=Paper=
{{Paper
|id=Vol-3382/Paper1
|storemode=property
|title=Virtual Reality in Digital Health: A Literature Review
|pdfUrl=https://ceur-ws.org/Vol-3382/Paper1.pdf
|volume=Vol-3382
|authors=Avnish Singh Jat,Tor-Morten Gronli
|dblpUrl=https://dblp.org/rec/conf/dtesi/JatG22
}}
==Virtual Reality in Digital Health: A Literature Review==
https://ceur-ws.org/Vol-3382/Paper1.pdf
Virtual Reality in Digital Health: A Literature Review
Avnish Singh Jat 1, and Tor-Morten Grønli1
1
Mobile Technology Lab, Department of Information Technology Kristiania University College, Oslo, Norway
Abstract
Due to its numerous use cases across a variety of sectors, virtual reality (VR) is becoming a
more and more vital technology nowadays. With the help of this technology, 3D visualization
for different real-life situations is improved. It offers a fresh method of interacting with the
patient's soft tissue. Therefore, the applications of this technology are in the sphere of
medicine and are becoming more and more adopted by the healthcare community. This
article presents a literature review on research projects related to virtual reality in health
informatics. For this, we have screened 430 research publications related to virtual reality in
healthcare and selected 17 publications for the review that matched our selection criteria.
Finally, we discussed future research perspectives and research challenges in virtual reality-
enabled healthcare architecture.
Keywords 1
Virtual Reality, e-health, digital health, VR in Healthcare
1. Introduction
Virtual reality is a 3D environment that the user can easily explore and interact with. Depending
on the level of presence, virtual reality technology can be classified into immersive virtual reality
which includes interactivity and user participation in the virtual environment to create a "present" and
non-immersive virtual reality sensation. Utilizing computer technology, virtual reality produces a
simulated environment. It enables user interaction in a 3D virtual environment utilizing a screen,
helping to imitate vision, hearing, and touch in the synthetic 3D environment. This device features a
head-mounted display that can fill an entire room. Software is used to create an artificial environment
that users can perceive as real. This technology's primary use is to build a fictional setting for video
games, interactive stories, and training exercises. [1,20] In order to engage with virtual features, this
technology creates realistic visuals in a virtual setting. Currently, it is used for training purposes in the
area of medical, design, automotive, driving training, aviation simulator, and the military. It offers
thorough details about the patient's anatomy and other bodily parts.
Virtual reality simulators can provide a learning experience similar to reality, with important
potential benefits in the teaching and self-teaching of manual surgical skills (14). In addition, it has
the potential to stratify different performance levels of healthcare students (15). Using VR headsets,
they are able to feel the holographic visuals. [11,2] With the evolution of hardware and software, VR
technology is becoming ever more popular. It helps a surgeon perform their work safely. Staff
members of the intensive care unit can swiftly rehearse the technique during emergency scenarios. In
order to establish trust and make wise decisions, it offers the finest way to research complicated issues
and solutions. Different cognitive problems are worked out to adequately treat the patient. [3-5]
It is a valuable technique for managing pain and beneficial to lessening the discomfort during
therapy. This technology is starting to be applied in ways that could lead to a breakthrough in the
Proceedings of the 7th International Conference on Digital Technologies in Education, Science and Industry (DTESI 2022), October 20-21,
2022, Almaty, Kazakhstan
EMAIL: avnishsinghjat@gmail.com (Avnish Singh Jat) tor-morten.gronli@kristiania.no (Tor-Morten Grønli)
ORCID: 0000-0001-7473-3010 (Avnish Singh Jat); 0000-0002-2026-4551 (Tor-Morten Grønli)
©️ 2022 Copyright for this paper by its authors.
Use permitted under Creative Commons License Attribution 4.0 International (CC BY 4.0).
CEUR Workshop Proceedings (CEUR-WS.org)
treatment of anxiety. In the virtual world, the patient can now encounter fear without any issues.
High-end virtual surgery is accessible to enhance the experience. Now that doctors may practice in the
virtual world, surgical errors will be less prevalent. Practicing successful surgery with fewer errors is
desirable. This technology is a more effective way to advance surgical techniques and tackle various
complex challenges. [6,7] VR is a cutting-edge approach to medical training. It can be utilized to
provide adequate medical communication for a scope of scenarios like in orthopaedics, it is used to
identify and evaluate broken bones. Wearing VR glasses promotes the efficiency and effectiveness of
operations. [8,9]
The rehabilitation of cancer patients using VR is a very crucial application of this technology. The
patient's chemotherapy is administered with precision and comfort. It readily submits to dialysis for
patients with chronic illnesses and disabilities. One can view the patient's body and its components
from various perspectives utilizing a VR headset. [10-12] When a patient uses VR glasses, this
response produces their confidence by reducing their apprehension because the information they
receive is more convincing. With the aid of this technology, a cardiac surgeon may now monitor a
patient's heart rhythm and rate hikes. It creates accurate sounds and sights in a made-up or virtual
world. [13,14] The screen, lenses, eye tracking, motion detection, activity recognition, and
microphone and speakers that provide the live sound, are all independent components of VR
technology. It includes robotic surgery, surgery modeling, PTSD treatment, and skills enhancement in
the medical industry. This technology transmits better information in the most cost-efficient way
possible. It is used to communicate effectively and slash therapeutic ideas. [15–17] This technology
appears to be helpful for treating brain pain. It is utilized to jog the patient's memory and help them
deal with various stressful situations. In VR, information is accurate and presented as it would be in
the actual world. It helps with risk detection so that results are effective. The creation of new diseases
is aided by this technology. A surgeon can now practice Simulink training in a secure environment as
it teaches medical personnel how to handle a challenging situation. [7,18] In orthopaedics, it is
advantageous to guide and give the proper mobility of fingertips and limbs. It is a clever strategy to
cope with discomfort. This technology educates the patient for a greater grasp of the operation and
treatment plan by educating them about diseases, their advantages, and their downsides. [19] The
need for VR in the medical industry is briefly discussed in this essay. Significant applications are
identified and discussed, as well as the processes this technology uses. Paper gives doctors and
surgeons greater ideas for difficult treatments.
2. Background
Robert Mann created the first virtual system for use in medicine in 1965 [22]. It was used to
determine the ideal course of action for an orthopaedic illness. Additionally, this approach was
employed to train inhabitants [23]. The first simulators with 3D visuals debuted in the 1960s. The
helmet-mounted display (HDM) was created in the 1980s, and "virtual reality" was defined. A decade
or more later, the first laparoscopy simulator debuted along with the use of virtual reality in medical
education (modelling of colonoscopy and higher gastrointestinal endoscopy). Even though simulation
technologies improved over time, developing a tactile interface between people and machines was
still important. Information is transmitted between a human and a computer using haptic systems. In
the modern day, force-feedback haptic devices are strongly related to virtual reality [23].
In order to give comprehensive training and ensure the surgical operation's success, this
technology was introduced to the medical industry in the 1990s. To innovate in the medical field,
doctors, surgeons, scientists, researchers, and students must work together more effectively. VR is a
practical technology that links these teams to resolve challenging issues. In a healthcare organization,
we must determine how it aids in preparing better solutions and delivering appropriate training. It
appears to be a helpful training device for medical professionals. We need to explore how students
can use a computerized simulation of complicated surgery performed in a surgical suite to aid in
giving the cancer patient the right treatment.
One of the top 3 sectors that will continue to be early adopters of VR technology through 2025 is
healthcare, according to Goldman Sachs Global Investment Research. According to Accenture, 82%
of healthcare workers feel that virtual reality offers medical students and working healthcare
professionals a convenient way to access and study knowledge. 62 percent of patients, according to
the organization, would be open to using virtual reality medical services instead of more conventional
ones.
The programme VR is used to accelerate training without any risk or worry. It is applied to treat a
variety of diseases in the medical field. This technology is helpful in enhancing the capabilities of the
medical industry. [20,21] It is a helpful and practical technology to raise trainee and patient
satisfaction. As seen in the image, this technology uses its method in the medical industry to deliver
an acceptable solution. VR is a crucial technology for the creation of specialised, cutting-edge
software and hardware. First, we can gather the necessary background data and determine the precise
treatment's goal. To create 3D virtual data that creates a 3D virtual world, various hardware and
software are required. The best method is used to construct and identify the virtual reality of the
necessary medical data. This process can be used to plan the course of treatment and ultimately aids in
carrying out the actual surgery.
3. Research Methodology
The convention followed for this review lines up with a five-step structure framed by Arksey and
O'Malley, and progressed by Levac et al. [4]. The system incorporates distinguishing the examination
questions and important investigations, choosing of studies, information extraction from the chosen
research works, and discussion of the outcomes.
3.1. Research Questions
1. How has virtual reality affected the medical services industry?
2. How is virtual reality being extended to supplement the current medical services framework?
3. What is the most targeted population and medical area in research work related to virtual
reality in healthcare?
4. What will be the future of virtual reality in the healthcare industry?
3.2. Literature Search
As part of this scoping review, literature from the following databases was searched:
ISI Web of Science®, IEEE Xplore®, PubMed®. Significant article identification criteria are
publication year and keywords. Keywords that were looked through in these data sets incorporate,
however, are not restricted to those displayed in Table1.
Table 1
Keywords
Virtual Reality VR in Healthcare e-health
Virtual Surgery Social Cognition VR in CBT
3.3. Selection Criteria
Table 2
Inclusion & Exclusion Criteria
Inclusion Criteria Exclusion Criteria
• Title is related to the questions. Studies should • Review study and studies related to policies of
report on marginal and internal fit. VR in Healthcare
• Included studies are relevant to study design. • Study with no citation count.
• Included studies must have been published • Study was published more than 5 years ago
between 2017 and 2022 Study was published in a language other than
English
Figure 1: Prisma Diagram
3.4. Articles Included
Table 3
Included Studies for Review
Sr. No. Year Title Study Design Target Population No. of Study Aim
participants/
Patients
1. 2020 Virtual Reality Social Prediction Randomised Patients with cerebellar 42 Social Cognitive intensive training
Improvement and Rehabilitation Controlled malformations having
Intensive Training (VR-SPIRIT) (…) Trial deficit in social
[31] cognition
2. 2022 Feasibility and acceptability of Randomized People receiving 13 controlled trials of 3D head-mounted
virtual reality for cancer pain in Controlled palliative care – Cancer (HMD) virtual reality for managing
people (…) [32] Trial patients cancer pain in adults.
3. 2018 Virtual reality as a distraction Randomized Females with breast 80 Reducing pain and anxiety among
technique for pain and anxiety (…) Controlled cancer female breast cancer patients.
[33] Trial
4. 2019 Virtual reality for management of Clinical Trial Hospitalized patients 120 Therapeutic virtual reality on pain
pain in hospitalized patients(…) with pain management for hospitalized patients.
[34]
5. 2019 Virtual Reality Rehabilitation Randomized Patients with 28 To investigate the manner of walking
Versus Conventional Physical Controlled Parkinson’s disease and balance in Parkinson’s disease
Therapy (…) [35] Trial patients.
6. 2018 Mobile Game-based Virtual Reality Clinical Trial Stroke patients with 24 virtual reality upper extremity stroke
Program for Upper Extremity upper extremity issues rehabilitation program
Stroke Rehabilitation [36]
7. 2020 Virtual Reality Rehabilitation in Clinical Trial Patients with Chronic 106 Compares the effects of inpatient-
Patients with Chronic Obstructive Obstructive Pulmonary based rehabilitation program for
Pulmonary Disease [37] Disease (COPD) patients with COPD using non-
immersive virtual reality training with a
traditional pulmonary rehabilitation
program.
Sr. No. Year Title Study Design Target Population No. of Study Aim
participants/
Patients
8. 2017 Virtual reality improves Randomized Patients with SCI – 40 Using multisensory own body illusions
embodiment and neuropathic pain Controlled Spinal Cord Injury and and virtual reality on patients with
caused by spinal cord injury[38] Trial Paraplegia spinal cord injury.
9. 2019 Using a Virtual Reality System to Clinical trial Old people suffering 5 virtual reality system with a 360-degree
Improve Quality of Life (…) [39] from depression virtual garden view to encouraging the
elderly with depression symptoms
10. 2021 The Effect of a Virtual Reality Randomized Patients going through 64 Use of immersive virtual reality utilizing
Immersive Experience Upon Controlled cardiac catheterization video-based material to enhance
Anxiety Levels, Procedural Trial informed consent and explanation
Understanding(…) [40] process.
11. 2021 Virtual Reality-Based Cognitive Randomized People suffering from 17 The effect of VR-based cognitive
Stimulation on People with Mild to Controlled dementia due to simulation that reproduces
Moderate Dementia due to Trial Alzheimer’s Disease Instrumental Activities of Daily Living.
Alzheimer’s Disease [41]
12. 2018 Virtual reality rehabilitation in Randomized Children with brain 80 The usefulness of VR system for
children with brain injury [42] Clinical Trial injury rehabilitation of children with brain
injury to improve the functioning of
their upper-limb.
13. 2022 The benefits and acceptability Pilot Women with 38 Virtual reality to relieve the physical
of virtual reality interventions for Randomised metastatic breast and psychological symptoms in women
women with metastatic breast Trial cancer (MBC) suffering from metastatic breast cancer.
cancer in their homes [43]
14. 2020 Can hypnosis and virtual reality Randomised Patients undergoing 100 Applications of VR, hypnosis and VRH in
reduce anxiety, pain and fatigue Controlled cardiac surgery medical procedures.
among patients who undergo Trial
cardiac surgery[44]
15 2021 Virtual Reality Relaxation for Crossover Patients with 50 To assess the effectiveness of virtual
Patients with a Psychiatric Disorder Randomized Psychiatric disorder reality relaxation tool by testing with
[45] Controlled clinical trials in psychiatric patients.
Trial
Sr. No. Year Title Study Design Target Population No. of Study Aim
participants/
Patients
16. 2021 Application of virtual reality on Randomized Children 120 To measure the efficacy of virtual
non-drug behavioural management Controlled reality as a distraction for behaviour
of short-term dental procedure in Trial management in dental procedures in
children. [46] children.
17. 2021 Effects of immersive virtual reality Study protocol Paediatric cancer 20 Virtual Reality (IMR), in intervention for
for preventing and managing for an patients. distracting paediatric cancer patients to
anxiety, nausea and vomiting (…) Exploratory manage anxiety, nausea and vomiting
[47] trial when receiving their first
chemotherapy.
4. Discussion
4.1 . Virtual Reality for Pain Reduction and Psychiatric Treatment
Among the articles reviewed 30% of research work presents novel approaches to the utilization of
Virtual Reality as a distraction technique to reduce pain and anxiety in different scenarios. VR has
been applied to treat patients for preventing and managing anxiety. Especially in patients during
chemotherapy, with a successful decrease in the perception of pain and anxiety during treatment (20).
In the perception of pain during surgical procedures, VR also has the potential to become a method
to prevent preventing and manage anxiety, nausea, and vomiting during clinical procedures (21). In
distractions through virtual reality, this methodology can be considered a relevant intervention for
treatments (9), reducing the anxiety of patients undergoing procedures such as chemotherapy (22).
Virtual reality-based treatments prove to be effective in enhancing psychiatric treatments. It has
the ability to reduce stress and can be used as a treatment for anxiety, psychotic, depressive, or bipolar
disorder. Compared to standard relaxation, VR-based treatments have shown a significantly greater
reduction of total negative affective state. It had a stronger beneficial effect on momentary anxiety,
sadness, and cheerfulness. Virtual Reality also showed improved cognitive function, effective for
neurocognitive stimulation. In a clinical trial by Angkana Suwanjatuporn for developing a VR system
to treat depression in old people. Providing a virtual reality system with a 360-degree virtual garden
view to encourage the elderly with depression symptoms to move their arms, and help them to
stimulate their brain functions and overcome depression quickly. Almost all the participants were able
to learn and make use of the VR system with a virtual 360-degree garden view. The elder people were
highly satisfied by the experience. They were eager and excited to learn to use the system [39]. VR is
also feasible and acceptable by children to improve social skills. It was very effective in improving
social interaction, empathy, opinions, and emotional recognition in particular children.
4.2 . Virtual Reality for Rehabilitation & Medical Education
Virtual reality (VR) technology is rapidly becoming a popular application for physical
rehabilitation and motor control research. Twenty-five percent of the reviewed article presented
different approaches to utilizing VR in rehabilitation. VR rehabilitation training performs better on
gait and balance in patients with PD than conventional rehabilitation trainingVR rehabilitation
preparation can be utilized as elective treatment. A VR-based non-intrusive treatment program can
add an incentive for patients and clinicians concerning genuine information assortment (to support
consistency checking, the movement toward objectives, and exercise security), expanded
commitment, and expanded admittance. Computer-generated reality headsets might be utilized to
cause circumstances that challenge your visual framework while you are in vestibular recovery.
Recordings of thrill rides, swooshing vehicles flashing by, or optokinetic shapes might be extended
before your eyes while attempting to keep up with great equilibrium. This difficulties your visual info
and nerves that assist you with remaining upstanding, attempting to fortify the fundamental
connections between your vestibular organs and eye developments.
Virtual reality improves knowledge and skills outcomes compared to traditional education or other
types of education; however, studies are limited and future research should assess the effectiveness of
this technology in addition to other variables such as attitude, satisfaction, cost-benefit, and clinical or
behavioural change [18].
In some universities, this technology has already been introduced into their preclinical curriculum,
with promising results as there has been an improvement in student performance, and it can be a
valuable adjunct during professional training.
Virtual reality has also been used to teach aesthetic techniques using a simulator. The training of
anesthesia to block the inferior alveolar nerve was highly appropriate considering the application of
the needle in an appropriate area, depth of insertion, as well as sensitivity of the needle. the virtual
resistance of the tissue.
This technology is becoming an essential part of modern education. The benefits of virtual reality
in health care are constantly evaluated as a method or adjunct to improve fine motor skills, and hand-
eye coordination in preclinical settings, and overcome the monetary and intellectual challenges related
to student training.
As an educational tool, this technology has provided better opportunities for college students and
will become a key function in the future of healthcare education. Offering new teaching possibilities
by combining digital elements with a real learning environment, there are still several uncertainties
that limit the widespread implementation of this technology. Most of these uncertainties can be
resolved through continued progress in information technology.
4.3 . Research Challenges
In contrast to many other industries where VR-based solutions are being created and used, the
healthcare industry is unique. The analysis of these distinctions is the focus of this part since knowing
them is crucial to avoiding several errors that could jeopardize the success of a VR system that is
otherwise well thought out and practical. From the perspective of engineering design, there are several
elements that make the healthcare sector unique. The first and most important one is how pertinent its
operations are to human life and health. Although this is obvious, engineers should keep it in mind as
they attempt to comprehend the perspectives and judgments of health professionals. A system must
first be demonstrated to be completely safe for patients before it can be fully validated and employed.
After that, it must also be demonstrated that it serves the function for which it was designed.
Companies and salesmen constantly approach healthcare professionals to try to persuade them to
utilize a certain solution for a variety of issues. It happens that a product that initially appeared to be
reliable later revealed harmful long-term adverse effects that did not surface during system testing. In
connection with this, mass media is another element influencing healthcare professionals' choices.
The public pays a tremendous amount of attention to any news affecting the healthcare industry. In an
example, using bad news to your advantage is a great method to boost sales. Finally, politics are
crucial because they can influence whether political parties succeed in winning elections. The logical
result of all these factors is that medical practitioners become cautious when implementing real ideas,
and the adoption of drastically different methodologies often develops more slowly than expected by
the engineers who build them. Additionally, until the benefits of the new ideas are completely
demonstrated, it is common to prefer old solutions and practices. This is not to say that the healthcare
industry is opposed to technological development in any way; on the contrary, it is likely one of the
industries where technology has had the greatest influence. It simply means that innovative solutions
take more time to gain popular adoption. The second obstacle to the development of VR healthcare
systems is complexity, which is also connected with high costs. Since they would provide
outrageously implausible outcomes, many applications in this business cannot use the majority of the
simplification assumptions that have been developed for other industries (simpler structures, simple
transient characteristics, rigid rather than flexible units, etc.). As a result, dealing with complex issues
is necessary for medical VR systems, and as is customary in VR, these issues must be resolved
immediately. A VR system may become unprofitable as a result of the increased hardware and
software costs and lengthened development timeframes.
4.4 . Suggestions
There is no doubt in the fact that VR has a promising future in the healthcare industry. Many
health professionals now consider VR-based solutions to be current and effective due to the gradual
invention and development of VR systems, their entry into the market, and their strong reputation.
Utilizing VR training systems for resident education in hospitals and institutions will boost their use,
but more crucially, it will change professionals' mindsets—at least momentarily. As VR techniques
are proven to be successful, more and more problems will be considered as prospective possibilities.
(at least in some circumstances). To do this, it is crucial to establish interdisciplinary teams made up
of engineers and professionals from the health sector in order to identify open issues and create
efficient solutions: failures or missed opportunities will result from a lack of understanding of actual
demands or processes.
A new phase begins when a well-thought-out and built VR system has been made: convincing the
users of the possible benefits it might provide. Young professionals tend to accept new technology
more quickly in general. There are occasionally strange circumstances since senior professionals often
make judgments about buying new technologies. Virtual reality (VR) systems typically deliver
comments to evaluate how well experts implement the exercises; typically, this rating is based just on
nimbleness, kinesthetic awareness, and physical capabilities, instead of expertise, the ability to make
corrections, the capacity to make the best choice, etc. Senior experts typically receive lower ratings
than newer, less experienced experts as a result. This fact may cause those who must determine if the
entire system is worthwhile to unconsciously reject the system as a whole. Dexterity alone should not
be the only factor included in practitioner assessments generated by VR systems.
When implementing VR applications for the healthcare sector, the following considerations can be
made in light of all these factors:
First, it's critical to focus efforts on innovations that genuinely solve certain issues or meet
pertinent demands. Since they are the ones with a broad perspective of the issues present in their
sector, this must be ensured by obtaining input and cooperation from healthcare professionals at every
level of development. This is merely another argument in support of multidisciplinary development
teams, which are frequently required in the VR industry.
Second, it's crucial to consider the functional requirements for VR systems in the healthcare
industry. It is crucial to prevent both the generation of irrelevant designs that don't actually solve any
problems and the generation of excessively complicated designs that will be difficult to build, and
sustain, which will cost a lot of money in terms of hardware and software. A balance between
intricacy and utility must be achieved; in every case, a straightforward approach that achieves the
desired result is the ideal choice, especially if it prevents the eventual need for trained operators to
make the system function [26].
Third, from a technical standpoint, VR systems for the healthcare industry provide a significant
difficulty. Numerous aspects still require improvement, such as the handling of deformable bodies,
systems, and organisms, enhanced visual stimuli, more suitable sensory instruments, etc. Real-time
simulations of intricate processes like chopping, grasping, slicing, etc. must also be created.
Last but not least, the development of Virtual reality technology for the medical industry involves
much more than only the actual engineering issue. Other important variables to take into account
include how the system will be used, the data it will provide regarding practitioners' performance, the
kind of training activities that will be put up, etc. [26].
5. Conclusion
By generating a virtual, three-dimensional environment, virtual reality opens up new options and
improves medical care. It provides a more accurate perception of the environment. It is possible to
cure illnesses caused by stress with this technology, It has several uses in the disciplines of psychiatry,
psychotherapy, physical rehabilitation, and other intervention methods. This technological
development appears to be the best option in the medical industry because it may allow situations to
be immersed. It might shorten the time spent with the therapist. These days, this technology can
handle challenging patient conditions. Since a few years ago, the uses of this technology have been
rapidly investigated in order to produce significant advancements. In order to effectively treat
patients, VR technology successfully addresses these needs in the healthcare profession. VR seems to
lower the overall cost of the rehabilitation process. By using this equipment, the patient is able to
focus around the outside of the world and is alleviated of overall tension. By providing interactive
movements and sensations, it gives the human brain an experience. This technology provides a potent
and superior solution for stress management that helps patients and according to research, it might
even help them live better life.
6. References
[1] J. I. Gold, N. E. Mahrer, Is virtual reality ready for prime time in the medical space? A
randomized control trial of pediatric virtual reality for acute procedural pain management, J
Pediatr Psychol, 43 (2018) 266–275.
[2] B. Birckhead, C. Khalil, X. Liu, et al., Recommendations for methodology of virtual reality
clinical trials in health care by an international working group: iterative study, JMIRMent Health,
6.1 (2019) e11973. URL: https://doi.org/10.2196/11973.
[3] P. S. Bordnick, B. L. Carter, A. C. Traylor, What virtual reality research in addictions can tell us
about the future of obesity assessment and treatment, J Diabetes Sci Technol, 5.2 (2011) 265–
271.
[4] S. Ghai, I. Ghai, Virtual reality enhances gait in cerebral palsy: a training dose-response meta-
analysis, Front Neurol, 10 (2019) 236. URL: https://doi.org/10.3389/fneur. 2019.00236.
[5] A. Haleem, M. Javaid, 3D scanning applications in medical field: a literature-based review, Clin
Epidemiol Global Health, 7.2 (2019) 199–210.
[6] E. Heyselaar, P. Hagoort, K. Segaert, How social opinion influences syntactic processing an
investigation using virtual reality, PLoS One, 12.4 (2017) e0174405.
[7] L. Coyne, T. A. Merritt, B. L. Parmentier, R. A. Sharpton, J. K. Takemoto, The past, present, and
future of virtual reality in pharmacy education, Am J Pharmaceut Educ., 83.3 (2019) 7456. URL:
https://doi.org/10.5688/ajpe7456.
[8] E. Malbos, R. M. Rapee, M. A. Kavakli, A controlled study of agoraphobia and the independent
effect of virtual reality exposure therapy, Aust N Z J Psychiatr, 47 (2013) 160–168.
[9] R. Khan, J. Plahouras, B. C. Johnston, M. A. Scaffidi, S. C. Grover, C. M. Walsh, Virtual reality
simulation training for health professions trainees in gastrointestinal endoscopy, Cochrane
Database Syst Rev, 8.8. (2018) CD008237.
[10] J. W. Yoo, D. R. Lee, Y. J. Sim, J. H. You, C. J. Kim, Effects of innovative virtual reality game
and EMG biofeedback on neuromotor control in cerebral palsy, Bio Med Mater Eng., 24 (2014)
3613–3618.
[11] S. Bouchard, S. Dumoulin, G. Robillard, et al., Virtual reality compared with exposure in the
treatment of social anxiety disorder: a three-arm randomised controlled trial, Br J Psychiatry,
210.4 (2017) pp. 276–283.
[12] M. Javaid, A. Haleem, L. Kumar, Current status and applications of 3D scanning in dentistry.
Clin Epidemiol Global Health, 7.2 (2019) 179–185.
[13] M. Lee, M. Billinghurst, W. Baek, R. Green, W. Woo, A usability study of multimodal input in
an augmented reality environment, Virtual Real., 17.4 (2013) 293–305.
[14] M. Peskin, K. Wyka, J. Cukor, et al., The relationship between posttraumatic and depressive
symptoms during virtual reality exposure therapy with a cognitive enhancer., J Anxiety Disord.
61 (2019) 82–88.
[15] M. Javaid, A. Haleem, Additive manufacturing applications in medical cases: a literature-based
review, Alexandria J Med. 54.4 (2018) 411–422.
[16] R. Crossley, T. Liebig, M. Holtmannspoetter, et al., Validation studies of virtual reality
simulation performance metrics for mechanical thrombectomy in ischemic stroke., J
Neurointerventional Surg. 11.8 (2019) 775–780.
[17] M. Javaid, A. Haleem, Industry 4.0 applications in medical field: a brief review, Curr Med Res
Prac. 9.3 (2019) 102–109.
[18] S. K. Subramanian, C.B. Lourenço, G. Chilingaryan, H. Sveistrup, M. F. Levin, Arm motor
recovery using a virtual reality intervention in chronic stroke: randomized control trial,
Neurorehabilitation Neural Repair 27.1 (2013) 13–23.
[19] H. Huygelier, B. Schraepen, R. van Ee, V. VandenAbeele, C. R. Gillebert, Acceptance of
immersive head-mounted virtual reality in older adults, Sci Rep. 9.1 (2019) 4519. URL:
https://doi.org/10.1038/s41598-019-41200-6.
[20] D. Vergara, M. P. Rubio, M. Lorenzo, On the design of virtual reality learning environments in
engineering, Multimodal Technol Interact 1.11 (2017). URL:
https://doi.org/10.3390/mti1020011.
[21] J. F. Zhang, A. R. Paciorkowski, P. A. Craig, F. Cui, Bio VR: a platform for virtual reality,
assisted biological data integration and visualization, BMC Bioinf. 20.1 (2019) 78. URL:
https://doi.org/10.1186/s12859-019-2666-z.
[22] S. Bouchard, S. Dumoulin, G. Robillard, et al., Virtual reality compared with exposure in the
treatment of social anxiety disorder: a three-arm randomised controlled trial, Br J Psychiatry
210.4 (2017) 276–283.
[23] B. Birckhead, C. Khalil, X. Liu, et al., Recommendations for methodology of virtual reality
clinical trials in health care by an international working group: iterative study, JMIRMent Health
6.1 (2019) e11973. URL: https://doi.org/10.2196/11973.
[24] A. Haleem, M. Javaid, R. Vaishya, I. H. Khan, Virtual reality applications in orthopaedics, J
Orthop Allied Sci (2019). URL: https://doi.org/10.4103/joas.joas_37_19.
[25] X. Pan, A. Hamilton, Why and how to use virtual reality to study human social interaction: the
challenges of exploring a new research landscape, Br J Psychol 109 (2018) 395–417
[26] S. Bayona, et al., Implementing virtual reality in the healthcare sector, Virtual Technologies for
Business and Industrial Applications: Innovative and Synergistic Approaches, IGI Global (2011)
138-163.
[27] N. Butti, E. Biffi, C. Genova, et al., Virtual Reality Social Prediction Improvement and
Rehabilitation Intensive Training (VR-SPIRIT) for paediatric patients with congenital cerebellar
diseases: study protocol of a randomised controlled trial, Trials 21 (2020) 82, 2020. URL:
https://doi.org/10.1186/s13063-019-4001-4.
[28] P. D. Austin, P. J. Siddall & M. R. Lovell, Feasibility and acceptability of virtual reality for
cancer pain in people receiving palliative care: a randomised cross-over study, Support Care
Cancer 30 (2022) 3995–4005. URL: https://doi.org/10.1007/s00520-022-06824-x.
[29] E. B. Mohammad, M. Ahmad, Virtual reality as a distraction technique for pain and anxiety
among patients with breast cancer: A randomized control trial, Palliative and Supportive Care
17.1 (2019) 29-34. URL: doi:10.1017/S1478951518000639.
[30] B. Spiegel, G. Fuller, M. Lopez, T. Dupuy, B. Noah, et al., Virtual reality for management of
pain in hospitalized patients: A randomized comparative effectiveness trial, PLoS One 14.8
(2019) e0219115. URL: https://doi.org/10.1371/journal.pone.0219115.
[31] N. Butti, E. Biffi, C. Genova, et al., Virtual Reality Social Prediction Improvement and
Rehabilitation Intensive Training (VR-SPIRIT) for paediatric patients with congenital cerebellar
diseases: study protocol of a randomised controlled trial, Trials 21 (2020) 82, 2020. URL:
https://doi.org/10.1186/s13063-019-4001-4.
[32] P. D. Austin, P. J. Siddall, M. R. Lovell, Feasibility and acceptability of virtual reality for cancer
pain in people receiving palliative care: a randomised cross-over study, Support Care Cancer 30
(2022) 3995–4005. URL: https://doi.org/10.1007/s00520-022-06824-x.
[33] E. B. Mohammad, M. Ahmad, Virtual reality as a distraction technique for pain and anxiety
among patients with breast cancer: A randomized control trial, Palliative and Supportive Care
17.1 (2019) pp. 29-34. URL: doi:10.1017/S1478951518000639.
[34] B. Spiegel, G. Fuller, M. Lopez, T. Dupuy, B. Noah, A. Howard, M. Albert, V. Tashjian, R.
Lam, J. Ahn, F. Dailey, B. T. Rosen, M. Vrahas, M. Little, J. Garlich, E. Dzubur, W. IsHak, I.
Danovitch, Virtual reality for management of pain in hospitalized patients: A randomized
comparative effectiveness trial, PLoS One 14.8 (2019):e0219115. doi:
10.1371/journal.pone.0219115.
[35] H. Feng, C. Li, J. Liu, L. Wang, J. Ma, G. Li, L. Gan, X. Shang, Z. Wu, Virtual Reality
Rehabilitation Versus Conventional Physical Therapy for Improving Balance and Gait in
Parkinson's Disease Patients: A Randomized Controlled Trial, Med Sci Monit. 25 (2019)4186-
4192. doi: 10.12659/MSM.916455.
[36] Y. H. Choi, N. J. Paik, Mobile Game-based Virtual Reality Program for Upper Extremity Stroke
Rehabilitation, J Vis Exp. 133 (2018) 56241. doi: 10.3791/56241.
[37] S. Rutkowski, A. Rutkowska, P. Kiper, D. Jastrzebski, H. Racheniuk, A. Turolla, J.
Szczegielniak, R. Casaburi, Virtual Reality Rehabilitation in Patients with Chronic Obstructive
Pulmonary Disease: A Randomized Controlled Trial, Int J Chron Obstruct Pulmon Dis. 15
(2020) 117-124. doi: 10.2147/COPD.S223592.
[38] P. Pozeg, E. Palluel, R. Ronchi, M. Solcà, A. W. Al-Khodairy, X. Jordan, A. Kassouha, O.
Blanke, Virtual reality improves embodiment and neuropathic pain caused by spinal cord injury,
Neurology 89.18 (2017) 1894-1903. doi: 10.1212/WNL.0000000000004585.
[39] A. Suwanjatuporn, T. Chintakovid, Using a Virtual Reality System to Improve Quality of Life of
the Elderly People with Depression, in: Proceedings of the IEEE International Conference on
Consumer Electronics – Asia (ICCE-Asia), 2019, pp. 153-156, doi: 10.1109/ICCE-
Asia46551.2019.8941607.
[40] H. Morgan, M. Nana, D. Phillips, S. Gallagher, The Effect of a VIrtual RealiTy Immersive
Experience Upon Anxiety Levels, Procedural Understanding, and Satisfaction in Patients
Undergoing CArdiac CaTHeterization: The VIRTUAL CATH Trial, J Invasive Cardiol 33.9
(2021) E681-E686.
[41] J. Oliveira, R. Gamito, T. Souto, R. Conde, M. Ferreira, T. Corotnean, A. Fernandes, H. Silva, T.
Neto, Virtual Reality-Based Cognitive Stimulation on People with Mild to Moderate Dementia
due to Alzheimer's Disease: A Pilot Randomized Controlled Trial, Int J Environ Res Public
Health 18.10 (2021) 5290. doi: 10.3390/ijerph18105290.
[42] J. Y. Choi, S. H. Yi, L. Ao, X. Tang, X. Xu, D. Shim, B. Yoo, E. S. Park, D. W. Rha, Virtual
reality rehabilitation in children with brain injury: a randomized controlled trial, Dev Med Child
Neurol 63.4 (2021) 480-487. doi: 10.1111/dmcn.14762.
[43] L. M. Reynolds, A. Cavadino, S. Chin, Z. Little, A. Akroyd, G, Tennant, R. Dobson, R. Broom,
A. Gautier, The benefits and acceptability of virtual reality interventions for women with
metastatic breast cancer in their homes; a pilot randomised trial, BMC Cancer 22.1 (2022) 360.
doi: 10.1186/s12885-021-09081-z.
[44] F. Rousseaux, M. E. Faymonville, A. S. Nyssen, N. Dardenne, D. Ledoux, P. B. Massion, A.
Vanhaudenhuyse, Can hypnosis and virtual reality reduce anxiety, pain and fatigue among
patients who undergo cardiac surgery: a randomised controlled trial, Trials 21.1 (2020) pp. 330.
doi: 10.1186/s13063-020-4222-6.
[45] W. Veling, B. Lestestuiver, M. Jongma, H. J. R. Hoenders, C. van Driel, Virtual Reality
Relaxation for Patients With a Psychiatric Disorder: Crossover Randomized Controlled Trial, J
Med Internet Res 23.1 (2021) e17233. doi: 10.2196/17233.
[46] L. Ran, N. Zhao, L. Fan, et al, Application of virtual reality on non-drug behavioral management
of short-term dental procedure in children, Trials 22 (2021) 562, 2021. URL:
https://doi.org/10.1186/s13063-021-05540-x.
[47] C. L. Wong, C. K. Li, K. C. Choi, W. K. W. So, J. Y. Y. Kwok, Y. T. Cheung, C. W. H. Chan,
Effects of immersive virtual reality for preventing and managing anxiety, nausea and vomiting
among paediatric cancer patients receiving their first chemotherapy: A study protocol for an
exploratory trial, PLoS One 16.10 (2021) e0258514. doi: 10.1371/journal.pone.0258514.