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Background: Research pertaining to the use of Virtual Reality (VR) in various healthcare settings is emerging. The aim of this study was to assess the feasibility of immersive VR in a haemodialysis setting and its effects on patients' adherence to dialysis regimens and quality of life in an Australian renal service. Trial design: A crossover Randomised Controlled Trial (RCT) was conducted in regional Queensland, Australia. The CONSORT reporting guidelines were used. Methods: The intervention was the use of immersive VR headsets to view three scenarios designed to represent the country of northern Queensland. Intervention and control periods were each four weeks' duration, with a one-week washout period. The primary objective was to compare participants' attendance at scheduled haemodialysis sessions between intervention and control periods. Secondary objectives included comparing adherence to fluid allowances, and changes in quality-of-life measures. Adult patients attending haemodialysis treatments three times per week were eligible. Data were gathered from medical records, the self-reported AQoL 6D scale, the K-5 scale and participant feedback. A survey was used to obtain clinicians' feedback on the feasibility of immersive VR reality in this setting. Results: Data were obtained for the 34 patients who completed the trial (one participant was withdrawn from the study) and 49 staff who completed the clinicians' survey. No harm or adverse events occurred. There were no statistically significant differences in attendance or adherence to fluid allowances between the intervention and control periods. Improvements in quality of life and mental wellbeing for participants who had lower self-reported measures at the commencement of the trial. Feedback from patients and clinicians was positive overall. Patients suggested modifications to the scenarios for enhanced engagement with VR. Conclusions: Results suggest haemodialysis patients can benefit from VR while on treatment. Further trials with larger sample sizes are needed to determine relationships between VR usage and patient outcomes. Trial registration: The trial was registered with the Australian New Zealand Clinical Trials Registry (ANZCTR). Registration number: ACTRN12621000732886. Registration date 01/06/2021. [ABSTRACT FROM AUTHOR]

Background: Virtual reality (VR) is a burgeoning technology within healthcare, though routine implementation of VR within hospital settings remains limited. Health professionals are key stakeholders in knowledge translation, though limited research has explored their knowledge and attitudes towards using VR for different purposes within healthcare. This study aimed to scope health professionals' knowledge of, and attitudes towards, the use of VR applications in a public hospital setting. Methods: A cross-sectional survey of multidisciplinary health professionals (medical, nursing, allied health professionals) was conducted in a major metropolitan public hospital in Australia. The custom survey was comprised of 28 mixed categorical and free-text fields designed to scope levels of knowledge, prior experience, and interest in VR; the perceived utility of VR within a hospital context; and perceived barriers and enablers of VR use within the hospital setting. Data were analyzed via descriptive and non-parametric statistics. Results: One hundred and thirty-seven health professionals participated (38% allied health, 37% nursing, 24% medical). The majority had no prior exposure to VR in clinical (95%) or recreational (67%) settings; and only 16% were aware of any clinical research evidence for VR. Despite limited awareness, participants expressed support for VR use in hospitals. 99% reported VR had potential utility in healthcare, most commonly for clinical simulations (81%), clinical education (80%) and as a physical therapy tool (68%). Participants identified multiple barriers to VR implementation most commonly relating to perceived cost, lack of required infrastructure, time, knowledge and technical skill. Prominent enablers related to increasing capability at provider and system levels. Participants' familiarity with VR was associated with stronger support for its' use (Rho = 0.4, p < 0.001). Conclusions: Health professionals in the hospital workforce reported limited knowledge and familiarity with VR; yet they perceived VR had broad utility and expressed overall support for different VR applications within hospitals. Health professionals appear interested in VR though face multiple barriers to its use in a hospital context. Increasing capability among multidisciplinary health providers and the wider hospital system appear to be important considerations for the success of future VR implementation in public hospitals. [ABSTRACT FROM AUTHOR]

Background: Chronic pain is often a debilitating condition that affects individuals physically and mentally. Reliance on pharmacotherapy for pain management comes with risks of analgesic misuse and dependence. Hence, non-pharmacologic treatment plays a crucial role in pain management. Virtual reality is a novel method in chronic pain management. However, there is little understanding about healthcare providers' perspectives on the use of virtual reality technology in managing chronic pain. This study aims to explore the current management challenges faced by chronic pain healthcare providers and their perspectives on using virtual reality as adjunctive therapy in managing chronic pain. Method: Individual semi-structured interviews were conducted among all chronic pain healthcare providers in a tertiary hospital. The interviews were analysed using qualitative thematic analysis. Results: Eight chronic pain healthcare providers participated in this study. Financial issues were cited as one of the biggest barriers to utilisation of non-pharmacological treatment. Participants highlighted the importance of psychosocial support from family and healthcare providers. Challenges identified included absence of patient engagement and lack of awareness about pain management among healthcare providers as well as the lack of an integrated multidisciplinary approach in our healthcare system. Participants were receptive towards the use of virtual reality in chronic pain management and offered ample opinions and suggestions for its application in chronic pain management. Conclusions: A multilevel, multifaceted approach is needed to improve chronic pain management. Virtual reality technology could be considered as an adjunct therapy to address some of the challenges and limitations identified in this study. [ABSTRACT FROM AUTHOR]

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Upright quiet stance is maintained through the complex integration of sensory information from the visual, vestibular, and somatosensory systems [1]. Virtual reality (VR) is a well-established tool that has been used to study sensory contributions to balance and induce visual perturbations. Previous assessments of virtual environments have suggested that VR can be used to create various visual stimuli that affect balance [2]; however, there is limited work examining which dynamic visual stimulus, in the form of circular vection (CV), is the most effective at inducing whole body lean. Therefore, this study assessed the effects of two visual stimuli using VR to better understand their effects on postural control. 33 healthy young adults between the ages of 18–40, free of neurological impairments, stood quietly on a force plate for 30 s while wearing a head-mounted display. Participants were exposed to a field of random white dots (DOTS) or a black and white striped tunnel (TUNNEL) that rotated in the roll plane at 60°/s clockwise or counterclockwise. Amplitude was calculated from head orientation data recorded from a head-mounted display, and centre of pressure (COP). Independent of visual stimuli, postural lean was in the same direction as the stimulus. The DOTS stimulus increased Head orientation and COP position compared to the TUNNEL stimulus. There was no significant main effect or interaction with direction for Head or COP data. When comparing the effect of stimulus design on postural sway, a DOTS stimulus was most effective at inducing direction-modulated postural sway This study builds on our understanding of the VR-related destabilizing effects on postural control and shows evidence that a DOTS stimulus has a stronger effect than a TUNNEL stimulus. Overall, it is important to consider the design of visual stimuli when examining VR effects on upright stance. • Postural responses to different circular vection stimuli were compared. • Body leaned in the same direction as the circular vection stimulus rotation. • Traditional dot-related stimuli elicited stronger effects on body position. • Visual stimuli type is important when examining visual effects on upright stance. [ABSTRACT FROM AUTHOR]

Gait adaptability training programs to prevent falls in healthy older adults can be proposed in virtual reality. The development of training programs requires the characterization of the target population. Before proposing an innovative training program to develop gait adaptability behavior of healthy older adults in fully immersive virtual reality, we had to compare gait adaptability behavior between healthy older adults and young adults in virtual reality. Twenty healthy older adults (with no fall history) and twenty young adults performed a goal-directed locomotion task in a totally secure virtual reality set-up. Gait adaptability behavior was investigated via a set of measures taking into account gait speed, pointing accuracy, and the evolution of the relationship between the participant and the environment through both inter-trial and trial-by-trial analyses. Mann-Whitney tests and linear regressions were performed to determine potential age differences. The results reveal some common and specific strategies in gait adaptability behavior between healthy older and young adults. In both populations, successive gait adjustments depend on the state of the agent-environment system. However, older adults walked more slowly than young adults (p <.001) with a greater coupling at the end of the target approach (p =.003). In the context of fall prevention in healthy older adults, fully immersive VR appears as a relevant tool to propose relevant gait training programs to improve gait adjustments. • Older adults initiated their gait adjustments earlier in comparison to young adults. • Gait adaptability behavior depends on the current state of the agent-environment system. • Virtual reality appears as a relevant tool to propose relevant training programs in older adults. [ABSTRACT FROM AUTHOR]

Considering the harmful effects of cannabis on individuals with a severe mental disorder and the limited effectiveness of current interventions, this case report showcases the beneficial results of a 10-session Avatar intervention for cannabis use disorder (CUD) on a polysubstance user with a comorbid schizoaffective disorder. Virtual reality allowed the creation of an Avatar representing a person significantly related to the patient's drug use. Avatar intervention for CUD aims to combine exposure, relational, and cognitive behavioral therapies while practicing real-life situations and learning how to manage negative emotions and cravings. Throughout therapy and later on, Mr. C managed to maintain abstinence from all substances. Also, an improvement in the severity of CUD, as well as a greater motivation to change consumption, was observed after therapy. As observed by his mother, his psychiatrist, and himself, the benefits of Avatar intervention for CUD extended to other spheres of his life. The drastic results observed in this patient could be promising as an alternative to the current treatment available for people with a dual diagnosis of cannabis use disorder and psychotic disorder, which generally lack effectiveness. A single-blind randomized control trial comparing the treatment with a classical intervention in a larger sample is currently underway to evaluate whether the results are reproducible on a larger sample. [ABSTRACT FROM AUTHOR]

Objectives: To explore the application effect of virtual reality (VR) combined with moderate perineal protection on singleton primipara delivery. Material and methods: The study utilised a two-group design intervention and a randomised clinical trial. A total of 200 singleton primiparas who had a regular prenatal examination in a third-class hospital (between 1 September 2018 and 30 December 2018) and were willing to give birth naturally were randomly divided into treatment (traditional prenatal health mission combined with desktop VR health education system mode) and control (traditional health education mode) groups. The delivery conditions of the two groups were surveyed, recorded, analysed and compared. Results: There was no significant difference in the time of the second stage of labour between the treatment and control groups, and the comparison of neonatal Apgar scores and neonatal weight between the two groups showed that the different modes of prenatal education had no effect on newborns (p > 0.05). The amount of postpartum haemorrhage in 2 h and the pain score in the treatment group were significantly lower than in the control group, and the degree of perineal injury in the treatment group was not as serious as that in the control group. Meanwhile, there was a statistically significant difference in the anxiety score, self-efficacy score and quality of life satisfaction between the treatment and control groups (p < 0.05). Conclusions: VR technology combined with moderate perineal protection could improve the delivery outcome of a primipara, maternal self-confidence of delivery and the quality of vaginal delivery; effectively alleviate the anxiety of a primipara; have no adverse effects on both mothers and newborns; and be widely used in clinical settings. [ABSTRACT FROM AUTHOR]

Background: Virtual reality (VR) is recognized as a versatile training tool across various domains, including healthcare. In Jordan, dementia is a significant public health concern, accounting for 5.17% of all recorded deaths. Given the complex nature of dementia care, preparing nursing students is crucial. Purpose: This paper explores the feasibility and effectiveness of VR-based empathy training for nursing students, with a growing global interest in VR training applications, despite the need for further study of VR acceptability in the Jordanian context. Methods: This mixed-methods study included 71 nursing students in a psychiatric course at a university in Jordan. Feasibility was assessed through recruitment, retention, adherence, data completion, and implementation fidelity. Pre- and post-intervention assessments measured empathy levels. Thematic analysis of participant feedback provided insights into usability. Results: Recruitment and retention rates were excellent, with a 100% participation rate and 100% retention. The intervention demonstrated a statistically significant enhancement in empathy scores following the program (M_pre = 50.44, SD_pre = 9.24; M_post = 65.17, SD_post = 8.53), t (71) = -23.89, p < 0.001. The thematic analysis highlighted the importance of a user-friendly interface, a supportive learning environment, and engaging content. Conclusion: This study highlights the potential of VR-based training to enhance empathy among nursing students in the context of dementia care. The robust feasibility outcomes and positive user experiences suggest that VR technology can be a valuable addition to nursing curricula, ultimately benefiting patient care and the nursing workforce. Implications for Nursing: Integrating VR into nursing education presents the potential for elevating empathy in nursing students, notably within dementia care. This innovative approach equips prospective healthcare providers with vital skills for delivering more compassionate patient care. [ABSTRACT FROM AUTHOR]

Background: Children and adolescent with serious burns require nursing and medical care to alleviate pain. As a non-pharmacological adjuvant analgesic used to divert children's attention, virtual reality (VR) has gained popularity. The study aimed to evaluate effect of virtual reality on distraction of children attention during dressing of second-degree burns. Subjects and method: Purposive Sampling of 50 children with second degree of burn participated in the study. The study was conducted at Pediatric Burn Unit of Plastic and Reconstructive Surgery department of Tanta University. Four tools were used to gather data: burn wound assessment, children behavioral distress observational check list, pain assessment tool, and physiological measurement sheet. Results: The study cleared that there were statistically significant differences in pain attention, behavioral distress and improving physiological parameters for children with second degree burn during dressing change using virtual reality distraction in study group than control group. Conclusion: Virtual reality as distraction technique appeared to be effective in reducing pain attention, behavioral distress and enhancing physiological parameters during dressing change in children with second degree burn. Recommendation: Creating periodic in-service educational program for all nurses working in the burn unit to learn about the use of virtual reality to lessen the pain associated with burn dressing. [ABSTRACT FROM AUTHOR]

Background: Pre-surgical simulation-based training with three-dimensional (3D) models has been intensively developed in complex surgeries in recent years. This is also the case in liver surgery, although with fewer reported examples. The simulation-based training with 3D models represents an alternative to current surgical simulation methods based on animal or ex vivo models or virtual reality (VR), showing reported advantages, which makes the development of realistic 3D-printed models an option. This work presents an innovative, low-cost approach for producing patient-specific 3D anatomical models for hands-on simulation and training. Methods: The article reports three paediatric cases presenting complex liver tumours that were transferred to a major paediatric referral centre for treatment: hepatoblastoma, hepatic hamartoma and biliary tract rhabdomyosarcoma. The complete process of the additively manufactured liver tumour simulators is described, and the different steps for the correct development of each case are explained: (1) medical image acquisition; (2) segmentation; (3) 3D printing; (4) quality control/validation; and (5) cost. A digital workflow for liver cancer surgical planning is proposed. Results: Three hepatic surgeries were planned, with 3D simulators built using 3D printing and silicone moulding techniques. The 3D physical models showed highly accurate replications of the actual condition. Additionally, they proved to be more cost-effective in comparison with other models. Conclusions: It is demonstrated that it is possible to manufacture accurate and cost-effective 3D-printed soft surgical planning simulators for treating liver cancer. The 3D models allowed for proper pre-surgical planning and simulation training in the three cases reported, making it a valuable aid for surgeons. [ABSTRACT FROM AUTHOR]

Virtual reality is the future of medical imaging diagnosis. Previous studies have introduced virtual reality rendering of anatomical models while others have mentioned processes to extract 3D models from Computed Tomography (CT) images. In this study, we provide a detailed workflow to transforming patient-specific two-dimensional (2D) CT dicom format imaging files to three-dimensional (3D) immersive, dynamic and interactive anatomical assembly models while incorporating them into a four-wall virtual reality environment system. Our study implemented 3D CAD and virtual reality capacities through software and engineering design tools to transform 2D medical images into interactive 3D models in our system. In doing so, the user was able to gain a sense of depth, scale, and dimensionality while immersed in the environment and while implementing interactive tools to investigate patient- specific hip-femur dynamics. At the same time, users were able to identify key anatomical landmarks in the patients’ hip joints. Applications of the VR system to the medical field and orthopedics, in particular, were discussed. [ABSTRACT FROM AUTHOR]

Background: Anxiety is one of the most common psychiatric comorbidities in people with epilepsy and often involves fears specifically related to the condition, such as anxiety related to the fear of having another seizure. These epilepsy- or seizure-related fears have been reported as being more disabling than the seizures themselves and significantly impact quality of life. Although research has suggested that exposure therapy (ET) is helpful in decreasing anxiety in people with epilepsy, no research to our knowledge has been conducted on ET in people with epilepsy using virtual reality (VR). The use of novel technologies such as an immersive VR head-mounted display for ET in this population offers several benefits. Indeed, using VR can increase accessibility for people with epilepsy with transportation barriers (eg, those who live outside urban centers or who have a suspended driver's license owing to their condition), among other advantages. In the present research protocol, we describe the design of an innovative VR-ET program administered in the home that focuses on decreasing anxiety in people with epilepsy, specifically anxiety related to their epilepsy or seizures. Objective: Our primary objective is to examine the feasibility of the study protocol and proposed treatment as well as identify suggestions for improvement when designing subsequent larger clinical trials. Our secondary objective is to evaluate whether VR-ET is effective in decreasing anxiety in a pilot study. We hypothesize that levels of anxiety in people with epilepsy will decrease from using VR-ET. Methods: This mixed methods study comprises 3 phases. Phase 1 involves engaging with those with lived experience through a web-based questionnaire to validate assumptions about anxiety in people with epilepsy. Phase 2 involves filming videos using a 360° camera for the VR-ET intervention (likely consisting of 3 sets of scenes, each with 3 intensity levels) based on the epilepsy- and seizure-related fears most commonly reported in the phase 1 questionnaire. Finally, phase 3 involves evaluating the at-home VR-ET intervention and study methods using a series of validated scales, as well as semistructured interviews. Results: This pilot study was funded in November 2021. Data collection for phase 1 was completed as of August 7, 2022, and had a final sample of 18 participants. Conclusions: Our findings will add to the limited body of knowledge on anxiety in people with epilepsy and the use of VR in this population. We anticipate that the insights gained from this study will lay the foundation for a novel and accessible VR intervention for this underrecognized and undertreated comorbidity in people with epilepsy. [ABSTRACT FROM AUTHOR]

Background: A magnetic resonance imaging (MRI) procedure can cause preprocedural and periprocedural anxiety in children. Psychosocial interventions are used to prepare children for the procedure to alleviate anxiety, but these interventions are time-consuming and costly, limiting their clinical use. Virtual reality (VR) is a promising way to overcome these limitations in the preparation of children before an MRI scan. Objective: The objective of this study is (1) to develop a VR smartphone intervention to prepare children at home for an MRI procedure; and (2) to examine the effect of the VR intervention in a randomized controlled trial, in which the VR intervention will be compared to care as usual (CAU). CAU involves an information letter about an MRI examination. The primary outcome is the child's procedural anxiety during the MRI procedure. Secondary outcomes include preprocedural anxiety and parental anxiety. We hypothesize that the VR preparation will result in a higher reduction of the periprocedural anxiety of both parents and children as compared to CAU. Methods: The VR intervention provides a highly realistic and child-friendly representation of an MRI environment. In this randomized controlled trial, 128 children (aged 6 to 14 years) undergoing an MRI scan will be randomly allocated to the VR intervention or CAU. Children in the VR intervention will receive a log-in code for the VR app and are sent cardboard VR glasses. Results: The VR smartphone preparation app was developed in 2020. The recruitment of participants is expected to be completed in December 2022. Data will be analyzed, and scientific papers will be submitted for publication in 2023. Conclusions: The VR smartphone app is expected to significantly reduce pre- and periprocedural anxiety in pediatric patients undergoing an MRI scan. The VR app offers a realistic and child-friendly experience that can contribute to modern care. A smartphone version of the VR app has the advantage that children, and potentially their parents, can get habituated to the VR environment and noises in their own home environment and can do this VR MRI preparation as often and as long as needed. [ABSTRACT FROM AUTHOR]

Background: Technology is increasingly being used and evolving in the dementia care landscape. One such technology that has gained traction over the last decade is virtual reality (VR). VR is being applied in many areas of dementia care, including cognitive assessment and training, reminiscence therapy, music therapy, and other recreational VR applications. Despite the plethora of applications, they are often not shaped by the experiences and perceptions of older adults living with dementia. Currently, there is no qualitative evidence synthesis (QES) to explore this area. This review aimed to provide qualitative evidence supporting existing systematic reviews in this area. Objective: The aim of this QES was to explore key stakeholders' experiences and perceptions of VR for older adults living with dementia. It aimed to explore the barriers and facilitators to VR use and provide recommendations for future design and implementation. Methods: QES was used, which involved a systematic search of 6 databases to identify studies that qualitatively explored key stakeholders' experiences and perceptions of VR for older adults living with dementia. Thematic synthesis was used to integrate the findings of 14 studies (from 15 reports). The Critical Appraisal Skills Programme tool was used to assess the methodological quality of the included studies. The confidence placed in the review findings was assessed using the GRADE-CERQUAL (Confidence in the Evidence from Reviews of Qualitative research). Results: A total of 15 reports from 14 studies were included in the review, consisting of a range of levels of VR immersion, stages of dementia, and care contexts. Three analytical themes were generated: stepping into virtuality, a virtual world, and returning to reality. The results indicate the importance of sensitively designing and introducing VR to this population, as older adults living with dementia often have no prior experience of using this technology. VR can be a positive experience for older adults living with dementia and can provide meaningful interactions, positive expressions, and long-term impacts on everyday functioning. However, it should be acknowledged that some negative associations must be accounted for before, during, and after use. Conclusions: This review highlights the positive implications as well as negative associations of VR use. It emphasizes the need for VR design and implementation driven by the needs and views of older adults living with dementia as well as with other key stakeholders. Future research needs to explore the vital role that older adults living with dementia can play in the design process and how they can be empowered to meaningfully design and use this technology. JMIR [ABSTRACT FROM AUTHOR]

Background: In recent years, there has been a growing interest in active virtual reality games (AVRGs) that provide entertainment and encourage more physical activity (PA). Since playing AVRGs involves primarily arm movements, the intensity of this form of PA may not be sufficient for health benefits. Therefore, it is worth looking for virtual entertainment solutions that are comfortable for users and at the same time increase physical exercise. Objective: The main objective of this study was to evaluate the effect of external loading of the arms in the form of handheld weights (HHWs) on exercise intensity in users playing a popular AVRG. The results obtained in the study were compared with the PA recommendations for health. The study also assessed the perceptions of the users about the attractiveness and usefulness of this type of exercise and discomfort caused by additional load on the arms. Methods: The study covered 17 young adults aged 18 to 25 years playing an AVRG (Beat Saber) with no arm load and with HHWs (0.5 kg). A PlayStation 4 PRO console (Sony) with accessories including a head-mounted display and controllers was used in the study. PA intensity was evaluated using a heart rate monitor based on the percentage of maximal heart rate (% HRmax). The usability, attractiveness, and comfort perceived during exercise by users were evaluated using a survey questionnaire. Results: The measurements showed that the mean % HRmax in participants playing Beat Saber without HHWs was significantly lower (P<.001; Cohen d=1.07) than that observed when playing with HHWs. It should be emphasized that with no additional load, the intensity of PA was low (mean 63.7% HRmax, SD 9.3% HRmax), while with the upper limb load, it increased to a moderate level (mean 67.1% HRmax, SD 10.3% HRmax), which is recommended for health benefits. The survey conducted in the study showed that HHWs (0.5 kg) attached to the wrists did not disturb Beat Saber players. Conclusions: Since PA in most of the modern AVRGs primarily involves upper limb movements, the use of HHW seems to be a simple and effective way to increase exercise intensity, especially because, as reported by the study participants, such a procedure does not cause discomfort while using the application. [ABSTRACT FROM AUTHOR]

Background: Immersive virtual reality (IVR) has been investigated as a tool for treating psychiatric conditions. In particular, the practical nature of IVR, by offering a doing instead of talking approach, could support people who do not benefit from existing treatments. Hence, people with mild to borderline intellectual disability (MBID; IQ=50-85) might profit particularly from IVR therapies, for instance, to circumvent issues in understanding relevant concepts and interrelations. In this context, immersing the user into a virtual body (ie, avatar) appears promising for enhancing learning (eg, by changing perspectives) and usability (eg, natural interactions). However, design requirements, immersion procedures, and proof of concept of such embodiment illusion (ie, substituting the real body with a virtual one) have not been explored in this group. Objective: Our study aimed to establish design guidelines for IVR embodiment illusions in people with MBID. We explored 3 factors to induce the illusion, by testing the avatar's appearance, locomotion using IVR controllers, and virtual object manipulation. Furthermore, we report on the feasibility to induce the embodiment illusion and provide procedural guidance. Methods: We conducted a user-centered study with 29 end users in care facilities, to investigate the avatar's appearance, controller-based locomotion (ie, teleport, joystick, or hybrid), and object manipulation. Overall, 3 iterations were conducted using semistructured interviews to explore design factors to induce embodiment illusions in our group. To further understand the influence of interactions on the illusion, we measured the sense of embodiment (SoE) during 5 interaction tasks. Results: IVR embodiment illusions can be induced in adults with MBID. To induce the illusion, having a high degree of control over the body outweighed avatar customization, despite the participants' desire to replicate their own body image. Similarly, the highest SoE was measured during object manipulation tasks, which required a combination of (virtual) locomotion and object manipulation behavior. Notably, interactions that are implausible (eg, teleport and occlusions when grabbing) showed a negative influence on SoE. In contrast, implementing artificial interaction aids into the IVR avatar's hands (ie, for user interfaces) did not diminish the illusion, presuming that the control was unimpaired. Nonetheless, embodiment illusions showed a tedious and complex need for (control) habituation (eg, motion sickness), possibly hindering uptake in practice. Conclusions: Balancing the embodiment immersion by focusing on interaction habituation (eg, controller-based locomotion) and lowering customization effort seems crucial to achieve both high SoE and usability for people with MBID. Hence, future studies should investigate the requirements for natural IVR avatar interactions by using multisensory integrations for the virtual body (eg, animations, physics-based collision, and touch) and other interaction techniques (eg, hand tracking and redirected walking). In addition, procedures and use for learning should be explored for tailored mental health therapies in people with MBID. [ABSTRACT FROM AUTHOR]

Background: Immersive virtual reality (IVR) can be defined as a fully computer-generated environment shown on a head-mounted display. Existing research suggests that key features of IVR can assist older adults in their everyday lives, providing opportunities for health promotion and tackling social isolation and loneliness. There has been a surge in qualitative studies exploring older adults' experiences and perceptions of IVR. However, there has been no systematic synthesis of these studies to inform the design of new, more accessible IVR technologies. Objective: This study aimed to systematically review and synthesize qualitative studies exploring older adults' experiences and perceptions of IVR. Methods: A systematic review and thematic synthesis were conducted following the ENTREQ (Enhancing Transparency in Reporting the Synthesis of Qualitative Research) guidelines. In total, 2 reviewers completed title and abstract screening, full-text screening, data extraction, and quality appraisal. Thematic synthesis is derived from the qualitative method, thematic analysis. It involves 3 key steps: initial coding and grouping of these codes, the formation of descriptive themes from these codes, and going beyond these data to form analytical themes. Confidence in the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation-Confidence in the Evidence from Reviews of Qualitative Research approach. Results: Overall, 13 studies were included in the final synthesis, including 224 participants across 9 countries and 5 continents. Confidence in the evidence ranged from high to moderate. Three descriptive themes were generated: practical aspects of IVR use, experiencing unique features of IVR, and perceptions of IVR. The findings from the descriptive themes suggested that there are several improvements that need to be made to existing IVR devices to facilitate older adults' use of this technology. However, older adults' responses to IVR were generally positive. Three analytical themes were generated: tolerating the bad to experience the good, buying in to IVR (don't judge a book by its cover), and "it proves to me I can do it." The analytical themes illustrated that older adults were willing to tolerate discomforts that accompany existing IVR technologies to experience features such as immersive social networking. There was a discrepancy between older adults' perceptions of IVR before use--which were generally negative--and after use--which were generally positive--and IVR provided a platform for older adults to access certain activities and environments more easily than in the real world because of limitations caused by aging. Conclusions: This review offers insights into older adults' experiences and perceptions of IVR and suggests how a few improvements to its existing hardware and software as well as how it is first presented could offer new opportunities for older adults to take part in meaningful activities tailored to their needs and preferences. [ABSTRACT FROM AUTHOR]

Background: Youth with cerebral palsy do not have enjoyable, accessible, and scalable exercise options that can empower them to independently maintain their cardiometabolic health. Objective: The primary aim is to examine the preliminary efficacy of a 12-week home-based virtual reality tele-exergaming intervention on several indicators of cardiometabolic health in youth with cerebral palsy compared to the wait list control. A secondary aim is to describe feasibility metrics, namely, recruitment, retention, and adherence rates; perceived enjoyment; intervention safety; and management issues. The tertiary aim is to generate a theory that reveals critical behavioral mechanisms of adherence to tele-exergaming. Methods: In this parallel group design randomized controlled trial, 34 inactive youths with cerebral palsy are randomly allocated to one of two groups: a group that immediately receives 12 weeks of virtual reality exergaming with tele-physical education or a wait list control group that undergoes their habitual activity for 12 weeks. Participants are recruited from a Children's Hospital and community network. At baseline (week 0), week 6, and week 12, high sensitivity C-reactive protein and blood insulin, hemoglobin A1c, triglycerides, cholesterol, and pressure are measured by the youth and a caregiver at home using a blood spot test kit and blood pressure cuff. They will also self-measure their lung function and body weight using a peak flow meter and bathroom scale, respectively. Collections are supervised by research staff via videoconference. Changes in outcomes are compared between and within groups using exploratory statistical analyses and descriptive statistics. At postintervention or dropout, participants will undergo semistructured interviews to identify behavioral mechanisms that underly participation. Results: Recruitment procedures started in June 2022. All data are expected to be collected by October 2023. Full trial results are expected to be published by February 2024. Secondary analyses of data will be subsequently published. Conclusions: This trial tests an innovative serious exergaming virtual reality program that includes a completely remote enrollment, assessment, and intervention tele-protocol. The knowledge obtained will inform the development of a larger effectiveness trial for improving the health and well-being of youth with cerebral palsy. Trial Registration: ClinicalTrials.gov NCT05336227; https://clinicaltrials.gov/ct2/show/NCT05336227 International Registered Report Identifier (IRRID): PRR1-10.2196/40708 [ABSTRACT FROM AUTHOR]

Introduction: The sequelae after a stroke cause proprioceptive disorders that cause disabilities in the individual, negatively influencing the performance of daily activities. Objectives: This paper aims to analyze the effectiveness of virtual reality (VR) rehabilitation methods through various technologies in post-stroke patients. Material and method: Web of Science Core Collection database was interrogated. Clinical trials from the last five years were included in the review. Results: Twelve papers were included in the literature review. Immersive and non-immersive technologies were used as an adjunct or standalone therapy in post-stroke rehabilitation, with 30 to 40 minutes daily sessions or 3 to 4 times a week. Virtual reality therapy was performed. The length and the therapy were heterogenous, with patients receiving conventional physiotherapy exercises, mirror therapy or robotic therapy. Conclusions: VR therapy seems to improve patients functioning and positively influences the rehabilitation of the upper extremities in post-stroke patients, especially in association with conventional physiotherapy. [ABSTRACT FROM AUTHOR]

Background: A considerable number of surgical residents fail the mandated endoscopy exam despite having completed the required clinical cases. Low-cost endoscopy box trainers (BTs) could democratize training; however, their effectiveness has never been compared with higher-cost virtual reality simulators (VRSs).Study Design: In this randomized noninferiority trial, endoscopy novices trained either on the VRS used in the Fundamental of Endoscopic Surgery manual skills (FESms) exam or a validated BT-the Basic Endoscopic Skills Training (BEST) box. Trainees were tested at fixed timepoints on the FESms and on standardized ex vivo models. The primary endpoint was FESms improvement at 1 week. Secondary endpoints were FESms improvement at 2 weeks, FESms pass rates, ex vivo tests performance, and trainees' feedback.Results: Seventy-seven trainees completed the study. VRS and BT trainees showed comparable FESms improvements (25.16 ± 14.29 vs 25.58 ± 11.75 FESms points, respectively; p = 0.89), FESms pass rates (76.32% vs 61.54%, respectively; p = 0.16) and total ex vivo tasks completion times (365.76 ± 237.56 vs 322.68 ± 186.04 seconds, respectively; p = 0.55) after 1 week. Performances were comparable also after 2 weeks of training, but FESms pass rates increased significantly only in the first week. Trainees were significantly more satisfied with the BT platform (3.97 ± 1.20 vs 4.81 ± 0.40 points on a 5-point Likert scale for the VRS and the BT, respectively; p < 0.001).Conclusions: Simulation-based training is an effective means to develop competency in endoscopy, especially at the beginning of the learning curve. Low-cost BTs like the BEST box compare well with high-tech VRSs and could help democratize endoscopy training. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Although gut-directed psychotherapies are effective for irritable bowel syndrome (IBS), they are rarely prescribed, given a paucity of trained clinicians. Virtual reality (VR) offers a solution by allowing patients to self-practice these techniques in a standardized manner. METHODS: A multidisciplinary team developed IBS/VR, a program that transports users into immersive VR worlds that teach patients about the brain-gut axis, cognitive behavioral therapy, and gut-directed meditation. We tested IBS/VR in Rome IV IBS patients and used inductive analysis to evaluate perceptions and identify recommendations. RESULTS: We achieved thematic saturation after 9 interviews; 3 additional interviews revealed no emergent themes. After making 23 software changes based on patient feedback, we conducted 3 additional interviews which confirmed thematic saturation (N = 15 total). DISCUSSION: This study offers initial validation of the first VR program designed for IBS. [ABSTRACT FROM AUTHOR]

In advanced medical technology, rendering methods plays an essential role in enhancing the accuracy of mitral valve abnormalities detection and replacement procedures especially in the process of virtual surgery. Consequently, the choice of rendering methods is very much important for real-time visualization of mitral valve echocardiography. This study compares two types of rendering methods in virtual reality visualization: Surface Rendering and Volume Rendering. Specifically, two rendering algorithms including Ray Casting and Marching Cubes were implemented and compared with respect to the rendering speed and interaction. These algorithms were implemented in unity platform to visualize the cardiac echo images in virtual reality. The methodologies, merits and demerits of these algorithms were discussed in detail. Based on the experimental results, rendering method can be determined according to the requirements of virtual mitral valve replacement surgery. [ABSTRACT FROM AUTHOR]