Published on in Vol 9, No 4 (2021): Oct-Dec

Preprints (earlier versions) of this paper are available at, first published .
Virtual Reality in Health Care: Bibliometric Analysis

Virtual Reality in Health Care: Bibliometric Analysis

Virtual Reality in Health Care: Bibliometric Analysis

Original Paper

Faculty of Economics and Social Sciences, University of Potsdam, Potsdam, Germany

*all authors contributed equally

Corresponding Author:

Victor Tiberius, MBA, Prof Dr rer pol, Dr phil

Faculty of Economics and Social Sciences

University of Potsdam

August-Bebel-Str 89

Potsdam, 14482


Phone: 49 3319773593


Background: Research into the application of virtual reality technology in the health care sector has rapidly increased, resulting in a large body of research that is difficult to keep up with.

Objective: We will provide an overview of the annual publication numbers in this field and the most productive and influential countries, journals, and authors, as well as the most used, most co-occurring, and most recent keywords.

Methods: Based on a data set of 356 publications and 20,363 citations derived from Web of Science, we conducted a bibliometric analysis using BibExcel, HistCite, and VOSviewer.

Results: The strongest growth in publications occurred in 2020, accounting for 29.49% of all publications so far. The most productive countries are the United States, the United Kingdom, and Spain; the most influential countries are the United States, Canada, and the United Kingdom. The most productive journals are the Journal of Medical Internet Research (JMIR), JMIR Serious Games, and the Games for Health Journal; the most influential journals are Patient Education and Counselling, Medical Education, and Quality of Life Research. The most productive authors are Riva, del Piccolo, and Schwebel; the most influential authors are Finset, del Piccolo, and Eide. The most frequently occurring keywords other than “virtual” and “reality” are “training,” “trial,” and “patients.” The most relevant research themes are communication, education, and novel treatments; the most recent research trends are fitness and exergames.

Conclusions: The analysis shows that the field has left its infant state and its specialization is advancing, with a clear focus on patient usability.

JMIR Serious Games 2021;9(4):e32721



There is no definite date for the first virtual reality (VR) application but the Sensorama device described by Morton Heilig in 1955 can be seen as a possible starting point [1,2]. His invention is one of the earliest known examples of immersive technology incorporating vision, sound, smell, as well as the sensation of touch, thereby letting users experience an illusory form of reality [2,3]. VR can be defined as a technology that makes users believe that they are in another place, based on heavily influencing the primary sensory inputs with computer-generated data [4]. What started as a pure form of entertainment involving immersion and interactivity has now become a thriving market with a wide range of use cases including recreation, communication, research, education, and health care [5-7]. VR initially started out as a luxury but has recently become more accessible, with companies like Facebook, Google, Samsung, and Sony making large investments in this technology [8,9]. The health sector benefits from this development as VR technology for entertainment purposes can also improve medical training [5,10,11], leading to a fusion of gaming and educational training called serious gaming [12]. Professionals, researchers, and students get early exposure to equipment, procedures, and clinical settings, as well as feedback, without putting anyone at risk [5,11]. The relevance of VR in the health sector is also increasing due to breakthroughs such as O’Keefe and Moser’s discovery of the brain’s “GPS” (for which they received the Nobel Prize), highlighting the possibilities of VR-supported studies [13]. While analyzing the brain activity of rodents in a VR setting, these researchers found “cells that constitute a positioning system in the brain” [14,15]. Additionally, a wide array of VR engines and VR applications for experimental and computational use is becoming more accessible for everyone [14,16-18]. Lastly, VR is a driving factor in the development of new treatments or the revamping of older ones [19,20]. Novel approaches include phobia therapy [21], rehabilitation [22], and many more. These new forms of psychological and physical treatment help patients and health professionals to achieve better results in care, healing, and comfort [19,20,23,24].

The widespread use of VR makes it an increasingly relevant topic for research, leading to a growing body of scholarly literature in recent years [25], which has become more and more complex and fragmented. As a consequence, a systematic overview of research on VR in health care is needed. Our research goal is to provide such a comprehensive overview, based on a bibliometric analysis. We aim to identify current trends to promote and guide future research.

Our study supplements previous bibliometric analyses on VR in the health sector, which have a narrower focus on specific use cases, such as dementia [26], autism [27], or rehabilitation [28]. Other bibliometric analyses are outdated and do not adequately represent the current state of available material [29]. Some bibliometric analyses are not limited to VR but also include augmented reality (AR) [25,30]. Cipresso et al [31] provided a large-scale network and cluster analysis for both VR and AR across all scientific disciplines. In contrast to all these analyses, this study aims to provide a current and comprehensive overview of VR research in the health sector via a bibliometric analysis. It therefore contributes to research on VR in health care by measuring and mapping the body of literature on this topic.

Search and Screening Strategy

We conducted a title search for “virtual reality” or “VR” on the Web of Science Core Collection on April 19, 2021. The title search ensured that only publications focused on VR were included in the data set, while publications touching on VR as a side aspect were excluded. The search yielded 12,979 publications from 1994-2021.

The data set was narrowed down by focusing on publications written in the predominant scientific language (English). We selected only publications in health care–related categories: Health Care Science Services, Public Environmental Occupational Health, Health Policy Services, and Primary Health Care. Finally, we excluded all document types other than articles (“early access” articles were included). This elimination process helped guarantee that only peer-reviewed research was included in the bibliometric analysis. The final data set consists of a total of 356 publications (Figure 1).

Figure 1. Data collection process.
View this figure

Bibliometric Analysis

Bibliometrics focuses on the analysis of quantifiable publication data [32], which can be used to create objective and reproducible results [33] and offer insights into relationships between analyzed documents [34]. The basic measures for bibliometric performance analyses are the number of articles (representing productivity) and the number of citations (representing impact or influence) [35]. We focused on performance data regarding productivity and impact by year as well as by country, journal, and author. Frequencies and pro rata percentages in each category were based on publication years, total share of records, or total global citation scores. Country scores were based on the affiliation data provided by the authors themselves. Additionally, the most used, most co-occurring, and most recent keywords were examined to find and structure the main research themes. Furthermore, the twenty most important keywords were determined. These bibliometric indicators are regularly used to provide a bibliometric overview of a field [36] and to determine the most influential countries, authors, and journals of a field [37]. Based on bibliometric findings, future research trends can be derived [37].

This analysis involved the use of total global citation scores and a computation of popularity based on appearance frequency. The underlying data for the bibliometric analysis was analyzed with BibExcel (version 2016-02-20), HistCite (version 12.03.17), and VOSviewer (version 1.6.16).

Annual Productivity

Table 1 depicts the annual numbers of publications on VR in health care from 1994 to April 2021. From 1994 to 2020, the average growth rate of scientific publications about VR in health care was 20.46%. Including the partial year 2021, the calculated average growth rate is currently 13.98%. The average growth rate from 1994-2010 was 10.58%, which increased to 20.54% and 60.05% for 2011-2015 and 2016-2020, respectively. The growth rate from 2016-2021 is currently 13.40%. There was a surge of scientific publications starting around 2014, accounting for 80.62% of all eligible articles. The biggest increase was in 2020, accounting for 29.49% of all analyzed scholarly works.

Overall, 88.8% (315/356) of the analyzed scientific articles were published by researchers from 20 countries (Table 1). The top three countries are the United States (94/356, 26.4%), the United Kingdom (28/356, 7.9%), and Spain (24/356, 6.7%). Another 24 countries not shown in Table 2 contributed to VR research in health care. The percentages shown in Table 1 relate to the total number of publications by the depicted countries (N=315), not the overall data set.

The country with the highest global citation score is the United States, accounting for nearly one-third of all citations in the data set (1995/6701, 29.8%). Canada is ranked second, with about one-tenth of all citations (659/6701, 9.8%), followed by the United Kingdom in third place, with about 9% of all citations (613/6701, 9.1%). The percentages in Table 3 refer to the total number of citations of the top 20 countries, not the complete data set.

Table 1. Country productivity and country impact.
YearNumber of publications
Early access2
Table 2. Country productivity (N=315).
RankCountryOutput, n (%)
1United States of America94 (29.8)
2United Kingdom28 (8.9)
3Spain24 (7.6)
4Canada21 (6.7)
5People’s Republic of China18 (5.7)
6Australia16 (5.1)
6Italy16 (5.1)
7South Korea15 (4.8)
8Germany13 (4.1)
8Taiwan13 (4.1)
9Netherlands12 (3.8)
10France8 (2.5)
11Brazil6 (1.9)
12Finland5 (1.6)
12Israel5 (1.6)
12Turkey5 (1.6)
13Norway4 (1.3)
13Poland4 (1.3)
13Portugal4 (1.3)
23Sweden4 (1.3)
Table 3. Country impact (N=6432).
RankCountryOutput, n (%)
1United States1995 (31.0)
2Canada659 (10.3)
3United Kingdom613 (9.5)
4Italy493 (7.7)
5Netherlands383 (6.0)
6Norway362 (5.6)
7Germany338 (5.3)
8Australia303 (4.7)
9Spain267 (4.2)
10Switzerland256 (4.0)
11Belgium147 (2.3)
12Israel112 (1.7)
13Taiwan100 (1.6)
14People’s Republic of China98 (1.5)
15Singapore63 (1.0)
16France60 (0.9)
17Mexico58 (0.9)
18New Zealand47 (0.7)
19India43 (0.7)
20Finland35 (0.5)

Journal Productivity and Impact

The highest-ranking journal regarding productivity is the Journal of Medical Internet Research, with 34 of the 356 total publications (9.6%). In second place is JMIR Serious Games (29/356, 8.2%), followed by the Games for Health Journal in third position (28/356, 7.9%). The percentages in Table 3 relate to the total number of articles in the top 20 most productive journals; the articles in the full data set were published in 70 additional journals not shown in Table 4.

The most cited journal is Patient Education and Counselling, with a total global citation score of 428 of the 3993 citations in the entire data set (10.7%). In second place is Medical Education (312/3993, 7.8%), followed by Quality of Life Research (281/3993, 7%). Again, out of the 90 journals included in the data set, 70 are not shown in Table 5. The percentages given in the table relate to the 3105 citations received by the top 20 journals, not the whole data set.

The three authors with the highest productivity are Riva (9/356, 3%), del Piccolo (6/356, 2%), and Schwebel (6/356, 2%). Out of 1698 authors in the data set, 1678 are not shown in Table 6. Most authors (1532, 90.2%) only published one article on VR in health care, while 129 (7.6%) published two qualifying articles.

The author with the highest impact as determined by overall citations is Finset, with a total of 340 citations of 20,363 (1.67%) in the whole data set. The next most influential authors are del Piccolo and Eide, both in second place with 308 citations (308/20,363, 1.51%). Taking all citations and authors into account, the average is 20.36 citations per researcher. The computed h-index of an author (shown in Table 7) relates to the subject of this bibliometric analysis, and does not include other publications by the author. Once again, the displayed percentage relates to the total number of citations represented in the table, not the whole data set.

Table 4. Journal productivity (N=235).
RankJournalOutput, n (%)
1Journal of Medical Internet Research34 (14.5)
2JMIR Serious Games29 (12.3)
3Games for Health Journal28 (11.9)
4International Journal of Environmental Research and Public Health27 (11.5)
5Patient Education and Counselling16 (6.8)
6Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare11 (4.7)
7Journal of Healthcare Engineering10 (4.3)
8Technology and Healthcare10 (4.3)
9Accident Analysis and Prevention8 (3.4)
9Annual Review of Cybertherapy and Telemedicine 2015: Virtual Reality in Healthcare: Medical Simulation and Experiential Interface8 (3.4)
10Annual Review of Cybertherapy and Telemedicine 2014: Positive Change: Connecting the Virtual and the Real7 (3.0)
11Frontiers in Public Health6 (2.6)
11Journal of Medical Systems6 (2.6)
12Aerospace Medicine and Human Performance5 (2.1)
12Aviation Space and Environmental Medicine5 (2.1)
12Injury Prevention5 (2.1)
12International Journal of Occupational Safety and Ergonomics5 (2.1)
12JMIR Research Protocols5 (2.1)
12Methods of Information in Medicine5 (2.1)
12Work: A Journal of Prevention Assessment & Rehabilitation5 (2.1)
Table 5. Journal impact (N=3105).
RankJournalCitations, n (%)
1Patient Education and Counselling428 (13.8)
2Medical Education312 (10.0)
3Quality of Life Research281 (9.1)
4Aviation Space and Environmental Medicine247 (8.0)
5Games for Health Journal234 (7.5)
6Academic Medicine213 (6.9)
7Accident Analysis and Prevention196 (6.3)
8Journal of Medical Internet Research142 (4.6)
9Nicotine & Tobacco Research111 (3.6)
10Supportive Care in Cancer106 (3.4)
11Telemedicine Journal and e-Health101 (3.3)
12Methods of Information in Medicine100 (3.2)
13Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare90 (2.9)
14International Journal on Disability and Human Development89 (2.9)
15Journal of Medical Systems80 (2.6)
15Simulation in Healthcare80 (2.6)
16Psychology & Health75 (2.4)
16Technology and Health Care75 (2.4)
17International Journal of Medical Informatics74 (2.4)
18JMIR Serious Games71 (2.3)
Table 6. Author productivity (N=87).
RankAuthorPublications, n (%)
1G Riva9 (10)
2L del Piccolo6 (7)
2DC Schwebel6 (7)
3A Finset5 (6)
3J Gutierrez-Maldonado5 (6)
3G Humphris5 (6)
3BK Wiederhold5 (6)
3SC Yeh5 (6)
4H Eide4 (5)
4M Ferrer-Garcia4 (5)
4L Smith4 (5)
4MD Wiederhold4 (5)
4C Zimmermann4 (5)
5SAW Andersen3 (3)
5WP Brinkman3 (3)
5R Cano de la Cuerda3 (3)
5P Cipresso3 (3)
5A Fisher3 (3)
5I Fletcher3 (3)
5C Goss3 (3)
Table 7. Author impact (N=5459).
RankAuthorCitations, n (%)H-index
1A Finset340 (6.2)5
2L del Piccolo308 (5.6)5
2H Eide308 (5.6)4
3G Humphris300 (5.5)5
4C Zimmermann297 (5.4)4
5W Rogers281 (5.2)3
6M Rimondini273 (5.0)3
7C Goss273 (5.0)3
8I Fletcher271 (5.0)3
9YM Kim256 (4.7)2
9S Bergvik256 (4.7)2
9P Salmon256 (4.7)2
9J Bensing256 (4.7)2
9C Heaven256 (4.7)2
9L Zandbelt256 (4.7)2
9W Langewitz256 (4.7)2
9S van Dulmen256 (4.7)2
9H de Haes256 (4.7)2
10L Wissow256 (4.7)2
11S Qian248 (4.5)2

Most Used and Co-Occurring Keywords

As shown in Table 8, the most used keyword is “virtual” (322/356, 90.4%), followed by “reality” (321/356, 90.2%). The third most used keyword is “training” (60/356, 16.9%).

The author keyword co-occurrence analysis led to 11 clusters, with a minimum citation threshold of 3 and 94 qualifying keywords. Figure 2 depicts the keyword co-occurrence map generated by VOSviewer. The 11 clusters are distinguished by different colors. The clusters comprise keywords, which are often mentioned together in the keyword lists of the articles in the literature sample and therefore have the tendency to form groups that represent common research themes. Of these clusters, 3 are relatively small, with only 2-3 keywords. Half of the clusters are made up of 10 or more keywords. Being presented as a cluster does not necessarily mean that publications deal with the same topic, albeit all qualifying publications within a respective cluster complement each other. Furthermore, 3 clusters have an everyday focus, 3 other ones address the specifics of VR training, 4 have diverse health care–related fields as their common topic, and one is centered around known issues in VR settings. The clusters are described in greater detail below.

Table 8. Most used keywords.
RankKeywordOccurrences (N=1168), n (%)Overall percentage of occurrences (n=356)
1Virtual322 (27.6)90.4
2Reality321 (27.5)90.2
3Training60 (5.1)16.9
4Based55 (4.7)15.4
5Using51 (4.4)14.3
6Trial36 (3.1)10.1
7Randomized32 (2.7)9.0
8Patients30 (2.6)8.4
9Therapy29 (2.5)8.1
10Simulation28 (2.4)7.9
11Controlled26 (2.2)7.3
12Health24 (2.0)6.7
13Children23 (2.0)6.5
14Pilot22 (1.9)6.2
15Rehabilitation20 (1.7)5.6
16Effects19 (1.6)5.3
16Immersive19 (1.6)5.3
17Care17 (1.5)4.8
17Effect17 (1.5)4.8
27Treatment17 (1.5)4.8
Figure 2. Keyword co-occurrence map.
View this figure


Cluster 1: Communication, Especially in Pediatrics

This large cluster covers 19 keywords revolving around promoting a more rounded caretaker/patient dialogue, with a focus on children. Some papers address issues regarding hindered communication with children and how VR can help with that [38,39], as well as the development of communication skills for patients [40,41] and medical staff [42,43].

Cluster 2: On-site or Telemedicine Health Care

This cluster containing 12 items highlights some positive aspects in caretaking via VR. A rather large focus lies with the enrichment and possibilities of interventions and care from a distance offering new and effective methods [21,44,45]. A smaller portion sees VR in use for on-site interventions [46].

Cluster 3: Physical Health Training

This cluster with 12 items specifies similarities and discrepancies between fitness training in real-life and VR settings. Findings of articles within this cluster are that VR-based training is effective but not more effective than real-life trainings [47,48]. VR-supported physical exercise can be applied to both private fitness endeavors and physical therapy, as the next cluster shows.

Cluster 4: Physical Rehabilitation

This group of keywords containing 11 items addresses the flexibility of VR in addition to conventional rehabilitation programs [49,50], and the possibility of expanding the reach of treatments beyond clinically controlled settings to achieve better results [22]. In addition, this cluster includes the adaption of VR games detached from any clinical setting and found the VR games had a positive effect on patient rehabilitation comparable to trainings conducted by medical professionals [51,52].

Cluster 5: Geriatric Care

This section containing 10 items centers around the care of older adults. VR was used to tackle dementia and memory loss [53-55]. Other application areas include VR interventions in life-threatening situations to improve patients’ moods [56], as well as patient education and training.

Cluster 6: Motivation, Health, and Adolescents

This cluster, also containing 10 items, addresses the need to motivate adolescents to partake in physical activities to tackle motivational and health issues. The focus is on cultivating fascination and enjoyment in young adults regarding the possibilities of VR and educating parents to promote the consideration of VR where antipathy might be prevalent [57-59]. This cluster underscores the need for awareness training.

Cluster 7: Psychological Treatments

This 7-item cluster focuses on new treatment possibilities, particularly for depression and stress disorders. Topics range from posttraumatic experience and chronic disorder treatments to preventive strategies [60-62], increasing the need for more training about the increased options for effective handling.

Cluster 8: Accident Prevention

This group of 7 keywords includes ophthalmology research and implements eye-tracking features to analyze behavior in dangerous situations. This is feasible because VR headsets are often very close to the eyes, and already analyze how and where the user moves in a predefined space [63-65], offering a safe environment for researchers to analyze test subjects in otherwise unworkable experimental situations.

Cluster 9: Palliative Care

This rather small cluster comprises only 3 keywords. The articles in this cluster focus on anxiety in people with terminal diseases and how to broaden the range of effective treatments [66]. It is closely related to cluster 7, with a focus on providing relief for the patient. For effective use, more training for caretakers needs to take place.

Cluster 10: Everyday Health Support

This small cluster with 2 keywords promotes interventions in relation to binge eating [67,68], but future fields of application include other interventions for working toward a healthier life every day via small reminders.

Cluster 11: Aftereffects of VR Environments

The last cluster also includes 2 keywords and addresses issues that may occur when people experience or cease using VR [69,70]. This is relevant for everyday life as well as trainings to increase awareness.

Figure 3 depicts the trend evolution of keywords. The map shows how the importance of keywords changed for VR in health care starting around 2013-2014 (blue) to the current date (yellow). Earlier focal points were about concerns with the new technology and possible fields of use. A selection of representative keywords is “concern,” “communication,” “anxiety disorders,” and “patient education.” A few years later, these application fields broadened and started to include medicine-related trends. This is seen in keywords such as “telemedicine,” “physical therapy,” “exposure therapy,” and “randomized controlled trial.” The latest trend sees VR in health care become centered around education and exergames, so-called exercise games for mental and physical health, as well as mobility for virtual realities. Representative keywords are “sport(s),” “video games,” “simulation training,” and “mobile phone.”

Figure 3. Keyword trend from 2013-2021.
View this figure


In this study, research focusing on VR in health care from 1994 to 2021 was analyzed by bibliometric measures. The focal points for this analysis were publication and author scores, as well as a trend analysis. Overall, research has been steadily increasing, with a recent spike in publications, underlining the relevance of research on VR applications in health care.

Growth Rate of Publications

Although VR emerged in the 20th century and has been a topic in health care–related research for over 25 years, it was initially a niche topic [2]. An increase in the number of VR publications can be seen between 2015 and 2017, with a notable spike in 2020. The growth rate nearly tripled to 60.05% when compared to the previous 5 years (20.54%). What may have been a decisive factor in this change was the sudden increase in investments and availability of high-quality technology, which increased scientific interest and use [8]. The gaming industry had a major impact, showcasing the manifold (though mostly unintentional) benefits and possibilities via development of new headsets and programs, which could be appropriated and modified for new applications [11,14,17]. Since then, an increasing number of medical fields saw the potential of VR for data collection, treatments, or trainings [10,41,65]. Following the past growth pattern of health care–related VR research, it can be expected that this field will continue to grow.

Publication Pattern

VR research is being conducted around the globe, with over one-fifth of all countries contributing to scientific progress in this field. The United States, as in many other fields, tends to lead research in this field. The top countries are consistently similar across different rankings, at most just swapping placements [71,72]. Germany, Spain, and the United Kingdom are also driving forces in the development of other digital health interventions such as telemedicine and artificial intelligence [72,73]. However, there is a notable absence of emerging countries, which could reap the benefits of the digitalization of their health sectors [74], especially as VR technology becomes more affordable [9]. The recent positive VR market development could help these countries to overcome obstacles including funding, distribution prioritization, and language support, promoting a future shift in research hotspots and more exponential growth in publications [75]. After all, research on VR and related topics of digitalization could have a large combined positive effect for developed and developing countries, which may result in cooperation and dialogue toward future progress.

The journals publishing VR-related health care content are mostly high-impact and well-known journals but lower-impact journals also add to the increasing reach and availability of research. With an average of 5 authors per publication (1698/256), VR in health care has seen growth in co-authorship over time. In terms of citations, the high-impact journals take the lead.

Scientists’ productivity and impact do not always go hand in hand. Due to the novelty and rapid development of the field, well-established scientists or articles do not exist yet. This could change over time, as rapid growth based on novelty is usually finite.

Trends and Research Themes

After clustering the author keywords, clear distinctions were apparent, with the currently highest trending area of research involving communication and the integration of VR for educational purposes. This topic spans over manifold instances like patient and caretaker interactions, communication training, and new forms of education [10,38,43]. The second most prominent field combines telemedicine and VR, with a foray into the development of VR-based “medical professionals.” The focus is on the implementation of a VR setting in which health care professionals do not necessarily need to be physically present, or even involved in the procedure at all [45,46]. This also includes the development of new treatments using VR, such as for phobias and mental disorders [21,61]. The third most important area is centered around physical activities for both younger and older people [47,59]. The findings here see great potential and marketing opportunities for a healthy lifestyle and better life expectancy by using VR.

When looking at the prominence of keywords from 2013 to 2021, the ranking is reversed. Modern research focuses on the fitness and health opportunities of VR and on (smaller) interventions to promote better health behavior, while the communication-related and educational aspects of VR in health care tend to be less researched. In particular, the surge of interest in this topic started at the end of 2019, which could be directly related to the COVID-19 outbreak, during which VR fitness may have been one of the few viable options for implementing physical activity into daily life. Another reason for the reversed relevance of keywords might be the latest developments in VR technology, such as omnidirectional treadmills, optimized gaming gear, and newly released games using new technologies that represent untapped research potential for fitness and entertainment [76,77].

Health care–related VR research has seen strong growth in the past decades. Current contexts and possibilities underline the potential of this field to gain more traction in the near future. The cross-sectional methods for implementation and simple ways of integrating VR into current systems are what makes the technology so interesting and worth researching. As a field, VR has passed the early first steps of development and is no longer under the radar. It can be expected that, with further technological progress, the availability of VR will increase, so that emerging countries can increasingly benefit from this technology.

However, VR in health care also has some obstacles, such as motion sickness, a lost sense of presence, eye strain, or inappropriate responses in the real world [78,79]. Future research can be expected to focus on how to tackle these challenges. In particular, holographic projections have the potential to alleviate many of the negative symptoms of VR [80]. Another issue is telemedicine, which is currently limited to algorithms or an AI responding to medical personnel or patients [42], rather than focusing on VR. Future integrations could see cybernetics become an essential part of VR to probe into autonomous health care with the help of robotics [81]. Even though this raises many questions and involves barriers [82], it could become a necessity to tackle the problem of a lack of health care professionals who can take care of the increasingly aging population [83]. Older adults’ acceptance of technology can also be challenging in this context. However, recent research seems to suggest these claims may be unfounded [83]. Future research could therefore provide guidelines to increase or secure older patients’ acceptance. Only a few standardized guidelines have been developed so far [84].


This bibliometric analysis has some limitations. First, our search was limited to the Web of Science, which is a widely used academic database. However, the use of other databases, such as Scopus or Google Scholar, may have provided slightly different results. Second, our analysis only included articles published in English, the lingua franca of science. The inclusion of other languages, grey literature, and books might also have led to different outcomes, especially as scholars from different cultures might have different perspectives on the use of VR in health care. Third, searching article titles alone and using only two search terms was very limiting. As our goal was to focus on literature that deals with VR as the main research theme, a title search was more appropriate than a topic search. However, articles dealing with VR as a side aspect might also enrich the body of knowledge in the field. Therefore, we encourage future research to also use topic searches including abstracts and keywords, and extend the range of search terms. Fourth, the inclusion of the specified disciplines alone might have excluded relevant articles that have been published in more technologically oriented journals rather than heath care–related ones. Future research might therefore use “health*” as an additional search term rather than using a filter based on disciplines. Fifth, whereas publication and citation numbers are objective, the interpretation of keyword clusters has a subjective character; other researchers may have drawn different conclusions.

An area which should also be pursued in future studies, which has not seen enough attention thus far, is the possible interconnection between AR and VR, which are closely related. However, mix-ups between these two occur, and AR might be as feasible for use in health care as VR. In addition, they might offer benefits upon their combined use, which should be analyzed further.


This bibliometric analysis aimed to give an overview of VR-related research in health care. It comprises 356 publications across about 27 years, from 1994 to 2021 (partial year). The main results are the following: (1) VR-related publications in health care have seen increased growth, (2) developed countries are the driving force in health care–related VR research but the topic has already been researched around the world, (3) the three predominant research themes center around communication, education, and novel treatments, and (4) the most recent research trends cover fitness and exergames for VR in health care. The analysis shows that the field has left its infant state and the research is becoming increasingly specialized, with a clear focus on patient usability. Future research should broaden the range of involved countries, industries, and companies.

Conflicts of Interest

None declared.

  1. Jones S, Dawkins S. The Sensorama revisited: evaluating the application of multi-sensory input on the sense of presence in 360-degree immersive film in virtual reality. In: Augmented reality and virtual reality. Cham: Springer; 2018:183-197.
  2. Morton Heilig: Inventor VR. USC School of Cinematic Arts.   URL: [accessed 2021-04-23]
  3. Yoh MS. The reality of virtual reality. 2001 Presented at: Seventh International Conference on Virtual Systems and Multimedia; 2001; Berkeley p. 666-674. [CrossRef]
  4. Heim M. Virtual Realism. Oxford: Oxford University Press; 1998.
  5. Zheng JM, Chan KW, Gibson I. Virtual reality. IEEE Potentials 1998;17(2):20-23. [CrossRef]
  6. Pedroli E, Serino S, Pallavicini F, Cipresso P, Riva G. Exploring virtual reality for the assessment and rehabilitation of executive functions. International Journal of Virtual and Augmented Reality 2018;2(1):32-47. [CrossRef]
  7. Liou HH, Yang SJH, Chen SY, Tarng W. The influences of the 2D image-based augmented reality and virtual reality on student learning. Educational Technology & Society 2017;20(3):110-121.
  8. Castelvecchi D. Low-cost headsets boost virtual reality's lab appeal. Nature 2016;533(7602):153-154. [CrossRef] [Medline]
  9. Ebert C. Looking into the Future. IEEE Software 2015;32(6):92-97. [CrossRef]
  10. Rubino F, Soler L, Marescaux J, Maisonneuve H. Advances in virtual reality are wide ranging. BMJ 2002;324(7337):612 [FREE Full text] [CrossRef] [Medline]
  11. McCloy R, Stone R. Science, medicine, and the future. Virtual reality in surgery. BMJ 2001;323(7318):912-915 [FREE Full text] [CrossRef] [Medline]
  12. Checa D, Bustillo A. A review of immersive virtual reality serious games to enhance learning and training. Multimed Tools Appl 2019 Dec 05;79(9-10):5501-5527. [CrossRef]
  13. Burgess N. The 2014 Nobel Prize in Physiology or Medicine: a spatial model for cognitive neuroscience. Neuron 2014;84(6):1120-1125 [FREE Full text] [CrossRef] [Medline]
  14. Minderer M, Harvey CD, Donato F, Moser EI. Neuroscience: Virtual reality explored. Nature 2016 May 19;533(7603):324-325. [CrossRef] [Medline]
  15. The 2014 Nobel Prize in Physiology or Medicine. Nobel Prize. 2014.   URL: [accessed 2021-05-07]
  16. Riva G, Gaggioli A, Grassi A, Raspelli P, Cipresso P, Pallavicini F, et al. NeuroVR 2 – A free virtual reality platform for the assessment and treatment in behavioral health care. Medicine Meets Virtual Reality 2011;18(1):493-495. [CrossRef]
  17. Brown A, Green T. Virtual Reality: Low-Cost Tools and Resources for the Classroom. TechTrends 2016 Jun 30;60(5):517-519. [CrossRef]
  18. Cipresso P, Serino S, Riva G. Psychometric assessment and behavioral experiments using a free virtual reality platform and computational science. BMC Med Inform Decis Mak 2016;16(1):37 [FREE Full text] [CrossRef] [Medline]
  19. Botella C, Fernández-Álvarez J, Guillén V, García-Palacios A, Baños R. Recent progress in virtual reality exposure therapy for phobias: A systematic review. Curr Psychiatry Rep 2017;19(7):42. [CrossRef] [Medline]
  20. Alahmari KA, Sparto PJ, Marchetti GF, Redfern MS, Furman JM, Whitney SL. Comparison of Virtual Reality Based Therapy With Customized Vestibular Physical Therapy for the Treatment of Vestibular Disorders. IEEE Trans Neural Syst Rehabil Eng 2014 Mar;22(2):389-399. [CrossRef]
  21. Levy F, Leboucher P, Rautureau G, Jouvent R. E-virtual reality exposure therapy in acrophobia: A pilot study. J Telemed Telecare 2015 Aug 06;22(4):215-220. [CrossRef]
  22. Tunney N, Perlow E. Expanding Rehabilitation Beyond the Clinic—Strategies to Increase Total Restorative Therapy Time for Adults with Hemiplegia. IJAHSP 2021;19(1):9. [CrossRef]
  23. Carl E, Stein AT, Levihn-Coon A, Pogue JR, Rothbaum B, Emmelkamp P, et al. Virtual reality exposure therapy for anxiety and related disorders: a meta-analysis of randomized controlled trials. J Anxiety Disord 2019;61:27-36. [CrossRef] [Medline]
  24. Hoffman HG, Patterson DR, Carrougher GJ. Use of virtual reality for adjunctive treatment of adult burn pain during physical therapy: a controlled study. Clin J Pain 2000 Sep;16(3):244-250. [CrossRef] [Medline]
  25. Cipresso P, Giglioli IAC, Raya MA, Riva G. The Past, Present, and Future of Virtual and Augmented Reality Research: A Network and Cluster Analysis of the Literature. Front Psychol 2018;9:2086 [FREE Full text] [CrossRef] [Medline]
  26. Sobral M, Pestana M. Virtual reality and dementia: A bibliometric analysis. The European Journal of Psychiatry 2020 Jul;34(3):120-131. [CrossRef]
  27. Fernández-Herrero J, Lorenzo-Lledó G, Carreres AL. A bibliometric study on the use of virtual reality (VR) as an educational tool for high-functioning autism spectrum disorder (ASD) children. In: Contemporary Perspective on Child Psychology and Education. London: IntechOpen; 2017.
  28. Huang Y, Huang Q, Ali S, Zhai X, Bi X, Liu R. Rehabilitation using virtual reality technology: a bibliometric analysis, 1996–2015. Scientometrics 2016 Oct 05;109(3):1547-1559. [CrossRef]
  29. Zhang T, Liu A. The research status on virtual reality by using of bibliometric analysis. 2010 Presented at: 2010 2nd International Conference on Computer Engineering and Technology; 2010; Chengdu p. 289-292. [CrossRef]
  30. Calabuig-Moreno F, González-Serrano MH, Fombona J, García-Tascón M. The Emergence of Technology in Physical Education: A General Bibliometric Analysis with a Focus on Virtual and Augmented Reality. Sustainability 2020 Mar 30;12(7):2728. [CrossRef]
  31. Cipresso P, Giglioli IAC, Raya MA, Riva G. The Past, Present, and Future of Virtual and Augmented Reality Research: A Network and Cluster Analysis of the Literature. Front Psychol 2018;9:2086 [FREE Full text] [CrossRef] [Medline]
  32. Schaer P. Applied informetrics for digital libraries: an overview of foundations, problems and current approaches. Historical Social Research 2013;38(3):267-281.
  33. Glänzel W. The need for standards in bibliometric research and technology. Scientometrics 1996 Feb;35(2):167-176. [CrossRef]
  34. Bibliometrics and citation analysis. University of Wisconsin-Madison Libraries.   URL: [accessed 2021-04-25]
  35. Gutiérrez-Salcedo M, Martínez MÁ, Moral-Munoz JA, Herrera-Viedma E, Cobo MJ. Some bibliometric procedures for analyzing and evaluating research fields. Appl Intell 2018;48:1275-1287. [CrossRef]
  36. Narin F, Hamilton KS. Bibliometric performance measures. Scientometrics 1996 Jul;36(3):293-310. [CrossRef]
  37. Marczewska M, Kostrzewski M. Sustainable Business Models: A Bibliometric Performance Analysis. Energies 2020 Nov 19;13(22):6062. [CrossRef]
  38. Gilardi F, De Falco F, Casasanta D, Andellini M, Gazzellini S, Petrarca M, et al. Robotic Technology in Pediatric Neurorehabilitation. A Pilot Study of Human Factors in an Italian Pediatric Hospital. Int J Environ Res Public Health 2020 May 17;17(10):3503 [FREE Full text] [CrossRef] [Medline]
  39. Ahmadpour N, Weatherall AD, Menezes M, Yoo S, Hong H, Wong G. Synthesizing Multiple Stakeholder Perspectives on Using Virtual Reality to Improve the Periprocedural Experience in Children and Adolescents: Survey Study. J Med Internet Res 2020 Jul 17;22(7):e19752 [FREE Full text] [CrossRef] [Medline]
  40. Romero-Ayuso D, Alcántara-Vázquez P, Almenara-García A, Nuñez-Camarero I, Triviño-Juárez JM, Ariza-Vega P, et al. Self-Regulation in Children with Neurodevelopmental Disorders "SR-MRehab: Un Colegio Emocionante": A Protocol Study. Int J Environ Res Public Health 2020 Jun 12;17(12):4198 [FREE Full text] [CrossRef] [Medline]
  41. Kron FW, Fetters MD, Scerbo MW, White CB, Lypson ML, Padilla MA, et al. Using a computer simulation for teaching communication skills: A blinded multisite mixed methods randomized controlled trial. Patient Educ Couns 2017;100(4):748-759. [CrossRef] [Medline]
  42. Daher S, Hochreiter J, Schubert R, Gonzalez L, Cendan J, Anderson M, et al. The Physical-Virtual Patient Simulator. Sim Healthcare 2020;15(2):115-121. [CrossRef]
  43. Frost J, Delaney L, Fitzgerald R. Exploring the application of mixed reality in Nurse education. BMJ STEL 2019 Aug 21;6(4):214-219. [CrossRef]
  44. Wiederhold BK, Riva G, Wiederhold MD. Annual Review of Cybertherapy and Telemedicine 2015: Virtual Reality in Healthcare: Medical Simulation and Experiential Interface. Amsterdam, Berlin, Washington DC: IOS Press; 2016.
  45. Knepley KD, Mao JZ, Wieczorek P, Okoye FO, Jain AP, Harel NY. Impact of Telerehabilitation for Stroke-Related Deficits. Telemed J E Health 2021 Mar;27(3):239-246. [CrossRef] [Medline]
  46. Tielman ML, Neerincx MA, Bidarra R, Kybartas B, Brinkman W. A Therapy System for Post-Traumatic Stress Disorder Using a Virtual Agent and Virtual Storytelling to Reconstruct Traumatic Memories. J Med Syst 2017 Aug;41(8):125 [FREE Full text] [CrossRef] [Medline]
  47. Sarig Bahat H, Hadar D, Treleaven J. Predictors for Positive Response to Home Kinematic Training in Chronic Neck Pain. J Manipulative Physiol Ther 2020 Oct;43(8):779-790. [CrossRef] [Medline]
  48. Gouveia E Silva EC, Lange B, Bacha JMR, Pompeu JE. Effects of the Interactive Videogame Nintendo Wii Sports on Upper Limb Motor Function of Individuals with Post-Polio Syndrome: A Randomized Clinical Trial. Games Health J 2020 Dec;9(6):461-471. [CrossRef] [Medline]
  49. Abbas RL, Cooreman D, Al Sultan H, El Nayal M, Saab IM, El Khatib A. The Effect of Adding Virtual Reality Training on Traditional Exercise Program on Balance and Gait in Unilateral, Traumatic Lower Limb Amputee. Games Health J 2021 Feb;10(1):50-56. [CrossRef] [Medline]
  50. García-Bravo S, Cano-de-la-Cuerda R, Domínguez-Paniagua J, Campuzano-Ruiz R, Barreñada-Copete E, López-Navas MJ, et al. Effects of Virtual Reality on Cardiac Rehabilitation Programs for Ischemic Heart Disease: A Randomized Pilot Clinical Trial. Int J Environ Res Public Health 2020 Nov 16;17(22):8472 [FREE Full text] [CrossRef] [Medline]
  51. Feyzioğlu Ö, Dinçer S, Akan A, Algun ZC. Is Xbox 360 Kinect-based virtual reality training as effective as standard physiotherapy in patients undergoing breast cancer surgery? Support Care Cancer 2020 Sep;28(9):4295-4303. [CrossRef] [Medline]
  52. Shahmoradi L, Almasi S, Ghotbi N, Gholamzadeh M. Learning promotion of physiotherapy in neurological diseases: Design and application of a virtual reality-based game. J Educ Health Promot 2020;9(1):234 [FREE Full text] [CrossRef] [Medline]
  53. Torpil B, Şahin S, Pekçetin S, Uyanık M. The Effectiveness of a Virtual Reality-Based Intervention on Cognitive Functions in Older Adults with Mild Cognitive Impairment: A Single-Blind, Randomized Controlled Trial. Games Health J 2021 Apr;10(2):109-114. [CrossRef] [Medline]
  54. Saredakis D, Keage HA, Corlis M, Loetscher T. Using Virtual Reality to Improve Apathy in Residential Aged Care: Mixed Methods Study. J Med Internet Res 2020 Jun 26;22(6):e17632 [FREE Full text] [CrossRef] [Medline]
  55. Coelho T, Marques C, Moreira D, Soares M, Portugal P, Marques A, et al. Promoting Reminiscences with Virtual Reality Headsets: A Pilot Study with People with Dementia. Int J Environ Res Public Health 2020 Dec 12;17(24):9301 [FREE Full text] [CrossRef] [Medline]
  56. Baños RM, Espinoza M, García-Palacios A, Cervera JM, Esquerdo G, Barrajón E, et al. A positive psychological intervention using virtual reality for patients with advanced cancer in a hospital setting: a pilot study to assess feasibility. Support Care Cancer 2013;21(1):263-270. [CrossRef] [Medline]
  57. Farič N, Smith L, Hon A, Potts HWW, Newby K, Steptoe A, et al. A Virtual Reality Exergame to Engage Adolescents in Physical Activity: Mixed Methods Study Describing the Formative Intervention Development Process. J Med Internet Res 2021 Feb 04;23(2):e18161 [FREE Full text] [CrossRef] [Medline]
  58. McMichael L, Farič N, Newby K, Potts HWW, Hon A, Smith L, et al. Parents of Adolescents Perspectives of Physical Activity, Gaming and Virtual Reality: Qualitative Study. JMIR Serious Games 2020 Aug 25;8(3):e14920 [FREE Full text] [CrossRef] [Medline]
  59. Farič N, Yorke E, Varnes L, Newby K, Potts HW, Smith L, et al. Younger Adolescents' Perceptions of Physical Activity, Exergaming, and Virtual Reality: Qualitative Intervention Development Study. JMIR Serious Games 2019 Jun 17;7(2):e11960 [FREE Full text] [CrossRef] [Medline]
  60. Lyons KD, Slaughenhaupt RM, Mupparaju SH, Lim JS, Anderson AA, Stankovic AS, et al. Autonomous Psychological Support for Isolation and Confinement. Aerosp Med Hum Perform 2020 Nov 01;91(11):876-885. [CrossRef]
  61. Veling W, Lestestuiver B, Jongma M, Hoenders HJR, van Driel C. Virtual Reality Relaxation for Patients With a Psychiatric Disorder: Crossover Randomized Controlled Trial. J Med Internet Res 2021 Jan 15;23(1):e17233 [FREE Full text] [CrossRef] [Medline]
  62. Zhang Z, Qi B, Xu Y, Jin Y, Gao B. The Effect of Hyperbaric Oxygen Combined with Virtual Reality Training on Oxidative Stress Indicators and Inflammatory Factors of Swimming Athletes Suffering from Depression. Journal of Healthcare Engineering 2021 Mar 11;2021:1-8. [CrossRef]
  63. Zeuwts LH, Vansteenkiste P, Deconinck FJ, Cardon G, Lenoir M. Hazard perception training in young bicyclists improves early detection of risk: A cluster-randomized controlled trial. Accid Anal Prev 2017 Nov;108:112-121. [CrossRef] [Medline]
  64. Tobler-Ammann BC, Surer E, de Bruin ED, Rabuffetti M, Borghese NA, Mainetti R, et al. Exergames encouraging exploration of hemineglected space in stroke patients with visuospatial neglect: a feasibility study. JMIR Serious Games 2017;5(3):e17 [FREE Full text] [CrossRef] [Medline]
  65. Sipatchin A, Wahl S, Rifai K. Eye-Tracking for Clinical Ophthalmology with Virtual Reality (VR): A Case Study of the HTC Vive Pro Eye's Usability. Healthcare (Basel) 2021 Feb 09;9(2):180 [FREE Full text] [CrossRef] [Medline]
  66. Niki K, Okamoto Y, Maeda I, Ueda M. Responses to Kako et al. (DOI: 10.1089/jpm.2019.0072) and Niki et al. (DOI: 10.1089/jpm.2018.0233): A Novel Palliative Care Approach Using Virtual Reality for Improving Various Symptoms of Terminal Cancer Patients: A Preliminary Prospective, Multicenter Study. J Palliat Med 2019 Dec;22(12):1490. [CrossRef] [Medline]
  67. Pla-Sanjuanelo J, Ferrer-Garcia M, Gutiérrez-Maldonado J, Vilalta-Abella F, Andreu-Gracia A, Dakanalis A, et al. Trait and state craving as indicators of validity of VR-based software for binge eating treatment. In: Volume 219: Annual Review of Cybertherapy and Telemedicine 2015. Amsterdam: IOS Press Ebooks; 2015:141-146.
  68. Ferrer-Garcia M, Gutiérrez-Maldonado J, Agliaro-López M, Lobera-Espi X, Pla J, Vilalta-Abella F. Validation of VR-based Software for Binge Eating Treatment: Preliminary Data. In: Volume 199: Annual Review of Cybertherapy and Telemedicine 2014. Amsterdam: IOS Press Ebooks; 2014:146-150.
  69. Szpak A, Michalski SC, Loetscher T. Exergaming With Beat Saber: An Investigation of Virtual Reality Aftereffects. J Med Internet Res 2020 Oct 23;22(10):e19840 [FREE Full text] [CrossRef] [Medline]
  70. Pettijohn KA, Pistone DV, Warner AL, Roush GJ, Biggs AT. Postural Instability and Seasickness in a Motion-Based Shooting Simulation. Aerosp Med Hum Perform 2020 Sep 01;91(9):703-709. [CrossRef]
  71. Guo Y, Hao Z, Zhao S, Gong J, Yang F. Artificial Intelligence in Health Care: Bibliometric Analysis. J Med Internet Res 2020 Jul 29;22(7):e18228 [FREE Full text] [CrossRef] [Medline]
  72. Şenel E, Demir E. A global productivity and bibliometric analysis of telemedicine and teledermatology publication trends during 1980–2013. Dermatologica Sinica 2015 Mar;33(1):16-20. [CrossRef]
  73. Savage N. The race to the top among the world’s leaders in artificial intelligence. Nature 2020 Dec 09;588(7837):S102-S104. [CrossRef]
  74. Martinerie L, Rasoaherinomenjanahary F, Ronot M, Fournier P, Dousset B, Tesnière A, et al. Health Care Simulation in Developing Countries and Low-Resource Situations. J Contin Educ Health Prof 2018;38(3):205-212. [CrossRef]
  75. Reis RS, Salvo D, Ogilvie D, Lambert EV, Goenka S, Brownson RC, Lancet Physical Activity Series 2 Executive Committee. Scaling up physical activity interventions worldwide: stepping up to larger and smarter approaches to get people moving. Lancet 2016 Sep 24;388(10051):1337-1348 [FREE Full text] [CrossRef] [Medline]
  76. Wehden L, Reer F, Janzik R, Tang WY, Quandt T. The Slippery Path to Total Presence: How Omnidirectional Virtual Reality Treadmills Influence the Gaming Experience. MaC 2021 Jan 06;9(1):5-16. [CrossRef]
  77. Breitkreuz KR, Kardong-Edgren S, Gilbert GE, DeBlieck C, Maske M, Hallock C, et al. A multi-site study examining the usability of a virtual reality game designed to improve retention of sterile catheterization skills in nursing students. Simulation & Gaming 2020 Sep 25;52(2):169-184. [CrossRef]
  78. Riva G. Virtual reality for health care: the status of research. Cyberpsychol Behav 2002 Jun;5(3):219-225. [CrossRef] [Medline]
  79. Lewis CH, Griffin MJ. Human factors consideration in clinical applications of virtual reality. In: Volume 44: Virtual Reality in Neuro-Psycho-Physiology. Amsterdam: IOS Press Ebooks; 1997:35-56.
  80. Custură-Crăciun D, Cochior D, Constantinoiu S, Neagu C. Surgical virtual reality - highlights in developing a high performance surgical haptic device. Chirurgia (Bucur) 2013;108(6):757-763 [FREE Full text] [Medline]
  81. Graur F. Virtual Reality in Medicine - Going Beyond the Limits. In: Lányi CS, editor. The Thousand Faces of Virtual Reality. London: IntechOpen; 2014.
  82. Turolla A, Dam M, Ventura L, Tonin P, Agostini M, Zucconi C, et al. Virtual reality for the rehabilitation of the upper limb motor function after stroke: a prospective controlled trial. J Neuroeng Rehabil 2013 Aug 01;10:85 [FREE Full text] [CrossRef] [Medline]
  83. Mazurek J, Kiper P, Cieślik B, Rutkowski S, Mehlich K, Turolla A, et al. Virtual reality in medicine: a brief overview and future research directions. hm 2019;20(3):16-22. [CrossRef]
  84. Moher D, Schulz KF, Altman D, CONSORT Group (Consolidated Standards of Reporting Trials). The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomized trials. JAMA 2001 Apr 18;285(15):1987-1991. [CrossRef] [Medline]

AR: augmented reality
VR: virtual reality

Edited by N Zary; submitted 07.08.21; peer-reviewed by B Chaudhry, J Gutiérrez-Maldonado; comments to author 26.08.21; revised version received 20.09.21; accepted 24.09.21; published 01.12.21


©Christian Matthias Pawassar, Victor Tiberius. Originally published in JMIR Serious Games (, 01.12.2021.

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