What is Virtual Reality and its Healthcare Use Cases?

With the advancements in digital healthcare, various tools are now being used to provide healthcare services and support the patient care journey. These include tools typically used in other industries, such as smartphones, cloud storage solutions, and virtual reality (VR) headsets.

Initially applied to education and training, and later, gaming and entertainment, VR has grown steadily popular in healthcare. Developers and researchers are adapting the technology for clinical care in multiple ways, and government agencies are integrating it into care pathways through approvals and reimbursement.

Here, mHealthIntelligence breaks down VR and how it is being integrated into healthcare delivery. 

UNDERSTANDING VR AND HOW IT WORKS

According to Britannica, VR technologies “immerse the user in a computer-generated environment that simulates reality through the use of interactive devices, which send and receive information and are worn as goggles, headsets, gloves, or body suits.”

In other words, VR uses computer modeling and 3D simulations to create the illusion of being elsewhere, though the person’s physical location does not change. VR typically relies on sensors to gather real-time responses to virtual stimuli and accept commands, the US Government Accountability Office noted in a 2022 report.

Though the term ‘virtual reality’ was coined in the mid-1980s, the roots of the technology can be traced back to the 1800s, with the invention of the first stereoscope that used twin mirrors to project a single image. In the 20th Century, the United States government supported various projects advancing computer graphics, simulation, and networked environments, which laid the foundation for VR. In 1985, NASA’s Ames Research Center launched the Virtual Environment Workstation (VIEW) project, which focused on developing low-cost, personal simulation environments. This gave rise to VR as we know it today.

There are various types of VR, including non-immersive, which refers to accessing a 3D simulated environment through a computer screen; semi-immersive, which refers to a partial virtual experience accessed through a computer screen or other devices; and fully immersive, which typically immerses the user fully in the simulated 3D world through special equipment like helmets, goggles or gloves.

HEALTHCARE USE CASES FOR VR

VR is well-suited for application in the healthcare field as its ability to immerse people in a simulated reality can help alleviate symptoms and create more comfortable settings to receive certain types of care. Here are some of the emerging use cases for VR technologies in healthcare:

Pain management. Pain management is a complex area of medicine focusing on alleviating acute and chronic pain. While medications are traditionally used for pain management, the opioid epidemic and other substance use disorder crises have spurred research into pain management approaches that do not involve medicines.

VR can provide an effective alternative or supplement to medication-based pain management. For instance, a study published in 2019 revealed that VR helped reduce pain scores among hospitalized patients.

The researchers evaluated 120 adults admitted to Cedars-Sinai Medical Center for a variety of conditions, including orthopedic issues, gastrointestinal diseases, and cancer. The patients had an average pain score of three out of ten in the 24 hours before participating in the study. Half of the patients were given VR goggles that offered relaxing and meditative experiences, while the other half were asked to watch the health and wellness channel on the TVs in their hospital rooms. The study showed that patients in the VR group averaged pain scores 1.7 points lower than those asked to watch their in-room TVs. 

Similarly, a study published in October 2023 showed that VR can help alleviate pain resulting from dressing changes for burn injuries. The study included data on 14 adult patients with burn injuries between May 2019 and February 2020. They were randomly assigned to either the active VR treatment arm, where they played a series of four VR games designed for the study; the passive VR arm, where they toured the same virtual environments as the active VR group but were not presented with any of the interactive elements of the games; or the standard care treatment arm.

Researchers found that average self-reported pain was lowest among participants in the active VR group and highest among those in the passive VR group across three dressing changes.

With this clinical backing, pain management-focused VR is gaining federal agency approval. In 2021, AppliedVR’s RelieVRx (formerly EaseVRx) became the first VR-based digital therapeutic for pain relief to gain approval from the Food and Drug Administration. The device, a VR headset preloaded with software content guiding chronic low back pain patients through an eight-week program, has been shown to reduce pain intensity and pain-related interference with activity and sleep.

Mental healthcare. With a growing mental health epidemic in America, technologies that can support care for these conditions are in high demand. According to the Centers for Disease Control and Prevention (CDC), more than one in five US adults live with a mental illness, and about one in 25 lives with a serious mental illness, such as schizophrenia or bipolar disorder.

VR can be especially effective in treating mental health conditions primarily because it can transport patients to simulated worlds with various environments and experiences. Thus, VR can recreate specific scenarios in a safe, virtual environment supporting exposure therapy or immerse patients in calming environments that can help alleviate stress and anxiety, a literature review published in 2022 stated.

For this reason, the Department of Veterans Affairs (VA) has leaned into VR, establishing VA Immersive in October 2019 to improve care delivery and healthcare experiences by leveraging and scaling immersive technology like VR across VA facilities. The department is using VR to tackle PTSD, treatment-resistant depression, and anxiety, among other conditions.

Research published in 2021 revealed that VR was a viable option for reducing anxiety in veteran populations across various age ranges. The study analyzed VR experiences at a VA medical center from August 30, 2019, to November 23, 2020. Among 79 study participants, researchers observed a 92-percent reduction in anxiety for those in concurrent pain.

Healthcare-related anxiety is the focus of an ongoing collaboration between AppliedVR and the National Cancer Institute (NCI), part of the National Institutes of Health (NIH). The organizations launched a study in 2019 to evaluate the impact of VR in reducing anxiety among terminal cancer patients. Last year, the NCI published results from its interim analysis showing that patients with primary brain tumors reported frequent VR use and high satisfaction.

Further, health system researchers are exploring direct-to-consumer applications of VR. In February 2024, Cedars-Sinai investigators announced their VR app, Xaia, will be available on the Apple Vision Pro. The app leverages artificial intelligence and spatial computing to offer conversational therapy in calming environments like forests or beaches.

Social isolation. Social isolation, which refers to a “lack of relationships with others and little to no social support or contact,” is associated with several health risks, according to the CDC. These include heart disease and stroke, type 2 diabetes, depression and anxiety, addiction, and self-harm.

VR tools can help address social isolation by transporting users to a virtual environment where they can interact with other users, the 2022 literature review noted. This is especially useful for supporting autism care, as VR can allow patients to participate in virtual cognition training to improve their social skills.

Research also shows that VR can reduce feelings of loneliness and social anxiety. According to a study published in November 2023, using a VR social platform significantly lowered loneliness and social anxiety levels during the COVID-19 pandemic. Leveraging a questionnaire inside the social VR platform, researchers observed that being part of an online group facilitates stronger feelings of belonging.

VR’s ability to alleviate feelings of loneliness and social isolation could also help boost care and quality of life among seniors in the US. In 2021, the University of California at Santa Barbara launched a study funded by a $2 million grant from the National Institutes of Health’s National Institute on Aging to examine the impact of a VR platform on helping seniors in Massachusetts and California manage social isolation.

Physical therapy and rehabilitation. Physical therapy and rehabilitation refers to exercise and physical movement that enables people to regain function following an injury or surgery and supports those with physical impairments or disabilities.

VR can be effective in engaging patients in physical therapy and rehabilitation programs.

For instance, a study published in 2021 reveals that a VR-based PT program supported objective data collection for clinicians and increased patient engagement and access. The study enrolled 15 orthopedic trauma patients in a VR program consisting of training, games, and a progress dashboard for three common lower extremity PT exercises. Patients rated the acceptability of VR-based PT as nearly four out of five, the feasibility as four out of five, and the usability as 67.5 out of 100.

Another study that involved a literature review noted that VR was “not inferior to traditional rehabilitation.” Published in 2022, the analysis included 11 studies examining multisensory high-end and game-based systems. Researchers also observed that users were “highly motivated and satisfied.”

In addition, the VA is exploring whether VR can meet veterans' rehabilitation needs. Through a three-year partnership with health technology company Penumbra, the VA is testing, co-developing, and scaling VR solutions to increase access to rehabilitation among veterans.

Though VR is not a new technology, its application in healthcare is relatively nascent. With healthcare stakeholders investing in VR research and technology adoption, VR use is poised to grow.