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Stroke frequently leads to various functional impairments. Both virtual reality (VR) and mirror therapy (MT) have shown efficacy in stroke rehabilitation. In recent years, the combination of these 2 approaches has emerged as a potential treatment for patients with stroke. This study aimed to evaluate the efficacy of combined immersive and nonimmersive VR with MT in stroke rehabilitation. Five electronic databases were systematically searched for relevant papers published up to January 2025. Randomized controlled trials (RCTs) that investigated the combination treatment of VR and MT for patients with stroke were included. A gray literature search was also conducted. The risk of bias and the certainty of the evidence were assessed using the Cochrane Collaboration's tool and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) guidelines, respectively. A total of 475 patients from 14 RCTs were included, of which 7 were eligible for meta-analysis. Meta-analysis revealed significant improvements in upper extremity (UE) motor function and hand dexterity, as evidenced by the Fugl-Meyer Assessment-Upper Extremity (FMA-UE; mean difference, MD 3.50, 95% CI 1.47 to 5.53; P=.<001), the manual function test (MD 2.15, 95% CI 1.22 to 3.09; P<.001), and the Box and Block Test (MD 1.09, 95% CI 0.14 to 2.05; P=.03). Subgroup analyses based on disease duration (>6 months or not) revealed significant differences in the FMA-UE outcome. However, the pooled FMA-UE improvement did not consistently exceed the established minimal clinically important difference (4.25-7.25), indicating that while statistically significant, the clinical significance of the observed effect remains uncertain. Narrative evidence also suggested potential benefits for lower extremity function, dynamic balance, and quality of life, though these findings were not meta-analyzed and should be interpreted with caution. Moderate-quality evidence supports combined VR and MT as a promising nonpharmacological intervention to improve upper extremity function and hand dexterity in stroke rehabilitation. While the intervention demonstrates statistically significant effects, it does not reach the minimum clinically important difference for the FMA-UE outcome. Preliminary descriptive evidence indicates possible advantages for lower extremity function, balance, and quality of life.

Natural disasters, including earthquakes, threaten global sustainable development, causing significant loss of life, displacement, and economic damage. Indonesia, located in the Pacific Ring of Fire, faces frequent seismic events, highlighting the need for effective disaster preparedness. Traditional training methods often fall short in practical application, prompting the exploration of innovative tools like virtual reality (VR) simulations. VR offers immersive, scenario-based training, improving knowledge retention and response skills. This study evaluated the effectiveness of VR simulation training in improving earthquake preparedness knowledge and practical response skills among rural volunteers in Indonesia. This quasi-experimental research involved 400 rural volunteers who were evenly divided into 2 groups: an intervention group (n=200) trained using VR simulations and a control group (n=200) that received standard training. The VR training modules covered earthquake awareness, search and rescue operations, first aid procedures, and evacuation practices. Participants' knowledge and practical skills were evaluated using the Earthquake Preparedness Knowledge Questionnaire and Earthquake Response Practical Skills Assessment at baseline, immediately after training, and at a 3-month follow-up. Data analysis used repeated-measures ANOVA and multiple regression. Volunteers trained with VR demonstrated substantial improvements in both knowledge (F2396=45.32; P<.001) and practical skills (F2396=38.76; P<.001) compared with the conventional training group. Post hoc tests confirmed that these improvements remained consistent even after 3 months. Regression analysis indicated education level (β=0.32; P<.001) and age (β=-0.18; P=.02) significantly influenced VR training outcomes. After controlling for demographic factors, the VR intervention still significantly enhanced earthquake preparedness knowledge (β=6.23; P<.001) and practical response abilities (β=5.45; P<.001). VR simulation training significantly boosts earthquake preparedness knowledge and practical response skills among rural Indonesian volunteers, with enduring benefits. These findings support VR's potential as a scalable, effective disaster preparedness tool in resource-constrained environments.

In recent years, virtual reality (VR) has gained significant importance in medical education. Radiology education also has seen the induction of VR technology. However, there is no comprehensive review in this specific area. This review aims to fill this knowledge gap. This systematic literature review aims to explore the scope of VR use in radiology education. A literature search was carried out using PubMed, Scopus, ScienceDirect, and Google Scholar for articles relating to the use of VR in radiology education, published from database inception to September 1, 2023. The identified articles were then subjected to a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)-defined study selection process. The database search identified 2503 nonduplicate articles. After PRISMA screening, 17 were included in the review for analysis, of which 3 (18%) were randomized controlled trials, 7 (41%) were randomized experimental trials, and 7 (41%) were cross-sectional studies. Of the 10 randomized trials, 3 (30%) had a low risk of bias, 5 (50%) showed some concerns, and 2 (20%) had a high risk of bias. Among the 7 cross-sectional studies, 2 (29%) scored \"good\" in the overall quality and the remaining 5 (71%) scored \"fair.\" VR was found to be significantly more effective than traditional methods of teaching in improving the radiographic and radiologic skills of students. The use of VR systems was found to improve the students' skills in overall proficiency, patient positioning, equipment knowledge, equipment handling, and radiographic techniques. Student feedback was also reported in the included studies. The students generally provided positive feedback about the utility, ease of use, and satisfaction of VR systems, as well as their perceived positive impact on skill and knowledge acquisition. The evidence from this review shows that the use of VR had significant benefit for students in various aspects of radiology education. However, the variable nature of the studies included in the review reduces the scope for a comprehensive recommendation of VR use in radiology education.

Virtual reality (VR) technologies have demonstrated therapeutic usefulness across a variety of health care settings. However, graduate medical education (GME) trainee perspectives on VR acceptability and usability are limited. The behavioral intentions of GME trainees with regard to VR as an anxiolytic tool have not been characterized through a theoretical framework of technology adoption. The primary aim of this study was to apply a hybrid Technology Acceptance Model (TAM) and a United Theory of Acceptance and Use of Technology (UTAUT) model to evaluate factors that predict the behavioral intentions of GME trainees to use VR for patient anxiolysis. The secondary aim was to assess the reliability of the TAM-UTAUT. Participants were surveyed in June 2023. GME trainees participated in a VR experience used to reduce perioperative anxiety. Participants then completed a survey evaluating demographics, perceptions, attitudes, environmental factors, and behavioral intentions that influence the adoption of new technologies. In total, 202 of 1540 GME trainees participated. Only 198 participants were included in the final analysis (12.9% participation rate). Perceptions of usefulness, ease of use, and enjoyment; social influence; and facilitating conditions predicted intention to use VR. Age, past use, price willing to pay, and curiosity were less strong predictors of intention to use. All confirmatory factor analysis models demonstrated a good fit. All domain measurements demonstrated acceptable reliability. This TAM-UTAUT demonstrated validity and reliability for predicting the behavioral intentions of GME trainees to use VR as a therapeutic anxiolytic in clinical practice. Social influence and facilitating conditions are modifiable factors that present opportunities to advance VR adoption, such as fostering exposure to new technologies and offering relevant training and social encouragement. Future investigations should study the model's reliability within specialties in different geographic locations.

Virtual reality (VR) has the potential to enhance telemental health care (TMH) by enabling accessible, engaging, and personalized treatment from home. Although VR is well-supported for in-person treatment, evidence for telehealth-based VR is limited. Moreover, no prior research has demonstrated the feasibility of therapists and clients conducting therapy sessions remotely within a shared (ie, multiuser) VR experience. The primary objective of this study was to evaluate the feasibility of conducting a randomized controlled efficacy trial (RCT) comparing exposure therapy delivered via Doxy.me VR (Doxy.me Inc)-a multiuser, telehealth-based VR app-to standard TMH in adults with clinically elevated fear of dogs, snakes, or spiders. A secondary objective was to preliminarily examine clinical (ie, specific phobia symptom severity) and treatment-related outcomes (ie, therapeutic alliance, client satisfaction, system usability, presence, cybersickness, and treatment fidelity). This study used a single-site, fully remote, parallel, feasibility RCT design. Participants were randomly assigned using a 1:1 ratio to receive 12 weekly exposure therapy sessions over 3 months, delivered via either standard TMH or Doxy.me VR. Assessments were conducted at baseline, each session, midtreatment, and posttreatment. All therapy sessions were audio recorded, 20% of which were randomly selected and rated for treatment fidelity. Feasibility benchmarks during the 12-month trial included: (1) enrolling 30 participants during Months 1-9 of the trial; (2) collecting 70% of midtreatment self-report data; (3) collecting 70% of posttreatment self-report data; (4) collecting 70% of weekly self-report data; and (5) achieving treatment fidelity ≥80%. Between-group differences in clinical treatment-related outcomes also were examined preliminarily. A total of 54 participants were enrolled between October 25, 2023 and July 26, 2024, and randomly assigned to the Doxy.me VR (n=29) and TMH (n=25) conditions, exceeding our recruitment target by 180%. Among the 30 participants targeted for completion, data were obtained from 29 (96.7%) at midtreatment and 28 (93.3%) at posttreatment. Participants completed 86.5% (180/208) of weekly self-report assessments. Treatment fidelity was 90% based on ratings of 41 session recordings. There were no significant between-group differences in clinical outcomes (all P>.05) or most treatment-related outcomes. However, client satisfaction improved significantly more for the Doxy.me VR condition compared to TMH (P=.04). Power analyses indicated that a sample of 160 participants would ensure adequate power for a fully powered trial. Telehealth-based, multiuser, synchronous VRET is feasible and shows preliminary evidence of efficacy. These findings are promising, and opportunities to improve procedures identified in this feasibility trial will directly inform the protocol for a fully powered RCT evaluating telehealth-based VR and its potential to improve treatment of mental health disorders.

Cognitive training is an effective approach to support cognitive function in older adults. Incorporating meaningful leisure activities, such as gardening, may enhance both engagement and training outcomes. While fully immersive virtual reality (VR) offers ecologically valid and engaging environments that can further boost motivation, limited research has explored the combination of VR-based cognitive training and leisure activities for older adults. This study aims to assess the feasibility, usability, and preliminary effectiveness of leisure-based VR cognitive training for community-dwelling older adults. A fully immersive VR cognitive training system, controlled via a head-mounted display, was developed, incorporating gardening-themed activities such as planting, fertilizing, watering, and harvesting. These tasks were designed to engage multiple cognitive domains, including memory, attention, executive function, processing speed, and visuospatial abilities. The program consisted of 16 sessions delivered over 8 weeks (twice weekly, 1 hour per session). Cognitive outcomes were assessed before and after training using the Montreal Cognitive Assessment, the digit symbol substitution test, word list immediate and delayed recall, spatial span, and the Stroop Color and Word Test. Feasibility, acceptance, and usability were evaluated using the System Usability Scale and a posttraining questionnaire. Licensed occupational therapists from both community and institutional settings assessed the training system's usability. All 41 participants (mean age 69.79, SD 5.05 y) completed the training with 100% adherence and no serious adverse events. Feasibility ratings-particularly for perceived usefulness, intention to use, and subjective norms-reflected strong acceptance. Usability ratings from older adults indicated high ease of use, enjoyment, and positive experience, while professionals rated the system as moderately usable (mean System Usability Scale score 68.01, SD 8.38). Statistically significant improvements were observed in general cognition (P=.004), processing speed (P=.049), immediate and delayed memory (P<.001), and executive function (P=.002). No significant changes were found in visuospatial memory (P=.29). This study provides preliminary evidence supporting the feasibility and usability of a gardening-based VR cognitive training program for older adults. Feasibility was demonstrated through full adherence, absence of major adverse events, and high participant acceptance. Usability feedback was favorable from both older adults and professionals across community and long term care settings. Additionally, improvements in multiple cognitive domains, including general cognition, processing speed, memory, and executive function, suggest potential cognitive benefits. Future randomized controlled trials with more diverse samples and extended follow-up are warranted to confirm and expand upon these findings.

Although technology is rapidly advancing in immersive virtual reality (VR) simulation, there is a paucity of literature to guide its implementation into health professions education, and there are no described best practices for the development of this evolving technology. We conducted a qualitative study using semistructured interviews with early adopters of immersive VR simulation technology to investigate use and motivations behind using this technology in educational practice, and to identify the educational needs that this technology can address. We conducted 16 interviews with VR early adopters. Data were analyzed via directed content analysis through the lens of the Unified Theory of Acceptance and Use of Technology. The main themes that emerged included focus on cognitive skills, access to education, resource investment, and balancing immersion. These findings help to clarify the intended role of VR simulation in health professions education. Based on our data, we synthesized a set of research questions that may help define best practices for future VR development and implementation. Immersive VR simulation technology primarily serves to teach cognitive skills, expand access to educational experiences, act as a collaborative repository of widely relevant and diverse simulation scenarios, and foster learning through deep immersion. By applying the Unified Theory of Acceptance and Use of Technology theoretical framework to the context of VR simulation, we not only collected validation evidence for this established theory, but also proposed several modifications to better explain use behavior in this specific setting.

Simulation-based training is essential for preparing medical interns to manage high-stakes emergencies. Although virtual reality (VR)-based simulation has been rapidly integrated into medical education, there remains limited evidence directly assessing its effectiveness relative to established high-fidelity simulation (HFS) methodologies. This study aimed to assess the perceived educational effectiveness of VR and HFS in enhancing novice physicians' confidence, satisfaction, and perceived preparedness for managing acute oxygen desaturation. A randomized controlled trial was conducted with 168 medical interns from Seoul National University Hospital. Participants were randomly assigned to VR group (n=81) or HFS group (n=87). Overall, 4 participants were excluded due to incomplete surveys, leaving 164 for analysis (VR: 79 and HFS: 85). Both groups were trained to manage simulated patients with low oxygen saturation. Confidence (10-point Likert scale) and satisfaction (7-point Likert scale) were measured using pre and posttraining surveys. Usability was assessed with the User Experience Questionnaire-Short. Between-group comparisons were conducted using t tests and chi-square tests, while within-group confidence changes were analyzed using paired t tests and repeated-measures analysis of variance. To account for correlated data and estimate effect sizes, generalized estimating equations were applied, with statistical significance set at P<.05. Focus group interviews at 1 and 5 months posttraining explored real-world application and behavior transfer. Transcripts were independently reviewed by 2 researchers (YJH and SJM) and thematically analyzed to identify recurring patterns and insights related to clinical behavior. Confidence in managing oxygen desaturation significantly improved from a mean 3.78 (SD 2.12) to mean 6.20 (SD 2.02) across VR and HFS groups (t163=-14.04; P<.001), with no significant difference between groups (F1,162=3.28; P=.07). Satisfaction was high overall mean 6.07 (SD 1.02), but significantly greater in the HFS group than in the VR group (mean 6.23, SD 0.92 vs mean 5.89, SD 1.10; t162 =2.29; P=.02). HFS participants rated tutor guidance (mean 6.49, SD 0.86 vs mean 6.10, SD 1.02; P=.008) and authenticity (mean 6.24, SD 1.05 vs mean 5.77, SD 1.15; P=.006) higher, whereas both groups scored usability above 5 on all items. Qualitative analyses revealed complementary strengths. Interns valued VR for its immersive environment, focused repetition, and reduced distractions that facilitated stepwise problem-solving. HFS was praised for palpable realism, hands-on practice with equipment, and immediate feedback that reinforced team communication and role clarity. Across follow-up interviews, interns reported improved recognition of desaturation, more structured initial responses (airway assessment, oxygen delivery adjustments, and escalation), and greater willingness to act promptly under pressure-suggesting perceived transfer of learning to clinical practice beyond the simulation lab. VR may complement HFS in emergency response training. Both modalities were associated with improvements in interns' self-reported confidence and perceived preparedness. The scalability and accessibility of VR suggest its potential value in diverse training contexts.

Traditional anatomy teaching relies on cadaveric dissection and 2D resources, which often require in-person attendance and may limit spatial understanding. Virtual reality (VR) provides an immersive, remote alternative that supports 3D visualization from home. Recent evidence suggests that while VR may yield comparable factual knowledge gains to 2D methods, its primary value lies in enhancing learner engagement, motivation, and perceived educational value. This pilot randomized controlled trial compares remote synchronized VR with didactic animated anatomy lectures for the teaching of tracheostomy anatomy. Participants were recruited via convenience sampling through the VRiMS (Virtual Reality in Medicine and Surgery) Surgical Society network. All participants first attended a synchronous 20-minute online lecture delivered by a consultant surgeon. They were then individually randomized to one of 2 groups using a computer-generated sequence. Allocation was concealed until the intervention; however, participants and researchers were unblinded. The intervention group completed a 10-minute metaverse-based VR session, delivered by a consultant surgeon via 3D Organon's Medverse platform on the PICO 4 Ultra headset. The control group completed a 10-minute prerecorded 2D animated lecture, accessed on their personal device. Participants then swapped to the other modality. Data were collected via Google Forms at 3 intervals (baseline, postintervention, and postcrossover) to assess confidence, spatial understanding, and knowledge (10-item multiple-choice questions). The analysis of nonparametric data utilized Wilcoxon signed-rank tests for within-group changes and Mann-Whitney U tests for between-group differences. Twenty-four medical students from 11 United Kingdom and Irish medical schools participated. Adherence was 100%, with all participants completing their assigned 10-minute intervention and all assessment points. Ninety-two percent of participants (n=22) reported no prior tracheostomy anatomy teaching. Additionally, 83% (n=20) had no prior remote-synchronized VR anatomy teaching experience. Anatomical confidence improved significantly in the VR group compared with animation (mean change 1.58, SD 1.00 vs mean 0.50, SD 0.80, P=.01). Knowledge scores improved significantly in both groups (VR: mean 1.75, SD 1.54, P=.007; animation: mean 2.83, SD 1.70, P=.003), with no significant postintervention difference between groups (P=.46). VR participants reported significantly superior spatial understanding across all measured domains (all P≤.009). These included depth perception (3.75 vs 2.58, P=.009), appreciation of anatomy from different viewpoints (4.25 vs 2.33, P=.001), mental reconstruction from varying angles (3.83 vs 2.08, P=.002), and spatial depth supporting anatomical understanding (4.08 vs 2.08, P=.001). Following the completion of both modalities, participants rated VR as more engaging (mean 4.54, SD 0.78) and more educationally effective (mean 4.29, SD 0.95) than animation. Remote VR teaching is feasible and engaging and enhances spatial understanding compared to animation. While knowledge gains were comparable between modalities, VR improved learner confidence and perceived 3D comprehension. Hence, VR may represent a scalable adjunct or alternative to traditional anatomy teaching.

Telerehabilitation is a promising solution to provide continuity of care. Most existing telerehabilitation platforms focus on rehabilitating upper limbs, balance, and cognitive training, but exercises improving cardiovascular fitness are often neglected. The objective of this study is to evaluate the acceptability and feasibility of a telerehabilitation intervention combining cognitive and aerobic exercises. A virtual reality-based dual-task exercise exploiting a cycle ergometer was designed, developed, and integrated with a commercially available telerehabilitation platform. Patients with different conditions were enrolled and administered subjective questionnaires investigating attitudes toward technology, usability, technology acceptance, and subjective workload. Their therapists were interviewed, and adherence and performance data were analyzed. In total, 26 patients with neurological or post-COVID symptoms were included. Their attitude toward technology (range: 0-5) did not change after the training period (pre: 3.44 [IQR 0.63]; post: 3.50 [IQR 0.48]); the platform was rated usable and acceptable. Frustration and physical and mental workload were present, especially among younger participants. The adherence was moderate, but individual differences were present (0.59 [IQR 0.54]). The therapists highlighted the potential of remote rehabilitation programs but also identified some limitations. This study proved the feasibility and acceptability of a customized virtual reality-based telerehabilitation program allowing for the safe implementation of aerobic cycling-based dual-task training. The solution was judged meaningful for dehospitalized patients, although some environmental and technical barriers should be overcome to implement telerehabilitation more effectively.