Task difficulty of virtual reality-based assessment tools compared to classical paper-and-pencil or computerized measures

Virtual reality-based assessment tools arise as a promising alternative for classic neuropsychological assessment with an increased level of ecological validity. Because virtual reality cognitive measures recreate tasks that resemble with the demands from the real world it is assumed that they require additional cognitive resources and are more difficult than classical paper-and-pencil or computerized measures. Although research has focused on comparing the performance obtained on virtual reality-based measures with classical paper-and-pencil or computerized measures, no meta-analysis has been conducted on this topic. Thirteen studies met our inclusion criteria: assessed any cognitive process using virtual reality and analogous classical or computerized assessment tools of the same process. Based on a random effects model, the results indicated a moderate effect size in favor of classical and computerized tests (g?=?-0.77) revealing an increased task difficulty in virtual reality. Overall, results from the current meta-analysis point out that cognitive performance obtained in virtual reality is poorer than the one in classical or computerized assessment which might suggest that tasks embedded in virtual reality have an increased level of complexity and difficulty and require additional cognitive resources. Meta-analysis revealed increased task difficulty for virtual reality measures.Subgroup analysis showed somehow different patterns for the three outcomes.Age, clinical status, and task performance indicator were significant moderators.