Validity and Reliability of an Immersive Virtual Reality System for Multidimensional Assessment of Cervical
Ya-Lan Chiu1,2, Pei-Yun Lee1,2, Pooi-Ling Lim1
1Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Background:
Cervical sensorimotor control (SMC) is often disrupted in individuals with chronic neck pain, contributing to persistent symptoms and functional limitations. Traditional cervical SMC assessments are limited by complex setups, single-domain testing, and examiner dependency. Virtual reality (VR) technology offers a promising platform for multidimensional, standardized, and user-friendly assessment.
Objective:
This study aimed to develop and evaluate the validity and reliability of a VR-based system for assessing cervical SMC in healthy adults.
Methods:
A cross-sectional observational study was conducted in 30 healthy adults (aged 18-60 years). The custom-developed VR system (HP Reverb G2 Omnicept Edition, Unity engine) incorporated 5 SMC tests: cervical range of motion (ROM), joint position error (JPE), head-tilt response, figure of eight (FOE), and postural sway (PS). Test-retest reliability was assessed across 2 sessions, separated by 1 week, using intraclass correlation coefficients (ICCs). Concurrent validity was examined by comparing VR-based measures with gold standard optical motion capture or established clinical tools using Pearson correlation coefficients.
Results:
The VR system demonstrated good to excellent test-retest reliability across most outcome measures. The ICC for cervical ROM ranged from 0.851 to 0.968 across movement directions. The ICC for JPE in each direction ranged from 0.813 to 0.827. The ICC for the FOE test's deviation frequency and task duration were 0.810 and 0.913, respectively. The ICC for the head-tilt response was 0.742 and ranged from 0.720 to 0.843 for PS under both visual conditions. The VR-based assessments for ROM, JPE, FOE, and PS showed strong correlations with reference measures (r=0.723-0.980), supporting concurrent validity.
Conclusions:
This VR-based assessment system provides a valid, reliable, and user-friendly multidimensional evaluation of cervical SMC. It offers a standardized, integrated, and clinically feasible alternative to conventional assessments, with potential applications in both clinical diagnostics and rehabilitation monitoring.
Trial Registration:
ClinicalTrials.gov NCT06474130; https://clinicaltrials.gov/study/NCT06474130.
