Cervical kinematic training with and without interactive VR training for chronic neck pain – a randomized clinical trial

Abstract

Impairments in cervical kinematics are common in patients with neck pain. A virtual reality (VR) device has potential to be effective in the management of these impairments. The objective of this study was to investigate the effect of kinematic training (KT) with and without the use of an interactive VR device. In this assessorblinded, allocation-concealed pilot clinical trial, 32 participants with chronic neck pain were randomised into the KT or kinematic plus VR training (KTVR) group. Both groups completed four to six training sessions comprising of similar KT activities such as active and quick head movements and fine head movement control and stability over five weeks. Only the KTVR group used the VR device. The primary outcome measures were neck disability index (NDI), cervical range of motion (ROM), head movement velocity and accuracy. Kinematic measures were collected using the VR system that was also used for training. Secondary measures included pain intensity, TAMPA scale of kinesiophobia, static and dynamic balance, global perceived effect and participant satisfaction. The results demonstrated significant (p<0.05) improvements in NDI, ROM (rotation), velocity, and the step test in both groups post-intervention. At 3-month post-intervention, these improvements were mostly sustained; however there was no control group, which limits the interpretation of this. Between-group analysis showed a few specific differences including global perceived change that was greater in the KTVR group.This pilot study has provided directions and justification for future research exploring training using kinematic training and VR for those with neck pain in a larger cohort.  The results demonstrated significant improvements in NDI, ROM, velocity, and the step test in both groups, with a few specific between-group differences including global perceived change that was greater in the VR group. This pilot study has provided directions and justification for future research exploring training using kinematic training and VR for those with neck pain.

Interactive cervical motion kinematics: Sensitivity, specificity and clinically significant values for identifying kinematic impairments in patients with chronic neck pain

“…As such, impaired neck kinematics should be addressed clinically. In a recent pilot trial, we demonstrated the potential value of kinematic training using this system with positive results (Sarig-Bahat et al , 2014). The results of this current study confirm the need for further research in this area and the establishment of appropriate classification criteria for kinematic assessment and treatment…”

Head-Mounted Virtual Reality and Mental Health: Critical Review of Current Research

“…VR has been used as a distraction tool for pain management. Different forms of VR distractions have been used for burn wound pain [ 44 - 47 ], phantom limb pain [ 48 , 49 ], cold pressor pain [ 50 , 51 ], dental pain [ 52 , 53 ], neck pain [ 54 , 55 ], back pain [ 56 ], and cystoscopy [ 57 ] as well as for the assessment of analgesia [ 58 - 60 ] and kinesiophobia [ 56 , 61 ]. Distractions ranged from coastal walks [ 52 ] and target-aiming tasks [ 61 ] to a Sonic the Hedgehog Nintendo video game [ 51 ].…”

Simulator sickness incidence and susceptibility during neck motion-controlled virtual reality tasks

“…This is potentially important for the progression of this device for use in neck rehabilitation as recently this system was used in a trial in 32 patients with chronic neck pain (Sarig Bahat et al 2015). Four out of 40 eligible patients withdrew from the study due to side effects (Sarig Bahat et al 2015). The information gained from the current study especially regarding VR exposure time may help to limit the degree of SS in the future.…”

“…Future research that aims to determine the optimal exposure time for the neck VR and any benefit of modifying the ROM module as suggested above to reduce exposure time should be explored further. This is potentially important for the progression of this device for use in neck rehabilitation as recently this system was used in a trial in 32 patients with chronic neck pain (Sarig Bahat et al 2015). Four out of 40 eligible patients withdrew from the study due to side effects (Sarig Bahat et al 2015).…”