PDF(Pubmed)
Abstract：
BACKGROUND: Neuropsychological assessments traditionally include tests of executive functioning (EF) because of its critical role in daily activities and link to mental disorders. Established traditional EF assessments, although robust, lack ecological validity and are limited to single cognitive processes. These methods, which are suitable for clinical populations, are less informative regarding EF in healthy individuals. With these limitations in mind, immersive virtual reality (VR)-based assessments of EF have garnered interest because of their potential to increase test sensitivity, ecological validity, and neuropsychological assessment accessibility.
OBJECTIVE: This systematic review aims to explore the literature on immersive VR assessments of EF focusing on (1) EF components being assessed, (2) how these assessments are validated, and (3) strategies for monitoring potential adverse (cybersickness) and beneficial (immersion) effects.
METHODS: EBSCOhost, Scopus, and Web of Science were searched in July 2022 using keywords that reflected the main themes of VR, neuropsychological tests, and EF. Articles had to be peer-reviewed manuscripts written in English and published after 2013 that detailed empirical, clinical, or proof-of-concept studies in which a virtual environment using a head-mounted display was used to assess EF in an adult population. A tabular synthesis method was used in which validation details from each study, including comparative assessments and scores, were systematically organized in a table. The results were summed and qualitatively analyzed to provide a comprehensive overview of the findings.
RESULTS: The search retrieved 555 unique articles, of which 19 (3.4%) met the inclusion criteria. The reviewed studies encompassed EF and associated higher-order cognitive functions such as inhibitory control, cognitive flexibility, working memory, planning, and attention. VR assessments commonly underwent validation against gold-standard traditional tasks. However, discrepancies were observed, with some studies lacking reported a priori planned correlations, omitting detailed descriptions of the EF constructs evaluated using the VR paradigms, and frequently reporting incomplete results. Notably, only 4 of the 19 (21%) studies evaluated cybersickness, and 5 of the 19 (26%) studies included user experience assessments.
CONCLUSIONS: Although it acknowledges the potential of VR paradigms for assessing EF, the evidence has limitations. The methodological and psychometric properties of the included studies were inconsistently addressed, raising concerns about their validity and reliability. Infrequent monitoring of adverse effects such as cybersickness and considerable variability in sample sizes may limit interpretation and hinder psychometric evaluation. Several recommendations are proposed to improve the theory and practice of immersive VR assessments of EF. Future studies should explore the integration of biosensors with VR systems and the capabilities of VR in the context of spatial navigation assessments. Despite considerable promise, the systematic and validated implementation of VR assessments is essential for ensuring their practical utility in real-world applications.
OBJECTIVE: This systematic review aims to explore the literature on immersive VR assessments of EF focusing on (1) EF components being assessed, (2) how these assessments are validated, and (3) strategies for monitoring potential adverse (cybersickness) and beneficial (immersion) effects.
METHODS: EBSCOhost, Scopus, and Web of Science were searched in July 2022 using keywords that reflected the main themes of VR, neuropsychological tests, and EF. Articles had to be peer-reviewed manuscripts written in English and published after 2013 that detailed empirical, clinical, or proof-of-concept studies in which a virtual environment using a head-mounted display was used to assess EF in an adult population. A tabular synthesis method was used in which validation details from each study, including comparative assessments and scores, were systematically organized in a table. The results were summed and qualitatively analyzed to provide a comprehensive overview of the findings.
RESULTS: The search retrieved 555 unique articles, of which 19 (3.4%) met the inclusion criteria. The reviewed studies encompassed EF and associated higher-order cognitive functions such as inhibitory control, cognitive flexibility, working memory, planning, and attention. VR assessments commonly underwent validation against gold-standard traditional tasks. However, discrepancies were observed, with some studies lacking reported a priori planned correlations, omitting detailed descriptions of the EF constructs evaluated using the VR paradigms, and frequently reporting incomplete results. Notably, only 4 of the 19 (21%) studies evaluated cybersickness, and 5 of the 19 (26%) studies included user experience assessments.
CONCLUSIONS: Although it acknowledges the potential of VR paradigms for assessing EF, the evidence has limitations. The methodological and psychometric properties of the included studies were inconsistently addressed, raising concerns about their validity and reliability. Infrequent monitoring of adverse effects such as cybersickness and considerable variability in sample sizes may limit interpretation and hinder psychometric evaluation. Several recommendations are proposed to improve the theory and practice of immersive VR assessments of EF. Future studies should explore the integration of biosensors with VR systems and the capabilities of VR in the context of spatial navigation assessments. Despite considerable promise, the systematic and validated implementation of VR assessments is essential for ensuring their practical utility in real-world applications.
摘要：
背景：神经心理学评估传统上包括执行功能（EF）的测试，因为它在日常活动中具有关键作用并与精神障碍有关。建立传统的EF评估，虽然健壮，缺乏生态有效性，仅限于单一的认知过程。这些方法,适合临床人群，在健康个体中，关于EF的信息较少。考虑到这些限制，基于沉浸式虚拟现实(VR)的EF评估已经引起了人们的兴趣，因为它们有可能提高测试灵敏度，生态有效性，和神经心理学评估可及性。
目的：本系统综述旨在探索有关EF的沉浸式VR评估的文献，重点是（1）被评估的EF成分，(2)如何验证这些评估，和(3)监测潜在不良(网络疾病)和有益(沉浸)影响的策略。
方法：EBSCOhost，Scopus,和WebofScience在2022年7月使用反映VR主要主题的关键字进行搜索，神经心理学测试,和EF。文章必须是用英语撰写的同行评审手稿，并在2013年之后发表，详细的经验，临床,或概念验证研究，其中使用头戴式显示器的虚拟环境来评估成人人群的EF。使用表格合成方法，其中每个研究的验证细节，包括比较评估和分数，被系统地组织在一张桌子上。对结果进行了总结和定性分析，以提供对研究结果的全面概述。
结果：搜索检索到555篇独特文章，其中19人(3.4%)符合纳入标准。综述的研究包括EF和相关的高阶认知功能，如抑制控制，认知灵活性，工作记忆,规划,和注意。VR评估通常会针对黄金标准的传统任务进行验证。然而,观察到差异，由于一些研究缺乏报告的先验计划相关性，省略使用VR范式评估的EF构造的详细描述，经常报告不完整的结果。值得注意的是,19项研究中只有4项(21%)评估了网络疾病，19项研究中有5项(26%)包括用户体验评估。
结论：尽管它承认VR范例评估EF的潜力，证据有局限性。纳入研究的方法学和心理计量学特性得到了不一致的解决，引起人们对其有效性和可靠性的担忧。对诸如网络疾病之类的不利影响的不频繁监测和样本量的相当大的差异可能会限制解释并阻碍心理评估。提出了一些建议，以改善EF沉浸式VR评估的理论和实践。未来的研究应该在空间导航评估的背景下探索生物传感器与VR系统的集成以及VR的功能。尽管有相当大的希望，VR评估的系统和经过验证的实施对于确保其在现实世界应用中的实际效用至关重要。
目的：本系统综述旨在探索有关EF的沉浸式VR评估的文献，重点是（1）被评估的EF成分，(2)如何验证这些评估，和(3)监测潜在不良(网络疾病)和有益(沉浸)影响的策略。
方法：EBSCOhost，Scopus,和WebofScience在2022年7月使用反映VR主要主题的关键字进行搜索，神经心理学测试,和EF。文章必须是用英语撰写的同行评审手稿，并在2013年之后发表，详细的经验，临床,或概念验证研究，其中使用头戴式显示器的虚拟环境来评估成人人群的EF。使用表格合成方法，其中每个研究的验证细节，包括比较评估和分数，被系统地组织在一张桌子上。对结果进行了总结和定性分析，以提供对研究结果的全面概述。
结果：搜索检索到555篇独特文章，其中19人(3.4%)符合纳入标准。综述的研究包括EF和相关的高阶认知功能，如抑制控制，认知灵活性，工作记忆,规划,和注意。VR评估通常会针对黄金标准的传统任务进行验证。然而,观察到差异，由于一些研究缺乏报告的先验计划相关性，省略使用VR范式评估的EF构造的详细描述，经常报告不完整的结果。值得注意的是,19项研究中只有4项(21%)评估了网络疾病，19项研究中有5项(26%)包括用户体验评估。
结论：尽管它承认VR范例评估EF的潜力，证据有局限性。纳入研究的方法学和心理计量学特性得到了不一致的解决，引起人们对其有效性和可靠性的担忧。对诸如网络疾病之类的不利影响的不频繁监测和样本量的相当大的差异可能会限制解释并阻碍心理评估。提出了一些建议，以改善EF沉浸式VR评估的理论和实践。未来的研究应该在空间导航评估的背景下探索生物传感器与VR系统的集成以及VR的功能。尽管有相当大的希望，VR评估的系统和经过验证的实施对于确保其在现实世界应用中的实际效用至关重要。
