Changing the physical environment of healthcare facilities can positively impact patient outcomes. Virtual reality (VR) offers the potential to understand how healthcare environment design impacts users’ perception, particularly among those with brain injuries like stroke, an area with limited research. In this study, our objective was to forge a new pathway in healthcare environment research by developing a comprehensive, six-module ‘user-centered’ design decision support approach, utilizing VR technology. This innovative method integrated patient engagement, architectural design principles, BIM prototyping, and a sophisticated VR user interface to produce realistic and immersive healthcare scenarios. Forty-four stroke survivors participated, experiencing 32 VR scenarios of in-patient bedrooms, followed by interactive in-VR questions and semi-structured interviews. The results of the approach proved to be comparatively efficient and feasible, provided a high level of immersion and presence for the participants, and effectively elicited extremely rich quantifiable response data, which revealed distinct environmental preferences. Our novel approach to understanding end-user responses to stroke rehabilitation architecture demonstrates potential to inform user-centered evidence-based design decisions in healthcare, to improve user experiences and health outcomes in other healthcare populations and environments.

Objectives: This study explores stroke rehabilitation facility design in Australia, identifying the key design typologies at multiple scales and assessing them against the critical design criteria for stroke rehabilitation. Background: The physical environment plays a crucial role in stroke rehabilitation, affecting patient recovery and well-being. However, limited research examines how design can support therapeutic outcomes in these facilities. Method: From a systematic review of 257 Australian stroke rehabilitation facilities, 30 were selected for detailed design review, with an in-depth room-level analysis conducted for 10. Using the modified PRISMA framework and a typology analysis approach, this study integrates architectural precedent with clinical research methods. Results: Typologies were identified at the site, building, ward, and room levels. Acute hospital wards (53%) and ‘blocks’ (73%) were the most common site and building arrangements, respectively. At the ward level, ‘racetrack with courtyard’ layouts enhanced natural light, views, and access to landscaped areas. A room-level analysis revealed limited innovation, with most rooms adhering to standard designs, though some adaptations improved visual connectivity and personal control. Hybrid nurse stations and courtyards supported efficiency, social interaction, and therapeutic stimulation. Conclusions: This study highlights the user-centred design strategies tailored to stroke patients’ needs and the importance of evidence-based approaches prioritising well-being. Future research should incorporate 3D spatial analysis for actionable design recommendations.