A virtual reality driving simulator as an analogue of motion sickness in electric vehicle emergency driving

Motion sickness (MS) is an operationally relevant problem for emergency drivers. Virtual reality (VR) may provide a practical method for inducing and studying MS symptoms under controlled conditions, with potential applications in future assessment and rehabilitation. This feasibility study examined whether immersive VR could induce an MS symptom burden resembling that experienced during emergency driving in electric police vehicles. Sixteen police officers and 16 controls were included. Motion sickness susceptibility was assessed in all participants using the Motion Sickness Susceptibility Questionnaire-Short (MSSQ-Short). Both police officers and controls underwent VR exposure and subsequently completed the Motion Sickness Assessment Questionnaire (MSAQ), allowing comparison of VR-induced symptoms between the two groups. The police officers additionally completed an emergency-driving session in an electric vehicle, followed by the MSAQ, to compare symptom responses following VR exposure and real-life emergency driving. Finally, six participants repeated the VR exposure to assess whether similar symptom responses could be reproduced. MSAQ scores following VR exposure and emergency driving showed a small mean difference, with a small effect size (Hedges’ g < 0.4), although the confidence intervals were relatively wide. Repeated VR exposure resulted in similar symptom levels, providing preliminary evidence that symptom responses may be reproducible. These findings suggest that immersive VR is a feasible and safe method for inducing and studying MS symptoms relevant to emergency driving under controlled conditions. The similar symptom responses observed upon repeated VR exposure provide preliminary support for reproducibility. Overall, the findings provide a methodological basis for larger studies to validate the model and further investigate its reproducibility. If confirmed, this approach may have applications in research, training, and rehabilitation involving professional drivers and relevant patient populations.

Motion sickness (MS) remains a common and operationally relevant problem in road transport (Koch et al., 2018; Metzulat et al., 2025). Although susceptibility varies widely across individuals, MS can affect a substantial proportion of passengers and drivers under provocative motion conditions. Symptom onset typically develops over minutes to hours, depending on motion intensity (Lackner, 2014; Laessoe et al., 2023; Takov and Tadi, 2026). The symptom complex is multidimensional and includes autonomic and gastrointestinal features (e.g., cold sweating, hypersalivation, nausea, and vomiting), central symptoms (e.g., dizziness, headache, fatigue), and impaired functional performance (Cha et al., 2021; Lackner, 2014). The prevailing explanatory framework is the sensory conflict or neural mismatch theory, whereby incongruent input from visual, vestibular, and proprioceptive systems produces discomfort and autonomic responses (Koch et al., 2018). From a practical perspective, gradual habituation through repeated exposure is often advocated as a preventive strategy, although the magnitude and durability of adaptation depend on stimulus characteristics and individual susceptibility (Golding, 2016; Heutink et al., 2019; Zhang et al., 2016).

While MS is frequently discussed in relation to private travel (Metzulat et al., 2025), the condition may be particularly consequential in occupational settings that involve high-intensity driving. Emergency driving is characterized by rapid acceleration and deceleration, abrupt changes in direction, and intermittent vertical and lateral motion components, creating complex three-dimensional inertial stimulation that challenges sensory integration and has been reported to increase the incidence of MS (Irmak et al., 2022; Koohestani et al., 2019). Importantly, passenger tasks common in emergency vehicles (e.g., map reading, in-vehicle communication, or other screen-based activities) may increase MS risk by amplifying visual-vestibular conflict and reducing access to anticipatory visual cues (Laessoe et al., 2023; Schmidt et al., 2020). Even transient symptoms may compromise task performance, readiness, and wellbeing in operational contexts. Thus, a safe and standardized method for inducing emergency-driving-related MS, without exposing the participant to real-world emergency manoeuvres, would be valuable.

Evidently, during a pilot phase of introducing EVs in the Danish police force, repeated reports of MS during emergency driving were noted, raising concerns regarding operational feasibility in the context of a planned large-scale transition away from fossil-fuel vehicles (Brander, 2026). Consequently, the increased prevalence of MS due to fleet electrification has prompted greater interest in understanding and managing MS related to emergency driving. Regardless of whether the symptoms arise from EV-specific driving characteristics, a broader emergency driving dynamic, or a combination of the two, a controlled and safe method for stimulation of MS reflecting the symptom burden experienced in an operational setting would be highly beneficial for future research, training of personnel, or interventions.

Virtual reality (VR) offers a potential experimental pathway because VR exposure can reliably induce MS-like symptoms (often termed ‘cybersickness’) in controlled settings (Laessoe et al., 2023). Symptom profiles induced through VR overlap substantially with classical MS (Koch et al., 2018), although the relative contributions of visual dominance and inertial/vestibular stimulation differ across paradigms (Heutink et al., 2019; Laessoe et al., 2023). It remains unknown whether immersive VR can function as a feasible, reproducible, and valid surrogate for the MS experienced during emergency driving.

Thus, the primary objective of this exploratory study was to evaluate the feasibility of the VR setup as a safe and standardized alternative to real-life exposure to create a methodological foundation for future studies on MS during emergency driving. A secondary objective was to assess the consistency of MS symptom responses across repeated VR sessions. We hypothesize that the VR setup can induce MS, and that the symptom profile is sufficiently similar to those observed during emergency driving, justifying further validation of the experimental method. These findings may inform the development of standardized methods for studying and managing MS in professional driving contexts, including during fleet electrification and future clinical research.

This feasibility study consisted of three linked experiments designed to evaluate the feasibility of using immersive virtual reality (VR) as an analogue of motion sickness (MS) during emergency driving in electric vehicles (EVs). Experiment 1 examined whether the VR setup could induce MS symptoms. Experiment 2 compared the severity and symptom profile of VR-induced MS with symptoms reported by the same police officers following real-life emergency driving in an EV. Experiment 3 assessed the reproducibility of VR-induced MS using repeated VR exposure after a minimum washout period of 2 weeks. The primary independent variable was experimental condition (VR exposure versus real-life emergency driving), while test session (initial test versus retest) was the independent variable in the reproducibility experiment. The primary dependent variable across all experiments was MS severity, assessed using the Motion Sickness Assessment Questionnaire (MSAQ). All participants completed one VR session; police officers additionally completed one emergency-driving session, and a subset of participants underwent repeated VR exposure.

Participants and baseline assessments

The study included sixteen volunteer police officers (15 men and one woman; median age, 35 years) and 16 age- and sex-matched healthy control participants (15 men and one woman; median age, 35 years). Police officers were recruited from four Danish police districts and selected based on self-reported susceptibility to MS during the roll-out of electric police vehicles. Eleven officers reported experiencing MS during emergency driving in an EV prior to the study, while five did not. Age- and sex-matched control participants were primarily recruited from volunteers at the Department of Otorhinolaryngology, Gødstrup Hospital, irrespective of MS susceptibility. Inclusion criteria were age ≥18 years and the ability to complete all testing procedures. Exclusion criteria included known vestibular or otological disorders, neurological disease, or other conditions potentially interfering with balance testing or VR exposure. No participants were excluded.

All participants underwent baseline vestibular and otoneurological assessments at the Balance Clinic, Department of Otorhinolaryngology, Gødstrup Hospital. The otoneurological examination included assessment of spontaneous and head-shaking nystagmus, cover test, Romberg test, smooth pursuit, Hennebert’s sign, and cranial nerve function. Objective vestibular testing included video head impulse testing (vHIT) and ocular vestibular evoked myogenic potentials (oVEMP). Postural control was assessed using computerized dynamic posturography (MotionVR; Virtualis, Interacoustics). The posturography platform was separate from and not integrated with the VR driving simulator used for experimental exposure. Baseline demographic and clinical variables included age, sex, weekly physical activity, self-reported balance function, and childhood and adult susceptibility to MS assessed using the Motion Sickness Susceptibility Questionnaire–Short Form (MSSQ-short) (Golding, 2006b). These characteristics are presented in Table 1. All participants were anonymized and provided informed verbal consent. The study was approved by the Data Protection Agency in the Central Denmark Region (case number 1-16-02-333-21).

Equipment and experimental setup

All VR experiments were conducted using an immersive driving simulator (Virtualis, Interacoustics, Middelfart, Denmark). The simulator consisted of a head-mounted VR display, steering wheel, and foot pedals, allowing participants to interact with the virtual environment while remaining seated throughout the experiment (Figure 1D). Visual feedback was synchronized with steering and pedal inputs. The simulator did not include a motion platform; therefore, participants received visual motion cues without corresponding physical motion.

Real-life emergency driving was conducted using electric police patrol vehicles in operational service. During the standardized closed-track sessions, participants were seated as passengers while a certified police driving instructor performed all emergency-driving maneuvers.

Experimental design and procedures

Experiment 1: VR-induced motion sickness

Experiment 1 examined whether an immersive VR driving simulator could induce MS-like symptoms under standardized laboratory conditions, thereby evaluating the methodological feasibility of the VR setup as an MS induction paradigm. All participants (16 police officers and 16 age- and sex-matched controls; N = 32) completed the VR experiment following the baseline assessments described above.

The standardized VR protocol consisted of five sequential driving scenarios of increasing visual complexity and motion intensity (Figure 1A). Each scenario lasted two minutes and was separated by a one-minute pause for safety monitoring and verbal symptom reporting. Participants remained seated with the VR headset in place throughout the protocol. The maximum active VR exposure time was 10 min. Three virtual driving environments were used. The easy circuit consisted of a flat country road with moderate curvature, low visual complexity, and a continuously visible horizon (Figure 1B). The medium circuit introduced greater visual complexity, hills, sharper turns, and intermittent horizon obstruction. The hard circuit consisted of mountainous roads with steep inclines and declines, sharp curves, and substantial horizon occlusion, providing the highest level of visual motion stimulation (Figure 1C). Participants first completed the easy, medium, and hard circuits as drivers, followed by passenger-mode exposure on the easy and hard circuits. Passenger-mode scenarios were included because MS is generally reported more frequently among vehicle passengers than drivers (Schmidt et al., 2020). To approximate emergency-driving conditions, the simulation speed was set to the maximum available setting (2× speed multiplier), while weather conditions remained constant across all scenarios. Participants progressed sequentially through all five scenarios unless VR exposure was terminated prematurely because of intolerable symptoms. Throughout the procedure, participants were instructed to report symptoms verbally for safety monitoring. MS severity following VR exposure was assessed using the MSAQ, as described in Section 2.4.

Experiment 2: VR versus real-life emergency driving

Experiment 2 examined whether the severity and symptom profile of MS induced by the VR driving simulator were comparable to those experienced during real-life emergency driving in electric police vehicles. The 16 police officers who completed the VR experiment also participated in a real-life emergency-driving session. Control participants did not undergo real-life emergency driving.

Police officers completed a single emergency-driving session either on a standardized closed test track (n = 11) or during operational emergency driving on public roads (n = 5), depending on scheduling availability. Data from both settings were pooled for the analysis. The emergency-driving exposure lasted approximately 8–10 min and included maneuvers representative of emergency driving, such as rapid acceleration, abrupt braking, and sharp directional changes. Participants who completed the session during operational emergency driving on public roads followed routine emergency-driving procedures using electric police vehicles. Because these sessions were conducted under operational conditions, immediate termination of the exposure was not feasible for safety reasons. Emergency driving consisted of one continuous exposure without graded stimulus levels or scheduled breaks. The overall duration of exposure was comparable to the 10-min active exposure of the VR protocol. MS severity following emergency driving was assessed using the MSAQ, as described in Section 2.4, and compared with MSAQ scores obtained following VR exposure.

Experiment 3: reproducibility of VR-induced motion sickness

Experiment 3 examined whether the VR driving simulator elicited reproducible MS responses when the standardized protocol was repeated after a washout period. A subset of six participants (one police officer and five control participants) underwent repeat VR testing. The subset included participants with (n = 3) and without (n = 3) self-reported MS susceptibility. Repeat testing was limited to six participants because of scheduling constraints. Participants repeated the VR driving protocol described in Experiment 1 after a minimum washout period of 2 weeks. The interval was chosen to reduce the likelihood of short-term habituation influencing symptom responses. All simulator settings, driving scenarios, exposure durations, and testing procedures were identical to those used during the initial VR session. MS severity following repeat VR exposure was assessed using the MSAQ, as described in Section 2.4, and compared with MSAQ scores from the initial VR session.

Outcome measures

The primary outcome was MS severity, assessed using the MSAQ. The MSAQ is a validated self-report questionnaire that quantifies MS across four symptom domains: gastrointestinal, central, peripheral, and sopite-related symptoms. Domain scores and a total MSAQ score were calculated according to the original scoring procedure (Czeisler et al., 2023). For the present study, the questionnaire was translated from English into Danish using a forward–backward translation procedure to ensure semantic equivalence. The MSAQ was completed within 30 min after each VR exposure and, for police officers, within 30 min after the emergency-driving session. Motion sickness susceptibility prior to experimental exposure was assessed using the MSSQ-short (Golding, 2006b). The MSSQ-short was administered during the baseline assessment to characterize participants’ self-reported childhood and adult susceptibility to MS and to describe the study population rather than as a primary outcome measure. In addition to questionnaire-based outcomes, completion of the standardized VR protocol was recorded as a descriptive feasibility outcome.

Statistical analysis

Statistical analyses were performed separately according to the three experiments. For Experiment 1, descriptive statistics were used to summarize MSAQ scores following VR exposure, and scores were compared between police officers and controls using the Mann-Whitney U test. For Experiment 2, MSAQ scores obtained following VR exposure and real-life emergency driving were compared within police officers using the Wilcoxon signed-rank test. For Experiment 3, MSAQ scores from the initial and repeated VR sessions were compared descriptively because the small sample size precluded formal statistical inference. Data normality was assessed using the Shapiro-Wilk test. Effect sizes (Hedges’ g) and 95% confidence intervals were calculated for the comparative analyses. No adjustment for multiple comparisons was performed. Statistical significance was defined as p < 0.05, although p-values were interpreted descriptively rather than as confirmatory evidence.

Results are presented according to the three experiments described in the Methods section.

Demographic

Baseline demographic characteristics are summarized in Table 1. No clinically meaningful differences between groups were observed.

Experiment 1: VR-induced motion sickness

The VR-based setup induced MS-like symptoms across participants. For descriptive purposes, the total MSAQ scores were grouped into equal-range categories: no MS (16), mild MS (17–56), moderate MS (57–96), or severe MS (97–144) (Figure 2A). These thresholds were not clinically validated and should be regarded cautiously. Participants were additionally grouped based on self-reported MS susceptibility. Police officers were categorized according to whether they had experienced MS during emergency driving in EVs, while controls were grouped based on whether they reported experiencing MS in daily life.

Among participants without self-reported MS, most remained below the moderate threshold (police: 4/5; controls: 8/9). Among those reporting susceptibility, only a minority exceeded the moderate threshold (police: 2/11; controls: 1/7). The agreement between self-reported susceptibility and observed symptom severity appeared to be partial. Only one police officer who reported no MS exceeded the moderate MS threshold during VR exposure, and a similar pattern was observed in the control group. Overall, most participants who reported MS did not exceed the moderate MS threshold during the simulation. Furthermore, MSSQ suggested a modest positive association with MSAQ symptom severity in both groups (police: R 2 = 0.306, b = 1.53, a = 27.76; controls: R 2 = 0.237, b = 1.19, a = 25.61), although the sample size is limited (Supplementary Figure 1). Additionally, mean domain-specific MSAQ scores (gastrointestinal (G), central (C), sopite-related (S), and peripheral (P)) and total scores are shown in Figure 2B. No significant differences were observed between police officers and controls in any MSAQ domain when using the Mann-Whitney U test. Mean differences were generally small, as [95% CI] were compared. Mean differences [95% CI] were gastrointestinal, 1.19 [-4.42, 6.79]; central, 2.12 [-3.99, 8.24]; sopite, −0.38 [-3.29, 2.54]; peripheral, 2.19 [-1.93, 6.30]; total, 5.12 [-11.72, 21.97]. The mean differences for MSAQ are for most of the domain-specific positive, indicating that police officers scored higher in the MSAQ when exposed to VR stimulus. Corresponding Hedges’ g values were 0.15, 0.25, −0.09, 0.38, and 0.21, respectively. Police officers demonstrated slightly higher mean scores across all symptom domains compared with controls, with the largest differences observed for peripheral and central symptoms. Additionally, total MSAQ scores were comparable between groups.

Experiment 2: VR versus real-life emergency driving

Mean domain-specific and total MSAQ scores for police officers during emergency driving in EVs are presented in Figure 2C. These values were compared with scores obtained during VR exposure. No significant difference was detected between VR and emergency driving when using the Wilcoxon signed rank test. VR simulation produced slightly higher mean scores across all domains and in the total score relative to EV emergency driving. Mean differences [95% CI] were: gastrointestinal, 2.94 [-1.99, 7.87]; central, 3.31 [-2.55, 9.17]; sopite, 0.25 [-2.08, 2.58]; peripheral, 2.25 [-1.30, 5.80]; total, 8.75 [-6.37, 23.87]. Positive mean differences show that police officers scored higher in MSAQ when exposed to VR stimulus during emergency driving in EV. Corresponding Hedges’ g values were 0.35, 0.37, 0.07, 0.37, and 0.35, respectively.

Experiment 3: reproducibility of VR-induced motion sickness

A total of six participants (five controls, one police officer) underwent VR stimulation twice with at least a 2-week interval during which no training with EV driving occurred (three control participants without subjective MS; two control participants with subjective MS as well as one police officer with subjective MS). Total and domain MSAQ scores after the initial test and the re-test are shown in Figure 3. Overall, the re-tests were very similar to the initial tests. The differences between the initial test and the re-test were −5, −7, −1, 0, 14 and −10 for C3, C4, C10, C13, C16 and PO14, respectively (Negative differences indicate lower MSAQ scores on the re-test, whereas positive differences indicate higher scores).

The present study aimed to elucidate whether a VR simulation could induce MS similar to that experienced during real-life emergency driving in an EV. The findings demonstrate that the VR protocol could induce measurable MS symptoms. Although symptoms were slightly to moderately elevated compared to those observed after emergency driving, this exploratory study was not powered to establish equivalence. This serves as a preliminary indication that immersive VR may represent a feasible method for investigating MS responses relevant to emergency vehicle operation in police work, while avoiding the safety risks and variability associated with real-life emergency driving.

Experiment 1: VR-induced motion sickness

The police officers and the control group appeared similar with respect to the characteristics presented in Table 1, including MSSQ-short child and adult scores, indicating similar baseline susceptibility to MS. As illustrated in Figure 2A, VR-induced MS showed only partial agreement with self-perceived susceptibility. While most police officers and participants from the control group, who reported no susceptibility, remained asymptomatic or developed only mild symptoms according to MSAQ results. Two nevertheless, experienced moderate MS during VR exposure (based on severity thresholds). Conversely, some participants who reported susceptibility only reached the mild symptom category, whereas moderate symptom scores occurred among individuals who did not consider themselves MS-prone. The observed findings suggest that self-perceived susceptibility may not reliably predict symptom severity, possibly reflecting the inherent limitations of self-report measures and variation in prior exposure to MS-inducing situations.

Police officers may have greater experience with intense vehicle motion and may therefore be more familiar with recognizing their own MS susceptibility. Additionally, occupational factors may influence symptom reporting, as police officers could underreport milder symptoms. Conversely, control participants without MS experience may report symptoms during VR exposure that they have not previously encountered, given the more provocative nature of the stimulus. The two cohorts may therefore differ in symptom perception and reporting. Moreover, it is well established that any individuals with an intact vestibular system may develop MS when exposed to sufficiently strong stimuli (Golding, 2006a). Consequently, simulator-based induction may provide additional information beyond self-reported susceptibility. In line with these observations, Supplementary Figure 1 suggests a possible positive association between MSSQ-short scores and MSAQ scores following VR tests. The fitted linear regression models indicate a modest proportion of explained variance, pointing to considerable variability not captured by MSSQ-short score alone. The positive slopes suggest a trend toward greater MSSQ-predicted susceptibility being associated with higher MSAQ-reported MS symptoms. The intercepts were greater than the minimum MSAQ-score (16), suggesting that MSSQ may not capture baseline symptom reporting. These patterns suggest that self-reported susceptibility has some relevance for experienced symptoms, while also highlighting the potential influence of additional factors. However, these findings should be interpreted cautiously due to the small sample size.

As shown in Figure 2B, the exploratory comparison with matched controls did not identify any clear between-group differences, although the study was not sufficiently powered for equivalence analysis. This may reflect that the simulated emergency driving scenario could induce measurable MS symptoms independent of occupational background or experience. Suggesting that the setup can be a feasible method for MS induction in other occupational contexts other than police work. Police officers demonstrated slightly higher mean scores than the control group across most of the domains and the total score. However, the small Hedges’ g values (g < 0.3) suggest that any true group differences are likely to be small. Furthermore, all 95% CIs included zero, indicating that the observed differences were compatible with no true difference between the police officers and the control group. The relatively wide 95% CIs indicate substantial uncertainty around the estimates, limiting the precision of these findings. Thus, validation of these preliminary findings is needed.

Experiment 2: VR versus real-life emergency driving

The data in Figure 2C show that VR-induced MS symptoms were of a similar numerical magnitude, if not slightly higher than those elicited during emergency driving in an EV. The small to moderate Hedges’ g values (g < 0.4) suggest that any true differences are rather small or modest. Though all CI included zero, the fact that the mean differences were consistently positive for the domain and total scores and that CI were predominantly distributed towards positive values suggests compatibility with a small to moderate difference with substantial overlap. The 95% CI appeared to be relatively broad, so these assessments are cautious.

Furthermore, no significant differences were observed in domain or total MSAQ scores. However, the absence of statistical differences should not be interpreted as evidence of equivalence, particularly given the limited sample size (N = 16). Previous studies have reported similar symptom profiles between VR-induced and physically induced MS, as well as between visually induced MS and symptoms experienced during vehicle motion (Gavgani et al., 2018; Irmak et al., 2025). Although these studies did not involve emergency driving, they support the rationale for investigating VR as a potential experimental analogue. As mentioned in Section 2.3.2, data from police officers who performed emergency driving on public roads and officers who drove on the closed track were pooled, which introduces some heterogeneity. Additionally, no objective measures were obtained on the driving dynamics during emergency driving, making it difficult to comment on the variability of vehicle movement between trials. Together, this means that conclusions on the comparability between VR and real-life emergency driving should be cautious.

Mean MSAQ scores were slightly higher during VR exposure, suggesting that the simulation may induce somewhat stronger symptoms. While this difference was not statistically significant, stronger stimulus in VR could be advantageous in controlled laboratory settings where rapid symptom induction facilitates the investigation of MS mechanisms and habituation. At the same time, excessive stimulus intensity may reduce participant compliance (Irmak et al., 2022; McCauley et al., 1976).

The literature remains inconsistent with regard to induced MS and MS caused by real-life driving. Talsma et al. (2023), for example, reported less severe MS in a motion-based simulator than during real-life driving. Such discrepancies may reflect differences in simulator configuration, induction protocols, and experimental conditions, all of which are known to influence VR-induced MS (Koohestani et al., 2019; Simón-Vicente et al., 2024). Larger studies are therefore needed to determine whether immersive VR driving simulators can serve as reliable analogues for real-life emergency driving.

Experiment 3: reproducibility of VR-induced motion sickness

The results presented in Figure 3 show that the preliminary repeat testing suggests broadly similar symptoms across repeated exposures. This was observed for both participants who had exhibited signs of MS previously and those who did not. With N = 6, the study is underpowered to reliably detect potentially meaningful differences, and due to the absence of any statistical analysis, the results should not be interpreted as evidence of equivalence or stability. Consequently, although the findings reflect the possibility that the VR simulation may elicit similar responses upon re-test, this interpretation remains tentative.

Strengths and limitations

This study employed the MSAQ for assessing MS symptoms. Although the MSAQ provides a practical means of assessing MS symptoms, it relies on self-reporting and is therefore inherently subjective. Perceived symptom severity may differ substantially between participants, limiting the precision of severity-related conclusions. Objective physiological measures, including electrocardiography, electrogastrography, heart rate, blood pressure, and body temperature, have been explored as potential indicators of MS (Koohestani et al., 2019). However, current evidence shows inconsistent correlations with subjective symptom severity (Irmak et al., 2021), and the required equipment and protocols were not feasible within the present study. Consequently, the MSAQ was selected as the most practical and reliable method available for MS assessment.

Five police officers completed the MSAQ following real-life emergency driving on public roads rather than the closed-track testing because of scheduling constraints. Although officers were instructed to complete the MSAQ within 30 min of exposure, this could not always be ensured during operational police work, potentially affecting comparability between public-road and closed-track assessments. Furthermore, closed-track testing differs from real emergency driving in several respects, including operational stress, braking intensity, and engagement in non-driving passenger tasks. Such tasks - particularly map reading and communication - are common during police emergency driving and may increase MS risk (Dam and Jeon, 2026; Kato and Kitazaki, 2008). Pooling data from closed-track and public-road settings may therefore have introduced additional variability in MSAQ scores. Thus, the heterogeneity limits the direct comparison of VR and real-life emergency driving. Furthermore, the limited sample size restricts meaningful subgroup analysis. Another procedural limitation is that participants were able to terminate the VR simulation prematurely if symptoms became intolerable; however, this was not possible during the real-life emergency driving due to safety constraints. Future studies should employ standardized closed-track exposure for all participants and incorporate controlled non-driving passenger tasks to better emulate operational emergency-driving conditions.

Although the VR protocol was motivated by reports of MS experienced during emergency driving in EVs specifically, the simulator was not designed to capture EV-specific driving dynamics. Rather, the VR setup was constructed to reproduce the broader visual and cognitive stimulus of emergency driving, such as acceleration/deceleration, sharp turns and visual-vestibular mismatch. Consequently, the findings of the study should be interpreted as reflective of emergency driving related MS in an EV-operational context, rather than an EV-specific biomechanical simulation. Future studies should strive to capture the EV-specific driving dynamics in VR simulation to examine the relationship between EVs and MS.

Psychological factors may influence both the occurrence and perception of MS symptoms (Golding, 2006a; Grassini et al., 2021). Participants may have expected stronger symptoms during VR exposure, particularly if the simulator was perceived as designed to induce MS. Expectation effects have previously been shown to modify susceptibility; positive expectations may reduce seasickness (Eden and Zuk, 1995), whereas negative expectations may increase symptom severity. Such effects could partly explain the numerically higher MSAQ scores observed during VR compared with real-life emergency driving.

Cognitive influences may be particularly relevant in VR, where the artificial environment may amplify expectancy effects. Consistent with this, a lower sense of presence has been associated with increased cybersickness (Weech et al., 2019). However, findings remain inconsistent; Williamson et al. (2004) reported that stronger negative expectations were associated with reduced symptom severity, possibly reflecting adaptive coping or anticipatory regulation. Psychological expectancy was not assessed in the present study and should be considered in future research.

Despite these limitations, this study demonstrates that the applied VR setup is a feasible method for inducing MS, thus, establishing a methodological foundation for future research. Furthermore, these results suggest that VR-induced MS may be broadly comparable to that elicited during emergency driving. Additionally, the test-retest results suggest that the VR setup is reproducible. If confirmed, these preliminary findings may imply that VR can be a practical tool for managing MS and justify larger future studies for further validation.

Practical implications

These preliminary findings demonstrate that the VR protocol can feasibly induce measurable MS symptoms under standardized laboratory conditions. Whether these findings accurately represent emergency driving MS requires confirmation in larger validation studies. If this hypothesis is validated through further studies, it may imply several applied uses. If VR proves to be an appropriate analogue to emergency driving, it may enable standardized and safe assessment of MS in professional drivers without exposing them to unnecessary traffic-related risks. It may further serve as a screening tool for MS susceptibility among personnel during fleet electrification or in clinical contexts. Such paradigms may also enable habituation-based interventions for MS during regular driving or emergency driving, although the sensory stimulation of VR and real-life driving differs. Future studies are needed to determine whether repeated exposure to this type of VR simulation leads to habituation over time and whether any such effects transfer to real-life emergency driving. The inclusion of motion platforms providing vestibular stimulation may also help to more closely approximate real driving conditions and could be explored to improve simulator realism.

In conclusion, the VR setup in this feasibility study was able to elicit MS in both the police officers and the control group, according to MSAQ scores. The MSAQ response between the VR setup and following emergency driving in an EV showed a small to moderate difference but did not deviate significantly from each other, and the 95% CIs of the mean differences spanned zero. Being a proof-of-concept study, the sample size was small, resulting in rather wide 95% CIs. However, the preliminary findings of this study may justify large-scale studies in the future as they lay a methodological groundwork, and they have valuable practical implications if verified. If these findings are validated, VR simulation may serve as a practical and safe platform for investigating and managing MS in clinical and professional driving contexts. Furthermore, the observed potential for reproducibility serves as an indication that VR may enable controlled MS exposure, thereby supporting its potential use in MS habituation protocols.