.80 (P<.001), 4.80 (P=.02), and 2.20 (P<.001). respectively, showing significant pre- and posttreatment effects.

CONCLUSIONS

VR exercises had statistically significant effects on improving pain, low back disability, and range of motion in all groups, but the combination of Reflex Ridge and Body Ball games with back-strengthening exercises had dominant effects compared to the other groups.

TRIAL REGISTRATION

Iranian Registry of Clinical Trial IRCT20200330046895N1; https://en.irct.ir/trial/46916.

Virtual reality to improve low-back pain and pelvic pain during pregnancy: a pilot RCT for a multicenter randomized controlled trial

A significant proportion of women experience low back and pelvic pain during and after pregnancy, which can negatively impact their daily lives. Various factors are attributed to these complaints, and many affected women do not receive adequate healthcare. However, there is evidence to support the use of different physiotherapeutic interventions to alleviate these conditions. Virtual reality is a promising complementary treatment to physiotherapy, particularly in improving pain perception and avoidance. The primary objective of this study is to evaluate the efficacy of a four-week program combining VR and physiotherapy compared to standard physiotherapy in pregnant women with low back and pelvic pain, in terms of improving pain avoidance, intensity, disability, and functional level. The study also aims to investigate patient satisfaction with the VR intervention. This research will be conducted through a multi-center randomized controlled clinical trial involving pregnant patients residing in the provinces of Seville and Malaga with a diagnosis of low back and pelvic pain during pregnancy. The alternative hypothesis is that the implementation of a Virtual Reality program in combination with standard physiotherapy will result in better clinical outcomes compared to the current standard intervention, which could lead to the development of new policies and interventions for these pathologies and their consequences. Clinical trial registration: clinicaltrials.gov, identifier NCT05571358.

The Efficacy of Virtual Reality-Based Interventions in Breast Cancer-Related Symptom Management: A Systematic Review and Meta-analysis

BACKGROUND

Breast cancer patients experience a range of disease- and treatment-related symptoms that seriously threaten their quality of life. Virtual reality (VR), an emerging complementary and integrative therapy, has been increasingly applied in clinical practice. However, there is insufficient evidence to support the effectiveness of VR-based interventions on symptom management in breast cancer patients.

OBJECTIVE

This article aimed to systematically examine the effects of VR on breast cancer-related symptom management.

METHODS

The PubMed, EMBASE, Cochrane Library, Web of Science, CINAHL, CNKI, Wan Fang, and VIP databases were comprehensively searched for randomized controlled trials (RCTs) and quasi-RCTs published up to April 10, 2021. Studies using VR-based interventions to manage breast cancer-related symptoms were included. Two investigators independently reviewed and extracted data and evaluated methodological quality. RevMan 5.3 was used for meta-analysis, and heterogeneity was evaluated using Higgins' I2 (%) statistic.

RESULTS

Eight RCTs and 6 quasi-RCTs with 797 participants were included. Virtual reality-based interventions significantly improved symptoms of anxiety, depression, pain, cognitive function, and shoulder range of motion in breast cancer patients, but no significant improvements in grip and upper extremity function were observed.

CONCLUSION

Virtual reality-based interventions had a positive effect on symptom management for breast cancer patients.

IMPLICATIONS FOR PRACTICE

Health professionals, especially nurses, can apply VR in clinical practice to reduce symptoms and improve the quality of life of breast cancer patients. More studies are needed to draw higher quality conclusions and explore the best interventions and cost-effectiveness of VR.

Game-based intradialytic non-weight-bearing exercise training on gait speed and balance in older adults with diabetes: a single-blind randomized controlled trial

Older adults with diabetes receiving hemodialysis have impaired gait speed and balance compared to the general population, which have been associated with increased risks of falls and mortality. This study evaluated the effectiveness of a game-based intradialytic exercise training program (iExergame) on improving gait speed and balance. This was a single-blind randomized controlled trial. The intervention group (IG) received iExergame training using real-time audiovisual feedback with wearable inertial sensors. The control group (CG) received conventional training without any technology. Both trainings were intradialytic, non-weight-bearing, and used ankle range of motion. Gait and balance parameters were collected at baseline and 4-week follow-up. Data from 70 adults (age 64.2 ± 9.0 years) were analyzed. Compared to the CG, the IG showed greater changes between baseline and 4-week follow-up in several parameters. Gait parameters included faster speeds and longer stride lengths, particularly during dual task walking (p < 0.050). Balance parameters included reductions in center of mass (p = 0.004), ankle (p < 0.001), and hip (p = 0.010) sways during semi-tandem stance, particularly in users of assistive devices. iExergame training could improve gait speed and balance in this population and might be an option to increase intradialytic exercise adherence while reducing burdens of exercise administration.

Rehabilitation effects of game therapy in people living with dementia: A systematic review and meta-analysis: Three formats of game therapy for Alzheimer's patients

BACKGROUND

As a devastating neurodegenerative disease, Alzheimer's disease (AD) imposes a considerable direct and indirect financial burden. However, effective drug treatment options are limited. In recent years, game therapy has become a research hotspot in this field.

AIMS

The purpose of this study was to synthesize the conclusions of existing studies and integrate the data to evaluate the effects of game therapy on people living with dementia (PLWD).

METHODS

We included randomized clinical trials and quasi-experimental studies which assessed the impacts of game therapy on PLWD and took cognitive function, quality of life, and depression as outcome indicators. Two trained researchers independently screened the studies, evaluated the quality, and extracted the data. Statistical analysis was performed by Review Manager (Revman) 5.3 and STATA16.0 software.

RESULTS

There were 12 studies involving 877 PLWD included, total. The results of the meta-analysis demonstrated that the Mini-Mental State Examination (MMSE) scores of the test group were significantly higher than that of the control group (SMD = 2.69, 95% CI [1.88, 3.51], p < .01), and the Cornell Scale for Depression in Dementia scores of the test group were significantly lower than those of the control group (SMD = -4.28, 95% CI [-6.96, -1.60], p < .01); but in terms of quality of life (SMD = 0.17, 95% CI [-0.82, 1.16], p = .74), the difference was not statistically significant.

LINKING EVIDENCE TO ACTION

Game therapy can improve cognitive function and depression in PLWD. The combination of different types of games can improve the different clinical symptoms of PLWD, and different intervention time also have different effects on the outcome, which shows that we can develop unique, systematic, safe, and scientific game intervention programs for PLWD to improve their cognitive function and depression.

The effects of virtual reality-based exercise in adults receiving haemodialysis treatment: A systematic review and meta-analysis of randomized controlled studies

This meta-analysis aimed to synthesize the effects of virtual reality-based exercise on physical function, depression symptoms and quality of life in adults receiving haemodialysis. Data were analysed using Comprehensive Meta-Analysis Version 3. The random-effects meta-analysis was performed to pool intervention effects. A total of five studies were included. The majority of included studies compared intervention with passive control group. This meta-analysis showed with a moderate to high quality of evidence that virtual reality-based exercise has positive medium effect on improving physical function such as gait speed (g = .40, 95% CI 0.00 to 0.81), sit to stand 10 times (g = -.41, 95% CI -0.825 to -0.009), sit to stand in 60 s (g = .56, 95% CI 0.151 to 0.974), 6-min walk test (g = .66, 95% CI 0.247 to 1.079), not affect time up and go and sit to stand five times. The study indicated with moderate quality of evidence that virtual reality-based exercise had no effect on depression symptoms. The study also showed with a moderate quality of evidence that the intervention had a positive medium effect on improving physical function (g = .64, 95% CI 0.20 to 1.09). In conclusion, virtual reality-based exercise can be performed to improve physical function and quality of life of adults receiving haemodialysis for health professionals.

Effects of virtual reality for psychological health of ICU patients: a study protocol for systematic review and meta-analysis

INTRODUCTION

Virtual reality (VR) has been shown to have a certain influence on the psychological health of intensive care unit (ICU) patients. However, its specific effects-particularly on psychological health problems, such as psychological well-being, quality of life (QOL) and patient satisfaction-remain unclear.

METHOD AND ANALYSIS

This study follows the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols guidelines. Electronic data search is carried out on PubMed, Web of Science, CINAHL, EBSCO, EMBASE, Cochrane Library, PsycINFO, China National Knowledge Infrastructure, Wan Fang, VIP and Chinese Biology Medicine Database. The inclusion criteria follow the PICO principle, wherein ICU patients who have been hospitalised for 24 hours or more are included. Studies using VR-based interventions to improve the psychological health of ICU patients, compared with waitlist controls or traditional therapy groups; outcome assessments containing psychological well-being, QOL and patient satisfaction; and those designed as randomised controlled trials (RCTs) and quasi-experimental research are included. Search time is from inception of each database to July 2023. No language restriction is considered. Studies for inclusion are screened by two independent reviewers for data extraction. Any dispute is resolved through discussion. Unresolved disputes are decided on by consulting a third author. For the risk of bias assessment in RCTs and non-RCTs, the Cochrane risk-of-bias tool for randomised trials and risk of bias in non-randomised studies of interventions tool are used, respectively. For meta-analysis, RevMan V.5.3 is used.

ETHICS AND DISSEMINATION

This protocol study does not include clinical research and thus does not require ethical approval. Research findings will be released in a peer-reviewed journal.

PROSPERO REGISTRATION NUMBER

CRD42023400428.

Virtual Reality and Cardiac Diseases: A Systematic Review of Applications and Effects

Introduction

Cardiac diseases have grown significantly in recent years, causing many deaths globally. Cardiac diseases can impose a significant economic burden on societies. The development of virtual reality technology has attracted the attention of many researchers in recent years. This study aimed to investigate the applications and effects of virtual reality (VR) technology on cardiac diseases.

Methods

A comprehensive search was carried out in four databases, including Scopus, Medline (through PubMed), Web of Science, and IEEE Xplore to identify related articles published until May 25, 2022. Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) guideline for systematic reviews was followed. All randomized trials that investigated the effects of virtual reality on cardiac diseases were included in this systematic review.

Results

Twenty-six studies were included in this systematic review. The results illustrated that virtual reality applications in cardiac diseases can be classified in three categories of physical rehabilitation, psychological rehabilitation, and education/training. This study revealed that the use of virtual reality in psychological and physical rehabilitation can reduce stress, emotional tension, Hospital Anxiety and Depression Scale (HADS) total score, anxiety, depression, pain, systolic blood pressure, and length of hospitalization. Finally, the use of virtual reality in education/training can enhance technical performance, increase the speed of procedures, and improve the user's skills, level of knowledge, and self-confidence as well as facilitate learning. Also, the most limitations mentioned in the studies included small sample size and lack of or short duration of follow-up.

Conclusions

The results showed that the positive effects of using virtual reality in cardiac diseases are much more than its negative effects. Considering that the most limitations mentioned in the studies were the small sample size and short duration of follow-up, it is necessary to conduct studies with adequate methodological quality to report their effects in the short term and long term.

Physical Activity in Immersive Virtual Reality: A Scoping Review

Physical activity has benefits for health, but many adolescents are inactive. However, video games such as Immersive Virtual Reality (IVR) have grown in popularity as a leisure activity among young people, allowing them to manipulate objects in virtual environments increasing the practice of physical activity. The evidence indicates that the interest in physical activity through IVR is greater than in traditional methods, and different experiences have been reported. However, few studies indicate the sample evaluated, the effects found, or the IVR instruments used. Due to this, is the aim of this study is to identify the publications referring to IVR and physical activity, characterize them, and present the obtained main findings. For this, the guidelines described in the PRISMA-ScR for scoping reviews were applied. After the use of the inclusion and exclusion criteria, eight articles were included. Results show evidence regarding physiological outcomes, perceptual variables, interest and enjoyment, and psychological effects regarding physical activity through IVR. Additionally, the use of different devices and their prescriptions are explored. It is concluded that there is interest from the scientific community for the practice of physical activity through IVR, as well as for its application for the maintenance of active habits. This is important as it positions IVR as a method that can be a more experiential and effective way to develop and maintain a healthy lifestyle.

A Recovery-Oriented Program for People with Bipolar Disorder through Virtual Reality-Based Cognitive Remediation: Results of a Feasibility Randomized Clinical Trial

Background: Cognitive impairment is a frequent consequence of bipolar disorder (BD) that is difficult to prevent and treat. In addition, the quality of the preliminary evidence on the treatment of BD through Cognitive Remediation (CR) with traditional methods is poor. This study aims to evaluate the feasibility of a CR intervention with fully immersive Virtual Reality (VR) as an additional treatment for BD and offers preliminary data on its efficacy. Methods: Feasibility randomized controlled cross-over clinical study, with experimental condition lasting three months, crossed between two groups. Experimental condition: CR fully immersive VR recovery-oriented program plus conventional care; Control condition: conventional care. The control group began the experimental condition after a three months period of conventional care (waiting list). After the randomization of 50 people with BD diagnosis, the final sample consists of 39 participants in the experimental condition and 25 in the control condition because of dropouts. Results: Acceptability and tolerability of the intervention were good. Compared to the waitlist group, the experimental group reported a significant improvement regarding cognitive functions (memory: p = 0.003; attention: p = 0.002, verbal fluency: p = 0.010, executive function: p = 0.003), depressive symptoms (p = 0.030), emotional awareness (p = 0.007) and biological rhythms (p = 0.029). Conclusions: The results are preliminary and cannot be considered exhaustive due to the small sample size. However, the evidence of efficacy, together with the good acceptability of the intervention, is of interest. These results suggest the need to conduct studies with larger samples that can confirm this data. Trial registration: ClinicalTrialsgov NCT05070065, registered in September 2021

Application and Effect of Virtual Reality Technology in Motor Skill Intervention for Individuals with Developmental Disabilities: A Systematic Review

Children and adolescents with developmental disabilities are often impaired with motor function, and motor skills are related to the performance of daily living activities, and their defects may limit social participation and reduce the quality of life. With the progress of information technology, virtual reality is used as an emerging and alternative intervention method for the intervention of its motor skills. However, the application of this field is still limited in our country, so it is of great significance to systematically analyze the foreign intervention in this field. The research used Web of Science, EBSCO, PubMed, and other databases to search the literature published in the past ten years on the application of virtual reality technology in the motor skill intervention of people with developmental disabilities, and analyzed the demographic characteristics, intervention target behavior, intervention time, intervention effect, and statistical methods. The advantages and disadvantages of research in this field are summarized, and on this basis, the reflection and prospects for follow-up intervention research are put forward.

Fully Immersive Virtual Reality-Based Cognitive Remediation for Adults with Psychosocial Disabilities: A Systematic Scoping Review of Methods Intervention Gaps and Meta-Analysis of Published Effectiveness Studies

BACKGROUND

Cognitive Remediation (CR) programs are effective for the treatment of mental diseases; in recent years, Virtual Reality (VR) rehabilitation tools are increasingly used. This study aimed to systematically review and meta-analyze the published randomized controlled trials that used fully immersive VR tools for CR programs in psychiatric rehabilitation. We also wanted to map currently published CR/VR interventions, their methods components, and their evidence base, including the framework of the development intervention of CR in fully immersive VR.

METHODS

Level 1 of evidence. This study followed the PRISMA extension for Scoping Reviews and Systematic Review. Three electronic databases (Pubmed, Cochrane Library, Embase) were systematically searched, and studies were included if they met the eligibility criteria: only randomized clinical trials, only studies with fully immersive VR, and only CR for the adult population with mental disorders.

RESULTS

We found 4905 (database) plus 7 (manual/citation searching articles) eligible studies. According to inclusion criteria, 11 studies were finally reviewed. Of these, nine included patients with mild cognitive impairment, one with schizophrenia, and one with mild dementia. Most studies used an ecological scenario, with improvement across all cognitive domains. Although eight studies showed significant efficacy of CR/VR, the interventions' development was poorly described, and few details were given on the interventions' components.

CONCLUSIONS

Although CR/VR seems to be effective in clinical and feasibility outcomes, the interventions and their components are not clearly described. This limits the understanding of the effectiveness and undermines their real-world implementation and the establishment of a gold standard for fully immersive VR/CR.

Differences in Brain Activity and Body Movements Between Virtual Reality and Offline Exercise: Randomized Crossover Trial

BACKGROUND

Virtual reality (VR) has been suggested to be effective at enhancing physical exercises because of its immersive characteristics. However, few studies have quantitatively assessed the range of motion and brain activity during VR exercises.

OBJECTIVE

We hypothesized that 3D immersive VR could stimulate body movement and brain activity more effectively than standard exercises and that the increased range of motions during 3D immersive VR exercises would be associated with orbitofrontal activation.

METHODS

A randomized crossover trial was conducted to compare exercises with and without VR. A total of 24 healthy males performed the same motions when exercising with and without 3D immersive VR, and the recorded videos were used for motion analysis. Hemodynamic changes in the prefrontal cortex were assessed using functional near-infrared spectroscopy.

RESULTS

There were significant differences in the total angle (z=-2.31; P=.02), length (z=-2.78; P=.005), calorie consumption (z=-3.04; P=.002), and change in accumulated oxygenated hemoglobin within the right orbitofrontal cortex (F^1,94=9.36; P=.003) between the VR and offline trials. Hemodynamic changes in the right orbitofrontal cortex were positively correlated with the total angle (r=0.45; P=.001) and length (r=0.38; P=.007) in the VR exercise; however, there was no significant correlation in the offline trial.

CONCLUSIONS

The results of this study suggest that 3D immersive VR exercise effectively increases the range of motion in healthy individuals in relation to orbitofrontal activation.

TRIAL REGISTRATION

Clinical Research Information Service KCT0008021; https://cris.nih.go.kr/cris/search/detailSearch.do/23671.

Cardiac autonomic modulation in response to postural transition during a virtual reality task in individuals with spinal cord injury: A cross-sectional study

PURPOSE

The postural transition from sitting to standing is a moment of dysautonomic occurrence in individuals with Spinal Cord Injury (SCI). Different tools can be used to minimize this event, such as virtual reality. Thus, we aimed to analyze cardiac autonomic modulation in individuals with SCI during postural transition from the sitting to orthostatism position using a cognitive virtual reality (VR) task.

METHODS

Individuals with and without SCI were positioned on the Easy Stand® device, sitting at rest, at 0° considering the angle between the seat and the floor, elevation at 45°, and orthostatism at 90°, for 5 minutes in each position. Heart rate variability (HRV) measures of sympathovagal balance were collected (heart rate receiver: Polar V800). The groups were subdivided into two groups, one that performed VR as an intervention during the postural angle changes and another group that did not perform VR.

RESULTS

We evaluated 76 individuals, 40 with a medical diagnosis of SCI and 36 who composed the able-bodied control group without SCI, matched by age and sex. The HRV results showed that the SCI group who performed the task in VR demonstrated no significant difference in parasympathetic activation and global variability between the sitting versus 90° positions. There was better sympathovagal balance in SCI and able-bodied control groups who performed the VR task between the sitting versus 90° positions.

CONCLUSION

The use of a VR task seems to contribute to better sympathovagal balance, with the potential to reduce dysautonomia during postural changes.

Can virtual reality technology be considered as a part of the surgical care pathway?

INTRODUCTION

Virtual reality (VR) is emerging as a new technology in the healthcare sector. It has been shown to enhance the patient's experience and satisfaction in various settings. This review aims to give a brief description of the use of VR and establish validity of its applications to improve the patient's pathway through surgery.

METHODS

A literature search was conducted using the PubMed and Embase™ databases to identify fields in which VR technology has been trialled in relation to surgery. The search terms 'virtual reality' and 'surgery' were employed.

RESULTS

Although benefits relating to VR use have been identified in mental health, obesity management, and physical and cognitive rehabilitation, those in surgery have been less well documented. There are, however, some important but limited benefits reported in managing surgery related stress and improving preoperative patient education as well as VR being an adjunct to some level of postoperative analgesia.

CONCLUSIONS

The current applications of VR in relation to surgical care fall into four main categories: preoperative education, supporting mental health, postoperative pain management, and pre and postoperative patient optimisation. Future studies and validation of VR applications should be carried out so the technology can be utilised throughout the entire patient pathway as VR surgical care bundles.

Breathlessness and exercise with virtual reality system in long-post-coronavirus disease 2019 patients

Long-post-coronavirus disease-2019 (COVID-19) patients tend to claim residual symptomatology from various systems, most importantly the respiratory and central nervous systems. Breathlessness and brain fog are the main complaints. The pulmonary function pattern is consistent with restrictive defects, which, in most cases, are self-resolved, while the cognitive profile may be impaired. Rehabilitation is an ongoing field for holistic management of long-post-COVID-19 patients. Virtual reality (VR) applications may represent an innovative implementation of rehabilitation. We aimed to investigate the effect of exercise with and without the VR system and to assess further breathlessness and functional fitness indicators in long-post-COVID-19 patients with mild cognitive impairment after self-selected exercise duration using the VR system. Twenty long-post-COVID-19 patients were enrolled in our study (age: 53.9 ± 9.1 years, male: 80%, body mass index: 28.1 ± 3.1 kg/m²). Participants' anthropometric data were recorded, and they underwent pulmonary functional test evaluation as well as sleep quality and cognitive assessment. The participants randomly exercised with and without a VR system (VR vs. no-VR) and, later, self-selected the exercise duration using the VR system. The results showed that exercise with VR resulted in a lower dyspnea score than exercise without VR. In conclusion, VR applications seem to be an attractive and safe tool for implementing rehabilitation. They can enhance performance during exercise and benefit patients with both respiratory and cognitive symptoms.

The effect of six week virtual reality training on the improvement of functional balance in women with type-I osteoporosis: A preliminary study

Purpose

This preliminary study aimed to investigate the effects of exergames in a virtual reality environment to improve functional balance during goal-directed functional tasks in postmenopausal women with osteoporosis.

Methods

Twelve volunteer postmenopausal women with osteoporosis were randomly assigned to virtual reality (VRT, n = 6) and conventional multimodal (CMT, n = 6) training groups. The exercise was performed for 6 weeks, 3 days weekly, and 18 sessions. Using a force platform, functional balance assessments were made through four dynamic tasks, including performance-based limits of stability (LOS), curve tracking (CT), sit-to-stand (STS), and turning before and after 18 sessions of treatment. Each task's time-dependent center of pressure (COP) variables was separately calculated via Kistler-Mars software.

Results

The COP variables of LOS and CT tasks were significantly improved after 6 weeks of CMT and VRT (P ≤ 0.05). In the VRT group, the rising index (P < 0.00), COP sway velocity in STS, and Turn sway were significantly reduced (P < 0.05). Following the VRT, the mean difference of forwarding maximum COP excursion increased (P = 0.03), and errors in CT (P = 0.03) significantly decreased.

Conclusion

The VRT and CMT improved the COP sway parameters during weight-shifting tasks. The VRT was more effective than CMT in increasing the ability to control weight-shifting and dynamic functional tasks in postmenopausal women with osteoporosis. This approach in training has suitable potential to provide convenient error feedback learning.

Virtual Therapy Complementary Prehabilitation of Women Diagnosed with Breast Cancer-A Pilot Study

Breast cancer is becoming an important issue due to its various consequences and epidemiology. Studies are showing that it extremely impacts the mental health as well as the physical activity of the patients. In addition to the most common symptom, which is fatigue, patients also have problems with the quality of sleep. Therefore, this study aimed to evaluate the effectiveness of virtual reality (VR) therapy in improving the mental state and quality of sleep, as well as increasing the physical activity (PA) of patients diagnosed with breast cancer. The study was conducted in a hospital's Breast Unit and included patients at the time of diagnosis of malignant breast cancer. A total of 16 subjects randomly divided into experimental (n = 9), and control (n = 7) groups were measured with the Beck Depression Scale, Mental Adjustment to Cancer Scale, International Physical Activity Questionnaire, and Pittsburgh Sleep Quality Index at two timepoints. The experimental intervention consisted of a 2-week (8 sessions) Virtual Therapeutic Garden (VRTierOne) procedure performed daily for about 15 min. Significant differences were identified between groups in the interactions between the main factors seen in the destructive style of the Mini-Mac scale: F(1.14) = 4.82, p = 0.04, and between multiple experiments: F(1.14)= 5.54, p = 0.03 showing a significant reduction in the destructive style of coping with the disease in the study group after therapy (32.44 vs. 28.33, p = 0.003). The level of main effects [study] for the constructive style is F(1.14) = 3.93, p = 0.06 with a significant increase in constructive style in the study group (43.33 vs. 45.33, p = 0.044). Significant differences in levels of depression between multiple experiments: F(1.14) = 5.04, p = 0.04, show a significant reduction in the severity of depressive symptoms was found in the experimental group after therapy (13.33 vs. 8.11, p = 0.02). However, the analysis did not show significant differences between group analyses (p = 0.25). It seems that VR reduces the severity of depressive symptoms and reduces the destructive style and can be an effective option in improving the mental state of patients diagnosed with breast cancer.

Effects of Virtual Reality Exercises versus Isokinetic Exercises in comparison with Conventional Exercises on the Imaging Findings and Inflammatory Biomarker Changes in Soccer Players with Non-Specific Low Back Pain: A Randomized Controlled Trial

Chronic non-specific low back pain (CNLBP) is the most common musculoskeletal problem. The purpose of this study was to investigate the effects of advanced physiotherapeutic exercise programs on imaging findings and inflammatory biomarkers in soccer players with CNLBP. In total, 60 CNLBP participants were divided into virtual reality exercise (VRE; n = 20), isokinetic exercise (IKE; n = 20), and conventional exercise (n = 20) groups. Pain intensity, imaging findings (muscle cross-sectional area (CSA) and muscle thickness), and changes in inflammatory biomarkers (CRP, TNF-α, IL-2, IL-4, and IL-6) were measured at baseline and after four weeks. After four weeks of intervention, there was a significant improvement (p = 0.001) in pain intensity for the VRE vs. IKE (0.7; CI 95% 0.38 to 1.07) and VRE vs. conventional (3.0 CI 95% 2.68 to 3.31) groups. The IKE group showed a greater number of significant changes in muscle CSA and muscle thickness than the other two groups (p < 0.001). Moreover, the VRE group showed significant improvement in inflammatory biomarker measures compared with the other two groups (p < 0.001). In CNLBP, virtual and isokinetic exercises had equal effects on reducing pain intensity. Isokinetic exercise is beneficial in increasing the muscle CSA and thickness, and virtual exercises are helpful for attenuating the inflammation process in soccer players with CNLBP.

Eye problems and musculoskeletal pain in Pokémon Go players

Individuals benefit from Pokémon Go (PG) gaming because this mobile augmented reality geolocation video game provides an attractive opportunity to increase physical activity outdoors and socialize. However, based on gaming and electronic media studies, intense involvement with PG is likely related to adverse phenomena, such as arm pain or eye-related problems. We aimed to test how PG use (problematic vs. non-problematic gaming and gaming time) is related to physical symptoms (pain in three body regions and computer vision syndrome). To dissect game-specific effects, we controlled for general problematic smartphone use, phubbing, and electronic media usage. PG players (N = 455) completed an online survey. We found that PG players with problematic game use reported more pain and vision problems. Problematic PG use was a better predictor of physical symptoms than PG gaming time and variables related to electronic media use. Problematic PG use and problematic smartphone use were correlated but independent predictors of physical symptoms. We conclude that the type of participation rather than the time spent playing predicts poorer physical health among PG players.

Virtual reality for neurorehabilitation: A bibliometric analysis of knowledge structure and theme trends

Background

As an emerging technology, virtual reality (VR) has been broadly applied in the medical field, especially in neurorehabilitation. The growing application of VR therapy promotes an increasing amount of clinical studies. In this paper, we present a bibliometric analysis of the existing studies to reveal the current research hotspots and guide future research directions.

Methods

Articles and reviews on the related topic were retrieved from the Science Citation Index Expanded of Web of Science Core Collection database. VOSviewer and Citespace software were applied to systematically analyze information about publications, countries, institutions, authors, journals, citations, and keywords from the included studies.

Results

A total of 1,556 papers published between 1995 and 2021 were identified. The annual number of papers increased gradually over the past three decades, with a peak publication year in 2021 (n = 276). Countries and institutions from North America and Western European were playing leading roles in publications and total citations. Current hotspots were focused on the effectiveness of VR therapy in cognitive and upper limb motor rehabilitation. The clusters of keywords contained the four targeted neurological diseases of VR, while the burst keywords represented that the latest studies were directed toward more defined types of VR therapy and greater study design.

Conclusions

Our study offers information regarding to the current hotspots and emerging trends in the VR for rehabilitation field. It could guide future research and application of VR therapy in neurorehabilitation.

Effect of Longitudinal Practice in Real and Virtual Environments on Motor Performance, Physical Activity and Enjoyment in People with Autism Spectrum Disorder: A Prospective Randomized Crossover Controlled Trial

(1) Background: People with ASD commonly present difficulty performing motor skills and a decline in physical activity (PA) level and low enjoyment of PA. We aimed to evaluate whether longitudinal practice of an activity in virtual and real environments improves motor performance and whether this improvement is transferred to a subsequent practice when changing the environment, promoting PA and providing enjoyment; (2) Methods: People with ASD, aged between 10 and 16 years, were included and distributed randomly into two opposite sequences. The participants performed a 10 session protocol, with five sessions practicing in each environment (virtual or real). Heart rate measurement was carried out and an enjoyment scale was applied; (3) Results: 22 participants concluded the protocol. Sequence A (virtual first) presented an improvement in accuracy and precision and transferred this when changing environment; they also had a greater change in heart rate reserve. The majority of participants reported "fun" and "great fun" levels for enjoyment; (4) Conclusions: The virtual reality activity presented a higher level of difficulty, with greater gains in terms of transference to the real environment. Considering PA, our task provided very light to light activity and the majority of participants enjoyed the task.

Virtual Reality and Exercise Training Enhance Brain, Cognitive, and Physical Health in Older Adults with Mild Cognitive Impairment

We investigated the effectiveness of virtual-reality-based cognitive training (VRCT) and exercise on the brain, cognitive, physical and activity of older adults with mild cognitive impairment (MCI).

METHODS

This study included 99 participants (70.8 ± 5.4) with MCI in the VRCT, exercise, and control groups. The VRCT consisted of a series of games targeting different brain functions such as executive function, memory, and attention. Twenty-four sessions of VRCT (three days/week) were performed, and each session was 100 min long. Exercise intervention consisted of aerobic and resistance trainings performed in 24 sessions for 60 min (2 times/week for 12 weeks). Global cognitive function was measured using the Mini-Mental State Examination (MMSE) test. Resting-state electroencephalography (EEG) of the neural oscillatory activity in different frequency bands was performed. Physical function was measured using handgrip strength (HGS) and gait speed.

RESULTS

After the intervention period, VRCT significantly improved the MMSE scores (p < 0.05), and the exercise group had significantly improved HGS and MMSE scores (p < 0.05) compared to baseline. One-way analysis of variance (ANOVA) of resting-state EEG showed a decreased theta/beta power ratio (TBR) (p < 0.05) in the central region of the brain in the exercise group compared to the control group. Although not statistically significant, the VRCT group also showed a decreased TBR compared to the control group. The analysis of covariance (ANCOVA) test showed a significant decrease in theta band power in the VRCT group compared to the exercise group and a decrease in delta/alpha ratio in the exercise group compared to the VRCT group.

CONCLUSION

Our findings suggest that VRCT and exercise training enhances brain, cognitive, and physical health in older adults with MCI. Further studies with a larger population sample to identify the effect of VRCT in combination with exercise training are required to yield peak benefits for patients with MCI.

Metaverse-based virtual reality experience and endurance performance in sports economy: Mediating role of mental health and performance anxiety

Metaverse sports arena is gaining popularity globally that empowers virtual reality sporting experience through digital avatars. The main objective of the current study is to explore the impact of the Metaverse-based virtual reality sporting experience on the endurance performance of young Chinese athletes, with the mediating role of their mental health condition and performance anxiety. The study's participants mainly included Chinese athletes, especially the sample group is an accurate depiction of young athletes using a convenience sampling approach. SEM-AMOS statistical software was used for the analysis and validation of the proposed relationships. The study findings statistically validate that mental health and performance anxiety fully mediate the direct associations between virtual reality sporting experiences and the endurance performance of young Chinese athletes. Interestingly, the mental health condition of the young Chinese athletes imposes a greater impact on their endurance performance, in contrast to the adverse effects of their performance anxiety. The outcomes of the present research guide young athletes on the opportunities to enhance their virtual reality sporting abilities and boost their endurance performance. Policymakers can also build systems to dissolve physical and geographical barriers, reduce performance anxiety, and sustain mental health in virtual reality sporting events through the metaverse.

Comparative efficacy of 5 non-pharmacological therapies for adults with post-stroke cognitive impairment: A Bayesian network analysis based on 55 randomized controlled trials

Background

As a common sequela after stroke, cognitive impairment negatively impacts patients' activities of daily living and overall rehabilitation. Non-pharmacological therapies have recently drawn widespread attention for their potential in improving cognitive function. However, the optimal choice of non-pharmacological therapies for post-stroke cognitive impairment (PSCI) is still unclear. Hence, in this study, we compared and ranked 5 non-pharmacological therapies for PSCI with a Bayesian Network Meta-analysis (NMA), to offer a foundation for clinical treatment decision-making.

Methods

PubMed, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials, Chinese Biomedical Medicine, China National Knowledge Infrastructure, Wangfang Database, and China Science and Technology Journal Database were searched from database inception to December 31, 2021, to collect Randomized Controlled Trials for PSCI. All of the studies were assessed (according to Cochrane Handbook for Systematic Reviews) and then data were extracted by two researchers separately. Pairwise meta-analysis for direct comparisons was performed using Revman. NMA of Bayesian hierarchical model was performed by WinBUGS and ADDIS. STATA was used to construct network evidence plots and funnel plots.

Results

A total of 55 trials (53 Two-arm trials and 2 Three-arm trials) with 3,092 individuals were included in this study. In the pair-wise meta-analysis, Transcranial Magnetic Stimulation (TMS), Virtual Reality Exposure Therapy (VR), Computer-assisted cognitive rehabilitation (CA), Transcranial Direct Current Stimulation (tDCS), and Acupuncture were superior to normal cognition training in terms of MoCA, MMSE, and BI outcomes. Bayesian NMA showed that the MoCA outcome ranked Acupuncture (84.7%) as the best therapy and TMS (79.7%) as the second. The MMSE outcome ranked TMS (76.1%) as the best therapy and Acupuncture as the second (72.1%). For BI outcome, TMS (89.1%) ranked the best.

Conclusions

TMS and Acupuncture had a better effect on improving cognitive function in post-stroke patients according to our Bayesian NMA. However, this conclusion still needs to be confirmed with large sample size and high-quality randomized controlled trials.

Registration

https://inplasy.com (No. INPLASY202260036).