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Immersive reality, the set of augmented reality, extended reality was born as a first experience in the world of games and entertainment but is taking its first steps generating profound transformations also in the health care sector, in the fields of medical and surgical imaging, mental health and medical education.

From the BCG study "The Health Care Metaverse Is More Than a Virtual Reality", based on a survey conducted globally among suppliers, customers and biopharma and medtech companies, it emerged that most companies are already conducting trials with these technologies and the expectation of 77% of suppliers and 94% of global customers in the sector, is that of a growing involvement already in the coming years of this new technology.

The Metaverse is a virtual environment accessed by virtual reality (VR), augmented reality (AR), or mixed reality technology. What started as a gaming platform has now opened doors for funfilled exercises that take the best tools from physical therapy, cognitive-behavioral psychology, and computer games to deliver immersive, playful exercises directly to you at home.

Current applications in the field of digital healthcare mainly concern the so-called "extended realities" (XR), i.e. the combination of visual and immersive experiences offered by augmented reality (AR), virtual reality (VR) and mixed reality (MR), but they can also make use of Web3 technologies and applications, such as blockchains and virtual resources, and M-worlds, i.e. virtual "places" in which to meet and create content. Technologies that can produce value for companies in various ways such as, for example, improving access to care by putting patients and suppliers in contact without the constraint of geographical positioning, improving the accuracy of diagnoses and the quality of surgery, reducing costs for supplies, medical training and data management, and much more.

"Thanks to 3D mixed reality, university students can move freely inside and outside the holograms and interact with the anatomy of the human body in a natural and fascinating way, improving the effectiveness of anatomy learning"

Some examples of products already available on the market are those made by companies that work with AR to assist with medical procedures, including surgical preparation and performing operations using a "digital twin" a digital twin that can simulate the virtual patient experience. Then there are the technologies that allow a complete visualization of the patient's anatomy, which leads to improved error rates, speed and results. Other applications may instead concern rehabilitation and physical therapies, as well as the treatment of anxieties, phobias and posttraumatic stress, but also in the cardiovascular field, while more and more new opportunities are being tested.

Of the practical experiences that personalized therapies are being created in order to support adherence through a fun activity (gamification) that through VR the patient is transported to an environment where they can see and experience the treatment. Equipped with a VR viewer, it receives assistance and continuous remote monitoring, using video calling and VR technology

Instead, thanks to 3D mixed reality, university students can move freely inside and outside the holograms and interact with the anatomy of the human body in a natural and fascinating way, improving the effectiveness of anatomy learning Immersive virtual reality based on cognitive-behavioral therapy and other behavioral methods helps patients diagnosed with chronic diseases for which pain is particularly traumatic to better manage it thanks to immersive educational content with guided mindfulness and relaxation exercises

Particularly effective are the rehabilitation therapies supported by virtual reality which provide a series of rehabilitation exercises aimed at promoting the improvement of manual skills and balance.

These are just a few examples that are being tested, the correct word is, in fact, experimentation because we are in a phase where technology runs fast, but the mentality is not yet ready to take a further step

Studying the surrounding world and keeping an eye on what the evolutions have been today, I believe that the development of the metaverse in the medical area can take place in three different moments: the initial experimentation period, in which we find ourselves; where they try to find useful solutions, opportunities, experiences that can make culture and study at the same time. The progressive adoption of existing use cases and the emergence of new cases fueled by the ongoing technological progress, which will see a progressive commitment over the next five years and the third phase, which will see the application in everyday life to arrive at the realization of a medicine of proximity ever closer to the patient's home, or even totally integrated with the "SMART HOUSE" where new technologies and digital will assume a fundamental importance.

Physical hospitals will obviously never disappear, but there are already those who are aiming to recreate an entire hospital environment in virtual reality accessible via a viewer. UAE chain Aster DM Healthcare has created the first virtual medical facility with the ambitious goal of becoming the hub of the global metaverse.

Through the large-scale implementation of its hospitals on Web 3.0, the new virtual hospital facility Medcare Women & Children Hospital aims to enable an engaging remote doctorpatient experience that is equal to (if not even better) than the physical one.

Keeping this temporal space in mind as a window onto the world, we can see how the metaverse allows us to significantly expand the methods of diagnosis, delivery and management of therapies, allowing for more equitable access to treatment.

Technologies that until a few years ago were inaccessible and underperforming are now available at significantly lower costs, while the resolution quality is constantly improving under the pressure of innovations made in the gaming sector.

We don't know how long it will take for the complete advent of the Metaverse, some observers speak of 10 years, others even 15. In any case, it promises to have revolutionary implications also in the field of health. Who, already today, accepted the challenge.

Certainly, the opportunity of digital therapy is more immediate and a lot of work is being done on government tables. Digital therapies are a sub-category of digital health tools (which include software or hardware components) which offer real therapeutic interventions capable of managing, treating, and preventing certain pathologies and which are based on changing lifestyles and coding of cognitive behavioral therapies. Unlike more general digital health tools, they are therapies based on scientific evidence obtained through confirmatory controlled and randomized clinical trials, just as happens to measure the effectiveness of traditional drug therapies. These are therapies, identified as such from the government’s point of view that use technology as a tool to manage the pathology, although we are not talking about very high technological competence, there are also more trivial channels that we are used to using in everyday life. The digital therapy intervention is represented by Apps (41.9%), web-based interventions (25.7%), video games (8.8%), and virtual reality systems (4.4%). There is no shortage of less advanced technological tools such as text messages (SMS and email, 3.7%), social media platforms (2.9%), and computer-based software (2.2%)*.

What is important behind digital therapy are the clinical studies that allow its validation. As far as the pathologies under study are concerned, the most present are those relating to mental health (34.6%), followed by chronic pathologies or those that produce chronic pain (19.1%), addictions to smoking, alcohol consumption, abuse addictive substances ( 12.5%), sleep-related problems (8.8%), obesity, diet and exercise problems (8.1%), and cardiovascular disease (7.4%) (ClinicalTrials.gov data)

Certainly what can be foreseen shortly is an evolution of video-conferencing visits, already widely used in some clinical contexts, through the implementation of virtual reality technologies and artificial intelligence algorithms. Doctor and patient, equipped with portable devices and/or an ad hoc viewer, could therefore interact in a three-dimensional digital space relying on a series of clinical data collected and processed in real time. At least ideally, such an approach could lead to a further evolution of telemedicine for the benefit of patients living in rural areas or people with motor disabilities.

On the other hand, on October 8, 2021, astronaut Thomas Pesquet underwent a check-up in space with NASA flight surgeon Josef Schmid. Or rather with its hologram of him teleported into space from the United States, so one cannot but say that it is not already reality.

* The Impact of a Novel Immersive Virtual Reality Technology Associated with Serious Games in Parkinson’s Disease Patients on Upper Limb Rehabilitation: A Mixed Methods Intervention Study.