Background & Aims
Chronic low back pain (CLBP) is one of the world’s most prevalent chronic pain conditions and a leading global contributor to disability. Fear of movement (i.e., kinesiophobia) due to expectations of pain and harm is an important risk indicator for the development of persistent pain and disability, with studies consistently showing that high fear is one of the strongest predictors of the transition from sub-acute to chronic low back pain. Using our standardized reaching tasks, we have repeatedly demonstrated reduced lumbar spine flexion in fearful acute, sub-acute, and CLBP sufferers. Virtual immersive gaming to optimize recovery in chronic back pain (VIGOR) was a Phase II RCT to assess a novel virtual reality (VR) dodgeball game to reduce pain and disability and increase lumbar motion in participants with chronic low back pain.
Methods
The VIGOR trial began January 2019 and was paused for four months during the COVID pandemic, resulting in unavoidable per-protocol dismissal of ongoing participants due to extended delays between treatment sessions. At pre-treatment baseline, the final sample of 145 men and women with CLBP had a mean age of 39.5 years (SD = 12.5; Range = 18-60), reported an average 7-day back pain intensity of 5.6 (SD = 1.9) on a 0 to 10 scale, and had significant pain-related impairment as indicated by a mean Roland-Morris Disability Questionnaire score of 12.9 (SD=5.4). The trial included a 9-week (18 session) virtual reality dodgeball intervention, wherein participants were randomly assigned to either an experimental group (VR game that promoted progressive increases in lumbar flexion) or a control group (same VR game, but smaller increases in lumbar flexion were promoted). Follow-up assessments were conducted at 1-, 12-, 24-, and 48-weeks post-intervention.
Results
Comparison of changes in back pain ratings on a 0 “no pain” to 10 “pain as bad as it could be” scale from session 1 (pre-treatment baseline) to session 20 (1-week post-treatment) revealed significant reductions of 32.7% for pain in the last 24 hours (F = 70.962, p<.001; ?p2= .399) and 37.4% for pain in the last week (F = 119.766, p<.001; ?p2= .528). Similarly, examination of session 1 to 20 changes in disability ratings revealed significant decreases in Brief Pain Inventory Pain Interference of 32.4% (F = 75.335, p<.001; ?p2= .413) and Roland-Morris Disability Questionnaire scores of 31.5% (F = 72.840, p<.001; ?p2= .412) that did not differ by group. Virtual dodgeball was also associated with significant reductions in kinesiophobia (F = 65.031, p<.001; ?p2= .380) and pain catastrophizing (F = 35.169, p<.001; ?p2= .247), and significant increases in pain-related self-efficacy (F = 15.876, p<.001; ?p2= .129).
Conclusions
VIGOR accomplished its goal of encouraging participant motion, and particularly lumbar flexion. Because all participants were assigned to 18 game sessions, with 90 trunk flexions per session, in retrospect it is not surprising that both groups also showed meaningful improvements. Specifically, when comparing the control and experimental conditions, an equivalent frequency of physical activation may have been sufficient to achieve the same clinical outcomes despite different lumbar flexion levels. While the fact that we observed improvement in both groups does not allow us to rule out potential non-specific effects in the observed outcomes (e.g., enhanced expectancy, treatment-related socialization), given the documented severity, chronicity, and prior efforts at seeking medical treatment among our sample, we posit that the observed outcomes are more likely to be related to increased activity and enhanced coping than to other factors.
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8977691
Presenting Author
James S. Thomas
Poster Authors
Topics
- Specific Pain Conditions/Pain in Specific Populations: Low Back Pain