‘Being There Together for Health’: A Systematic Review on the Feasibility, Effectiveness and Design Considerations of Immersive Collaborative Virtual Environments in Health Applications
Tohid Zarei, Michelle Emery, Dimitrios Saredakis, Gun Lee, Ben Stubbs, Ancrêt Szpak, Tobias Loetscher · Human Behavior and Emerging Technologies · 2025
Effectively using immersive multiuser environments for digital applications (via virtual, augmented and mixed reality technologies) beckons the future of healthcare delivery in the metaverse. We aimed to evaluate the feasibility and effectiveness of immersive multiuser environments used in health applications while identifying their design features. We systematically searched MEDLINE, PsycINFO and Emcare databases for peer‐reviewed original reports, published in English, without date restrictions until 30 August 2023, and conducted manual citation searching in February 2024. All studies using fully immersive extended reality technologies (e.g., head‐mounted displays and smart glasses) while engaging more than one participant in an intervention with direct health benefits were included. A qualitative synthesis of findings is reported. The quality of research was assessed using JBI Critical Checklists. The review was preregistered on PROSPERO (CRD42023479155). Of 2862 identified records, 10 studies were eligible, with high average quality ratings of quantitative (85%) and qualitative (74%) data analyses. Included studies were mostly conducted with young adults (five studies) and older adults (four studies). They were aimed at various well‐being promotion, symptom reduction and skill acquisition applications. While they all used different models of Oculus/Meta headsets, their environments′ designs were distinctive and aligned with their objectives. Findings indicated varying degrees of positive health outcomes for engagement in rehabilitation, meaningful interactions across distances, positive affect, transformative experiences, mental health therapies and motor skill learning. Participants reported high usability, motivation, enjoyment, presence and copresence. They also expressed the need for more training time with technology. The heterogeneous methodologies prevent conclusions about the effectiveness of immersive collaborative virtual environments in health programs. However, adopting an intentional intervention design, considering factors affecting presence and copresence, as well as integrating cocreation of the program with participants, seems integral to achieving positive health outcomes.