Virtual reality in healthcare: a new therapeutic tool?

What is virtual reality?

The first volume of the Treatise on Virtual Reality, published in 2006, defines it as “a scientific and technical field using computing and interfaces in order to simulate in a virtual environment the behavior of 3D entities, which interact in real time with each other and with one or more users in pseudo-natural immersion through sensori-motor channels.”¹Bouyer, G (s. d.). Réalité virtuelle & Santé – Applications & Enjeux [Diapositives]. École Nationale Supérieure d’Informatique pour l’Industrie et l’Entreprise (ENSIIE). https://web4.ensiie.fr/~guillaume.bouyer/RVIG/vr-health.pdf

Thus, three criteria seem essential to describe virtual reality:

• Immersion (to convey the feeling of being in the three-dimensional space of the image),
• Interactivity (to describe the possibility of moving through this space and manipulating its objects),
• and real time (to allow the user to immediately perceive changes in the space resulting from their actions).

Unlike augmented reality, which superimposes digital elements onto our real world, VR immerses the user in a world entirely created by computer, where they can dynamically interact with their environment.

In the healthcare field, this ability to create realistic and controlled simulations opens up a wide range of possibilities for teaching, treatment, and research.

In what cases and for which applications is virtual reality used in healthcare today?

In the healthcare field, the number of publications concerning VR has increased exponentially in recent years, with a little over 15,500 publications for the period 1985–2021. In 2021, nearly 2,800 publications were published versus 950 in 2016.²Djelti, M. & Beladi, A. (2012). Virtual reality and medical learning. Science & Technology Communications. https://www.researchgate.net/publication/313878319_LA_REALITE_VIRTUELLE_ET_L’APPRENTISSAGE_MEDICAL While early research focused primarily on medical training and rehabilitation, applications have now expanded to include exposure therapy through virtual reality and pain management.

Training healthcare professionals

Virtual reality has revolutionized the training of healthcare professionals by offering realistic simulation environments where practitioners can practice without risk to patients. For example, medical students can take part in surgical simulations where they perform complex procedures in a virtual setting before performing them on real patients. These simulations allow not only the repetition of technical gestures but also preparation for handling emergency situations or unforeseen complications. For example, the Hôpital Privé de la Baie in the Manche is the first French facility to integrate virtual reality in continuing education to prevent risks in the operating room. The serious game called “the error room” in virtual immersion in the operating room is accessible to caregivers including internal or external medical students.

Pain management

Virtual reality offers innovative solutions for pain management, particularly for patients suffering from chronic pain or in palliative care. By immersing patients in relaxing or distracting virtual environments, VR can reduce their perception of pain, thus decreasing the need for analgesic medications. For example, in a study conducted on 11 burn victims aged 9 to 40 who required hospitalization, a 35 to 50% reduction in perceived pain was reported when virtual reality was used alongside standard pharmacological treatment compared to pharmacotherapy alone (Hoffman et al., 2008).³Fuchs, P., Moreau G., Berthoz A., Le traité de la réalité virtuelle volume 1 : L’Homme et l’environnement virtuel. Presse des Mines, pp.380, 2006, Mathématique et informatique, 9782911762628. ⟨hal-00753715⟩

Cybertherapies or exposure therapy using virtual reality

Virtual reality is also used to treat various psychological conditions. As part of cognitive-behavioral therapy, VR is used to treat phobias, anxiety, addictions, and post-traumatic stress by exposing patients to stressful situations in a controlled and gradual way. For example, a patient suffering from acrophobia (fear of heights) can be exposed to height simulations, allowing them to work on their phobia in a safe environment.

Physical rehabilitation

Virtual reality programs are used to help patients recover motor skills after a stroke or injury. Thanks to immersive exercises, patients are encouraged to perform repetitive and engaging movements, which can accelerate their recovery.

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What are the advantages of using virtual reality in healthcare?

The use of virtual reality in healthcare presents several well-known advantages today. The enthusiasm for virtual reality lies in its ability to offer new possibilities that were previously limited in real environments, namely:

Advantage n°1: a controlled and controllable environment

There are no unpleasant surprises or randomness. The stable environments created immerse both practitioners and patients in risk-free scenarios, even for the rarest situations. Moreover, virtual reality allows the created environments to be configured and to record objective variables and metrics. The data generated can therefore be more easily compared since they come from environments with known parameters.

Advantage n°2: a customizable environment adapted to users’ needs (patients and practitioners alike)

The environment evolves progressively to closely match the patient’s needs. For example, during therapy for agoraphobia, it is not always easy for the practitioner to reliably predict the parameters of a scenario (such as the number of passengers in a subway car). In addition, the customization of 3D environments enhances user engagement and motivation and optimizes results, whether therapeutic or not (e.g., learning during training) through better immersion.

Advantage n°3: a gamified environment that facilitates long-term engagement

In rehabilitation, it is common to observe a decline in patient engagement over time, especially when the processes are long and painful. VR can then be used to immerse the patient in a gamified universe customizable to their needs and preferences. Absorbed by the game, this “staging” allows them to forget that they are in a rehabilitation session. Mainly used by physiotherapists, this technique has been adopted by several companies in recent years. One example is MindMotion, FDA-approved and CE-marked, which has already supported more than 3,300 patients.

What are the current challenges to fully exploit the future potential of virtual reality in healthcare?

Despite its many advantages, the use of virtual reality in healthcare also has challenges and limitations.

Challenge n°1: overcoming the side effects of cybersickness

Indeed, exposure to virtual reality can disrupt the sensory system and lead to symptoms such as nausea, dizziness, sweating, pallor, loss of balance… grouped under the term “cybersickness.” In susceptible individuals, these symptoms can appear within minutes and prove counterproductive.

Challenge n°2: reducing the costs of acquiring and maintaining VR equipment

Furthermore, the cost of acquiring and maintaining VR equipment remains high, which may limit its adoption in certain institutions.

Challenge n°3: mitigating technological barriers

Technological barriers, such as the need for sophisticated hardware and the learning curve associated with its use, may slow its integration into daily clinical practice.

Challenge n°4: ensuring the confidentiality and security of data

Moreover, ethical and data privacy issues regarding the data generated or collected are also major concerns, particularly with regard to the use of patient data in virtual environments. It is essential to ensure that these technologies comply with privacy standards such as the General Data Protection Regulation (GDPR) applied to the healthcare sector.

Challenge n°5: ensuring the hygiene and safety of VR equipment

Finally, virtual reality headsets used in healthcare settings must also comply with strict hygiene and safety rules. Indeed, the specific hygiene requirements of the sector demand that headsets be resistant to solvents in case of repeated disinfection, include a cleaning procedure specifying the instructions to follow, or even provide removable accessories with easily replaceable protections. In short, the entire design of the headset must be adapted using materials with properties that meet the expectations of the sector. Moreover, if VR headsets are used as medical devices in the European Union, they must be CE certified. The manufacturer must therefore demonstrate that the headset meets the safety and performance standards set by European Regulation 2017/745.

Despite these technical, economic, ethical, and regulatory challenges, the future of virtual reality in healthcare is promising. Indeed, if these obstacles are overcome and if future research manages to increase the evidence level of current studies, then virtual reality could become an essential component of future healthcare, offering solutions to improve the quality of care and training. The momentum is underway, as evidenced by the continuous innovations in this field that pave the way for even more sophisticated and accessible applications. This is notably the case with the improvement of motion capture technologies, the integration of artificial intelligence, or the development of devices including even more senses such as smell… Alcimed closely follows the rapid developments of these technologies that are revolutionizing tomorrow’s healthcare and is ready to support you on these topics. Don’t hesitate to contact our team!

About the author

Mathilde, Consultant in the Innovation and Public Policy team at Alcimed in France.