Effects of personalized movement models in virtual reality on pain expectancy and motor behavior in patients with chronic back pain: a feasibility study

Abstract

Cognitive-behavioral therapy (CBT) of chronic pain focuses on behavioral, cognitive, affective and social factors that play a role in the transition from acute to chronic pain, which often is initially caused by a specific event but then takes on “a life of its own”. CBT models assume that fear of pain and subsequent avoidance behavior contribute to pain chronicity and the maintenance of chronic pain. In chronic back pain (CBP), avoidance is often addressed by teaching patients to reduce pain behaviors (such as guarding and bracing that may become dysfunctional over time) and increase healthy behaviors (such as physical exercise and meaningful social activities). The current study explored if personalized virtual movement models (doppelganger avatars), who maximize model-observer similarity in virtual reality (VR), can influence fear of pain, motor avoidance and movement-related pain and function. In a randomized controlled trial, participants with CBP observed and imitated an avatar (AVA, N = 17) or a videotaped model (VID, N = 16) over three sessions, where moving a beverage crate, bending sideward (BS), and rotation in the horizontal plane (RH) were shown. Self-reported pain expectancy, as well as engagement, functional capacity and pain during movements, were analyzed along with range of motion (ROM). The AVA group reported higher engagement with no significant group differences observed in ROM. Pain expectancy increased in AVA but not VID over the sessions. Pain and limitations did not significantly differ. However, we observed a significant moderation effect of group, with prior pain expectancy predicting pain and avoidance in the VID but not in the AVA group. This can be interpreted as an effect of personalized movement models decoupling pain behavior from movement-related fear and pain expectancy. Thus, personalized virtual movement models may provide an additional tool for exposure and exercise treatments in cognitive-behavioral treatment approaches to CBP.

The Impact of Virtual Reality Technology on Student Engagement and Learning Outcomes in Higher Education

“…The statistically significant improvement in knowledge acquisition and retention following exposure to VR-enhanced learning environments is in line with the potential for VR to facilitate deeper understanding of complex concepts [17]. Moreover, participants' perceptions of adaptive learning opportunities through VR align with previous research that underscores the potential for personalized learning experiences [11]. This suggests that VR's adaptability can cater to the diverse learning styles and needs of students, promoting more efficient and effective learning.…”

“…Adaptive VR environments can adjust content and difficulty levels to individual student needs, catering to the diverse abilities and prior knowledge of learners. This adaptability holds the promise of more efficient and effective learning [11].…”