Background & Aims
Acute orthopedic traumatic musculoskeletal injuries (e.g., fractures, dislocations) are painful and a leading cause of adult hospitalizations. [1] Psychological factors (pain catastrophizing and anxiety) increase the risk for disability and pain regardless of the severity, location, or type of injury. [2] Yet, there are no evidence-based interventions to mitigate these risk factors and prevent persistent pain after acute orthopedic injury. To address this gap, our mixed methods pilot study aimed to assess the feasibility and preliminary efficacy of a therapeutic Virtual Reality (VR) that combines mindfulness and cognitive behavioral therapy to promote pain self-management after injury. We aimed to: (1) evaluate the feasibility and acceptability of an FDA-authorized VR (RelieVRx) [3-5] in a home-based setting; (2) examine its impact on pain, physical function, sleep, depression, and coping; and (3) gather qualitative insights into patient experiences and perceived benefits of the VR.
Methods
We enrolled 10 adults (M age = 46.8) with a recent (? 2 months) orthopedic injury and significant pain catastrophizing or anxiety (PASS-20 ? 40; PCS-13 ? 20). Participants were referred by orthopedic surgeons within the Mass General Brigham healthcare system in Boston, USA. We excluded patients with chronic pain, VR contraindications (e.g., epilepsy), severe medical (e.g., cancer) and psychiatric (e.g., schizophrenia) comorbidities, and confounding treatments (e.g., CBT). Participants completed 1 VR session per day at home for 8 weeks. The VR was self-administered in a sequence of pain education, relaxation, mindfulness, distraction games, and dynamic breathing biofeedback sessions. The primary outcomes were feasibility, appropriateness, acceptability, satisfaction, and safety of VR following established benchmarks. [6–11] Secondary outcomes were pre-post measures of pain, physical function, sleep, depression, and coping. Qualitative data were gathered via individual exit interviews.
Results
Feasibility of recruitment and enrollment (83%), credibility (80%), expectancy (90%), satisfaction (90%), acceptability (100% VR completers), usability (80% scored over System Usability Scale cutoff), data collection (100%), and safety (no serious adverse events or motion sickness) met or exceeded benchmarks. VR was associated with large and clinically significant improvements in pain intensity (-3.40, p < 0.001), DVPRS pain interference (-3.90, ps < .001), PASS-20 pain anxiety (-32.70, p = 0.001), PCS-13 pain catastrophizing (-16.40, p = 0.003), PROMIS physical functioning (7.94, p < 0.001), PROMIS sleep disturbance (-10.59, p = 0.02), CESD depression (-9.10, p = 0.003), PSEQ pain self-efficacy (15.40, p = 0.008), CAMS-R mindfulness (3.29, p = 0.01), and MOCS coping (0.59, p = 0.01). Exit interviews confirmed positive user experiences with VR, emphasizing its role in enhancing pain management skills, promoting physical therapy engagement, and improving sleep quality.
Conclusions
VR was a highly feasible and acceptable intervention for patients to self-administer at home after orthopedic injury. Improvements in pain, physical function, sleep, and depression demonstrate the potential efficacy of VR. Corresponding improvements in pain self-efficacy, mindfulness, and general coping suggest that VR engages multiple mechanisms of recovery. Participants’ positive experiences and feedback underscore VR’s role in enhancing coping skills. Fully-powered RCTs are needed to confirm efficacy and determine whether VR can reduce pain chronification after injury. Investigating VR’s role in diverse populations and different stages of injury recovery will further determine its applicability in orthopedic care. The findings, while preliminary, have immediate clinical implications for guiding VR into early pain management strategies in orthopedic care, potentially reducing reliance on pharmacological treatments.
References
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6.Lester EG, Hopkins SW, Popok PJ, Vranceanu AM. Adaptation of a Live Video Mind-Body Program to a Web-Based Platform for English-Speaking Adults With Neurofibromatosis: Protocol for the NF-Web Study. JMIR Res Protoc. 2021;10(6):e27526. doi:10.2196/27526
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8.Jacobs CA, Mace RA, Greenberg J, et al. Development of a mind body program for obese knee osteoarthritis patients with comorbid depression. Contemp Clin Trials Commun. 2021;21(January):100720. doi:10.1016/j.conctc.2021.100720
9.Lester E, DiStefano S, Mace R, Macklin E, Plotkin S, Vranceanu AM. Virtual mind-body treatment for geographically diverse youth with neurofibromatosis: A pilot randomized controlled trial. Gen Hosp Psychiatry. 2020;62:72-78. doi:10.1016/j.genhosppsych.2019.12.001
10.Mace R, Greenberg J, Stauder M, Reynolds G, Vranceanu A. My Healthy Brain: A multimodal lifestyle program to promote brain health. Aging Ment Health. Published online 2021.
11.Mace RA, Doorley JD, Popok PJ, Vranceanu AM. Live Video Adaptations to a Mind-Body Activity Program for Chronic Pain and Cognitive Decline: Protocol for the Virtual Active Brains Study. JMIR Res Protoc. 2021;10(1):e25351. doi:10.2196/25351
Presenting Author
Ryan Mace
Poster Authors
Topics
- Novel Experimental/Analytic Approaches/Tools