Virtual Reality Simulation Research Articles

Innovative use of virtual reality simulation technology for pet health care education: a hybrid system for cardiopulmonary resuscitation training

Innovative use of virtual reality simulation technology for pet health care education: a hybrid system for cardiopulmonary resuscitation training

The Looking Glass Framework: Using Virtual Reality and Video Game Simulations to Improve Clinical Decision-Making and Reduce Healthcare Disparities in African Americans

A central mission of a healthcare organization is to provide equal access and excellent health outcomes to all populations, regardless of race and ethnicity. However, in the everyday practice of healthcare, organizations have fallen short of this primary tenant. Healthcare disparities in the Black community are well-documented in the literature. Although the reasons are multi-faceted, racial bias contributes to healthcare disparities, and eliminating those disparities should be a chief focus in improving the health and well-being of every community. This paper discusses healthcare disparities in the Black community and the complex cycle that enables gaps to persist despite best efforts among healthcare professionals, policymakers, and the general public. It concludes with a presentation of the Looking Glass Framework; an innovative onboarding and continuing education program using virtual reality and computer-based educational modules to reduce healthcare disparities within clinics, hospitals, and health systems.

Application of Virtual Reality (VR) in Health, Safety and Environment Subject for Fire Exit Training Module

The significance and extraordinary effectiveness of using VR technology into health, safety, and environment (HSE) education are highlighted. It addresses the many benefits that VR has to offer, especially when it comes to fire exit training, by giving students engaging, involving, and profound learning experiences. The research highlights the seamless incorporation of VR into Health, Safety and Environment (HSE) courses, where VR simulations serve as important tools for teaching crucial evacuation tactics and encouraging students' in-depth understanding and preparedness for actual fire emergencies. This study investigates students' responses regarding their understanding in one of the HSE subject following the implementation of VR technology. Valuable student feedback has been gathered through comprehensive surveys, enabling a continuous process of improvement and refinement for the HSE program. Overall, this research stands as a compelling testament to the profound impact of VR in optimizing learning outcomes and fostering a heightened sense of safety awareness in professional environments.

Virtual reality to aid in competency-based online nurse practitioner curriculum (VR-NP)

Virtual reality (VR) simulation use in graduate nursing education is a growing innovative trend that can help with competency-based education. The Virtual Reality Simulation to aid in competency-based online nurse practitioner curriculum (VR-NP) pilot innovation and quality improvement project sought to deliver VR simulation as an educational strategy in an online graduate nursing program advanced health assessment course that enrolled sixty-six students. Twenty-nine of the students were provided loaner VR equipment to complete simulated advanced health assessments from their home while the remainder of students completed the same simulations using screen-based technology. For all students, weekly simulations were paired with follow-up debriefing led by faculty using synchronous web conferencing. Students using VR completed a mid-implementation and post-implementation survey, consisting of the System Usability Scale (SUS), Simulation Effectiveness Tool-Modified (SET-M), and open ended questions. Students using screen-based technology, completed similar surveys with only the SET-M and open-ended questions. Necessary adjustments were made to the implementation process based on data received mid-implementation. Overall students were satisfied with the use of VR simulation from a distance and minimal implementation challenges were encountered. Recommendations for integration of VR into other graduate nursing programs are shared.

Research on the Impact of User Behavior on Sustainable Design Strategies

This study aims to explore the influence of user behavior on sustainable design strategies and proposes a framework for optimizing design interventions. User behavior data regarding energy use, resource consumption, and waste management were collected through surveys, in-depth interviews, and virtual reality simulations. K-means clustering and Principal Component Analysis (PCA) were employed to systematically identify user behavior patterns. The findings reveal three distinct user groups: environmentally conscious, economically driven, and neutral/passive. Experimental results validated the effectiveness of various design intervention strategies—such as behavioral incentives, interactive feedback, and visual prompts—in increasing the frequency of energy-saving actions and reducing energy consumption. The behavioral incentive strategy showed the most significant impact, reducing energy consumption by 20% and achieving the highest user satisfaction. Through multiple regression analysis and ANOVA, the statistical significance of the behavioral incentive strategy was further confirmed. The innovation of this study lies in optimizing user behavior through customized strategies and proposing a combination of interventions to achieve greater energy savings. This provides new theoretical and practical support for sustainable design practices.

Learner evaluation of an immersive virtual reality mass casualty incident simulator for triage training

BackgroundTo minimize loss of life, modern mass casualty response requires swift identification, efficient triage categorization, and rapid hemorrhage control. Current training methods remain suboptimal. Our objective was to train first responders to triage a mass casualty incident using Virtual Reality (VR) simulation and obtain their impressions of the training’s quality and effectiveness.We trained subjects in a triage protocol called Sort, Assess, Lifesaving interventions, and Treatment and/or Transport (SALT) Triage then had them respond to a terrorist bombing of a subway station using a fully immersive virtual reality simulation. We gathered learner reactions to their virtual reality experience and post-encounter debriefing with a custom electronic survey. The survey was designed to gather information about participants’ demographics and prior experience, including roles, triage training, and virtual reality experience. We then asked them to evaluate the training and encounter and the system’s potential for training others.ResultsWe received 375 completed evaluation surveys from subjects who experienced the virtual reality encounter. Subjects were primarily paramedics, but also included medical learners as well as other emergency medical service (EMS) professionals. Most participants (95%) recommended the experience for other first responders and rated the simulation (95%) and virtual patients (91%) as realistic. Ninety-four percent (94%) of participants rated the virtual reality simulator as “excellent” or “good.” We observed some differences between emergency medical service and medical professionals regarding their prior experience with disaster response training and their opinions on how much the experience contributed to their learning. We observed no differences between subjects with extensive virtual reality experience and those without.ConclusionsOur virtual reality simulator is an automated, customizable, fully immersive virtual reality system for training and assessing personnel in the proper response to a mass casualty incident. Participants perceived the simulator as an adequate alternative to traditional triage and treatment training and believed that the simulator was realistic and effective for training. Prior experience with virtual reality was not a prerequisite for the use of this system.

Exploring ambulance clinicians’ clinical reasoning when training mass casualty incidents using virtual reality: a qualitative study

BackgroundHow ambulance clinicians (ACs) handle a mass casualty incident (MCI) is essential for the suffered, but the training and learning for the ACs are sparse and they don’t have the possibility to learn without realistic simulation training. In addition, it is unclear what type of dilemmas ACs process in their clinical reasoning during an MCI. With virtual reality (VR) simulation, the ACs clinical reasoning can be explored in a systematic way. Therefore, the objective was to explore ambulance clinicians’ clinical reasoning when simulating a mass casualty incident using virtual reality.MethodsThis study was conducted as an explorative interview study design using chart- stimulated recall technique for data collection. A qualitative content analysis was done, using the clinical reasoning cycle as a deductive matrix. A high-fidelity VR simulation with MCI scenarios was used and participants eligible for inclusion were 11 senior ACs.Results/conclusionAll phases of the clinical reasoning cycle were found to be reflected upon by the participants during the interviews, however with a varying richness of analytic reflectivity. Non-analytic reasoning predominated when work tasks followed specific clinical guidelines, but analytical reasoning appeared when the guidelines were unclear or non-existent. Using VR simulation led to training and reflection on action in a safe and systematic way and increased self-awareness amongst the ACs regarding their preparedness for MCIs. This study increases knowledge both regarding ACs clinical reasoning in MCIs, and insights regarding the use of VR for simulation training.

Changes in forklift driving performance and postures among novices resulting from training using a high-fidelity virtual reality simulator: An exploratory study

Virtual reality (VR) has emerged as a promising tool for training. Our study focused on training for forklift driving, to address an ongoing worker shortage, and the unknown impact of repeated VR training on task performance and kinematic adaptations. We trained 20 novice participants using a VR forklift simulator over two days, with two trials on each day, and including three different driving lessons of varying difficulties. Driving performance was assessed using task completion time, and we quantified kinematics of the head, shoulder, and lumbar spine. Repeated training reduced task completion time (up to ∼29.8% of initial trial) and decreased both kinematic variability and peak range of motion, though these effects were larger for lessons requiring higher precision than simple driving maneuvers. Our results highlight the potential of VR as an effective training environment for novice drivers and suggest that monitoring kinematics could help track skill acquisition during such training.

Exploring Innovative Methods in Maritime Simulation: A Ship Path Planning System Utilizing Virtual Reality and Numerical Simulation

In addressing the high costs, inefficiencies, and limitations of purely digital simulations in maritime trials for unmanned vessel path planning, this paper introduces a ship virtual path planning simulation test system. This system, unbound by temporal and spatial constraints, vividly showcases the navigational performance of vessels. After analyzing the virtual testing requirements for the autonomous navigation performance of unmanned surface vehicles (USVs), we established the overall framework of this system. Data-driven by a numerical simulation platform, the system achieves synchronized operation between physical and virtual platforms and supports interactive path planning simulations between USVs and the virtual testing system. Furthermore, to address the limitations of traditional ship trajectory planning evaluation, this paper develops a global path planning fitness evaluation function that comprehensively considers trajectory safety, navigation distance, and vessel stability, achieving optimal comprehensive routes through the particle swarm optimization algorithm. Test results indicate an average roll reduction of 14.31% in the planned routes, with a slight increase in navigation distance. By integrating two-dimensional curve simulation with three-dimensional visualization, this paper not only overcomes the limitations of purely physical and purely virtual simulations but also enhances the overall credibility and intuitiveness of the simulation. Experimental results validate the system’s effectiveness, providing a novel method for autonomous navigation testing and evaluation of USVs.

A virtually-induced overview effect? How seeing the world from above through a simulated space tour is related to awe, global identity and pro-environmental behaviour

Global environmental crises require concerted action around the globe. Previous research has suggested that salient global identity (i.e. identification with and concern for people all over the world) might motivate such action, as it is positively related to pro-environmental behaviour. However, little is known about how to strengthen global identity. Inferred from astronauts' experiences when seeing our planet from space (i.e. the overview effect), we hypothesised that a virtual reality (VR) space tour elicits awe (i.e. an experience of extraordinary vastness associated with feeling moved, amazed and overwhelmed), makes global identity more salient and motivates pro-environmental behaviour. We compared the effect of the VR simulation to that of music, a stimulus unrelated to nature. In a preregistered laboratory experiment, participants of a convenience sample in Germany (N = 128) were randomly assigned to four groups, using a 2 (VR: yes vs. no) × 2 (music: yes vs. no) design, and answered a self-report questionnaire. We found that both the VR space tour and music elicited awe, but that the effects of VR were stronger. We found neither significant main nor interaction effects of VR and music on global identity. However, both the VR simulation and music indirectly predicted stronger global self-investment (i.e. one dimension of global identity reflecting solidarity and concern for people world-wide) through a stronger awe experience. Neither the VR simulation nor music impacted people's pro-environmental behaviour in terms of their willingness to sign a petition asking the government to prioritise the Paris climate agreement. However, they both indirectly predicted willingness to sign the petition through a stronger awe experience. We discuss the role of awe for global identity and pro-environmental behaviour, and elaborate on the idea that a greater portion of global identity may be a stable trait rather than a variable state. We also discuss how useful VR simulations are for encouraging pro-environmental behaviour.

Defibrillator Training in the Virtual Setting is Feasible and Improves Medical Student Self-Efficacy; A Pilot Study

Background Management of in-hospital cardiac arrest includes many component skills that require considerable training in order to gain mastery. Practicing defibrillation skills in a simulated setting improves performance and time to shock delivery but is cumbersome and costly. Virtual reality (VR) simulation training may provide an alternative platform to help medical students learn and build confidence in the critical steps required to operate a manual defibrillator. Intervention We performed a pilot study to implement a VR simulation that trains learners on the stepwise operation of a manual defibrillator. Methods We conducted a cross-sectional survey that measured the feasibility, usability, and likeability of a VR simulation among fourth-year medical students at a large urban academic medical center. Secondary outcomes included self-efficacy with operating a defibrillator before and after the VR simulation, and time to defibrillation within the simulation. Results Twenty-six participants completed the VR simulation. The majority of participants found the VR simulation easy to use (71% agreed), liked the experience (96% agreed), found it realistic (87.5% agreed), and would recommend it to their peers (96% agreed). Most students (96%) agreed that the training improved their knowledge of how to use a defibrillator, and all (100%) students agreed that they were more confident than beforehand in using the defibrillator to defibrillate a patient with cardiac arrest. Self-reported knowledge and comfort with using the defibrillator significantly improved from before to after the VR training, as did average time to defibrillation. Discussion VR simulation for defibrillator training is feasible and well-liked by senior medical students and is associated with improved self-perceived knowledge and comfort with using a manual defibrillator.

The Impact of Virtual Reality Simulations on Social Work Education: A Qualitative Study

ABSTRACT The purpose of this qualitative study was to explore the potential of virtual reality (VR) simulations for use as an effective learning modality for social work education. At a public college in a large U.S. Northeastern city with a mostly self-identified non-White student body, 19 respondents, including five BA and seven MSW social work students, as well as seven graduated former MSW students, participated in one of three focus groups in which they shared their thoughts and feelings regarding two VR simulations they experienced. One of the VR applications concerned racism and the other homelessness. The study found that VR has the ability to be an immersive and immediate experience that arouses intense emotional reactions in participants, thereby enhancing their empathy toward the individuals portrayed in the simulations and increasing participants’ motivation to participate in social action. The respondents overwhelmingly expressed that VR should be integrated into social work education, but that the emotional intensity it engenders creates the need for careful pre-briefing and debriefing. Issues of physical discomfort for some participants during the simulations need to be addressed as well.

The Effectiveness of Technology-Enhanced Learning in Prosthodontic Education: A Systematic Review.

To compare the effectiveness of technology-enhanced learning (TEL) with traditional learning in prosthodontic education. The protocol was registered before commencement [CRD42023390277]. The search was conducted to identify randomized controlled trials (RCTs) focused on comparative assessment of TEL and traditional learning in prosthodontic education up to 6 June 2024. A comprehensive search strategy was formulated, encompassing multiple electronic databases. Screening, data extraction and risk of bias assessment using the Cochrane tool (RoB 2) were performed. Educational outcomes were evaluated by Kirkpatrick's four-level evaluation model. Of 2830 records identified, 14 RCTs were included. All the trials were judged at high risk of bias or had some concerns. The included studies assessed the short-term benefits of various TEL approaches, including e-learning, blended learning, video demonstration specialized self-evaluation software and virtual reality simulation in prosthodontic education for undergraduates. Promising results were found in individual studies, particularly in terms of perceived learning conditions with problem-based learning (PBL) and self-reported understanding and confidence when using video demonstrations. Most studies reported comparable outcomes to traditional learning in practical skills assessments, while the results regarding the acquisition of theoretical knowledge through the incorporation of TEL approaches were contradictory. One study reported promising results in perceived learning conditions with the PBL approach, as well as improved self-reported understanding and confidence with the use of video demonstrations. Furthermore, there was a limited number of studies assessing the effect of TEL approaches on students' behaviour. There is a lack of high-quality evidence to support the adoption of TEL approaches in prosthodontics. However, the incorporation of virtual reality simulation has demonstrated promising results, particularly in improving practical clinical skills.

Using distributed simulations to investigate driver-pedestrian interactions and kinematic cues: Implications for automated vehicle behaviour and communication

As we move towards a future with Automated Vehicles (AVs) incorporated in the current traffic system, it is crucial to understand driver-pedestrian interaction, in order to enhance AV design and optimization. Previous research in this area, which has primarily used naturalistic observations or single-actor virtual reality simulations, has been limited by its inability to draw causal conclusions, also due to a lack of real human–human interactions. Our study addresses these limitations by employing a high-fidelity distributed simulation setup that links drivers in a motion-based simulator with pedestrians in a CAVE-based environment. This method allows for the examination of real-time and reciprocal interactions across a range of road-crossing scenarios. Using thirty-two pairs of drivers and pedestrians, we investigated how different factors, such as the presence of zebra crossings and varying time gaps of the approaching vehicle, influence driver behaviour and pedestrian crossing decisions. The effect of drivers’ control of the vehicle during such crossings (e.g., braking behaviour and lateral deviation) on pedestrians’ crossing decisions were also analysed. We found that the distribution of drivers’ average deceleration values were bimodal, where drivers either markedly yielded to pedestrians, or continued in their path, with very few instances of intermediate behaviour. We also found that pedestrian decisions were seemingly influenced by the different braking strategies adopted by the driver, with pedestrians crossing before the vehicles in response to soft and early, or late and hard braking, while late and soft braking often resulted in the vehicle passing first. We also observed a slight lateral movement of the vehicle away from pedestrians when drivers were not yielding, but more of a lateral deviation towards them when yielding. This may be because drivers subconsciously transfer their walking interaction habits to their driving behaviour, to avoid a collision with pedestrians. Finally, our results showed a stronger influence of these kinematic cues on pedestrian crossing decisions, when compared to zebra crossings. As well as highlighting the value of a novel approach for investigating vehicle–pedestrian interactions, this study illustrates how vehicle cues can assist pedestrian decisions, adding new knowledge in the development of human-like behaviour for future AVs.

Focus on proficiency levels is necessary when virtual reality simulator software is updated–a randomized trial

BackgroundVirtual reality simulators are an integral part of modern surgical training and allow novice surgeons to acquire basic laparoscopic skills that are transferable to the operation room without compromising patient safety. The gold standard training method is proficiency-based training, where all trainees practice until a pre-defined proficiency level is reached. Simulator software versions are regularly updated to increase the quality of the simulator experience, but the impact of software updates used in conjunction with existing proficiency levels is unknown. MethodsTwenty surgical novices were randomized to simulator training on the LapSim® virtual reality simulator using either a 2019-version (new software group) or a 2016-version (old software group) of the simulator software. All participants practiced until reaching the proficiency level established for the old software. After 3-5 weeks, all participants returned and practiced to proficiency again using the old software. ResultsThe mean time to proficiency for the new software group was 183 minutes (SD: 43) versus 285 minutes (SD: 26) for the old software group (p<0.001). During the follow-up test, participants from the new software group spent 189 minutes (SD: 61) versus 91 minutes (SD: 50) (p=0.001) for the old software group to reach proficiency again. ConclusionUpdating simulator software without updating the proficiency levels creates the risk of changing the amount of training necessary to reach proficiency. Updates of simulator software for virtual reality simulators must lead to a critical re-evaluation of the previously established proficiency levels to ensure optimal outcomes of simulation-based training.

Does Preoperative Virtual Reality Experience Enhance Implant Positioning Accuracy in Total Hip Arthroplasty?

Purpose Total hip arthroplasty (THA) requires precise implant positioning to ensure long-term success. Herein, we evaluated the effect of virtual reality (VR) on the surgical precision of THA, particularly when used by experienced surgeons. Methods In this single-center, prospective, case-control study, 34 patients who underwent primary THA performed by a single experienced surgeon were divided into the control (without VR simulation) and VR (with VR simulation) groups. Preoperative planning involved the creation of three-dimensional models from computed tomography scans using ZedHip® software (Lexi, Tokyo, Japan). The primary outcomes assessed included the accuracy of implant placement, operative time, and intraoperative blood loss. The secondary outcomes included postoperative hospital stay and in-hospital complications. Results A significant improvement in radiographic inclination (RI) was observed in the VR group as compared to controls. Other surgical parameters, such as radiographic anteversion, operation time, blood loss, and postoperative hospital stay, showed no significant differences between the groups. Discrepancies in planned versus actual implant sizes were notedbut were not significantly different between groups. Conclusion VR application in preoperative planning improved the RI accuracy in acetabular cup placement for THA, demonstrating its potential to enhance surgical precision for experienced surgeons. This study highlights the evolving role of VR, from a training tool to an integral part of advanced surgical planning in orthopedics.

Enhancing Operating Theatre Conduct through Virtual Reality Simulation

Abstract In hospital operating theatres, inadvertent violations of behavioural rules by novices may increase risk. Virtual reality (VR) can provide a training environment to ease the burden for healthcare professionals. Our work develops and tests a VR training program for correct operating room (OR) etiquette. The VR simulator incorporates realistic 3D models as well as corresponding character and object interactions. The simulator provides a comprehensive interactive educational game covering hand hygiene and disinfection, surgical attire and OR behaviour. 13 clinical trainees and experts assessed acceptance and perceived benefit of the simulator. This evaluation shows promise in supporting clinical staff education. Future developments aim to enhance effectiveness, including the integration of hand tracking and a more detailed selection of interactive tasks.

Virtual Reality in Cancer Care: Enhancing Knowledge and Reducing Anxiety about Chemotherapy among Patients and Caregivers.

Virtual reality (VR) technology has evolved from entertainment to significant applications in healthcare and education. Despite its potential, there is limited research on the role of VR in cancer care. This study investigates VR's ability to simulate the chemotherapy process, aiming to enhance patients' knowledge and mitigate anxiety associated with chemotherapy. Utilizing a two-arm, mixed-methods pre/post-survey design, the study measured changes in patients' anxiety and knowledge before and after exposure to a VR simulation. Participants (n = 267) engaged with VR simulations or interactive 360-degree videos depicting the chemotherapy process. Data analyses revealed a significant median increase in chemotherapy knowledge post-exposure to the VR content (z = 12.511, p < 0.001). Demographic factSors significantly influenced perceptions of VR realism and usefulness (p < 0.05). Additionally, VR exposure was correlated with reduced anxiety levels and improved treatment expectations (p < 0.05). Participants with higher post-understanding chemotherapy scores considered VR a useful tool for managing anxiety about chemotherapy and recommended VR for other medical procedures (p < 0.001). These findings underscore VR technology's potential as a valuable tool in cancer treatment, suggesting it can enhance patient education and reduce anxiety, thereby improving patient outcomes during cancer therapy.

Validity of task-specific metrics for assessment in perineal proctectomy.

Perineal proctectomy is a complex procedure that requires advanced skills. Currently, there are no simulators for training in this procedure. As part of our objective of developing a virtual reality simulator, our goal was to develop and validate task-specific metrics for the assessment of performance for this procedure. We conducted a three-phase study to establish task-specific metrics, obtain expert consensus on the appropriateness of the developed metrics, and establish the discriminant validity of the developed metrics. In phase I, we utilized hierarchical task analysis to formulate the metrics. In phase II, a survey involving expert colorectal surgeons determined the significance of the developed metrics. Phase III was aimed at establishing the discriminant validity for novices (PGY1-3) and experts (PGY4-5 and faculty). They performed a perineal proctectomy on a rectal prolapse model. Video recordings were independently assessed by two raters using global ratings and task-specific metrics for the procedure. Total scores for both metrics were computed and analyzed using the Kruskal-Wallis test. A Mann-Whitney U test with Benjamini-Hochberg correction was used to evaluate between-group differences. Spearman's rank correlation coefficient was computed to assess the correlation between global and task-specific scores. In phase II, a total of 23 colorectal surgeons were recruited and consensus was obtained on all the task-specific metrics. In phase III, participants (n = 22) included novices (n = 15) and experts (n = 7). There was a strong positive correlation between the global and task-specific scores (rs = 0.86; P < 0.001). Significant between-group differences were detected for both global (χ2 = 15.38; P < 0.001; df = 2) and task-specific (χ2 = 11.38; P = 0.003; df = 2) scores. Using a biotissue rectal prolapse model, this study documented high IRR and significant discriminant validity evidence in support of video-based assessment using task-specific metrics.

Caffeine Gum Improves Reaction Time but Reduces Composure Versus Placebo During the Extra-Time Period of Simulated Soccer Match-Play in Male Semiprofessional Players.

This study aimed to determine whether caffeine gum influenced perceptual-cognitive and physical performance during the extra-time period of simulated soccer match-play. Semiprofessional male soccer players (n = 12, age: 22 ± 3years, stature: 1.78 ± 0.06m, mass: 75 ± 9kg) performed 120-min soccer-specific exercise on two occasions. In a triple-blind, randomized, crossover design, players chewed caffeinated (200mg; caffeine) or control (0mg; placebo) gum for 5min following 90min of soccer-specific exercise. Perceptual-cognitive skills (i.e.,passing accuracy, reaction time, composure, and adaptability) were assessed using a soccer-specific virtual reality simulator, collected pre- and posttrial. Neuromuscular performance (reactive-strength index, vertical jump height, absolute and relative peak power output, and negative vertical displacement) and sprint performance (15 and 30m) were measured at pretrial, half-time, 90min, and posttrial. Caffeine gum attenuated declines in reaction time (pre: 90.8 ± 0.8AU to post: 90.7 ± 0.8AU) by a further 4.2% than placebo (pre: 92.1 ± 0.8AU to post: 88.2 ± 0.8AU; p < .01). Caffeine gum reduced composure by 4.7% (pre: 69.1 ± 0.8AU to post: 65.9 ± 0.8AU) versus placebo (pre: 68.8 ± 0.8AU to post: 68.3 ± 0.8AU; p < .01). Caffeine gum did not influence any other variables (p > .05). Where caffeine gum is consumed by players prior to extra-time, reaction time increases but composure may be compromised, and neuromuscular and sprint performance remain unchanged. Future work should assess caffeine gum mixes with substances like L-theanine that promote a relaxed state under stressful conditions.