Abstract
BackgroundChronic low back pain (cLBP) can interfere with daily activities, and individuals with elevated pain-related fear (also known as kinesiophobia or the fear of injury due to movement) can develop worse long-term disability. Graded exposure (GEXP) protocols use successive participation in avoided activities to help individuals overcome fearful movement appraisals and encourage activity. We sought to develop a series of GEXP virtual reality (VR) walking and reaching scenarios to increase the exposure and engagement of people with high kinesiophobia and cLBP.ObjectiveThis study aims to (1) determine GEXP content validity of the VR application and (2) determine the feasibility of individuals with cLBP performing locomotion-enabled physical activities.MethodsWe recruited 13 individuals with cLBP and high pain-related fear to experience six VR modules, which provide progressive movement exposure over three sessions in a 1 week period. At session 1, participants ranked each module by likelihood to avoid and assigned an expected pain and concern for harming their back rating to each module. Participants provided a rating of perceived exertion (RPE) after experiencing each module. To test feasibility, we administered the system usability scale (SUS) and treatment evaluation inventory (TEI) following the final session. In addition, we measured pain and pain-related fear at baseline and follow-up.ResultsThe 12 participants who completed the study period assigned higher avoidance (P=.002), expected pain (P=.002), and expected concern (P=.002) for session 3 modules compared with session 1 modules. RPE significantly increased from session 1 (mean 14.8, SD 2.3) to session 3 (mean 16.8, SD 2.2; P=.009). The VR application showed positive feasibility for individuals with cLBP through acceptable SUS (mean 76.7, SD 13.0) and TEI (mean 32.5, SD 4.9) scores. Neither pain (P=.20) nor pain-related fear (P=.58) changed significantly across sessions.ConclusionsThe GEXP VR modules provided progressive exposure to physical challenges, and participants found the VR application acceptable and usable as a potential treatment option. Furthermore, the lack of significant change for pain and pain-related fear reflects that participants were able to complete the modules safely.
Highlights
BackgroundChronic low back pain—low back pain present for longer than 3 months—is a common symptom with an estimated lifetime prevalence of 80% and is the second leading cause of disability in the United States [1,2]
Elevated pain-related fear is the belief that pain always signals serious tissue damage, and the fear-avoidance model (FAM) postulates that individuals with high pain-related fear will avoid physical activities that they believe will further exacerbate pain, trigger reinjury, or prevent recovery
We have developed an engaging, locomotion-enabled Graded exposure (GEXP) virtual reality (VR) application to address the lack of applications that provide progressive movement challenges for individuals with Chronic low back pain (cLBP)
Summary
BackgroundChronic low back pain (cLBP)—low back pain present for longer than 3 months—is a common symptom with an estimated lifetime prevalence of 80% and is the second leading cause of disability in the United States [1,2]. The biomedical model of pain described the experience of pain solely through biological mechanisms and suggested a predictable and linear relationship between pain and tissue damage This straightforward relationship has failed to explain many clinical observations of pain and has led to the uptake of a more biopsychosocial approach to chronic pain, which considers the experience of pain as a dynamic interaction between biological, sociocultural, and psychological factors [4,5]. The fear-avoidance model (FAM), a widely used theory that attempts to explain the development of chronic disability after a back injury, identifies pain-related fear as a central cognition that predicts long-term disability after musculoskeletal injury [6,7,8,9]. Chronic low back pain (cLBP) can interfere with daily activities, and individuals with elevated pain-related fear ( known as kinesiophobia or the fear of injury due to movement) can develop worse long-term disability. We sought to develop a series of GEXP virtual reality (VR) walking and reaching scenarios to increase the exposure and engagement of people with high kinesiophobia and cLBP
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