Preliminary User Research Articles

Unlocking Potential: The Development and User-Friendly Evaluation of a Virtual Reality Intervention for Attention-Deficit/Hyperactivity Disorder

(1) Background: Attention-Deficit/Hyperactivity Disorder (ADHD) is typically first diagnosed in early childhood. Medication and cognitive behavioural therapy are considered effective in treating children with ADHD, whereas these treatments appear to have some side effects and restrictions. Virtual reality (VR), therefore, has been applied to exposure therapy for mental disorders. Previous studies have adopted VR in the cognitive behavioural treatment for children with ADHD; however, no research has used VR to develop social skills training for children with ADHD. This study aimed to develop a VR-based intervention (Social VR) to improve social skills in children with symptoms of ADHD. Prior to conducting the pilot trial to assess the effectiveness of Social VR, valuable user feedback was gathered regarding the mechanics of Social VR, satisfaction and motion sickness. This study presented the development and preliminary usability of Social VR to enhance social interaction skills among children with ADHD. (2) Methods: The development process of the Social VR intervention was demonstrated. The Social VR intervention consisted of three scenarios, namely MTR, Campus and Market and Restaurant. In the usability study, 25 children with ADHD were recruited to test the Social VR during the preliminary usability stage of a clinical trial at preinclusion. The participants completed a survey about their experience of playing Social VR, satisfaction, and motion sickness. (3) Results: The participants indicated the three conditions had easy-to-follow instructions, were easy to pick up, and that they understood when the situations changed. The control and beauty of the graphics of Market and Restaurant were relatively lower compared with those of MTR and Campus. The three scenarios are applicable to children diagnosed with any subtype of ADHD. (4) Conclusion: The participants were satisfied with Social VR. Social VR was generally considered realistic and immersive. Further trials to assess the feasibility and efficacy were discussed. If proven effective, VR-based intervention can be an adjunctive approach to current multimodal training for children with ADHD.

'Touching' Stories: Towards the Development of Tangible User Interfaces Story-Building Authoring Tool for Inclusive Education.

Tangible User Interfaces (hereafter, TUIs) are novel forms of human-computer interactions based on the physical manipulation of any kind of object/artifact. A great potential of TUIs technologies is the possibility to personalize objects and interaction between the user and the system. The high level of platform flexibility allows, for example, a multisensory approach, that is crucial for children that have sensory limitations and disabilities. This contribution aims at presenting and discussing the development of an authoring tool for creating TUI-supported activities for inclusive digital storytelling. The authoring tool is a product of collaboration and consultation with researchers and teachers involved in the ERASMUS+ project I'M IN TALES. A preliminary usability validation study using a mixed-method approach has been conducted involving 50 educators and assistive technology professionals. The results indicate an overall acceptance of the system. The feedback provided by the participants involved will be used for the future refinement of the tool.

A Preliminary Usability Study of Integrated Electronic Tattoo Surface Electromyography (sEMG) Sensors.

Surface electromyography (sEMG) sensor measures the user's muscle activities by noninvasively placing electrodes on the surface of the user's skin. It has been widely used in monitoring various human movements. Recently a wearable and flexible epidermal sensor system called Electronic Tattoo (E-Tattoo) has been developed to enable intimate attachment of electrodes on the skin, improving long-term comfort. In order to make the E-Tattoo usable in monitoring muscle activities, it is always connected with a connector and signal processing blocks to collect and process the measured sEMG signals. We call it an integrated system. This paper investigates the usability of a prototype of the integrated system developed in the laboratory for monitoring muscle activities by testing its comfort with user experience surveys and comparing the quality of the sEMG signals by widely used performance metrics. Two typical movements, maximum voluntary isometric and non-isometric contractions, are considered for the experiments. Our preliminary results on five subjects demonstrate the effectiveness of the proposed integrated system. This system showed a comparable signal quality for these two movements as the commercial product with a much better comfort feeling from the user. It is also interesting to note that this prototype shows a much better signal-to-motion artifact ratio (SMR), which reflects the ability to measure muscle activities during active movements, compared with the commercial product, showing the potential of using this integrated system in monitoring sEMGs during active and dynamic movements.

Development and preliminary usability testing of an electronic conversation guide incorporating patient values and prognostic information in preparation for older people's decision-making near the end of life

Initiating end-of-life conversations can be daunting for clinicians and overwhelming for patients and families. This leads to delays in communicating prognosis and preparing for the inevitable in old age, often generating potentially harmful overtreatment and poor-quality deaths. We aimed to develop an electronic resource, called Communicating Health Alternatives Tool (CHAT) that was compatible with hospital medical records software to facilitate preparation for shared decision-making across health settings with older adults deemed to be in the last year of life.The project used mixed methods including: literature review, user-directed specifications, web-based interface development with authentication and authorization; clinician and consumer co-design, iterative consultation for user testing; and ongoing developer integration of user feedback. An internet-based conversation guide to facilitate clinician-led advance care planning was co-developed covering screening for short-term risk of death, patient values and preferences, and treatment choices for chronic kidney disease and dementia. Printed summary of such discussion could be used to begin the process in hospital or community health services. Clinicians, patients, and caregivers agreed with its ease of use and were generally accepting of its contents and format. CHAT is available to health services for implementation in effectiveness trials to determine whether the interaction and documentation leads to formal decision-making, goal-concordant care, and subsequent reduction of unwanted treatments at the end of life.

Preliminary Usability Evaluation of Personal Medical Devices towards Better Home Healthcare

Portable medical devices have been playing an important role in improving health outcomes across the socio-economic spectrum. In the recent decades, substantial population have started using such devices to monitor important vital signs. Significant proportion of these users are older patients with chronic diseases, declined physical and/or cognitive capabilities. Furthermore, these portable devices are often used in unguided environments, that can present unpredictable use contexts. In this preliminary study, we conducted usability inspection on five portable medical devices. Cognitive walkthrough followed by Nielson’s ten Usability Heuristic evaluation method were utilized for the purpose of usability inspection. Sixteen usability concerns were uncovered in such evaluation study. We also recorded the elapsed time of measuring vital signs with all five devices on a daily basis in a month. The average total completion time after familiarization (after the first week) was 5.17 minutes. Results suggest that ‘non-expert’, independent users may face challenges when using portable medical devices in home care settings. Further, the study results also indicate that unsatisfactory usability of portable medical devices could pose hinderances in technology adoption among low eHealth literate users.

Nisotak

This paper outlines the design, development, and preliminary usability study of a system comprising 1) a web-based Indigenous lesson-creation interface and 2) an accompanying mobile app for studying the lessons. The Nisotak project was developed in response to the need for the preservation of Indigenous languages and to support reconciliation within Canada. In this paper, the authors discuss the technological aspects of the project and the less tangible decision-making that helped navigate software development in ways that support and honour Indigenous languages, Indigenous knowledge, and Indigenous people while, at the same time, making space for non-Indigenous allies. The key decisions that guided this project included privileging the target language(s), accommodating multiple dialects, creating an easy-to-use and engaging interface for non-technical users, and designing for easy transfer of ownership and management. Finally, the authors share the results of a small usability study.

An augmented reality interface to control a collaborative robot in rehab: A preliminary usability evaluation.

Human emotions can be seen as a valuable variable to explore in Human-Computer Interaction for effective, efficient, and satisfying interface development. The inclusion of appropriate emotional triggers in the design of interactive systems can play a decisive role in users' acceptance or rejection. It is well known that the major problem in motor rehabilitation is the high dropout rate resulting from the frustrated expectations given the typical slow recovery process and consequent lack of motivation to endure. This work proposes grouping a collaborative robot with one specific augmented reality equipment to create a rehabilitation system where some gamification levels might be added to provide a better and more motivating experience to patients. Such a system, as a whole, is customizable to adapt to each patient's needs on the rehabilitation exercises. By transforming a tedious exercise into a game, we expect to create an additional layer of enjoyment that can help in triggering positive emotions and stimulate users to continue the rehabilitation process. A pre-prototype was developed to validate this system's usability, and a cross-sectional study using a non-probabilistic sample of 31 individuals is presented and discussed. This study included the application of three standard questionnaires on usability and user experience. The analyses of these questionnaires show that the majority of the users found the system easy and enjoyable. The system was also analysed by a rehabilitation expert who gave a positive output regarding its usefulness, and positive impact on its use in the upper-limb rehabilitation processes. These results clearly encourage further development of the proposed system.

Teen Well Check: an e-health prevention program for substance use, sexual assault, and sexual risk behaviors for adolescents in primary care

ABSTRACT Objective: Adolescents are at risk for substance use, sexual assault, and sexual risk behaviours; however, to date no integrated prevention programmes address all three risk behaviours. The goal of this study was to evaluate the usability and acceptability of Teen Well Check, an e-health prevention programme targeting substance use, sexual assault, and sexual risk among adolescents in primary care settings. Methods: The current study included content analysis of interviews with adolescents in primary care (aged 14–18; n = 25) in the intervention development process, followed by usability and acceptability testing with qualitative interviews among adolescents in primary care (aged 14–18; n = 10) and pediatric primary care providers (n = 11) in the intervention refinement process. All data were collected in the Southeastern U.S. Results: Feedback on Teen Well Check addressed content, engagement and interaction, language and tone, aesthetics, logistics, inclusivity, parent/guardian-related topics, and the application of personal stories. Overall, providers reported they would be likely to use this intervention (5.1 out of 7.0) and recommend it to adolescents (5.4 out of 7.0). Conclusions: These findings suggest preliminary usability and acceptability of Teen Well Check. A randomized clinical trial is needed to assess efficacy.

Design, characterization and preliminary usability testing of a portable robot for unsupervised therapy of hand function

Introduction:There is evidence that increasing therapy dose after stroke might promote recovery. Unfortunately, in clinical practice, therapy dose is limited by financial and organizational constraints. Simple robotic devices could be used without supervision in the clinic or at home to increase dose without requiring additional resources. For this purpose, we developed HandyBot, a portable three-degrees-of-freedom end-effector haptic device to perform sensorimotor task-oriented therapy of hand function (i.e., grasping, forearm pronosupination, wrist flexion-extension) in different environments.Methods:We present the mechatronic design of the device and its technical evaluation in terms of workspace, dynamics (i.e., max end-effector velocity, acceleration and force), sensing (i.e., position, velocity and force resolution) and haptic performance (i.e., transparency, maximum stable impedance range, rigid contact rendering accuracy). In addition, its feasibility and usability (in terms of System Usability Scale (SUS)) were assessed in a single-session experiment with four subjects with chronic stroke that tested the HandyBot therapy platform (i.e., haptic device with a graphical/physical user interface and a set of therapy exercises) while simulating unsupervised use (i.e., the subject used the device independently while a therapist was only observing the session).Results:HandyBot showed hardware and control performances comparable to other less portable therapy devices for hand function (e.g., 94% accuracy in stiffness rendering, low apparent mass of 0.2 kg in transparency mode), making it a suitable platform for the implementation of sensorimotor therapy exercises. HandyBot showed good platform usability in terms of SUS (i.e., above 75 out of 100 for device and graphical user interfaces, above 65 out of 100 for the exercises) when tested in simulated unsupervised settings. These tests underlined minor design improvements that should be considered to allow using such a device in uncontrolled settings.Discussion:HandyBot is a novel robot for hand rehabilitation after stroke that revealed high-quality hardware and haptic performance. HandyBot was usable for stroke patients at first exposure for (simulated) unsupervised robot-assisted sensorimotor therapy of hand function. This therapy approach combined with this novel portable robotic device has the potential to help increase therapy dose and decrease therapy-associated costs (e.g., therapist time to therapy time ratio) in different environments.

Usability and validity of a virtual reality cognitive assessment tool for pediatric traumatic brain injury.

Deficits in executive functions are prevalent among children with traumatic brain injury (TBI). Assessing cognitive impairment is critical for evaluating and monitoring recovery. The present article reports a pilot study to evaluate the preliminary usability and validity of a virtual reality cognitive assessment tool (VR-CAT) specifically designed for children with TBI. A total of 54 children, 24 with TBI and 30 with orthopedic injury, participated in a cross-sectional cohort study at a Level-1 trauma center. The VR-CAT was evaluated in terms of user experience as well as preliminary psychometric properties including test-retest reliability, face validity, concurrent validity with two standard executive function assessment tools, and utility in distinguishing the TBI and orthopedic injury groups. Children in both groups reported high levels of usability (i.e., enjoyment and motivation). The VR-CAT composite and scores on tests of inhibitory control and working memory demonstrated modest test-retest reliability across two independent assessment visits, as well as acceptable face validity, modest concurrent validity, and clinical utility. The present study is among the first to evaluate the applicability of an immersive VR-CAT in children with TBI. The findings support high usability, adequate psychometric properties, and satisfactory clinical utility of the VR-CAT, suggesting it is a promising tool for assessing executive functions in this vulnerable population. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Systematic Evaluation and Usability Analysis of Formal Methods Tools for Railway Signaling System Design

Formal methods and supporting tools have a long record of success in the development of safety-critical systems. However, no single tool has emerged as the dominant solution for system design. Each tool differs from the others in terms of the modeling language used, its verification capabilities and other complementary features, and each development context has peculiar needs that require different tools. This is particularly problematic for the railway industry, in which formal methods are highly recommended by the norms, but no actual guidance is provided for the selection of tools. To guide companies in the selection of the most appropriate formal methods tools to adopt in their contexts, a clear assessment of the features of the currently available tools is required. To address this goal, this paper considers a set of 13 formal methods tools that have been used for the early design of railway systems, and it presents a systematic evaluation of such tools and a preliminary usability analysis of a subset of 7 tools, involving railway practitioners. The results are discussed considering the most desired aspects by industry and earlier related studies. While the focus is on the railway signaling domain, the overall methodology can be applied to similar contexts. Our study thus contributes with a systematic evaluation of formal methods tools and it shows that despite the poor graphical interfaces, <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">usability</i> and <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">maturity</i> of the tools are not major problems, as claimed by contributions from the literature. Instead, support for <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">process integration</i> is the most relevant obstacle for the adoption of most of the tools. Our contribution can be useful to R&D engineers from railway signaling companies and infrastructure managers, but also to tool developers and academic researchers alike.

Employee-centric innovation: Integrating participatory design and video-analysis to foster the transition to Industry 5.0

Recently, the paradigm of Industry 5.0 has been introduced to complement that of Industry 4.0, which turned out to be technology- rather than human-oriented. Industry 5.0 is meant to foster a transition toward a human-centric industry, where the worker’s well-being is prioritized. To meet this goal, it is crucial to directly involve employees from the earliest stages of design project. In the present work, we describe a case study that was meant to re-design the technology used in a validation laboratory. We adopted a mixed-method approach integrating employee’s self-reported data and objective event-based data from in-the-field video-analysis. By doing this we could build a thorough understanding of the work activities and of the related main issues. We then devised a list of re-design recommendations that were translated in a revised application and in the suggested introduction of portable devices. The outcomes of a preliminary usability evaluation of the revised application were promising, indicating the effectiveness of the methodological approach.

Brain M-App's Structure and Usability: A New Application for Cognitive Rehabilitation at Home.

Cognitive frailty is defined as a clinical condition characterized by both physical frailty and cognitive impairment, without reaching the criteria for dementia. The major goal of rehabilitation intervention is to assist patients in performing ordinary personal duties without the assistance of another person, or at the very least to remove the need for additional support, using adaptive approaches and facilities. In this regard, home-based rehabilitation allows patients to continue an intervention begun in a hospital setting while also ensuring support and assistance when access to healthcare systems is limited, such as during the present pandemic situation. We thus present Brain m-App, a tablet-based application designed for home-based cognitive rehabilitation of frail subjects, addressing spatial memory, attention, and executive functions. This app exploits the potential of 360° videos which are well-suited to home-based rehabilitation. The Brain m-app is made up of 10 days of activities that include a variety of exercises. The activities were chosen based on those patients used to do during their clinical practice in the hospital with the aim to improve their independence and autonomy in daily tasks. The preliminary usability test, which was conducted on five older people, revealed a sufficient level of usability, however, the sample size was modest. Results from the clinical study with 10 patients, revealed that Brain m-App improved especially executive functions and memory performances.

Usability of the Virtual Supermarket Test for Older Adults with and without Cognitive Impairment.

This study conducted a preliminary usability assessment of the Virtual Supermarket Test (VST), a serious game-based self-administered cognitive screening test for mild cognitive impairment (MCI). Twenty-four healthy older adults with subjective cognitive decline and 33 patients with MCI self-administered the VST and then completed the System Usability Scale (SUS). The average SUS score was 83.11 (SD = 14.6). The SUS score was unaffected by age, education, touch device familiarity, and diagnosis of MCI. SUS score correlated with VST performance (r = –0.496, p = 0.000). Results of this study indicate good usability of the VST.

Usability evaluation of a novel compact pneumatic compression device for the treatment of lymphoedema: Pilot study.

ObjectiveTo perform a preliminary usability evaluation of a novel, compact pneumatic compression device in patients with lymphoedema.MethodsThis open-label, single-arm trial had two phases: the first focused on the fitting of the pneumatic compression device (Aria FreeTM, Aria Health, San Diego CA, USA) and the second focused on evaluating the comfort of the entire system during a 45-min usage period. Both phases were conducted in a monitored clinical environment. Patients aged ≥18 years with a diagnosis of lower limb lymphoedema who had used a pneumatic compression device for ≥3 months were eligible. Patients rated subjective fit, comfort and usability on an 11-point Likert scale (where higher scores indicate better fit/comfort/usability). The truncated cone method was used to infer limb volume before and after therapy in phase 2.ResultsTwenty-four patients were screened, and 15 were enrolled (80% female; mean age 62 years); all completed both study phases. Patients rated the garment as easy to set up and fit (median score 6.5), and all reported that the therapy was comfortable (median score 10; p < 0.001 vs. reference score of 6). There was a 1.85% reduction in limb volume after device use for 45 min (p = 0.018 vs. before therapy). No safety issues were identified.ConclusionsThe new pneumatic compression device fitted well, was easy to use and reduced leg oedema.

Career Interview Readiness in Virtual Reality (CIRVR): A Platform for Simulated Interview Training for Autistic Individuals and Their Employers

Employment outcomes for autistic 1 individuals are often poorer relative to their neurotypical (NT) peers, resulting in a greater need for other forms of financial and social support. While a great deal of work has focused on developing interventions for autistic children, relatively less attention has been paid to directly addressing the employment challenges faced by autistic adults. One key impediment to autistic individuals securing employment is the job interview. Autistic individuals often experience anxiety in interview situations, particularly with open-ended questions and unexpected interruptions. They also exhibit atypical gaze patterns that may be perceived as, but not necessarily indicative of, disinterest or inattention. In response, we developed a closed-loop adaptive virtual reality (VR)–based job interview training platform, which we have named Career Interview Readiness in VR (CIRVR). CIRVR is designed to provide an engaging, adaptive, and individualized experience to practice and refine interviewing skills in a less anxiety-inducing virtual context. CIRVR contains a real-time physiology-based stress detection module, as well as a real-time gaze detection module, to permit individualized adaptation. We also present the first prototype of the CIRVR Dashboard, which provides visualizations of data to help autistic individuals as well as potential employers and job coaches make sense of the data gathered from interview sessions. We conducted a feasibility study with 9 autistic and 8 NT individuals to assess the preliminary usability and feasibility of CIRVR. Results showed differences in perceived usability of the system between autistic and NT participants, and higher levels of stress in autistic individuals during interviews. Participants across both groups reported satisfaction with CIRVR and the structure of the interview. These findings and feedback will support future work in improving CIRVR’s features in hopes for it to be a valuable tool to support autistic job candidates as well as their potential employers.

INC-Hg: An Intelligent Collaborative Haptic-Gripper Virtual Reality System

Collaborative Virtual Environments (CVE) have shown potential to be an effective social skill training platform for children with Autism Spectrum Disorders (ASD) to learn and practice collaborative and communication skills through peer interactions. However, most existing CVE systems require that appropriately matched partners be available at the same time to promote interaction, which limits their applicability to some community settings due to scheduling constraints. A second shortcoming of these more naturalistic peer-based designs is the intensive resources required to manually code the unrestricted conversations that occurred during the peer-based interactions. To preserve the benefits of CVE-based platforms and mitigate some of the resource limitations related to peer availability, we developed an Intelligent Collaborative Haptic-Gripper System (INC-Hg). This system provides an intelligent agent partner who can understand, communicate, and haptically interact with the user, without requiring the presence of another human peer. The INC-Hg operates in real time and thus is able to perform collaborative training tasks at any time and at the user's pace. INC-Hg can also record the real-time data regarding spoken language and task performance, thereby greatly reducing the resource burden of communication and interaction performance analysis. A preliminary usability study with 10 participants with ASD (ages 8–12 years) indicated that the system could classify the participant's utterances into five classes with an accuracy of 70.34%, which suggested the potential of INC-Hg to automatically recognize and analyze conversational content. The results also indicated high accuracies of the agent to initiate a conversation (97.56%) and respond to the participants (86.52%), suggesting the capability of the agent to conduct proper conversations with the participants. Compared to the results of human-to-human collaborative tasks, the human-to-agent mode achieved higher average collaborative operation ratio (61% compared to 40%) and comparable average frequencies for Initiations and Responses among the participants with ASD. These results offer preliminary support as well as areas of improvement regarding the agent's ability to respond to participants, work with participants to complete tasks, engage in back-and-forth conversations, and support the potential of the agent to be a useful partner for individuals with ASD completing CVE tasks.

A Graphical Toolkit for Longitudinal Dataset Maintenance and Predictive Model Training in Health Care.

Predictive analytic models, including machine learning (ML) models, are increasingly integrated into electronic health record (EHR)-based decision support tools for clinicians. These models have the potential to improve care, but are challenging to internally validate, implement, and maintain over the long term. Principles of ML operations (MLOps) may inform development of infrastructure to support the entire ML lifecycle, from feature selection to long-term model deployment and retraining. This study aimed to present the conceptual prototypes for a novel predictive model management system and to evaluate the acceptability of the system among three groups of end users. Based on principles of user-centered software design, human-computer interaction, and ethical design, we created graphical prototypes of a web-based MLOps interface to support the construction, deployment, and maintenance of models using EHR data. To assess the acceptability of the interface, we conducted semistructured user interviews with three groups of users (health informaticians, clinical and data stakeholders, chief information officers) and evaluated preliminary usability using the System Usability Scale (SUS). We subsequently revised prototypes based on user input and developed user case studies. Our prototypes include design frameworks for feature selection, model training, deployment, long-term maintenance, visualization over time, and cross-functional collaboration. Users were able to complete 71% of prompted tasks without assistance. The average SUS score of the initial prototype was 75.8 out of 100, translating to a percentile range of 70 to 79, a letter grade of B, and an adjective rating of "good." We reviewed persona-based case studies that illustrate functionalities of this novel prototype. The initial graphical prototypes of this MLOps system are preliminarily usable and demonstrate an unmet need within the clinical informatics landscape.

Teaching Emotions in Children With Autism Spectrum Disorder Through a Computer Program With Tangible Interfaces

Autism spectrum disorders (ASD) belong to the permanent neurodevelopmental disorders, degrading the areas related to interaction with society, communication as well as behavior. Being the identification of emotions one of the difficulties presented in these people. The present work demonstrates the first exploratory phase showing the development of a computer tool for the understanding of emotions for children with ASD using tangible user interfaces and gamification techniques that is in process. Related works in our area of study are shown indicating our main differentiator with them. Regarding the development of the software, the METUIGA methodology has been used, exposing part of the process followed in the construction of the software. The first preliminary results of a preliminary usability evaluation using the Nielsen heuristic are shown, obtaining positive results in the system interfaces by experts in the education of children with ASD.

Virtual and Augmented Reality Direct Ophthalmoscopy Tool: A Comparison between Interactions Methods

Direct ophthalmoscopy (DO) is a medical procedure whereby a health professional, using a direct ophthalmoscope, examines the eye fundus. DO skills are in decline due to the use of interactive diagnostic equipment and insufficient practice with the direct ophthalmoscope. To address the loss of DO skills, physical and computer-based simulators have been developed to offer additional training. Among the computer-based simulations, virtual and augmented reality (VR and AR, respectively) allow simulated immersive and interactive scenarios with eye fundus conditions that are difficult to replicate in the classroom. VR and AR require employing 3D user interfaces (3DUIs) to perform the virtual eye examination. Using a combination of a between-subjects and within-subjects paradigm with two groups of five participants, this paper builds upon a previous preliminary usability study that compared the use of the HTC Vive controller, the Valve Index controller, and the Microsoft HoloLens 1 hand gesticulation interaction methods when performing a virtual direct ophthalmoscopy eye examination. The work described in this paper extends our prior work by considering the interactions with the Oculus Quest controller and Oculus Quest hand-tracking system to perform a virtual direct ophthalmoscopy eye examination while allowing us to compare these methods without our prior interaction techniques. Ultimately, this helps us develop a greater understanding of usability effects for virtual DO examinations and virtual reality in general. Although the number of participants was limited, n = 5 for Stage 1 (including the HTC Vive controller, the Valve Index controller, and the Microsoft HoloLens hand gesticulations), and n = 13 for Stage 2 (including the Oculus Quest controller and the Oculus Quest hand tracking), given the COVID-19 restrictions, our initial results comparing VR and AR 3D user interactions for direct ophthalmoscopy are consistent with our previous preliminary study where the physical controllers resulted in higher usability scores, while the Oculus Quest’s more accurate hand motion capture resulted in higher usability when compared to the Microsoft HoloLens hand gesticulation.