A Graded Exposure, Locomotion-Enabled Virtual Reality App During Walking and Reaching for Individuals With Chronic Low Back Pain: Cohort Gaming Design

Hennessy, Rebecca White; Rumble, Deanna; Christian, Mike; Brown, David A.; Trost, Zina

doi:10.2196/17799

Cited by 24 publications

(20 citation statements)

References 50 publications

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“…Although all included articles were clinical trials, two were single armed studies, one study acting as a proof-of-concept and the other to further validate its specific VR program. Most (eight out of thirteen) articles justified their chosen sample size ranging from 13 participants ( 14 ), to 179 participants ( 21 ). On average, sample size was approximately 50.…”

Section: Resultsmentioning

confidence: 99%

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Virtual Reality in the Management of Chronic Low Back Pain: A Scoping Review

Nagpal¹,

Raghunandan²,

Tata³

et al. 2022

Front. Pain Res.

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Virtual reality (VR) is a burgeoning treatment option for chronic pain. Its use has been heterogenous in the literature. This scoping review assesses the current literature for the use of VR in the treatment of chronic low back pain (CLBP). The following themes were identified by the analysis: safety and feasibility of VR, quality of life associated with VR treatment for CLBP, efficacy of VR to treat CLBP, and efficacy of VR to treat functional changes associated with CLBP. Gaps were identified after analysis of the extant literature. Although the nascent research uncovered in this scoping review found good evidence for safety and tolerability of VR, more studies of safety, acceptance, and satisfaction are recommended including focused studies of spinal pain risks specific to use of VR. Overall, the methodological quality of studies reviewed in this scoping review was poor and outcomes were limited to short-term posttreatment outcomes.

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Section: Resultsmentioning

confidence: 99%

“…Forty-eight articles were initially identified by this strategy. Thirty articles were then excluded (11 were duplicates, 24 were excluded because they did not meet inclusion criteria), and so 13 total studies were included (14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26).…”

Section: Search Strategymentioning

confidence: 99%

Virtual Reality in the Management of Chronic Low Back Pain: A Scoping Review

Nagpal¹,

Raghunandan²,

Tata³

et al. 2022

Front. Pain Res.

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“…Hennesy et al [ 35 ] undertook a small feasibility trial testing a virtual reality app during walking and reaching for patients with chronic low back pain. In this graded exposure approach to the functional task, they found that patients were able to undertake more difficult tasks over the sessions, measured by rate of perceived exertion, without increasing their pain or fear of movement.…”

Section: Discussionmentioning

confidence: 99%

Virtual Environment Rehabilitation for Patients with Motor Neglect Trial (VERMONT): A Single-Center Randomized Controlled Feasibility Trial

et al. 2021

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Background: Motor neglect occurs in patients with chronic pain conditions. Virtual environments (VE) help rehabilitation through biofeedback and improving motivation. Aim: To assess the feasibility of a VE for patients with motor neglect with chronic pain. Methods: 10 subjects with chronic pain (Fibromyalgia, Sciatica, and Complex Regional Pain Syndrome) underwent a treadmill task three times per week for two weeks. Groups were randomized to receive real-time biofeedback from the VE (intervention) or shown still images (control). Primary outcomes were: (i) distance walked at baseline compared to the final 5 min cycle of week 2; (ii) the Lower Extremity Functional Index (LEFI) questionnaire. A satisfaction questionnaire was used. Follow up was to 24 weeks. Results: Total distance walked was significantly higher in the intervention group (p < 0.05), and 33% (2/6) of the intervention group had a clinically important LEFI improvement compared to 0/4 in the control group at week 2. No secondary outcome measures demonstrated any significant differences. The intervention received high satisfaction scores, significantly greater than the control group at week 24. No harms were recorded. Discussion: This feasibility study showed that VE and treadmill-walking improved walking distances and function for subjects with motor neglect. This is a promising novel approach and requires further validation through larger study.

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“…VR and AR applications could help patients overcome the fear of movement through exposition to activities perceived as painful ( 162 , 163 ). While patients are distracted by VR applications, therapists could also reproduce supposed painful movements and then make patients aware that the movements were executed with little or no pain.…”

Section: The Crossroads Between Mts Vr and Armentioning

confidence: 99%

The Challenges and Perspectives of the Integration Between Virtual and Augmented Reality and Manual Therapies

Cerritelli¹,

Chiera²,

Abbro³

et al. 2021

Front. Neurol.

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Virtual reality (VR) and augmented reality (AR) have been combined with physical rehabilitation and psychological treatments to improve patients' emotional reactions, body image, and physical function. Nonetheless, no detailed investigation assessed the relationship between VR or AR manual therapies (MTs), which are touch-based approaches that involve the manipulation of tissues for relieving pain and improving balance, postural stability and well-being in several pathological conditions. The present review attempts to explore whether and how VR and AR might be integrated with MTs to improve patient care, with particular attention to balance and to fields like chronic pain that need an approach that engages both mind and body. MTs rely essentially on touch to induce tactile, proprioceptive, and interoceptive stimulations, whereas VR and AR rely mainly on visual, auditory, and proprioceptive stimulations. MTs might increase patients' overall immersion in the virtual experience by inducing parasympathetic tone and relaxing the mind, thus enhancing VR and AR effects. VR and AR could help manual therapists overcome patients' negative beliefs about pain, address pain-related emotional issues, and educate them about functional posture and movements. VR and AR could also engage and change the sensorimotor neural maps that the brain uses to cope with environmental stressors. Hence, combining MTs with VR and AR could define a whole mind-body intervention that uses psychological, interoceptive, and exteroceptive stimulations for rebalancing sensorimotor integration, distorted perceptions, including visual, and body images. Regarding the technology needed to integrate VR and AR with MTs, head-mounted displays could be the most suitable devices due to being low-cost, also allowing patients to follow VR therapy at home. There is enough evidence to argue that integrating MTs with VR and AR could help manual therapists offer patients better and comprehensive treatments. However, therapists need valid tools to identify which patients would benefit from VR and AR to avoid potential adverse effects, and both therapists and patients have to be involved in the development of VR and AR applications to define truly patient-centered therapies. Furthermore, future studies should assess whether the integration between MTs and VR or AR is practically feasible, safe, and clinically useful.

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A Graded Exposure, Locomotion-Enabled Virtual Reality App During Walking and Reaching for Individuals With Chronic Low Back Pain: Cohort Gaming Design

Cited by 24 publications

References 50 publications

Virtual Reality in the Management of Chronic Low Back Pain: A Scoping Review

Virtual Reality in the Management of Chronic Low Back Pain: A Scoping Review

Virtual Environment Rehabilitation for Patients with Motor Neglect Trial (VERMONT): A Single-Center Randomized Controlled Feasibility Trial

The Challenges and Perspectives of the Integration Between Virtual and Augmented Reality and Manual Therapies

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