Tampa Scale of Kinesiophobia may underestimate task-specific fear of movement in people with and without low back pain

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

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.

Impact of sensory reweighting strategies on postural control using the sensory organization test in older adults with and without fall risks

BACKGROUND

The Sensory Organization Test (SOT), an integral part of computerized dynamic posturography, plays a crucial role in evaluating postural stability under various altered sensory conditions. Despite its importance, there have been noted inconsistencies in the results pertaining to equilibrium and sensory system evaluations. This study aimed to compare four sensory analysis scores and equilibrium indices between older adults with and without fall risks.

METHODS

The study included 34 participants identified as being at risk of falls and 42 control subjects. To categorize individuals between the two groups, we performed area under the receiver operating characteristic curve analyses. This classification was based on scores from the Modified Falls Efficacy Scale (MFES) and the composite scores obtained from the SOT. In addition, we used the Tampa Scale for Kinesiophobia (TSK) as well as the level of disability.

RESULTS

The fall risk group demonstrated significantly higher TSK scores (39.39 ± 15.24 for control group vs. 54.65 ± 10.70 for fall risk group; t = -5.09, p = 0.001). The groups demonstrated a significant interaction on the equilibrium index (F = 4.59, p = 0.03), which was lower in the fall risk group in Condition 6 with a moving surface and surround and eyes open (t = 2.29, p = 0.01). The fall risk group demonstrated a higher somatosensory score (t = -1.73, p = 0.04).

CONCLUSIONS

The fall risk group had a lower equilibrium index score in Condition six of the SOT, which was useful for identifying deficits in vestibular function to integrate sensory information under challenging conditions for postural adaptation. This strategy suggested that the fall risk group could compensate for their risk of falls by utilizing more effective somatosensory reweighting strategies compared with the control group.