Pain Education and Virtual Reality Improves Pain, Pain-related Fear of Movement, and Trunk Kinematics in Individuals With Persistent Low Back Pain

Article

Window, Peter, McGrath, Michelle, Harvie, Daniel S., Smits, Esther, Johnston, Venerina and Murdoch, Megan. 2024. "Pain Education and Virtual Reality Improves Pain, Pain-related Fear of Movement, and Trunk Kinematics in Individuals With Persistent Low Back Pain." Clinical Journal of Pain. 40 (8), pp. 478-489. https://doi.org/10.1097/AJP.0000000000001221
Article Title

Pain Education and Virtual Reality Improves Pain, Pain-related Fear of Movement, and Trunk Kinematics in Individuals With Persistent Low Back Pain

ERA Journal ID15926
Article CategoryArticle
AuthorsWindow, Peter, McGrath, Michelle, Harvie, Daniel S., Smits, Esther, Johnston, Venerina and Murdoch, Megan
Journal TitleClinical Journal of Pain
Journal Citation40 (8), pp. 478-489
Number of Pages12
Year2024
PublisherLippincott Williams & Wilkins
Place of PublicationUnited States
ISSN0749-8047
1536-5409
Digital Object Identifier (DOI)https://doi.org/10.1097/AJP.0000000000001221
Web Address (URL)https://journals.lww.com/clinicalpain/abstract/2024/08000/pain_education_and_virtual_reality_improves_pain,.4.aspx
Abstract

Objectives:
To evaluate the effect of combining pain education and virtual reality (VR) exposure therapy using a cognitive-behavioral therapy-informed approach (virtual reality-based cognitive behavioral therapy [VR-CBT]) on pain intensity, fear of movement, and trunk movement in individuals with persistent low back pain.

Materials and Methods:
Thirty-seven participants were recruited in a single cohort repeated measures study, attending 3 sessions 1 week apart. The VR-CBT intervention included standardized pain education (session 1) and virtual reality-based exposure therapy (VRET; session 2) incorporating gameplay with mixed reality video capture and reflective feedback of performance. Outcome measures (pain intensity, pain-related fear of movement (Tampa Scale of Kinesiophobia), and trunk kinematics during functional movements (maximum amplitude and peak velocity) were collected at baseline (session 1) and 1 week after education (session 2) and VRET (session 3). One-way repeated measures analysis of variances evaluated change in outcomes from baseline to completion. Post hoc contrasts evaluated effect sizes for the education and VR components of VR-CBT.

Results:
Thirty-four participants completed all sessions. Significant (P < 0.001) reductions were observed in mean (SD) pain (baseline 5.9 [1.5]; completion 4.3 [2.1]) and fear of movement (baseline 42.6 [6.4]; completion 34.3 [7.4]). Large effect sizes (Cohen d) were observed for education (pain intensity: 0.85; fear of movement: 1.28), whereas the addition of VRET demonstrated very small insignificant effect sizes (pain intensity: 0.10; fear of movement: 0.18). Peak trunk velocity, but not amplitude, increased significantly (P < 0.05) across trunk movement tasks.

Conclusion:
A VR-CBT intervention improved pain, pain-related fear of movement, and trunk kinematics. Further research should explore increased VR-CBT dosage and mechanisms underlying improvement.

Keywordskinematics; Low Back Pain; virtual reality; Pain Science Educatio; Kinesiophobia
Contains Sensitive ContentDoes not contain sensitive content
ANZSRC Field of Research 2020420109. Rehabilitation
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Byline AffiliationsRoyal Brisbane and Women’s Hospital, Australia
University of Queensland
Metro North Health, Australia
University of South Australia
School of Health and Medical Sciences
Centre for Health Research
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