Seeing Through the Headset: How Immersion Levels Shape User Experience in VR and AR-Assisted Physiotherapy

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Date

2026-04-20

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Abstract

Neck pain is a prevalent musculoskeletal condition associated with disability, reduced function, and recurrent symptoms. Although exercise-based physiotherapy is commonly recommended, sustained engagement remains a challenge. This thesis presents the design and comparative evaluation of two functionally matched prototype applications for neck-related interaction: one delivered in immersive virtual reality (VR) and the other in headset-based augmented reality (AR) with passthrough. Both systems supported four task modules targeting mobility, velocity and reaction performance, movement smoothness, and proprioceptive accuracy using head-tracking data. A within-subject mixed-methods study was conducted with 17 healthy participants who completed both conditions in counterbalanced order. Quantitative evaluation used the SUS, NASA-TLX, UES-SF, and SSQ, with paired statistical analyses and Holm-Bonferroni correction. No statistically reliable between-condition differences were observed after correction. Qualitative findings showed that user experience was shaped primarily by onboarding, control mapping, environmental awareness, and visual comfort. These findings inform the future design of AR and VR-based neck assessment and rehabilitation systems.

Summary for Lay Audience

Neck pain is extremely common and can greatly affect a person’s daily life. Physiotherapy can help, but many people struggle to follow treatment plans consistently, which reduces the chances of long-term improvement. New technologies such as virtual reality (VR) and augmented reality (AR) may help by making physiotherapy more engaging, easier to access, and more motivating, but little is known about how people actually experience and adopt these tools. This research explores how VR and AR could support neck physiotherapy by developing two digital exercise applications and studying how people interact with them. Instead of focusing only on clinical measurements, the study examines how users feel while using each system, how easy they are to use, and how comfortable and engaging the experiences are. We also interview participants to better understand their concerns, preferences, and expectations. The design process for both applications is informed throughout by people with a history of neck pain, ensuring that the application reflected the needs and perspectives of those with neck pain. Optimization was further guided by two groups at Western University. The Human-Centered Computing Group (HCCG) focused on human factors such as cognitive load and engagement, while the CANSpine Research Group ensured adherence to physiotherapy standards and introduced clinically relevant refinements. The modules in both applications assess mobility, velocity, smoothness, and proprioception. Performance data is generated through the headset’s motion-tracking system, which captures head pose and movement kinematics during each task. By comparing VR and AR from a human-factors perspective, this work aims to identify which aspects of immersive technologies might help people stay more engaged with physiotherapy. These insights could guide the design of future digital tools that fit more naturally into people’s lives and better support adherence to neck-pain treatment. Future work will expand the system toward holistic neck health evaluation and eventually rehabilitation exercises. This pathway aims to improve accessibility by reducing reliance on costly equipment and direct clinical supervision.

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Keywords

Neck Pain, Physiotherapy, Virtual Reality, Augmented Reality, Human Factors

URI

https://hdl.handle.net/20.500.14721/39651

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