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

Peter Window; Michelle McGrath; Daniel S Harvie; Esther Smits; Venerina Johnston; Megan Murdoch; Trevor Russell

doi:10.1097/AJP.0000000000001221

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

Clin J Pain. 2024 May 6. doi: 10.1097/AJP.0000000000001221. Online ahead of print.

Authors

Peter Window^{1

2}, Michelle McGrath^{1

2}, Daniel S Harvie³, Esther Smits⁴, Venerina Johnston^{5

6

7}, Megan Murdoch^{1

8}, Trevor Russell^{2

4}

Affiliations

¹ Physiotherapy Department, Royal Brisbane and Women's Hospital, Herston, AUSTRALIA.
² STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service, The University of Queensland and Metro North Health, Brisbane, AUSTRALIA.
³ School of Allied Health and Human Performance, University of South Australia, Adelaide, AUSTRALIA.
⁴ RECOVER Injury Research Centre, University of Queensland, St Lucia, AUSTRALIA.
⁵ School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, AUSTRALIA.
⁶ School of Health and Medical Sciences, University of Southern Queensland, Ipswich, AUSTRALIA.
⁷ Centre for Health Research, University of Sothern Queensland, AUSTRALIA.
⁸ Tess Cramond Pain and Research Centre, Surgical Treatment and Rehabilitation Service, Herston AUSTRALIA.

PMID: 38708788
DOI: 10.1097/AJP.0000000000001221

Abstract

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

Methods: Thirty-seven participants were recruited in a single cohort repeated measures study, attending three sessions one week apart. The VR-CBT intervention included standardised pain education (Session 1), and virtual reality exposure therapy (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, peak velocity) were collected at baseline (Session1), and one week following education (Session 2) and virtual reality exposure therapy (Session 3). One-way repeated measures ANOVAs evaluated change in outcomes from baseline to completion. Post-hoc contrasts evaluated effect sizes for the education and virtual reality 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's d) were observed for education (pain intensity 0.85; fear of movement 1.28) while the addition of virtual reality exposure therapy 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.

Discussion: 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.