JMIR Publications

ABSTRACT

Background:

Non-physician health professionals in rheumatology (HPR) play an increasingly important role in the management of rheumatoid arthritis (RA), yet structured continuing education opportunities remain limited compared with those available to physicians. Virtual reality (VR)-based education has shown superior knowledge outcomes over traditional learning, but no randomized controlled trial has evaluated whether HPR benefit from disease-specific VR-based education, or which format is most effective.

Objective:

The aim of this randomized controlled pilot trial was to evaluate whether an immersive VR-enhanced training leads to superior disease-specific knowledge acquisition compared with conventional lecture-based training in HPR, and whether this education yields additional benefits in illness perception and patient-care behavior beyond factual knowledge gains.

Methods:

This pilot trial randomized HPR (specialized rheumatology assistants and rheumatology nurses) 1:1 at four German rheumatology centers. The intervention group trained with the immersive VR application Rheumality®, delivered via a head-mounted display. The control group received the same content as a conventional PowerPoint lecture. Disease-specific knowledge (Patient Knowledge Questionnaire, PKQ) was assessed at baseline, immediately after training, and at four-week follow-up. The primary outcome was whether knowledge changed differently over time between the two groups. Secondary, exploratory outcomes were illness perception (Brief Illness Perception Questionnaire, BIPQ) and empathy (Consultation and Relational Empathy Measure, CARE). User acceptance and tolerability of VR were assessed descriptively in the intervention group. Group differences over time were analyzed with linear mixed-effects models, using Tukey-adjusted post-hoc comparisons and estimated marginal means (95% CI).

Results:

Of 44 HPR screened, 40 were randomized (VR group: n=20; control group: n=20). Three participants allocated to the VR group did not receive the intervention. Nine participants in the conventional education group were lost to follow-up four weeks after intervention. Linear mixed-effects modeling demonstrated a significant visit-by-group interaction for disease-specific knowledge (χ²=16.54, p < 0.001), indicating different knowledge trajectories between groups. In the VR group, PKQ scores increased from 19.8±2.4 at baseline to 23.1±2.5 immediately after the intervention (p = 0.008) and to 27.8±5.3 after four weeks (p < 0.001), whereas the conventional education group showed no significant improvement over time. No significant group-specific changes were observed for illness perception (BIPQ) or empathy (CARE). User acceptance was high. All participants of the VR group reported a positive overall experience and would recommend the VR application. Adverse events were rare (n=3), mild, and transient (e.g., nausea or dizziness).

Conclusions:

This pilot trial provides evidence that immersive VR-enhanced training was associated with greater and sustained disease-specific knowledge gains in HPR compared with conventional lecture-based training, with the effect widening over the four-week follow up. The VR application demonstrated high user acceptance and good tolerability. Clinical Trial: DRKS00021507