# Virtual & mixed reality fatigue questionnaire

## TL;DR

This paper introduces a questionnaire to measure fatigue in users of virtual and mixed reality training, finding that sessions should last around 20 minutes for best results.

## Contribution

A novel questionnaire to assess fatigue in VR and MR training, validated with emergency professionals.

## Key findings

- VR and MR training can cause visual fatigue, general fatigue, and reduced concentration.
- Optimal training time is about 20 minutes, especially for inexperienced users.
- The questionnaire effectively measures different fatigue profiles in mixed reality settings.

## Abstract

Virtual Reality (VR) generates an artificial environment in which users interact with computer-generated scenarios and sounds. Using devices such as headsets and motion sensors, users are immersed in a simulated world. Augmented reality (AR) is an interactive overlay of the real environment that provides an additional wrapper over the environment, and the user experiences an immersive and interactive environment. In Mixed reality (MR), VR and AR elements are combined; computer graphics interplay with real objects, allowing users to interact with virtual and physical objects at the same time.

VR and MR are effective training tools in different healthcare settings. These tools are useful for preparing emergency health personnel to respond to disasters by providing them with an immersive reality since real practices are very difficult to implement in mass casualty incidents.

Given the usefulness of this approach, assessing the optimal training times associated with this method and the side effects that may influence learning is helpful. One of the most common side effects is fatigue. We developed a questionnaire to assess fatigue in terms of various dimensions, that can affect a person while training in the context of VR and MR.

We designed a questionnaire to assess the fatigue levels perceived by professionals and validated this measure after VR training experience. We analyzed ratings of visual, mental, physical, and general fatigue. This questionnaire was applied to emergency professionals (Sample size = 101).

The reliability and validity of the questionnaire were assessed in terms of the following factors: general, social, emotional, visual, and motivational fatigue.

The results of this research suggest that fatigue is an element of VR and MR training. Educators should take these effects into account to optimize learning in the context of VR and MR. According to user feedback, the optimal length of time for mixed reality training is around 20 min, especially when the user has little or no experience.

The online version contains supplementary material available at 10.1186/s12909-026-08641-w.

Headset-based virtual training simulation modalities yield fatigue symptoms.The Virtual and mixed reality fatigue questionnaire can value the different fatigue profiles.Virtual reality training can cause visual fatigue, general fatigue, and decreased concentration afterwards.The optimal time for mixed reality training is about 20 minutes, especially when the user has little prior experience.

Headset-based virtual training simulation modalities yield fatigue symptoms.

The Virtual and mixed reality fatigue questionnaire can value the different fatigue profiles.

Virtual reality training can cause visual fatigue, general fatigue, and decreased concentration afterwards.

The optimal time for mixed reality training is about 20 minutes, especially when the user has little prior experience.

The online version contains supplementary material available at 10.1186/s12909-026-08641-w.