Recommendations for the use of virtual reality-oriented telemedicine: a systematic review
Resumo
The inclusion of immersive technologies in the field of telehealth is helping to reach more patients in remote areas and to develop training, treatments and surgical techniques. This article discusses the impact reflected in the use of emerging technologies, virtual reality (VR), mixed reality (MR) and Metaverse, with application in telemedicine. It shows how the experiences of users, professionals and patients were relevant in validating the studies evaluated. Through a Systematic Review using the PRISMA framework, the aim was to evaluate the main contributions, challenges and limitations surrounding this modality in the health area. In the bibliographic evaluation, the study was based on the collection of data derived from PubMed, Scopus and Web Of Science, between the years 2021-2025. In this review, 22 articles were compiled to generate recommendations for the use of telemedicine in conjunction with virtual reality.
Palavras-chave:
telemedicine, virtual reality, mixed reality, metaverse, digital health
Referências
Yew, S. Q. Trivedi, D. Adanan, N. I. H. and Chew, B. H. Facilitators and Barriers to the Implementation of Digital Health Technologies in Hospital Settings in Lower- and Middle-Income Countries Since the Onset of the COVID-19 Pandemic: Scoping Review. Journal of Medical Internet Research, 27, 2025.
Mitgang, E. A. Blaya, J. A. and Chopra, M. Digital Health in Response to COVID-19 in Low- and Middle-income Countries: Opportunities and Challenges. Global Policy, 12(Suppl 6), 107–109, 2021.
Aytekin, A. Alan, H. Demirel, H. Onur, N. Yalman, A. Livberber, T. and Yigit-Acikgoz, F. Digital Health Technologies in Patient Experience Literature: A Scoping Review and Future Outlook for Sustainable Digital Health Interventions. Sustainability, 17, 456, 2025.
Crotty, B. H. Hyun, N. Polovneff, A. Dong, Y. Decker, M. C. Mortensen, N. Holt, J. M. Winn, A. N. Laud, P. W. and Somai, M. M. Analysis of Clinician and Patient Factors and Completion of Telemedicine Appointments Using Video. JAMA Network Open, 4(11), 2021.
Tiwari, A. Dubey, A. Yadav, A. K. Bhansali, R. and Bagaria, V. A review of Smart future of healthcare in the digital age to improve Quality of orthopaedic patient care in metaverse called: The Healthverse!!. Journal of Clinical Orthopaedics and Trauma, 48, 102340, 2024.
Skalidis, I. Muller, O. and Fournier, S. CardioVerse: The cardiovascular medicine in the era of Metaverse. Trends in Cardiovascular Medicine, 33(8), 471–476, 2023.
Felnhofer, A. Pfannerstill, F. Gansler, L. Kothgassner, D. Humer, E. Buttner, J. and Probst, T. Barriers to adopting therapeutic virtual reality: the perspective of clinical psychologists and psychotherapists. Frontiers in Psychiatry, 16, 2025.
Creswell, J. W. Research design: Qualitative, quantitative, and mixed methods approaches. 4th ed. SAGE Publications, Thousand Oaks, 2014.
Booth, W. C. Colomb, G. G. and Williams, J. M. The craft of research. 2nd ed. University of Chicago Press, Chicago, 2003.
Page, M. J. McKenzie, J. E. Bossuyt, P. M. Boutron, I. Hoffmann, T. C. Mulrow, C. D. Shamseer, L. Tetzlaff, J. M. Akl, E. A. Brennan, S. E. et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. Systematic Reviews, 10, n71, 2021.
Chamusca, I. L. Ferreira, C. V. Murari, T. B. Apolinario, A. L. Jr. and Winkler, I. Towards Sustainable Virtual Reality: Gathering Design Guidelines for Intuitive Authoring Tools. Sustainability, 15(4), 2023.
Elmakias, O. and Dabran, I. Using Machine Learning and Virtual Reality for Orthopedic Treatment and Abnormality Detection Based on Multivariate Time Series Data. 2021 IEEE International Conference on Microwaves, Antennas, Communications and Electronic Systems (COMCAS), Tel Aviv, Israel, 70–74, 2021.
Checcucci, E. Amparore, D. Volpi, G. De Cillis, S. Piramide, F. Verri, P. Piana, A. Sica, M. Gatti, C. Alessio, P. Quara, A. Burgio, M. Colombo, M. Busacca, G. Mottrie, A. Cherullo, E. Breda, A. Antonelli, A. Bollens, R. Minervini, A. and Porpiglia, F. Metaverse Surgical Planning with Three-dimensional Virtual Models for Minimally Invasive Partial Nephrectomy. European Urology, 85(4), 320–325, 2024.
Kim, T. Kwon, H.-S. Cho, K. and Woo, W. Holistic Patient Assessment System using Digital Twin for XR Medical Teleconsultation. Proceedings of the Augmented Humans International Conference 2024 (AHs '24), ACM, 72–78, 2024.
Mitchell, S. Bragg, A. De La Cruz, B. Winter, M. Reichert, M. Laird, L. Moldovan, I. Parker, K. Martin-Howard, J. Gardiner, P. Effectiveness of an Immersive Telemedicine Platform for Delivering Diabetes Medical Group Visits for African American, Black and Hispanic, or Latina Women With Uncontrolled Diabetes: The Women in Control 2.0 Noninferiority Randomized Clinical Trial. Journal of Medical Internet Research, 25:e43669, 2023.
Yun, W. G. Youn, J. and Ko, D. Tele-consent using mixed reality glasses (NREAL) in pediatric inguinal herniorrhaphy: a preliminary study. Scientific Reports, 12, 3105, 2022.
Zahedi, F. M. Zhao, H. Sanvanson, P. Walia, N. Jain, H. and Shaker, R. My Real Avatar has a Doctor Appointment in the Wepital: A System for Persistent, Efficient, and Ubiquitous Medical Care. Information & Management, 59(8), 2022.
Contrada, M. Arabia, G. Vatrano, M. Pucci, C. Mantia, I. Scarfone, F. Torchia, G. Quintieri, M. Cerasa, A. and Pignolo, L. Multidomain Cognitive Tele-Neurorehabilitation Training in Long-Term Post-Stroke Patients: An RCT Study. Brain Sciences, 15(2), 145, 2025.
Pagliari, C. Della Tella, S. Bonanno, C. Cacciante, L. Cioeta, M. De Icco, R. Jonsdottir, J. Federico, S. Franceschini, M. Goffredo, M. Rainoldi, F. Rovaris, M. Springhetti, I. Calabro, R. S. Tassorelli, C. Rossini, P. M. and Baglio, F. Enhancing the effect of rehabilitation on multiple sclerosis: A randomized clinical trial investigating the impact of remotely-supervised transcranial direct current stimulation and virtual reality telerehabilitation training. Multiple Sclerosis and Related Disorders, 94, 106256, 2025.
Schuler, K. Ong, T. Welch, B. Craggs, J. and Bunnell, B. Examining a Telemedicine-Based Virtual Reality Clinic in Treating Adults With Specific Phobia: Protocol for a Feasibility Randomized Controlled Efficacy Trial. JMIR Research Protocols, 14:e65770, 2025.
De Simone, M. S. Costa, A. Tieri, G. Taglieri, S. Cona, G. Fiorenzato, E. Carlesimo, G. A. Caltagirone, C. and Zabberoni, S. The effectiveness of an immersive virtual reality and telemedicine-based cognitive intervention on prospective memory in Parkinson's disease patients with mild cognitive impairment and healthy aged individuals. Frontiers in Psychology, 14, 1268337, 2023.
Contrada, M. Arcuri, F. Tonin, P. Pignolo, L. Mazza, T. Nudo, G. Pignataro, M. L. Quintieri, M. Iozzi, A. and Cerasa, A. Stroke Telerehabilitation in Calabria: A Health Technology Assessment. Frontiers in Neurology, 12, 777608, 2022.
Wisotzky, E. L. Rosenthal, J. C. Meij, S. van den Dobblesteen, J. Arens, P. Hilsmann, A. Eisert, P. Uecker, F. C. and Schneider, A. Telepresence for surgical assistance and training using eXtended reality during and after pandemic periods. Journal of Telemedicine and Telecare, 31(1), 14–28, 2025.
Ammendola, M. Vescio, F. Al Ansari, M. Hila, J. Rizzo, L. Romano, R. Marchegiani, F. de’Angelis, N. Piardi, T. Cavaliere, D. Frampton, A. E. Gall, T. M. H. Luposella, M. Memeo, R. Navarra, G. Curcio, S. and Curro, G. Metaverse and Telementoring: From Surgery to Workshop. Surgical Innovation, 31(2), 212–219, 2024.
Din, N. Chan, C. C. Cohen, E. Iovieno, A. Dahan, A. Rootman, D. S. and Litvin, G. Remote Surgeon Virtual Presence: A Novel Telementoring Method for Live Surgical Training. Cornea, 41(3), 385–389, 2022.
Tadlock, M. D. Olson, E. J. Gasques, D. Champagne, R. Krzyzaniak, M. J. Belverud, S. A. Ravindra, V. Kerns, J. Choi, P. M. Deveraux, J. Johnson, J. Sharkey, T. Yip, M. Weibel, N. and Davis, K. Mixed reality surgical mentoring of combat casualty care related procedures in a perfused cadaver model: Initial results of a randomized feasibility study. Surgery, 172(5), 1337–1345, 2022.
Vishwakarma, H. Sampath, A. Sharma, V. K. and Biswas, P. Immersive Teleoperation of Collaborative Robot for Remote Vital Monitoring in Healthcare. 33rd IEEE International Conference on Robot and Human Interactive Communication (ROMAN), Pasadena, CA, 210–215, 2024.
Lin, Z. Xu, Z. Liu, H. Wang, X. Ai, X. Zhou, C. Huang, B. Chen, W. Yang, G. and Gao, A. Robotic Manipulator-Assisted Omnidirectional Augmented Reality for Endoluminal Intervention Telepresence. Advanced Intelligent Systems, 6:2300373, 2024.
Mocan, B. Mocan, M. Fulea, M. Murar, M. and Feier, H. Home-Based Robotic Upper Limbs Cardiac Telerehabilitation System. International Journal of Environmental Research and Public Health, 19(18):11628, 2022.
Lu, L. Wang, H. Liu, P. Liu, R. Zhang, J. Xie, Y. Liu, S. Huo, T. Xie, M. Wu, X. and Ye, Z. Applications of Mixed Reality Technology in Orthopedics Surgery: A Pilot Study. Frontiers in Bioengineering and Biotechnology, 10, 740507, 2022.
Yu, K. et al. Magnoramas: Magnifying Dioramas for Precise Annotations in Asymmetric 3D Teleconsultation. IEEE Virtual Reality and 3D User Interfaces (VR), Lisbon, Portugal, 392–401, 2021.
Owusu, G. and Luke, N. Training Graduate Students’ Shaping Skills in an Immersive Virtual Reality Environment. Education Sciences, 14(11), 1228, 2024.
Maltby, S. Garcia-Esperon, C. Jackson, K. Butcher, K. Evans, J. W. O’Brien, W. Dixon, C. Russell, S. Wilson, N. Kluge, M. G. Ryan, A. Paul, C. L. Spratt, N. J. Levi, C. R. and Walker, F. R. TACTICS VR Stroke Telehealth Virtual Reality Training for Health Care Professionals Involved in Stroke Management at Telestroke Spoke Hospitals: Module Design and Implementation Study. JMIR Serious Games, 11:e43416, 2023.
Mitgang, E. A. Blaya, J. A. and Chopra, M. Digital Health in Response to COVID-19 in Low- and Middle-income Countries: Opportunities and Challenges. Global Policy, 12(Suppl 6), 107–109, 2021.
Aytekin, A. Alan, H. Demirel, H. Onur, N. Yalman, A. Livberber, T. and Yigit-Acikgoz, F. Digital Health Technologies in Patient Experience Literature: A Scoping Review and Future Outlook for Sustainable Digital Health Interventions. Sustainability, 17, 456, 2025.
Crotty, B. H. Hyun, N. Polovneff, A. Dong, Y. Decker, M. C. Mortensen, N. Holt, J. M. Winn, A. N. Laud, P. W. and Somai, M. M. Analysis of Clinician and Patient Factors and Completion of Telemedicine Appointments Using Video. JAMA Network Open, 4(11), 2021.
Tiwari, A. Dubey, A. Yadav, A. K. Bhansali, R. and Bagaria, V. A review of Smart future of healthcare in the digital age to improve Quality of orthopaedic patient care in metaverse called: The Healthverse!!. Journal of Clinical Orthopaedics and Trauma, 48, 102340, 2024.
Skalidis, I. Muller, O. and Fournier, S. CardioVerse: The cardiovascular medicine in the era of Metaverse. Trends in Cardiovascular Medicine, 33(8), 471–476, 2023.
Felnhofer, A. Pfannerstill, F. Gansler, L. Kothgassner, D. Humer, E. Buttner, J. and Probst, T. Barriers to adopting therapeutic virtual reality: the perspective of clinical psychologists and psychotherapists. Frontiers in Psychiatry, 16, 2025.
Creswell, J. W. Research design: Qualitative, quantitative, and mixed methods approaches. 4th ed. SAGE Publications, Thousand Oaks, 2014.
Booth, W. C. Colomb, G. G. and Williams, J. M. The craft of research. 2nd ed. University of Chicago Press, Chicago, 2003.
Page, M. J. McKenzie, J. E. Bossuyt, P. M. Boutron, I. Hoffmann, T. C. Mulrow, C. D. Shamseer, L. Tetzlaff, J. M. Akl, E. A. Brennan, S. E. et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. Systematic Reviews, 10, n71, 2021.
Chamusca, I. L. Ferreira, C. V. Murari, T. B. Apolinario, A. L. Jr. and Winkler, I. Towards Sustainable Virtual Reality: Gathering Design Guidelines for Intuitive Authoring Tools. Sustainability, 15(4), 2023.
Elmakias, O. and Dabran, I. Using Machine Learning and Virtual Reality for Orthopedic Treatment and Abnormality Detection Based on Multivariate Time Series Data. 2021 IEEE International Conference on Microwaves, Antennas, Communications and Electronic Systems (COMCAS), Tel Aviv, Israel, 70–74, 2021.
Checcucci, E. Amparore, D. Volpi, G. De Cillis, S. Piramide, F. Verri, P. Piana, A. Sica, M. Gatti, C. Alessio, P. Quara, A. Burgio, M. Colombo, M. Busacca, G. Mottrie, A. Cherullo, E. Breda, A. Antonelli, A. Bollens, R. Minervini, A. and Porpiglia, F. Metaverse Surgical Planning with Three-dimensional Virtual Models for Minimally Invasive Partial Nephrectomy. European Urology, 85(4), 320–325, 2024.
Kim, T. Kwon, H.-S. Cho, K. and Woo, W. Holistic Patient Assessment System using Digital Twin for XR Medical Teleconsultation. Proceedings of the Augmented Humans International Conference 2024 (AHs '24), ACM, 72–78, 2024.
Mitchell, S. Bragg, A. De La Cruz, B. Winter, M. Reichert, M. Laird, L. Moldovan, I. Parker, K. Martin-Howard, J. Gardiner, P. Effectiveness of an Immersive Telemedicine Platform for Delivering Diabetes Medical Group Visits for African American, Black and Hispanic, or Latina Women With Uncontrolled Diabetes: The Women in Control 2.0 Noninferiority Randomized Clinical Trial. Journal of Medical Internet Research, 25:e43669, 2023.
Yun, W. G. Youn, J. and Ko, D. Tele-consent using mixed reality glasses (NREAL) in pediatric inguinal herniorrhaphy: a preliminary study. Scientific Reports, 12, 3105, 2022.
Zahedi, F. M. Zhao, H. Sanvanson, P. Walia, N. Jain, H. and Shaker, R. My Real Avatar has a Doctor Appointment in the Wepital: A System for Persistent, Efficient, and Ubiquitous Medical Care. Information & Management, 59(8), 2022.
Contrada, M. Arabia, G. Vatrano, M. Pucci, C. Mantia, I. Scarfone, F. Torchia, G. Quintieri, M. Cerasa, A. and Pignolo, L. Multidomain Cognitive Tele-Neurorehabilitation Training in Long-Term Post-Stroke Patients: An RCT Study. Brain Sciences, 15(2), 145, 2025.
Pagliari, C. Della Tella, S. Bonanno, C. Cacciante, L. Cioeta, M. De Icco, R. Jonsdottir, J. Federico, S. Franceschini, M. Goffredo, M. Rainoldi, F. Rovaris, M. Springhetti, I. Calabro, R. S. Tassorelli, C. Rossini, P. M. and Baglio, F. Enhancing the effect of rehabilitation on multiple sclerosis: A randomized clinical trial investigating the impact of remotely-supervised transcranial direct current stimulation and virtual reality telerehabilitation training. Multiple Sclerosis and Related Disorders, 94, 106256, 2025.
Schuler, K. Ong, T. Welch, B. Craggs, J. and Bunnell, B. Examining a Telemedicine-Based Virtual Reality Clinic in Treating Adults With Specific Phobia: Protocol for a Feasibility Randomized Controlled Efficacy Trial. JMIR Research Protocols, 14:e65770, 2025.
De Simone, M. S. Costa, A. Tieri, G. Taglieri, S. Cona, G. Fiorenzato, E. Carlesimo, G. A. Caltagirone, C. and Zabberoni, S. The effectiveness of an immersive virtual reality and telemedicine-based cognitive intervention on prospective memory in Parkinson's disease patients with mild cognitive impairment and healthy aged individuals. Frontiers in Psychology, 14, 1268337, 2023.
Contrada, M. Arcuri, F. Tonin, P. Pignolo, L. Mazza, T. Nudo, G. Pignataro, M. L. Quintieri, M. Iozzi, A. and Cerasa, A. Stroke Telerehabilitation in Calabria: A Health Technology Assessment. Frontiers in Neurology, 12, 777608, 2022.
Wisotzky, E. L. Rosenthal, J. C. Meij, S. van den Dobblesteen, J. Arens, P. Hilsmann, A. Eisert, P. Uecker, F. C. and Schneider, A. Telepresence for surgical assistance and training using eXtended reality during and after pandemic periods. Journal of Telemedicine and Telecare, 31(1), 14–28, 2025.
Ammendola, M. Vescio, F. Al Ansari, M. Hila, J. Rizzo, L. Romano, R. Marchegiani, F. de’Angelis, N. Piardi, T. Cavaliere, D. Frampton, A. E. Gall, T. M. H. Luposella, M. Memeo, R. Navarra, G. Curcio, S. and Curro, G. Metaverse and Telementoring: From Surgery to Workshop. Surgical Innovation, 31(2), 212–219, 2024.
Din, N. Chan, C. C. Cohen, E. Iovieno, A. Dahan, A. Rootman, D. S. and Litvin, G. Remote Surgeon Virtual Presence: A Novel Telementoring Method for Live Surgical Training. Cornea, 41(3), 385–389, 2022.
Tadlock, M. D. Olson, E. J. Gasques, D. Champagne, R. Krzyzaniak, M. J. Belverud, S. A. Ravindra, V. Kerns, J. Choi, P. M. Deveraux, J. Johnson, J. Sharkey, T. Yip, M. Weibel, N. and Davis, K. Mixed reality surgical mentoring of combat casualty care related procedures in a perfused cadaver model: Initial results of a randomized feasibility study. Surgery, 172(5), 1337–1345, 2022.
Vishwakarma, H. Sampath, A. Sharma, V. K. and Biswas, P. Immersive Teleoperation of Collaborative Robot for Remote Vital Monitoring in Healthcare. 33rd IEEE International Conference on Robot and Human Interactive Communication (ROMAN), Pasadena, CA, 210–215, 2024.
Lin, Z. Xu, Z. Liu, H. Wang, X. Ai, X. Zhou, C. Huang, B. Chen, W. Yang, G. and Gao, A. Robotic Manipulator-Assisted Omnidirectional Augmented Reality for Endoluminal Intervention Telepresence. Advanced Intelligent Systems, 6:2300373, 2024.
Mocan, B. Mocan, M. Fulea, M. Murar, M. and Feier, H. Home-Based Robotic Upper Limbs Cardiac Telerehabilitation System. International Journal of Environmental Research and Public Health, 19(18):11628, 2022.
Lu, L. Wang, H. Liu, P. Liu, R. Zhang, J. Xie, Y. Liu, S. Huo, T. Xie, M. Wu, X. and Ye, Z. Applications of Mixed Reality Technology in Orthopedics Surgery: A Pilot Study. Frontiers in Bioengineering and Biotechnology, 10, 740507, 2022.
Yu, K. et al. Magnoramas: Magnifying Dioramas for Precise Annotations in Asymmetric 3D Teleconsultation. IEEE Virtual Reality and 3D User Interfaces (VR), Lisbon, Portugal, 392–401, 2021.
Owusu, G. and Luke, N. Training Graduate Students’ Shaping Skills in an Immersive Virtual Reality Environment. Education Sciences, 14(11), 1228, 2024.
Maltby, S. Garcia-Esperon, C. Jackson, K. Butcher, K. Evans, J. W. O’Brien, W. Dixon, C. Russell, S. Wilson, N. Kluge, M. G. Ryan, A. Paul, C. L. Spratt, N. J. Levi, C. R. and Walker, F. R. TACTICS VR Stroke Telehealth Virtual Reality Training for Health Care Professionals Involved in Stroke Management at Telestroke Spoke Hospitals: Module Design and Implementation Study. JMIR Serious Games, 11:e43416, 2023.
Publicado
30/09/2025
Como Citar
MOTTA, Helen Cristina Nogueira; ALMEIDA, Lucas Gregory Gomes de; TEMPESTA, Camila Araujo; FONSECA, Fernanda Batista da; OKIMOTO, Maria Lucia Leite Ribeiro; CATAPAN, Marcio Fontana.
Recommendations for the use of virtual reality-oriented telemedicine: a systematic review. In: SIMPÓSIO DE REALIDADE VIRTUAL E AUMENTADA (SVR), 27. , 2025, Salvador/BA.
Anais [...].
Porto Alegre: Sociedade Brasileira de Computação,
2025
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p. 567-575.
