Authors: Amish Patel, MD
Affiliations: Verity XR

Executive Summary

Virtual reality (VR) technology has evolved beyond entertainment and is proven to be an effective tool for pain management and rehabilitation, with immersive systems showing superior results. By incorporating VR into treatment programs, some clinics have reported more effective use of time, shortened hospital stays, and lower treatment costs.
Verity’s EnGauge XR ™ system exemplifies a comprehensive approach to pain management, combining physical therapy gaming, pain education, and guided meditation. Integrating the features known to increase the cost-effectiveness of treatment, EnGauge XR ™’s ability to personalize therapy, provide real-time feedback, and engage patients, positions it as a valuable addition to pain management and rehabilitation practices.

What is VR?

Virtual reality (VR) is a system whereby users are immersed into a simulated three dimensional (3D) virtual environment that makes them feel as though they are in a new world1. It has a wide variety of uses from entertainment to education to clinical rehabilitation. The use of VR can be in the form of a 3D representation on a computer screen (non-immersive), headsets or goggles (immersive) or somewhere in between such as with simulators (semi-immersive)2. As the name suggests, immersive VR has the greatest level of immersion whereby, the simulated environment is much more realistic in terms of sensory experience and user interaction. When VR is combined with interactions from wearable technologies it is referred to as extended reality (XR)3. Users are able to disengage from the real-world much easier and fully engage with the simulated environment. Here we review how immersive VR systems have been shown to benefit pain management and how this can translate to positive business outcomes.

How is immersive VR used in pain management?

Immersive VR has been shown to be beneficial for managing and/or rehabilitating from a variety of painful conditions, from musculoskeletal injury to cancer-related pain and even during labour4-7. The games of choice are highly variable and can range from passive visualisation of different nature environments e.g. feeling like you are at the beach, to physical patient engagement games involving range of motion and functional mobility exercises.
The choice of game used is largely dependent on the cause of treatment. Immersive environments are primarily used for lowering anxiety and providing distraction from painful treatments. For example, when patients being treated for cancer experienced a nature scene using immersive VR, anxiety8,9, fatigue9, and pain8 were all found to be reduced compared to usual care.
The mobility games are primarily for assisting physical therapy programs, most commonly for rehabilitation from orthopaedic surgery10, stroke11-14, and chronic pain conditions15,16. Regardless of the game or condition of treatment, it is hypothesised that the benefits of VR for pain management are due to increased distraction from the pain itself, reduced inhibition of functional range of motion, and improvements in mindfulness and mental wellbeing.

How do clinics benefit from VR-integrated treatment plans?

We have previously discussed how using VR for rehabilitation and pain management may be more effective for improving treatment adherence, outcomes, and functional independence (Verity XR Usability Study). However, integrating VR into treatment programs can have additional benefits for reducing patient stays in hospital, providing more efficient treatment, and reducing overall treatment costs compared to usual care.
A comprehensive economic analysis of integrating immersive VR visualisation therapy for pain management in hospitalised patients17, identified an average overall cost savings of $5.39 per patient compared to usual care. Importantly, this accounted for a conservative estimate of only 50% of these patients opting to try the VR therapy, while the actual numbers may be much higher. In the subset who did engage with VR therapy, the average cost savings per patient was estimated to be a substantial $98.49. To account for a variety of hospital circumstances, the researchers17 simulated the outcome of using VR in clinics for 1000 hospital settings and identified that integrating VR was cost-saving in 89% of cases, primarily due to the potential for VR to shorten the length of hospital stays.
In stroke patients in Taiwan, a 7-day hospital program that included VR was shown to improve symptom severity by 20% compared to only 4.6% without VR, decrease disability scores by 0.58 compared to 0.23 and increased patient independence when performing activities of daily life by 68% versus 60% without VR18. In addition, the hospital stays for those undergoing VR-integrated therapy cost an average of ~49.5k Taiwan dollars whereas without VR cost ~66.3k. This equates to approximately $500usd saved per patient across their hospital stay when they received treatment that included VR.
Further, when matching the dosage of VR therapy to usual care in stroke patients, a meta-analysis revealed that VR was superior to usual care in improving upper limb function in these patients19. Thus, while VR may improve clinic efficiency by reducing the length of patient stays, even if the length of treatment remains the same, integrating VR is more effective time-use for both patients and clinicians and reduces costs. Importantly these improvements were specific to patients engaging in virtual environments as opposed to computer gaming19. Thus, highlighting the importance of using more immersive treatment options.
What is Verity’s EnGauge XR ™?
Verity’s EnGauge XR ™ is an immersive VR system that incorporates physical therapy gaming, pain education training, and guided meditation. Physical therapists can adjust the game parameters to cater to the patient’s individual capabilities. Real-time metrics of range of motion and stress parameters allows the patient and therapist to monitor progress and adapt the rehabilitation program accordingly.
EnGauge XR ™ is designed to take a multi-pronged approach to pain management by providing exercises that target both mental and physical wellbeing.
Thus, the mindfulness, personalised physical therapy, and immersive components of VR-based therapeutic programs that were found to be important contributors for improved cost-effectiveness, are all core components of Verity’s EnGauge XR ™ system. By integrating the EnGauge XR ™ system into clinical pain management programs, both patients and clinics may benefit from improved treatment efficacy and reduced costs.

Conclusions

Virtual reality-based treatment programs have been shown to be beneficial for improving treatment outcomes, improving clinic efficiency, and reducing treatment costs across a variety of conditions. The major contributing factors to these benefits include providing options for visualisation of virtual environments, physical therapy based gaming, and increased immersive-ness of the system. Verity’s EnGauge XR ™ system therefore provides a holistic toolkit, which aims to maximise both the efficacy and cost-effectiveness of treatment programs for the benefit of clinics and patients alike.

References

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