{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T18:14:17Z","timestamp":1788459257188,"version":"build-2803163510"},"reference-count":50,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["1154904"],"award-info":[{"award-number":["1154904"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"name":"the Felton Bequest"},{"DOI":"10.13039\/501100001782","name":"the University of Melbourne","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100001782","id-type":"DOI","asserted-by":"crossref"}]},{"name":"the Victorian government"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>Stroke is a leading cause of disability worldwide, and stroke rehabilitation plays a critical role in recovery. Early rehabilitation often occurs in a hospital setting, but the hospital built environment is rarely designed to support the specific needs and priorities of people who have had a stroke. In recent decades, there has been an ongoing debate regarding the benefits of single versus multi-bed rooms in healthcare settings. This debate centres around balancing privacy and rest, with social interaction and safety. While single rooms may be beneficial for some people, multi-bed rooms may be better for others. Both options, however, come with their own set of drawbacks in the context of stroke rehabilitation. In this study, we conducted a collaborative Living Lab to design a series of provocative-prototype hybrid room typologies that merged different aspects of single and multi-bed rooms to provide options specific for stroke rehabilitation. These typologies were used to generate four alternative bedroom designs which were modelled in virtual reality. The designs were informed by a values-based brief, outlining a set of predefined key criteria for optimising stroke rehabilitation environments: opportunities for activity and rest, wellbeing, safety, efficiency, flexibility, personal control, access to outdoors and green space, and access to a positive and stimulating environment. Twenty lived-experience and professional experts evaluated these virtual designs against the predefined values-based criteria. Evaluation revealed two preferred hybrid hospital room designs that incorporated beneficial features of both multi-bed and single-bed rooms. Our approach of values-based design and evaluation within a virtual environment proved an effective means of generating and evaluating design options with meaningful input from a wide range of stakeholders. These findings highlight the potential for flexible and adaptable room design to meet the specific needs and priorities of people participating in early-stage rehabilitation after stroke.<\/jats:p>","DOI":"10.1371\/journal.pone.0356623","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T17:26:41Z","timestamp":1788456401000},"page":"e0356623","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Ending the single versus multi-bedroom debate: Hybrid rooms meet stroke rehabilitation needs"],"prefix":"10.1371","volume":"21","author":[{"given":"Marcus","family":"White","sequence":"first","affiliation":[{"name":"STR\u00dcDAL, Centre for Design Innovation, Swinburne University of Technology","place":["Hawthorn, Victoria, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-9226-2882","authenticated-orcid":true,"given":"Mark Huen Choong","family":"Lam","sequence":"additional","affiliation":[{"name":"STR\u00dcDAL, Centre for Design Innovation, Swinburne University of Technology","place":["Hawthorn, Victoria, Australia"]},{"name":"Building and Planning, The University of Melbourne","place":["Victoria, Australia"],"department":["Faculty of Architecture"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tianyi","family":"Yang","sequence":"additional","affiliation":[{"name":"STR\u00dcDAL, Centre for Design Innovation, Swinburne University of Technology","place":["Hawthorn, Victoria, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruby","family":"Lipson-Smith","sequence":"additional","affiliation":[{"name":"Building and Planning, The University of Melbourne","place":["Victoria, Australia"],"department":["Faculty of Architecture"]},{"name":"The Florey Institute of Neuroscience and Mental Health","place":["Heidelberg, Victoria, Australia"]},{"name":"The MARCS Institute for Brain, Behaviour and Development, Western Sydney University","place":["Westmead, New South Wales, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5483-3559","authenticated-orcid":true,"given":"Juan Pablo","family":"Saa","sequence":"additional","affiliation":[{"name":"The Florey Institute of Neuroscience and Mental Health","place":["Heidelberg, Victoria, Australia"]},{"name":"La Trobe University","place":["Bundoora, Victoria, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron","family":"Davis","sequence":"additional","affiliation":[{"name":"The University of South Australia, UniSA Creative","place":["Adelaide, South Australia, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehrnoush Latifi","family":"Khorasgani","sequence":"additional","affiliation":[{"name":"STR\u00dcDAL, Centre for Design Innovation, Swinburne University of Technology","place":["Hawthorn, Victoria, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2787-8484","authenticated-orcid":true,"given":"Julie","family":"Bernhardt","sequence":"additional","affiliation":[{"name":"The Florey Institute of Neuroscience and Mental Health","place":["Heidelberg, Victoria, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of NOVELL Redesign","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,9,3]]},"reference":[{"issue":"9913","key":"pone.0356623.ref001","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1016\/S0140-6736(13)61953-4","article-title":"Global and regional burden of stroke during 1990-2010: findings from the Global Burden of Disease Study 2010","volume":"383","author":"VL Feigin","year":"2014","journal-title":"Lancet"},{"key":"pone.0356623.ref002","volume-title":"The economic impact of stroke report 2024","year":"2024"},{"key":"pone.0356623.ref003","volume-title":"National stroke audit\u2013rehabilitation services report","author":"Stroke Foundation","year":"2018"},{"issue":"6","key":"pone.0356623.ref004","doi-asserted-by":"crossref","DOI":"10.1161\/STR.0000000000000098","article-title":"Guidelines for adult stroke rehabilitation and recovery: a guideline for healthcare professionals from the American Heart Association\/American Stroke Association","volume":"47","author":"CJ Winstein","year":"2016","journal-title":"Stroke"},{"issue":"9778","key":"pone.0356623.ref005","doi-asserted-by":"crossref","first-page":"1693","DOI":"10.1016\/S0140-6736(11)60325-5","article-title":"Stroke rehabilitation","volume":"377","author":"P Langhorne","year":"2011","journal-title":"Lancet"},{"key":"pone.0356623.ref006","volume-title":"Clinical guidelines for stroke management","author":"Stroke Foundation","year":"2022"},{"issue":"3","key":"pone.0356623.ref007","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1177\/193758670800100306","article-title":"A review of the research literature on evidence-based healthcare design","volume":"1","author":"RS Ulrich","year":"2008","journal-title":"HERD"},{"issue":"12","key":"pone.0356623.ref008","doi-asserted-by":"crossref","first-page":"2796","DOI":"10.1111\/jan.13281","article-title":"A systematic review of the psychometric properties of instruments for assessing the quality of the physical environment in healthcare","volume":"73","author":"M Elf","year":"2017","journal-title":"J Adv Nurs"},{"issue":"4","key":"pone.0356623.ref009","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1177\/17474930211042485","article-title":"Why hospital design matters: a narrative review of built environments research relevant to stroke care","volume":"17","author":"J Bernhardt","year":"2022","journal-title":"Int J Stroke"},{"issue":"8","key":"pone.0356623.ref010","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2021-050247","article-title":"Built environments for inpatient stroke rehabilitation services and care: a systematic literature review","volume":"11","author":"R Lipson-Smith","year":"2021","journal-title":"BMJ Open"},{"issue":"4","key":"pone.0356623.ref011","first-page":"186","article-title":"Nature-based design in stroke rehabilitation environments: a scoping review","volume":"17","author":"B Seale","year":"2024","journal-title":"Health Environ Res Des"},{"issue":"3","key":"pone.0356623.ref012","first-page":"95","article-title":"Economic argument for innovative design from valuing patient-centered stroke rehabilitation","volume":"18","author":"R Kerr","year":"2025","journal-title":"Health Environ Res Des"},{"issue":"12","key":"pone.0356623.ref013","doi-asserted-by":"crossref","first-page":"3968","DOI":"10.3390\/buildings14123968","article-title":"The state of stroke rehabilitation design in australia: a multi-scalar systematic architecture precedent review","volume":"14","author":"T Yang","year":"2024","journal-title":"Buildings"},{"issue":"6","key":"pone.0356623.ref014","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0280690","article-title":"The role of the physical environment in stroke recovery: Evidence-based design principles from a mixed-methods multiple case study","volume":"18","author":"R Lipson-Smith","year":"2023","journal-title":"PLoS One"},{"issue":"4","key":"pone.0356623.ref015","first-page":"96","article-title":"Stroke Patients\u2019 free-time activities and spatial preferences during inpatient recovery in rehabilitation centers","volume":"15","author":"M Kevdzija","year":"2022","journal-title":"Health Environ Res Des"},{"key":"pone.0356623.ref016","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.f5695","article-title":"Should hospitals provide all patients with single rooms?","volume":"347","author":"H Pennington","year":"2013","journal-title":"BMJ"},{"key":"pone.0356623.ref017","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1080\/17508975.2013.764838","article-title":"Physical characteristics of the indoor environment that affect health and wellbeing in healthcare facilities: a review","volume":"5","author":"H Salonen","year":"2013","journal-title":"Intelligent Buildings International"},{"key":"pone.0356623.ref018","first-page":"421","article-title":"Quality of the hospital experience: impact of the physical environment","volume-title":"International handbooks of quality-of-life","author":"AS Devlin","year":"2016"},{"key":"pone.0356623.ref019","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1080\/17508975.2018.1548339","article-title":"Bringing the single versus multi-patient room debate to vulnerable patient populations: a systematic review of the impact of room types on hospitalized older people and people with neurological disorders","volume":"12","author":"MM Shannon","year":"2020","journal-title":"Intell Build Int"},{"key":"pone.0356623.ref020","unstructured":"Daemen E. The design of an adaptive healing room for stroke patients. 2017."},{"key":"pone.0356623.ref021","volume-title":"Value-focused thinking: a path to creative decisionmaking","author":"RL Keenley","year":"2009"},{"issue":"4","key":"pone.0356623.ref022","first-page":"85","article-title":"Design ideas for inpatient stroke rehabilitation facilities: living lab findings","volume":"18","author":"R Lipson-Smith","year":"2025","journal-title":"Health Environ Res Des"},{"issue":"4","key":"pone.0356623.ref023","first-page":"142","article-title":"A framework for designing inpatient stroke rehabilitation facilities: a new approach using interdisciplinary value-focused thinking","volume":"12","author":"R Lipson-Smith","year":"2019","journal-title":"Health Environ Res Des"},{"key":"pone.0356623.ref024","volume-title":"Speculative everything: design, fiction, and social dreaming","author":"A Dunne","year":"2013"},{"key":"pone.0356623.ref025","first-page":"86","volume-title":"Urbanism up to 11 \u2013 a design studio of extremes","author":"M White","year":"2013"},{"issue":"2","key":"pone.0356623.ref026","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1080\/15710882.2013.788193","article-title":"Challenging industry conceptions with provotypes","volume":"9","author":"L Boer","year":"2013","journal-title":"CoDesign"},{"key":"pone.0356623.ref027","unstructured":"Smith ND. Design charrette: a vehicle for consultation or collaboration?. 2012."},{"key":"pone.0356623.ref028","unstructured":"Cramer HL, Wehking RJ. Charretting the planning process. 1973. https:\/\/eric.ed.gov\/?id=ED084681"},{"key":"pone.0356623.ref029","first-page":"15","article-title":"The Design Charrette","volume-title":"The Design Charrette","author":"R Roggema","year":"2013"},{"key":"pone.0356623.ref030","first-page":"155","article-title":"A ladder-truss of citizen participation: re-imagining Arnstein\u2019s ladder to bridge between the community and sustainable urban design outcomes","volume":"19","author":"M White","year":"2021","journal-title":"J Des Res"},{"key":"pone.0356623.ref031","doi-asserted-by":"crossref","unstructured":"Boer L, Donovan J. Provotypes for participatory innovation. In: Proceedings of the designing interactive systems conference. 2012. 388\u201397. https:\/\/doi.org\/10.1145\/2317956.2318014","DOI":"10.1145\/2317956.2318014"},{"key":"pone.0356623.ref032","first-page":"174","article-title":"Quantitative assessment of view from within high density development using a perverted light modelling approach","volume":"8","author":"M White","year":"2016","journal-title":"J Urban Reg Plan"},{"key":"pone.0356623.ref033","unstructured":"Yang T, White M, Lipson-Smith R, Khorasgani ML. Sightlines and visual connection in stroke rehabilitation facilities: a systematic desktop review and evaluation of different facility designs. Melbourne, Australia. 2022."},{"issue":"2","key":"pone.0356623.ref034","doi-asserted-by":"crossref","first-page":"1341","DOI":"10.3390\/ijerph20021341","article-title":"Informing streetscape design with citizen perceptions of safety and place: an immersive virtual environment e-participation method","volume":"20","author":"M White","year":"2023","journal-title":"Int J Environ Res Public Health"},{"issue":"3","key":"pone.0356623.ref035","doi-asserted-by":"crossref","first-page":"797","DOI":"10.3390\/buildings14030797","article-title":"Design decision support for healthcare architecture: a VR-integrated approach for measuring user perception","volume":"14","author":"T Yang","year":"2024","journal-title":"Buildings"},{"issue":"17","key":"pone.0356623.ref036","doi-asserted-by":"crossref","first-page":"4496","DOI":"10.1080\/09638288.2025.2451771","article-title":"Exploration of hospital room design on emotions, activity, and social connections after stroke: a qualitative study of patient experiences using virtual reality","volume":"47","author":"MM Shannon","year":"2025","journal-title":"Disabil Rehabil"},{"key":"pone.0356623.ref037","volume-title":"Multiple criteria decision analysis: an integrated approach","author":"V Belton","year":"2012"},{"key":"pone.0356623.ref038","unstructured":"Data management. Accessed 2026 March 17. https:\/\/www.swinburne.edu.au\/research\/ethics-integrity\/data-management\/"},{"issue":"2","key":"pone.0356623.ref039","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1016\/j.cptl.2020.09.005","article-title":"Using cognitive interviews and think-aloud protocols to understand thought processes","volume":"13","author":"MD Wolcott","year":"2021","journal-title":"Curr Pharm Teach Learn"},{"issue":"103","key":"pone.0356623.ref040","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1177\/039219217802610301","article-title":"Aesthetic paradigms for an urban ecology","volume":"26","author":"A Berleant","year":"1978","journal-title":"Diogenes (Engl ed)"},{"issue":"6","key":"pone.0356623.ref041","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1016\/S0003-9993(99)90171-5","article-title":"Measurement of mood states in stroke patients: validation of the visual analog mood scales","volume":"80","author":"JE Arruda","year":"1999","journal-title":"Arch Phys Med Rehabil"},{"issue":"1","key":"pone.0356623.ref042","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1007\/s10729-006-9003-6","article-title":"A consensus process for identifying a prioritised list of study questions","volume":"10","author":"M Utley","year":"2007","journal-title":"Health Care Manag Sci"},{"key":"pone.0356623.ref043","volume-title":"Australasian Health Facility Guidelines Revision 6.0 - Part A","year":"2016"},{"issue":"4647","key":"pone.0356623.ref044","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1126\/science.6143402","article-title":"View through a window may influence recovery from surgery","volume":"224","author":"RS Ulrich","year":"1984","journal-title":"Science"},{"key":"pone.0356623.ref045","unstructured":"Ulrich RS. Biophilic theory and research for healthcare design. Biophilic Des Theory Sci Pract Bringing Build Life. 2008. p. 87\u2013106."},{"key":"pone.0356623.ref046","doi-asserted-by":"crossref","first-page":"122870","DOI":"10.1016\/j.jns.2024.122870","article-title":"Green space and stroke: a scoping review of the evidence","volume":"457","author":"M Whyte","year":"2024","journal-title":"J Neurol Sci"},{"key":"pone.0356623.ref047","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1007\/978-3-030-37639-0_4","article-title":"Virtual reality design for stroke rehabilitation","volume":"1235","author":"D Charles","year":"2020","journal-title":"Adv Exp Med Biol"},{"issue":"3","key":"pone.0356623.ref048","doi-asserted-by":"crossref","DOI":"10.1136\/gpsych-2019-100061","article-title":"Mental health facility codesign: a new research method for integrating the service user voice in design processes using virtual reality","volume":"32","author":"S Liddicoat","year":"2019","journal-title":"Gen Psychiatr"},{"issue":"2","key":"pone.0356623.ref049","doi-asserted-by":"crossref","first-page":"44","DOI":"10.3390\/computers8020044","article-title":"Use of virtual environment and virtual prototypes in co-design: the case of hospital design","volume":"8","author":"T Tiainen","year":"2019","journal-title":"Computers"},{"issue":"3","key":"pone.0356623.ref050","doi-asserted-by":"crossref","first-page":"797","DOI":"10.3390\/buildings14030797","article-title":"Design decision support for healthcare architecture: a vr-integrated approach for measuring user perception","volume":"14","author":"T Yang","year":"2024","journal-title":"Buildings"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0356623","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T17:26:52Z","timestamp":1788456412000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0356623"}},"subtitle":[],"editor":[{"given":"Ruixin","family":"Liang","sequence":"first","affiliation":[{"name":"The Hong Kong Polytechnic University","place":["HONG KONG"]}],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,9,3]]},"references-count":50,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9,3]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0356623","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,3]]}}}