首頁資訊沉浸式醫(yī)療虛擬現(xiàn)實：還是一種新奇還是已經(jīng)是必需品了？

沉浸式醫(yī)療虛擬現(xiàn)實：還是一種新奇還是已經(jīng)是必需品了？

來源：泰然健康網(wǎng) 時間：2024年12月16日 02:35

Immersive medical virtual reality: still a novelty or already a necessity?

Full text

Virtual reality (VR) technologies have been explored for medical applications for over half a century. With major tech companies such as Meta (formerly Facebook), HTC and Microsoft investing heavily in the development of VR technologies, significant advancements have recently been made in hardware (eg, standalone headsets), ease of use (eg, gesture tracking) and equipment cost. These advancements helped spur research in the medical field, with over 2700 VR-related articles indexed in PubMed alone in 2022, and the number of VR articles more than tripling in the last 6?years. Recently, the US Food and Drug Administration (FDA) also approved the first VR-based therapy for chronic back pain.1 虛擬現(xiàn)實（VR）技術在醫(yī)療領域的應用已經(jīng)探索了半個多世紀。隨著梅塔（前Facebook）、HTC和微軟等主要科技公司在VR技術開發(fā)上的大量投資，最近在硬件（如獨立耳機）、易用性（如手勢跟蹤）和設備成本方面都取得了重大進展。這些進步有助于刺激醫(yī)學領域的研究，2022年僅PubMed就收錄了2700多篇VR相關文章，VR文章的數(shù)量在過去6年中增加了兩倍多。最近，美國食品和藥物管理局（FDA）也批準了第一個基于VR的慢性背痛療法。1

Whether the technology has reached a tipping point for its use in medicine is debatable, but it seems timely to provide a brief overview of the current state of immersive VR in neurology and related fields. In this editorial, we will discuss the characteristics of VR that make it a potentially transformative tool in healthcare, review some of the most mature VR solutions for medical use and highlight barriers to implementation that must be addressed before the technology can be widely adopted in healthcare. This editorial will focus solely on immersive VR technology and will not delve into the applications and use cases of augmented or mixed reality. 這項技術是否已經(jīng)達到了在醫(yī)學上使用的臨界點是有爭議的，但現(xiàn)在似乎是時候簡要概述一下沉浸式VR在神經(jīng)學和相關領域的現(xiàn)狀了。在這篇社論中，我們將討論使VR成為醫(yī)療保健領域潛在變革工具的特性，回顧一些最成熟的醫(yī)療用途VR解決方案，并強調(diào)在醫(yī)療保健領域廣泛采用該技術之前必須解決的實施障礙。這篇社論將只關注沉浸式VR技術，而不會深入研究增強現(xiàn)實或混合現(xiàn)實的應用和用例。

Characteristics of VR VR的特點

VR is a technology that allows users to interact with and experience a simulated environment.2 The technology typically involves the use of a headset or other device that displays a 3D computer-generated environment, as well as sounds and haptic feedback, and input devices to create a fully interactive immersive experience. The immersion establishes a sense of presence3—a user’s subjective feeling that they are actually present in the virtual environment. This subjective sense of presence is modulated by the employed technology4 and is enhanced by the use of head tracking and other technologies that allow the user to move around within the virtual environment. Medical VR applications take advantage of the technology’s ability to elicit emotional responses, convey spatial information and provide a sense of presence in a simulated environment. Typically, the applications use engaging VR experiences while providing a safe and controlled environment for failsafe practice, learning, distraction, relaxing or treatment.5 VR是一種允許用戶與模擬環(huán)境交互并體驗模擬環(huán)境的技術。2 該技術通常涉及使用顯示3D計算機生成的環(huán)境以及聲音和觸覺反饋的耳機或其他設備，以及輸入設備來創(chuàng)建完全交互式沉浸式體驗。沉浸感建立了一種存在感 3- 用戶實際上存在于虛擬環(huán)境中的主觀感覺。這種主觀的存在感是由所采用的技術調(diào)制的 4并且通過使用頭部跟蹤和允許用戶在虛擬環(huán)境內(nèi)四處移動的其它技術來增強。醫(yī)療VR應用利用了該技術在模擬環(huán)境中引發(fā)情感反應、傳達空間信息和提供存在感的能力。通常情況下，這些應用程序使用引人入勝的VR體驗，同時為故障保護實踐，學習，分散注意力，放松或治療提供安全和受控的環(huán)境。

Examples of more mature VR solutions for medical use 更成熟的醫(yī)療VR解決方案示例

The range of trialled medical VR applications is vast and their maturity varies widely, with some still being in the proof-of-concept stage and others having been evaluated in high-quality randomised control studies (RCTs). Some of the strongest evidence for the effectiveness of medical VR is in the areas of mental health interventions, pain management and medical training. 試驗的醫(yī)療VR應用范圍很廣，它們的成熟度差異很大，其中一些仍處于概念驗證階段，而另一些則已在高質(zhì)量的隨機對照研究（RCT）中進行了評估。醫(yī)療VR有效性的一些最有力的證據(jù)是在心理健康干預，疼痛管理和醫(yī)療培訓領域。

Mental health interventions心理健康干預

VR has been shown to be an effective treatment for various psychological conditions, including phobias,6 Posttraumatic stress disorder (PTSD)7 and anxiety disorders.7 For example, a single-blind RCT in 346 patients with psychosis found significant reductions in agoraphobic avoidance and distress in the VR plus usual care group compared with the usual care group.8 Patients with severe avoidance at baseline demonstrated large VR treatment effects even at the 6-month follow-up.8 A meta-review of 11 meta-analyses on VR therapies for psychiatric disorders found medium-to-large effects for anxiety-related disorders when compared with inactive controls. However, no meaningful differences were found when VR was compared with standard evidence-based interventions.9 The lack of statistically significant differences necessitates thoughts and further research into the best use cases for each intervention. VR已被證明是各種心理狀況的有效治療方法，包括恐懼癥， 6 創(chuàng)傷后應激障礙 7和焦慮癥。7 例如，在346例精神病患者中進行的一項單盲隨機對照試驗發(fā)現(xiàn)，與常規(guī)護理組相比，VR加常規(guī)護理組的廣場恐懼回避和痛苦顯著減少。8 基線時嚴重回避的患者即使在6個月隨訪時也表現(xiàn)出較大的VR治療效果。8 對11項關于VR治療精神疾病的薈萃分析進行的薈萃審查發(fā)現(xiàn)，與非活動對照組相比，VR對焦慮相關疾病的影響為中等至較大。然而，當VR與標準循證干預措施進行比較時，沒有發(fā)現(xiàn)有意義的差異。9 缺乏統(tǒng)計學上的顯著差異需要思考和進一步研究每種干預措施的最佳用例。

Pain management疼痛管理

VR is effective as an intervention to control acute pain during medical procedures.10 11 For example, a randomised, crossover study reported a 39% reduction in opioid medication when using VR during painful medical procedures compared with the non-VR condition.12 While less researched than VR interventions for acute pain,13 there are also promising results for chronic pain management.14 This includes an at-home VR intervention for chronic lower back pain, which produced clinically meaningful symptom reduction in pain intensity and pain-related interference.15 While these findings are encouraging, more rigorous high-quality RCT studies are needed13 and unanswered questions about the optimal frequency and dosage of interventions, as well as the durability of any treatment effects remain. VR是一種有效的干預措施，以控制急性疼痛在醫(yī)療程序。10 11例如，一項隨機交叉研究報告稱，與非VR條件相比，在疼痛的醫(yī)療程序中使用VR時阿片類藥物減少了39%。12 雖然對急性疼痛的研究比VR干預少，13但對慢性疼痛管理也有很好的結果。14 這包括針對慢性下背痛的家庭VR干預，其在疼痛強度和疼痛相關干擾方面產(chǎn)生了臨床上有意義的癥狀減輕。15 雖然這些發(fā)現(xiàn)令人鼓舞，但仍需要更嚴格的高質(zhì)量隨機對照試驗研究13，并且關于干預的最佳頻率和劑量以及任何治療效果的持久性的未回答問題仍然存在。

Medical training醫(yī)療培訓

There is evidence that VR can be an effective tool for medical training16 in addition to its use with patients. For example, VR simulations can improve surgical skills, especially in comparison to non-VR traditional training.17 A meta-analysis of 15 RCT studies using VR to teach anatomy found moderately improved anatomy test scores compared with other teaching approaches.18 There is also emerging evidence that VR simulations are useful for non-technical skills, such as training empathy,19 that are essential for providing high-quality patient care. 有證據(jù)表明，VR可以成為醫(yī)學培訓的有效工具 16除了用于患者之外。例如，VR模擬可以提高手術技能，特別是與非VR傳統(tǒng)培訓相比。17 對15項使用VR教授解剖學的RCT研究進行的薈萃分析發(fā)現(xiàn)，與其他教學方法相比，解剖學考試成績略有提高。18 還有新的證據(jù)表明，VR模擬對非技術技能有用，例如訓練同理心， 19 這對于提供高質(zhì)量的病人護理至關重要。

Barriers to implementation執(zhí)行障礙

The accumulated evidence for the effectiveness of at least some medical VR applications will aid in the removal of roadblocks to their implementation. Some of the most significant barriers to broader adoption of medical VR in hospitals, which are not necessarily mutually exclusive, include: 至少一些醫(yī)療VR應用的有效性的累積證據(jù)將有助于消除其實施的障礙。在醫(yī)院中更廣泛地采用醫(yī)療VR的一些最重要的障礙，不一定是相互排斥的，包括：

Content內(nèi)容

Current medical VR knowledge is primarily based on the evaluation of research prototypes. The heterogeneity of the VR systems (eg, display type, method and amount of interaction) and the content (eg, how the tasks and activities are introduced, presented and measured) impact outcomes. The lack of generalisation, combined with a lack of standardisation, makes demonstrating evidence for specific VR applications time-consuming and costly. As a result, there are currently very few readily available commercial VR applications to choose from that have proven their effectiveness. 目前的醫(yī)學VR知識主要基于對研究原型的評估。VR系統(tǒng)的異質(zhì)性（例如，顯示類型，方法和交互量）和內(nèi)容（例如，如何引入，呈現(xiàn)和測量任務和活動）影響結果。缺乏概括性，加上缺乏標準化，使得為特定的VR應用程序展示證據(jù)既耗時又昂貴。因此，目前幾乎沒有現(xiàn)成的商業(yè)VR應用程序可供選擇，并已證明其有效性。

Data use and regulatory barriers數(shù)據(jù)使用和監(jiān)管障礙

Uncertainty around regulations related to data collection, storage, ownership and use are considerable barriers to use of VR. There may be regulatory obstacles to implementing VR technology in hospitals, such as obtaining approval from relevant governing bodies before using the technology. In the USA, for example, the FDA regulates medical devices, including VR technology used in a medical setting. Hospitals may also be required to follow other medical technology-related regulations, such as those governing patient privacy and data security. The parent companies of two leading VR headset manufacturers (Meta and ByteDance) operate social media platforms that collect large amounts of personal data for advertising and other purposes. Good solutions must be found to ensure that the collected data is not misused or disclosed without the individual’s consent. These regulatory requirements can increase the cost and complexity of implementing VR in hospitals, potentially impeding immediate widespread adoption. 與數(shù)據(jù)收集、存儲、所有權和使用相關的法規(guī)的不確定性是使用VR的相當大的障礙。在醫(yī)院實施VR技術可能存在監(jiān)管障礙，例如在使用該技術之前獲得相關管理機構的批準。例如，在美國，F(xiàn)DA監(jiān)管醫(yī)療設備，包括醫(yī)療環(huán)境中使用的VR技術。醫(yī)院還可能被要求遵守其他與醫(yī)療技術相關的法規(guī)，例如管理患者隱私和數(shù)據(jù)安全的法規(guī)。兩家領先的VR頭顯制造商（梅塔和字節(jié)跳動）的母公司運營社交媒體平臺，這些平臺收集大量個人數(shù)據(jù)用于廣告和其他目的。必須找到良好的解決方案，以確保收集的數(shù)據(jù)不會被濫用或未經(jīng)個人同意而披露。這些監(jiān)管要求可能會增加在醫(yī)院實施VR的成本和復雜性，可能會阻礙VR的立即廣泛采用。

Proof of cost-effectiveness成本效益證明

The cost-effectiveness of VR technology in hospitals has not yet been well established. One study found that VR therapy for pain management saved US$5.39 per patient, compared with usual care, due to lower opioid use and hospital length of stay.20 A randomised clinical trial in senior orthopaedic surgery residents found that not only was VR training superior to technical video training for the acquisition of procedural knowledge and decision-making, but it was also 34.1 times more cost-effective than the control group training.21 A return on investment analysis for a US$300 000 VR delivery (including staff, equipment, software and consumables) revealed a loss of US$38 and cost savings of US$6.79, with 5000 and 20?000 hospital admissions, respectively.20 The analysis, done with the assumption of a 19.3% eligibility and acceptance rate for VR pain interventions, nicely demonstrates the importance of scale. VR技術在醫(yī)院的成本效益尚未得到很好的確立。一項研究發(fā)現(xiàn)，與常規(guī)護理相比，用于疼痛管理的VR療法為每位患者節(jié)省了5.39美元，這是由于阿片類藥物的使用和住院時間較低。20 一項在骨科住院醫(yī)師中進行的隨機臨床試驗發(fā)現(xiàn)，VR培訓不僅在獲取程序知識和決策方面上級技術視頻培訓，而且其成本效益也是對照組培訓的34.1倍。21 對價值300，000美元的虛擬現(xiàn)實交付項目（包括人員、設備、軟件和耗材）的投資回報分析顯示，分別有5，000和20，000名住院患者損失了38美元，節(jié)省了6.79美元。20 該分析假設VR疼痛干預的合格率和接受率為19.3%，很好地證明了規(guī)模的重要性。

Competency development能力發(fā)展

Lack of training and familiarity is a major barrier to the adoption of VR technology. Technological competence, knowledge of the safe use of VR (eg, monitoring for cybersickness, infection control, mitigating the risk of physical hazards such as falls) and the selection of appropriate VR content for a specific patient are required. Many healthcare professionals will lack the necessary skills to use VR effectively. The issue of competency development is amplified by the rapid pace of hardware and VR application developments, with new versions being introduced constantly and headsets becoming outdated within years. The rapidly evolving medical VR field poses significant challenges for developing and sustaining staff competency. A lack of competency undermines not only the acceptability to use the technology, but also impedes buy-in from all stakeholders, including clinicians, senior administrators and IT professionals. 缺乏培訓和熟悉是采用VR技術的主要障礙。需要技術能力、安全使用VR的知識（例如，監(jiān)測電腦病、感染控制、減輕福爾斯等身體危害的風險）以及為特定患者選擇適當?shù)腣R內(nèi)容。許多醫(yī)療保健專業(yè)人員將缺乏有效使用VR的必要技能。硬件和VR應用程序的快速發(fā)展加劇了能力發(fā)展的問題，新版本不斷推出，耳機在幾年內(nèi)就會過時?？焖侔l(fā)展的醫(yī)療VR領域?qū)﹂_發(fā)和維持員工能力提出了重大挑戰(zhàn)。缺乏能力不僅破壞了使用該技術的可接受性，而且還阻礙了所有利益相關者（包括臨床醫(yī)生，高級管理人員和IT專業(yè)人員）的認可。

Conclusions結論

Advances in VR technology and the accumulating evidence for the effectiveness of VR for some medical applications in the last decade are promising. They provide critical stepping stones towards the wider adoption of medical VR. Further evidence demonstrated in high-quality trials,10–13 linking applications to theoretical frameworks,13 shedding light on mediating outcome factors (eg, content, dosage, frequency, patient characteristics), improving ease of use, and evidence for VR’s cost-effectiveness are required for broader acceptance and medical VR uptake. 在過去的十年中，VR技術的進步和VR在某些醫(yī)療應用中的有效性的積累證據(jù)是有希望的。它們?yōu)楦鼜V泛地采用醫(yī)療VR提供了關鍵的墊腳石。高質(zhì)量試驗中證明的進一步證據(jù)，10-13將應用與理論框架聯(lián)系起來，13闡明介導結果因素（例如，內(nèi)容，劑量，頻率，患者特征），提高易用性，以及VR成本效益的證據(jù)，都需要更廣泛的接受和醫(yī)療VR吸收。

The high level of academic research activity, combined with massive investments from established companies such as Meta, and the rise of numerous start-up companies in the field provide an ecosystem that has the potential to drive the growth and adoption of medical VR. However, moving from development and pilot evaluation activities to commercially available and evidence-based VR applications will take time and a widespread use in the medical field is still years away. While VR is undeniably a promising technology, it still has a long way to go before becoming a necessity and to live up to its potential to transform healthcare. 高水平的學術研究活動，加上梅塔等老牌公司的大量投資，以及該領域眾多初創(chuàng)公司的崛起，提供了一個有可能推動醫(yī)療VR增長和采用的生態(tài)系統(tǒng)。然而，從開發(fā)和試點評估活動轉(zhuǎn)向商業(yè)化和基于證據(jù)的VR應用需要時間，并且在醫(yī)療領域的廣泛使用仍然需要幾年時間。雖然VR無疑是一項很有前途的技術，但在成為必需品并實現(xiàn)其改變醫(yī)療保健的潛力之前，它還有很長的路要走。

THE END

本文由“健康號”用戶上傳、授權發(fā)布，以上內(nèi)容（含文字、圖片、視頻）不代表健康界立場?！敖】堤枴毕敌畔l(fā)布平臺，僅提供信息存儲服務，如有轉(zhuǎn)載、侵權等任何問題，請聯(lián)系健康界（jkh@hmkx.cn）處理。

網(wǎng)址: 沉浸式醫(yī)療虛擬現(xiàn)實：還是一種新奇還是已經(jīng)是必需品了？ http://m.u1s5d6.cn/newsview558016.html