Purpose: In virtual reality, avatar embodiment can spur perceptions and behaviours related the avatars' characteristics. We tested whether embodying superhero-like avatars can change self-perceptions in people with chronic low back pain (CLBP).
Design: A non-blinded pilot randomized controlled trial.
Methods: Participants were randomly allocated to embody a superhero (VR-SH, n = 20) or a neutral, non-superhero (VR-Play, n = 10) avatar. Primary outcomes related to body image (e.g., self-perceived vulnerability) and pain intensity were assessed at baseline, during exposure, immediately after and at one-week follow-up. Fear of movement, strength and patient impression of change were also recorded.
Results: The VR-SH group reported gains in body image during (p < .001,=0.71) and immediately after (p < .001,=0.66) VR, whereas the VR-Play group reported small gains during VR (p = .021,=0.46) but not immediately after (p = .076, =0.31). Pain, strength and fear of movement did not change and there were no sustained effects at follow-up (all ps > .05). A greater proportion of people in the VR-SH group reported at least minimal improvement at follow-up (7/20 vs. 1/10).
Conclusion: A VR-SH session produced temporary positive effects on body image. Future research may consider whether larger and sustained effects can be obtained with multisession exposures or explore combined interventions. Implications for rehabilitationPhysical confidence and bodily trust can be significantly enhanced in people with chronic back pain using virtual reality.These positive body image effects may have implications for rehabilitation, such as in enhancing confidence with movementWhether a multisession intervention might produce more robust effects and changes in pain is yet to be determined.
Keywords: Virtual reality; body illusions; body image; embodiment; extended reality; low back pain; motor imagery; persistent pain; rehabilitation.