System Immersion in Virtual Reality-Based Rehabilitation of Motor Function in Older Adults: A Systematic Review and Meta-Analysis

Background: As the elderly population continues to grow, so does the demand for new and innovative solutions to tackle age-related chronic diseases and disabilities. Virtual Reality (VR) has been explored as a novel therapeutic tool for numerous health-related applications. Although findings frequently favors VR, methodological shortcomings prevent clinical recommendations. Moreover, the term “VR” is frequently used ambiguously to describe e.g., video games; the distinction remains vague between immersive VR (IVR) systems and non-immersive VR (NVR). With no distinct demarcation, results of outcome measures are often pooled in meta-analyses, without accounting for the immersiveness of the system.Objective: This systematic review focused on virtual reality-based rehabilitation of older adults (+60) in motor rehabilitation programs. The review aims to retrospectively classify previous studies according to the level of immersion, in order to get an overview of the ambiguity-phenomenon, and to utilize meta-analyses and subgroup analyses to evaluate the comparative efficacy of system immersion in VR-based rehabilitation.Methods: Following PRISMA guidelines, we conducted a systematic search for randomized controlled trials, describing virtual rehabilitation or video games interventions for older adults (+60). Main outcomes were pain, motivation, mobility, balance, and adverse events.Results: We identified 15 studies which included 743 patients. Only three studies utilized IVR. The rest used various NVR-equipment ranging from commercial products (e.g., Nintendo Wii), to bespoke systems that combine tracking devices, software, and displays. A random effects meta-analysis of 10 studies analyzed outcome measures of mobility, balance, and pain. Protocols and dosage varied widely, but outcome results were in favor of immersive and non-immersive interventions, however, dropout rates and adverse events were mostly in favor of the control.Conclusions: We initialize a call-for-action, to distinguish between types of VR-technology and propose a taxonomy of virtual rehabilitation systems based on our findings. Most interventions use NVR-systems, which have demonstrably lower cybersickness-symptoms than IVR-systems. Therefore, adverse events may be under-reported in RCT-studies. An increased demand for IVR-systems highlight this challenge. Care should be given, when applying the results of existing NVR tools to new IVR-technologies. Future studies should provide more detail about their interventions, and future reviews should differentiate between NVR and IVR.

Interactive Voice Response systems for informing citizens about the COVID-19 pandemic: A study on Brazil's Disque Saúde

In order to slow down the spread of the coronavirus SARS-CoV-2, it is vital to adopt measures to inform citizens about preventive actions. Such an operation requires a wide-ranged system that comprises a variety of interfaces as channels between citizens and healthcare authority’s information services. Amongst such interfaces, the Interactive Voice Response (IVR) systems can present benefits for informing citizens about the pandemic. Although the literature shows that IVR systems have been used for healthcare, the extent of the COVID-19 pandemic demands new examinations on the role of IVR systems on a multiplatform system for delivering information. This paper aimed to identify gaps and opportunities for the use of IVR systems to inform citizens about the COVID-19 pandemic. A case study was conducted by mapping the Brazilian Ministry of Healthcare’s channels of information about the coronavirus and analyzing the Disque Saúde IVR system – a phone-based ombudsman channel - based on literature recommendations. The results showed that while IVR systems have great potential for accessibility, it is essential that all types of information are available and continuously updated for citizens. Furthermore, the vast and mutable availability of information in a pandemic scenario may be a challenge for the usability of such systems.

What’s wrong with IVR system service? A spatial theorisation of customer confusion and frustration

Purpose – The purpose of this paper is to re-examine the important question of what is wrong with interactive voice response (IVR) system service by expanding a spatially informed conceptualisation of virtual navigation which recognises the experience of movement within and through space. Design/methodology/approach – First, previous research on IVR systems is reviewed to highlight key themes to a service audience. Second, the metaphorical aspects of language used by the popular and trade press to describe IVR systems is examined. Usability and design issues are identified from previous research as a basis from reinterpreting them from a spatial perspective of navigation. Findings – Both figurative and conceptual spatial metaphors are used to describe the IVR system as an enclosed physical space, within which customers enter, feel stuck, get lost, or try to escape from. The usability issues of human memory, linearity, and feedback, can be reinterpreted from a spatial perspective as a basis for explaining confusion and frustration with IVR systems. Research limitations/implications – Since the paper is conceptual, further research is needed to empirically investigate different types and features of IVR systems. The possible influence of age and culture upon the spatial nature of experience is especially interesting topics for future study. Practical implications – The paper identifies the absence of space as an inherent limitation of IVR systems. It subsequently recommends that firms should provide spatial resources to support customer use of IVR systems, which is supported by the recent emergence of visual IVR. Originality/value – The paper introduces the broader literature on IVR systems to the service field as a basis for raising awareness about this ubiquitous technological component of telephone-based service delivery. It applies and develops a highly abstract conceptual perspective to examine and interpret the representation and experience of IVR systems, as a basis for explaining the confusion, frustration, and dislike of them.