Virtual and Augmented Reality Applications in Medicine: Analysis of the Scientific Literature

Yeung A.W., Souto E.B., Durazzo A., Lucarini M., Novellino E., Tewari D., Wang D., Atanasov A.G., Santini A.

Nanopharmaceuticals and nanonutraceuticals research has been lately receiving a lot of scientific attention. We aimed to identify the top 100 most cited original articles of the scientific area, analyze their research themes, major contributors regarding authors, institutions, countries and journals. The bibliometric data was extracted from the Web of Science electronic database. Data was further processed by a bibliometric software, VOSviewer, to generate bubble maps to visualize the results. Inter-institutional and international collaboration networks were constructed to further understand the cooperation between different study centers. Results revealed that over 60% of the articles were published in the 2000s. As of November 2019, the articles were cited 576–3665 times, with 20.1–261.8 citations per year. The majority of the most prolific institutions were based in the United States. Besides the United States, China, South Korea, Canada and Germany contributed heavily to the 100 articles. Some popular themes included drug delivery, tumor, toxicity/biocompatibility and biodistribution. Regarding composition materials, gold, silver and polymeric nanoparticles were the most commonly used.

Fiani B., De Stefano F., Kondilis A., Covarrubias C., Reier L., Sarhadi K.

Virtual reality (VR) technology had its early development in the 1960s in the U.S. Air Force and has since evolved into a budding area of scientific research with many practical medical purposes. From medical education to resident training to the operating room, VR has provided tangible benefits to learners and trainees and has also improved surgery through enhanced preoperative planning and efficiency in the operating room. Neurosurgery is a particularly complex field of medicine, in which VR has blossomed into a tool with great usefulness and promise. In spinal surgery, VR simulation has allowed for the practice of innovative minimally invasive procedures. In cranial surgery, VR has excelled in helping neurosurgeons design unique patient-specific approaches to particularly challenging tumor excisions. In neurovascular surgery, VR has helped trainees practice and perfect procedures requiring high levels of dexterity to minimize intraoperative complications and patient radiation exposure. In peripheral nerve surgery, VR has allowed surgeons to gain increased practice and comfort with complex microsurgeries such as nerve decompression. Overall, VR continues to increase its potential in neurosurgery and is poised to benefit patients in a multitude of ways. Although cost-prohibiting, legal, and ethical challenges surrounding this technology must be considered, future research and more direct quantitative outcome comparisons between standard and VR-supplemented procedures would help provide more direction regarding the feasibility of widespread adoption of VR technology in neurosurgery.

Sobral M., Pestana M.H.

Some studies have shown that the Virtual Reality (VR) has emerged as a promising tool for the diagnosis, treatment and cognitive improvement in people with dementia. The objective was to make a bibliometric analysis to reflect on VR and dementia research from 1998 until 2018, identifying its intellectual structure and emerging trends. Data encompassing 356 documents and 19,238 citations collated between 1998 and 2018 from Web-of-Science and Scopus databases was analyzed through CiteSpace. There is an increasing growth of VR research as an instrument of diagnosis and intervention in dementia. Both databases show differences in terms of scope, the volume of data, and coverage policies. The Journal of Alzheimer's Disease is the top source. Giuseppe Riva is the most productive author. The USA and the UK are leading contributors. There is a dynamic shift in the focus of research over time and some new topics are now catching the attention of researchers. The results showed the relevance of VR in improving the health of patients with dementia and they found that the use of VR in people with dementia had a precious applicability, fundamentally, as a tool in diagnosis, treatment, cognitive improvement, or rehabilitation. The co-citation and co-authorship network analysis, the identification of critical papers, and the development of new emerging tendencies highlights the priorities in this field, pointing to new opportunities to guide researchers.

Yeung A.W., Tzvetkov N.T., Georgieva M.G., Ognyanov I.V., Kordos K., Jóźwik A., Kühl T., Perry G., Petralia M.C., Mazzon E., Atanasov A.G.

Significance: The excessive production of reactive oxygen species (ROS) has been linked to neurodegenerative diseases (NDs), and, therefore, many scientific works were published on the impact of RO...

van der Kolk N.M., de Vries N.M., Kessels R.P., Joosten H., Zwinderman A.H., Post B., Bloem B.R.

High-intensity aerobic exercise might attenuate the symptoms of Parkinson's disease, but high-quality evidence is scarce. Moreover, long-term adherence remains challenging. We aimed to evaluate the effectiveness of aerobic exercise-gamified and delivered at home, to promote adherence-on relieving motor symptoms in patients with Parkinson's disease with mild disease severity who were on common treatment regimes.In this single-centre, double-blind, randomised controlled trial (Park-in-Shape), we recruited sedentary patients with Parkinson's disease from the outpatient clinic at Radboudumc, Nijmegen, Netherlands. Patients were made aware of the study either by their treating neurologist or via information in the waiting room. Patients could also contact the study team via social media. We included patients aged 30-75 years with a Hoehn and Yahr stage of 2 or lower, who were on stable dopaminergic medication. Patients were randomly assigned (in a 1:1 ratio) to either aerobic exercise done on a stationary home-trainer (aerobic intervention group) or stretching (active control group) by means of a web-based system with minimisation for sex and medication status (treated or untreated) and permuted blocks of varying sizes of more than two (unknown to study personnel). Patients were only aware of the content of their assigned programme. Assessors were unaware of group assignments. Both interventions were home based, requiring 30-45 min training three times per week for 6 months. Both groups received a motivational app and remote supervision. Home trainers were enhanced with virtual reality software and real-life videos providing a so-called exergaming experience (ie, exercise enhanced by gamified elements). The primary outcome was the between-group difference in the Movement Disorders Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) motor section at 6 months, tested during the off state (≥12 h after last dopaminergic medication). The analysis was done on an intention-to-treat basis in patients who completed the follow-up assessment, regardless of whether they completed the assigned intervention. Patients reported adverse events directly to their coach and also after the 6-month visit retrospectively. A between-group difference of 3·5 points or more was deemed a-priori clinically relevant. The study is concluded and registered with the Dutch Trial Registry, NTR4743.Between Feb 2, 2015, and Oct 27, 2017, 139 patients were assessed for eligibility in person, of whom 130 were randomly assigned to either the aerobic intervention group (n=65) or the active control group (n=65). Data from 125 (96%) patients were available for the primary analysis; five patients were lost to follow-up (four in the intervention group; one in the control group). 20 patients (ten in each group) did not complete their assigned programme. The off-state MDS-UPDRS motor score revealed a between-group difference of 4·2 points (95% CI 1·6-6·9, p=0·0020) in favour of aerobic exercise (mean 1·3 points [SE 1·8] in the intervention group and 5·6 points [SE 1·9] for the control group). 11 patients had potentially related adverse events (seven [11%] in the intervention group, four [6%] in the control group) and seven had unrelated serious adverse events (three in the intervention group [vestibilar disorder, vasovagal collapse, knee injury during gardening that required surgery; 6%], four in the control group [supraventricular tachycardia, hip fracture, fall related injury, severe dyskinesias after suprathreshold dose levodopa in a patient with deep brain stimulation; 7%]).Aerobic exercise can be done at home by patients with Parkinson's disease with mild disease severity and it attenuates off-state motor signs. Future studies should establish long-term effectiveness and possible disease-modifying effects.Netherlands Organization for Health Research and Development.

Ahmadpour N., Randall H., Choksi H., Gao A., Vaughan C., Poronnik P.

Virtual Reality (VR) is now consumer ready and nearing ubiquity. In terms of clinical applications, several studies suggest that VR can be effective as a complementary adjunct or alternative non-pharmacologic analgesic in a range of pain-inducing procedures and in management of chronic pain. The increasing affordability and quality of portable VR headsets and the ongoing utility of pain therapy signals an exciting future for the use of VR for analgesia. However, further research is needed to establish its long-term benefits if VR is to be adopted into mainstream protocols for analgesia management. This research requires a range of study designs with collection of patient self-report and clinical data together to develop bespoke interventions for different cohorts.

Cicerone K.D., Goldin Y., Ganci K., Rosenbaum A., Wethe J.V., Langenbahn D.M., Malec J.F., Bergquist T.F., Kingsley K., Nagele D., Trexler L., Fraas M., Bogdanova Y., Harley J.P.

To conduct an updated, systematic review of the clinical literature, classify studies based on the strength of research design, and derive consensual, evidence-based clinical recommendations for cognitive rehabilitation of people with traumatic brain injury (TBI) or stroke.Online PubMed and print journal searches identified citations for 250 articles published from 2009 through 2014.Selected for inclusion were 186 articles after initial screening. Fifty articles were initially excluded (24 focusing on patients without neurologic diagnoses, pediatric patients, or other patients with neurologic diagnoses, 10 noncognitive interventions, 13 descriptive protocols or studies, 3 nontreatment studies). Fifteen articles were excluded after complete review (1 other neurologic diagnosis, 2 nontreatment studies, 1 qualitative study, 4 descriptive articles, 7 secondary analyses). 121 studies were fully reviewed.Articles were reviewed by the Cognitive Rehabilitation Task Force (CRTF) members according to specific criteria for study design and quality, and classified as providing class I, class II, or class III evidence. Articles were assigned to 1 of 6 possible categories (based on interventions for attention, vision and neglect, language and communication skills, memory, executive function, or comprehensive-integrated interventions).Of 121 studies, 41 were rated as class I, 3 as class Ia, 14 as class II, and 63 as class III. Recommendations were derived by CRTF consensus from the relative strengths of the evidence, based on the decision rules applied in prior reviews.CRTF has now evaluated 491 articles (109 class I or Ia, 68 class II, and 314 class III) and makes 29 recommendations for evidence-based practice of cognitive rehabilitation (9 Practice Standards, 9 Practice Guidelines, 11 Practice Options). Evidence supports Practice Standards for (1) attention deficits after TBI or stroke; (2) visual scanning for neglect after right-hemisphere stroke; (3) compensatory strategies for mild memory deficits; (4) language deficits after left-hemisphere stroke; (5) social-communication deficits after TBI; (6) metacognitive strategy training for deficits in executive functioning; and (7) comprehensive-holistic neuropsychological rehabilitation to reduce cognitive and functional disability after TBI or stroke.

Yeung A.W., Tzvetkov N.T., Jóźwik A., Horbanczuk O.K., Polgar T., Pieczynska M.D., Sampino S., Nicoletti F., Berindan-Neagoe I., Battino M., Atanasov A.G.

Tran B., Vu G., Ha G., Vuong Q., Ho M., Vuong T., La V., Ho M., Nghiem K., Nguyen H., Latkin C., Tam W., Cheung N., Nguyen H., Ho C., et. al.

The increasing application of Artificial Intelligence (AI) in health and medicine has attracted a great deal of research interest in recent decades. This study aims to provide a global and historical picture of research concerning AI in health and medicine. A total of 27,451 papers that were published between 1977 and 2018 (84.6% were dated 2008–2018) were retrieved from the Web of Science platform. The descriptive analysis examined the publication volume, and authors and countries collaboration. A global network of authors’ keywords and content analysis of related scientific literature highlighted major techniques, including Robotic, Machine learning, Artificial neural network, Artificial intelligence, Natural language process, and their most frequent applications in Clinical Prediction and Treatment. The number of cancer-related publications was the highest, followed by Heart Diseases and Stroke, Vision impairment, Alzheimer’s, and Depression. Moreover, the shortage in the research of AI application to some high burden diseases suggests future directions in AI research. This study offers a first and comprehensive picture of the global efforts directed towards this increasingly important and prolific field of research and suggests the development of global and national protocols and regulations on the justification and adaptation of medical AI products.

Maggio M.G., Latella D., Maresca G., Sciarrone F., Manuli A., Naro A., De Luca R., Calabrò R.S.

This review evaluates the use of virtual reality (VR) tools in cognitive rehabilitation of stroke-affected individuals.Studies performed between 2010 and 2017 that fulfilled inclusion criteria were selected from PubMed, Scopus, Cochrane, and Web of Sciences databases. The search combined the terms "VR," "rehabilitation," and "stroke."Stroke patients experienced significant improvement in many cognitive domains (such as executive and visual-spatial abilities and speech, attention, and memory skills) after the use of VR training.Rehabilitation using new VR tools could positively affect stroke patient cognitive outcomes by boosting motivation and participation.

Cipresso P., Giglioli I.A., Raya M.A., Riva G.

The recent appearance of low cost Virtual Reality (VR) technologies – like the Oculus Rift, the HTC Vive and the Sony PlayStation VR – and Mixed Reality Interfaces (MRITF) – like the Hololens – is attracting the attention of users and researchers suggesting it may be the next largest stepping stone in technological innovation. However, the history of VR technology is longer than it may seem: the concept of VR was formulated in the 1960s and the first commercial VR tools appeared in the late 1980s. For this reason, during the last twentyyears, hundreds of researchers explored the processes, effects and applications of this technology producing thousands of scientific papers. What is the outcome of this significant research work? This paper wants to provide an answer to this question by exploring, using advanced scientometric techniques, the existing research corpus in the field. We collected all the existent articles about VR in the Web of Science Core Collection scientific database, and the resultant dataset contained 21,667 records for VR and 9,944 for AR. The bibliographic record contained various fields, such as author, title, abstract, country, and all the references (needed for the citation analysis). The network and cluster analysis of the literature showed a composite panorama characterized by evolutions over the time. Indeed, whether until five years ago, the main publication media on VR concerned both conference proceeding and journals, more recently journals constitute the main medium. Similarly, if at first computer science was the leading research field, nowadays clinical areas increased, as well as the number of countries involved in virtual reality research. The present work discusses the evolution of the use of virtual reality in the main areas of application with an emphasis on the future expected virtual reality’s capacities, increases and challenges. We conclude considering the disruptive contribution that VR/AR/MRITF will be able to get in scientific fields, as well in human communication and interaction, as already happened with the advent of mobile phones by increasing the use and the development of scientific applications (e.g. in clinical areas) and by modifying the social communication and interaction among people.

Freeman D., Haselton P., Freeman J., Spanlang B., Kishore S., Albery E., Denne M., Brown P., Slater M., Nickless A.

Engaging, interactive, and automated virtual reality (VR) treatments might help solve the unmet needs of individuals with mental health disorders. We tested the efficacy of an automated cognitive intervention for fear of heights guided by an avatar virtual coach (animated using motion and voice capture of an actor) in VR and delivered with the latest consumer equipment.We did a randomised trial of automated VR versus usual care. We recruited adults aged older than 18 years with a fear of heights by radio advertisements in Oxfordshire, UK. We diagnosed fear of heights if participants scored more than 29 on the Heights Interpretation Questionnaire (HIQ). We randomly allocated participants by computer in a 1:1 ratio to either automated VR delivered in roughly six 30-min sessions administered about two to three times a week over a 2-week period (intervention group) or to usual care (control group). Randomisation was stratified by severity of fear of heights. The research team, who were unaware of the random allocation, administered three fear-of-height assessments, at baseline (0 weeks), at the end of treatment (2 weeks), and at follow-up (4 weeks). The primary outcome measure was HIQ score (range 16-80, with higher scores indicating greater severity). This trial is registered with the ISRCTN registry, number ISRCTN11898283.Between Nov 25, 2017, and Feb 27, 2018, 100 individuals were enrolled and underwent randomisation, of whom 49 were assigned to the VR treatment group and 51 to the control group. All participants completed the 4-week follow-up. The mean total treatment time in VR was 124·43 min (SD 34·23). Compared with participants in the control group, the VR treatment reduced fear of heights at the end of treatment (mean change score -24·5 [SD 13·1] in the VR group vs -1·2 [7·3] in the control group; adjusted difference -24·0, 95% CI -27·7 to -20·3; Cohen's d=2·0; p

Pourmand A., Davis S., Marchak A., Whiteside T., Sikka N.

To evaluate the use of virtual reality (VR) therapies as a clinical tool for the management of acute and chronic pain. Recent articles support the hypothesis that VR therapies can effectively distract patients who suffer from chronic pain and from acute pain stimulated in trials. Clinical studies yield promising results in the application of VR therapies to a variety of acute and chronic pain conditions, including fibromyalgia, phantom limb pain, and regional specific pain from past injuries and illnesses. Current management techniques for acute and chronic pain, such as opioids and physical therapy, are often incomplete or ineffective. VR trials demonstrate a potential to redefine the approach to treating acute and chronic pain in the clinical setting. Patient immersion in interactive virtual reality provides distraction from painful stimuli and can decrease an individual’s perception of the pain. In this review, we discuss the use of VR to provide patient distraction from acute pain induced from electrical, thermal, and pressure conditions. We also discuss the application of VR technologies to treat various chronic pain conditions in both outpatient and inpatient settings.

Corriveau Lecavalier N., Ouellet É., Boller B., Belleville S.

Virtual reality (VR) allows for the creation of ecological environments that could be used for cognitive assessment and intervention. This study comprises two parts that describe and assess an immersive VR task, the Virtual Shop, which can be used to measure episodic memory. Part 1 addresses its applicability in healthy older adults by measuring presence, motivation, and cybersickness symptoms. Part 2 addresses its construct validity by investigating correlations between performance in the VR task and on a traditional experimental memory task, and by measuring whether the VR task is sensitive to age-related memory differences. Fifty-seven older and 20 younger adults were assessed in the Virtual Shop, in which they memorised and fetched 12 familiar items. Part 1 showed high levels of presence, higher levels of motivation for the VR than for the traditional task, and negligible cybersickness symptoms. Part 2 indicates that memory performance in the VR task is positively correlated with performance on a traditional memory task for both age groups, and age-related differences were found on the VR and traditional memory tasks. Thus, the use of VR is feasible in older adults and the Virtual Shop is a valid task to assess and train episodic memory in this population.

Spiegel B.M.

Belhan Z., Munhan R., Aksoy M.E., Ozker E., Unver V.

Noh H., Chishti S.M., Jo H., Newhouse N., Kim S., Van Kleek M., Kang Y.

Abdelouahed M., Yateem D., Amzil C., Aribi I., Abdelwahed E.H., Fredericks S.

Higher education institutions are accustomed to sudden and abrupt jolts that provoke poor enrollments, unviable courses, unsustainable practices, budget cuts, and job losses. Such a situation arose with the worldwide education crisis of COVID-19 and the global mandate to shift to online teaching and learning. Policies and guidelines were based on available solutions, often implemented by leaders with limited experience in online education. As a result, the focus was on transitioning to online teaching rather than creating pragmatic policy changes. This article explores the practices in higher education institutions during the COVID-19 pandemic and investigates how the crisis affected teaching and learning across different countries. It also offers insights into the adaptations made during and after the pandemic, particularly within public health education, workforce training, and healthcare, along with actionable suggestions for integrating artificial intelligence (AI) and lessons learned from COVID-19 into these sectors. To highlight the potential benefits of AI in public health education, we discuss how AI-driven epidemiological modeling could play a crucial role in future outbreak preparedness, using the ongoing monkeypox virus (Mpox) outbreaks as a case study. As Mpox continues to emerge as a potential global health threat, the shift to remote learning during the COVID-19 pandemic has demonstrated the importance of preparing the educational system for future uncertainties, including new outbreaks. The pandemic has shown how disruptions can catalyze reforms in public health education, workforce training, and healthcare systems. Looking ahead, AI holds significant potential in transforming epidemic and pandemic preparedness by predicting outbreaks, understanding their trajectories, and even forecasting the individual impact of diseases by analyzing immune responses. Integrating AI into pandemic response frameworks could save lives and strengthen readiness for future health crises.

Lopes I., Simões de Almeida R., Veloso Gomes P., Marques A.

Arachnophobia is a specific phobia characterized by an intense and persistent fear of spiders, often leading to avoidance behaviors that can significantly impact daily life. Virtual Reality Exposure Therapy (VRET) offers a controlled, adaptable, and immersive therapeutic environment, allowing for greater personalization, flexibility, and the real-time modulation of exposure parameters. This pilot study employed a quasi-experimental design without a control group to evaluate the efficacy of a gamified VRET intervention for treating arachnophobia. A sample of 25 participants underwent the intervention, with outcomes assessed through a Behavioral Approach Test (BAT) and self-report measures, including the Fear of Spiders Questionnaire (FSQ) and the Spider Phobia Questionnaire (SPQ-15), administered pre-intervention, post-intervention, and at a two-week follow-up. Findings indicate that gamified VRET led to significant reductions in self-reported fear and avoidance behaviors, suggesting its potential as an effective therapeutic tool for arachnophobia. Although some results were not entirely conclusive, the overall improvements observed support further investigation in larger, controlled trials.

Lee B., Ahmed B., Koizumi N., Galvão C.G., Sikka N., Ranniger C.

Díaz Molina R.J., Comesaña Castellar C., Crespí Rigo J., Radu Tomsa C., Quesada Bauzá P., Porcel Corra I., Sendra Rumbeu P., Royo Escosa V., Herrera González M.D., Puchol Segarra E., Ginard Vicens D.

Alruwaili A.N., Alshammari A.M., Alhaiti A., Elsharkawy N.B., Ali S.I., Ramadan O.M.

Díaz Molina R.J., Comesaña Castellar C., Crespí Rigo J., Radu Tomsa C., Quesada Bauzá P., Porcel Corra I., Sendra Rumbeu P., Royo Escosa V., Herrera González M.D., Puchol Segarra E., Ginard Vicens D.

Virtual reality (VR) is a neurosensory experience in which simulated spaces a person has the sensation of being able to function within them. Some patients with inflammatory bowel disease (IBD) receive intravenous biological treatments in an Adult Day Hospital (ADH) regime. VR has been used in some fields of medicine, demonstrating its usefulness in reducing negative symptoms. However, we do not have any literature showing the applicability in real clinical practice of VR in IBD.

Kronner N., Strebl M., Lenk J., Gebauer B., Schweizerhof O., Frisch A., Wintergerst C., Uller W., de Bucourt M., Can E.

Abstract To address the challenges of staff shortages and the need to gain practical experience in interventional radiology by increasing attention in the medical curriculum, especially in combination with the opportunity to successfully gain hands-on experience, can help influence medical students’ career decisions in favor of IR. Regular training on VR simulators can reduce the amount of X-ray radiation needed to adequately care for patients. Ten medical students underwent five angiographic training sessions using an endovascular simulator. Virtual fluoroscopy time was recorded during each session to measure skill development. Pre- and post-training questionnaires were conducted to assess changes in subjective proficiency and career interests. The median virtual fluoroscopy time decreased from 19.3 min initially to 9.3 min (p = 0.007), indicating enhanced procedural proficiency. Post-training questionnaires revealed a notable increase in interest in interventional radiology among participants. Additionally, participants reported improvements in practical skills, understanding of interventional radiology, and readiness for real-world interventions. Simulator-based training significantly enhances procedural proficiency and could impact career interests in interventional radiology. Despite the small sample size, the findings support the efficacy of VR training in medical education, highlighting the need for further research to optimize the implementation of simulation technology in medical training.

Hirschberg D.O., von Bosse A., Rauschnabel P.A.

Safwan N., Suchak K.K., Liran O., Kingsberg S.A., Spiegel B.M., Shufelt C.L., Faubion S.S.

Abstract Importance and Objective Menopause is the natural cessation of ovarian function, typically occurring at a mean age of 52 years in the United States. Vasomotor symptoms (VMS; hot flashes and night sweats) affect over 75% of midlife women and typically last 7 to 9 years, with only 54% seeking medical attention. Although hormone therapy is the most effective treatment for VMS, <4% of women currently use it, primarily due to safety concerns. There is evidence that cognitive behavioral therapy (CBT) is an effective management strategy for VMS. Virtual reality (VR) has shown promise in delivering an immersive form of CBT for various medical conditions, including acute and chronic pain, sleep, and mood disorders, potentially overcoming barriers such as access and cost while improving quality of life. This narrative review aims to summarize the existing literature on VR for managing menopause symptoms. Methods A comprehensive literature review was conducted through PubMed and Medline databases. The search focused on keyword combinations related to VR, artificial intelligence, and menopause symptoms. Discussion and Conclusion The search yielded one study specifically targeting symptoms related to menopause. A pilot study (n = 42) evaluating an immersive VR and artificial intelligence intervention based on CBT and mindfulness techniques for managing hot flashes in women with breast or ovarian cancer demonstrated a significant reduction in frequency of hot flashes (P < 0.01) and improvements in sleep quality, mood, anxiety, stress, and overall quality of life. However, these women experienced hot flashes that might have been associated with their cancer diagnosis or treatment rather than relating specifically to menopause, potentially limiting the generalizability of the findings to women with menopause symptoms. Although VR has shown effectiveness in delivering CBT for other conditions, there remains a significant gap in research on its specific use for menopause-related symptoms.

Patel K.R., Brahmbhatt V.B., Dubey N., Jayswal H.

Farronato M., Crispino R., Fabbro M.D., Tartaglia G.M., Cenzato N.

Wankhede N.L., Koppula S., Bhalla S., Doshi H., Kumawat R., Raju S., Arora I., Sammeta S.S., Khalid M., Zafar A., Taksande B.G., Upaganlawar A.B., Gulati M., Umekar M.J., Kopalli S.R., et. al.

Galvin C., Watt J., Ghatnekar P., Peres N., Rees-Lee J.

Abstract Background Demands on health care services can greatly outweigh capacity. Multifactorial causative factors present great challenges, forcing the National Health Service (NHS) to increase efficiency and adaptivity. Concurrently, digital advancements are excelling and long-term plans for NHS sustainability are focusing on the use of technological interventions to benefit patients. As a result, integration of extended reality (XR) technology has become an important focus of health care research. However, models of how the digital literacy of health care workforces can be developed and how frontline staff can be actively involved in the design and development of creative digital interventions are lacking. Such programs are essential to allow the development and upscaling of digital innovation within the NHS for the benefit of the patients. Such a program has been developed in the Digital Futures research lab at Torbay and South Devon NHS Foundation Trust, representing one of the first immersive digital technologies research spaces embedded within the NHS. A “Digital Deep Dive” training program has been developed, allowing local health care workers to recognize the possibilities of digital health care technologies and supporting them in the evolution of ideas for potential bespoke digital solutions appropriate to their own patient groups and care pathways. Objective This paper aims to explain the development of this unique XR Deep Dive program and present the evaluation that informed future directions for its ongoing development. Methods The Deep Dive sessions were designed according to relevant pedagogic principles, including experiential, active, and contextual learning theories. Voluntary pilot sessions were held for local clinical teams comprised of junior doctors, consultants, nurses, and allied health professionals. Self-selection sampling was used. Participants completed an anonymous postsession feedback form, which was used to conduct a service evaluation. Data were analyzed using descriptive statistics (quantitative) and thematic analysis (qualitative). Results In total, 21 completed questionnaires were analyzed. Overall, the sessions were positively received: all participants reported increased awareness of the potential for digital health care innovation postsession and most found it useful and relevant to their clinical careers. Participants valued the sessions being grounded in a context relevant to local practice with opportunities to interact with the technology through the lens of use cases. Conclusions We have developed a unique training initiative providing contextually relevant XR technology awareness training for health care professionals locally. Despite the growing pace of digital health care innovation, we recognized a knowledge gap in our local workforce regarding the potential of XR technologies within health care. We responded by developing a training program grounded in the concept of digital co-creation—working with staff and service users to develop bespoke solutions integrated within patient pathways. The results from this paper will help to inform future directions for developing digital awareness training in our trust and have implications for wider NHS digital literacy training.