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Ding ME, Traiba H, Perez HR. Virtual Reality Interventions and Chronic Pain: Scoping Review. J Med Internet Res 2025; 27:e59922. [PMID: 39965778 PMCID: PMC11888090 DOI: 10.2196/59922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Revised: 09/15/2024] [Accepted: 12/09/2024] [Indexed: 02/20/2025] Open
Abstract
BACKGROUND Virtual reality (VR) interventions have demonstrated efficacy for more than a decade for mood and anxiety disorders and emerging evidence suggests they can reduce pain symptoms in both acute and chronic pain. More recently, these interventions have abounded within the commercial and academic sectors, immersing participants within a virtual environment to confer health benefits to users. VR immersion can facilitate the delivery of health interventions by isolating participants from distractors and stressors in a therapeutic environment. While recent studies of VR interventions have exploded, they are not uniform in approach or device type, limiting generalizability. Recent scoping reviews on VR and chronic pain have focused on specific diseases or limited inquiries to specific interventions or study types. OBJECTIVE We conducted a scoping review to generate new knowledge about the sum total of VR studies on chronic pain with specific emphasis on the methods and results of each study, including (1) the type of interventions, (2) outcomes chosen, (3) samples studied, and (4) data generated. METHODS A scoping review was performed on the literature on VR and chronic pain to describe themes associated with the literature to date and identify important gaps and unanswered questions to guide future research. CINAHL [EBSCO] (Cumulative Index to Nursing and Allied Health Literature) and PubMed were queried for the terms "virtual reality" and "pain," providing studies of chronic pain adult participants using VR delivered through headset displays. We included English-language manuscripts that had at least one VR intervention arm with adults with chronic pain. For this analysis, we only included VR interventions that were immersive (ie, using headsets). Non-study reports, studies with no specific chronic pain component, those not involving adults, and those using VR as part of a comprehensive rehabilitation program were excluded. A descriptive analytical method was used to extract data, compare studies, and contextualize the presented outcomes. Articles were categorized into several themes including the type of intervention, outcomes chosen, participant characteristics, degree to which immersion was achieved, and adverse effect monitoring and reporting. RESULTS A total of 36 articles were included in our analysis. We summarize the literature using 5 themes: (1) heterogeneity of chronic pain types, (2) highly variable intervention types, (3) highly variable secondary and exploratory outcomes, (4) immersion was highly variable between studies and not systemically explored in many articles, and (5) side effect monitoring was limited. CONCLUSIONS The literature on VR in chronic pain is highly variable and lacks theoretical rigor. While there is emerging evidence that supports VR use in a wide variety of health conditions including chronic pain, future research should focus on producing theoretically rigorous work that focuses on mechanisms and that systematically assesses side effects to generate robust generalizable knowledge.
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Affiliation(s)
- Michael E Ding
- Department of Medicine, Division of General Internal Medicine, Montefiore Medical Center, Bronx, NY, United States
| | - Hajar Traiba
- Department of Medicine, Division of General Internal Medicine, Montefiore Medical Center, Bronx, NY, United States
| | - Hector R Perez
- Department of Medicine, Division of General Internal Medicine, Montefiore Medical Center, Bronx, NY, United States
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Conen R, Mueller S, Tibubos AN. Integration of Conventional and Virtual Reality Approaches in Augmented Reality for Theory-Based Psychoeducational Intervention Design for Chronic Low Back Pain: Scoping Review. Interact J Med Res 2025; 14:e59611. [PMID: 39832362 PMCID: PMC11791447 DOI: 10.2196/59611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 11/07/2024] [Accepted: 11/10/2024] [Indexed: 01/22/2025] Open
Abstract
BACKGROUND Psychoeducation positively influences the psychological components of chronic low back pain (CLBP) in conventional treatments. The digitalization of health care has led to the discussion of virtual reality (VR) interventions. However, CLBP treatments in VR have some limitations due to full immersion. In comparison, augmented reality (AR) supplements the real world with virtual elements involving one's own body sensory perception and can combine conventional and VR approaches. OBJECTIVE The aim of this study was to review the state of research on the treatment of CLBP through psychoeducation, including immersive technologies, and to formulate suggestions for psychoeducation in AR for CLBP. METHODS A scoping review following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was performed in August 2024 by using Livivo ZB MED, PubMed, Web of Science, American Psychological Association PsycINFO (PsycArticle), and PsyArXiv Preprints databases. A qualitative content analysis of the included studies was conducted based on 4 deductively extracted categories. RESULTS We included 12 studies published between 2019 and 2024 referring to conventional and VR-based psychoeducation for CLBP treatment, but no study referred to AR. In these studies, educational programs were combined with physiotherapy, encompassing content on pain biology, psychological education, coping strategies, and relaxation techniques. The key outcomes were pain intensity, kinesiophobia, pain catastrophizing, degree of disability, quality of life, well-being, self-efficacy, depression, attrition rate, and user experience. Passive, active, and gamified strategies were used to promote intrinsic motivation from a psychological point of view. Regarding user experience from a software development perspective, user friendliness, operational support, and application challenges were recommended. CONCLUSIONS For the development of a framework for an AR-based psychoeducational intervention for CLBP, the combination of theories of acceptance and use of technologies with insights from health psychological behavior change theories appears to be of great importance. An example of a theory-based design of a psychoeducation intervention in AR for CLBP is proposed and discussed.
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Affiliation(s)
- Robin Conen
- Department of Nursing Science, Diagnostics in Healthcare and eHealth, Trier University, Trier, Germany
| | - Steffen Mueller
- Department of Computer Science/Therapeutic Science, Trier University of Applied Sciences, Trier, Germany
| | - Ana Nanette Tibubos
- Department of Nursing Science, Diagnostics in Healthcare and eHealth, Trier University, Trier, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
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Window P, McGrath M, Harvie DS, Smits E, Johnston V, Murdoch M, Russell T. 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; 40:478-489. [PMID: 38708788 DOI: 10.1097/ajp.0000000000001221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 04/16/2024] [Indexed: 05/07/2024]
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.
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Affiliation(s)
- Peter Window
- Department of Physiotherapy, Royal Brisbane and Women's Hospital
- STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service, The University of Queensland and Metro North Health, Brisbane
| | - Michelle McGrath
- Department of Physiotherapy, Royal Brisbane and Women's Hospital
- STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service, The University of Queensland and Metro North Health, Brisbane
| | - Daniel S Harvie
- School of Allied Health and Human Performance, University of South Australia, Adelaide
| | - Esther Smits
- RECOVER Injury Research Centre, University of Queensland
| | - Venerina Johnston
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia
- School of Health and Medical Sciences, University of Southern Queensland, Ipswich
- Centre for Health Research, University of Sothern Queensland, Australia
| | - Megan Murdoch
- Department of Physiotherapy, Royal Brisbane and Women's Hospital
- Tess Cramond Pain and Research Centre, Surgical Treatment and Rehabilitation Service, Herston
| | - Trevor Russell
- STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service, The University of Queensland and Metro North Health, Brisbane
- RECOVER Injury Research Centre, University of Queensland
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Longo UG, Carnevale A, Andreoli F, Mannocchi I, Bravi M, Sassi MSH, Santacaterina F, Carli M, Schena E, Papalia R. Immersive virtual reality for shoulder rehabilitation: evaluation of a physical therapy program executed with oculus quest 2. BMC Musculoskelet Disord 2023; 24:859. [PMID: 37919702 PMCID: PMC10621204 DOI: 10.1186/s12891-023-06861-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 09/07/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Virtual Reality (VR) systems have been increasingly used across several medical fields. A crucial preliminary step for developing optimized VR-based applications for rehabilitation purposes is identifying potential interventions to meet the requirements necessary to satisfy end-users' needs. This study aims to assess the acceptability, usability, and appropriateness of a VR physical therapy program executed with Oculus Quest 2 by expert physiotherapists of shoulder musculoskeletal rehabilitation. METHODS Eleven physiotherapists were enrolled to test a VR program for shoulder musculoskeletal rehabilitation. At the end of each session, physiotherapists completed three questionnaires about the acceptability, usability, and appropriateness of the VR system and application, investigating aspects such as wearability, safety, stability, ease of control, comfort, size, utility, playability, and use mode. RESULTS The acceptability questionnaire revealed that all the physiotherapists found the VR system easy to wear and control, very confident, and safe. The usability questionnaire showed that most physiotherapists (73%) found the VR application entertaining, although only 45% said the system could be used independently by patients without the support of a therapist. Many physiotherapists found the use of the VR application appropriate for patients with rotator cuff tears treated conservatively (63.6%) or surgically (54.5%), for patients with shoulder osteoarthritis treated conservatively (72.7%), for patients with shoulder osteoarthritis after surgical treatment (63.6%). 91% of physiotherapists think it would be best for patients to use the VR system under the supervision of a therapist and not independently in a home setting. CONCLUSIONS The use of VR in orthopaedic rehabilitation is encouraging, although further efforts are needed to increase the independent use of patients without the supervision of a physiotherapist. Moreover, future studies should strive to ensure the clinical effectiveness of VR rehabilitation in reaching therapeutic goal settings.
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Affiliation(s)
- Umile Giuseppe Longo
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo, Roma, 200, 00128, Italy.
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Universit? Campus Bio-Medico di Roma, Via Álvaro del Portillo, Roma, 21, 00128, Italy.
| | - Arianna Carnevale
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo, Roma, 200, 00128, Italy
| | - Flavia Andreoli
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo, Roma, 200, 00128, Italy
| | - Ilaria Mannocchi
- Department of Industrial, Electronic and Mechanical Engineering, University of Roma Tre, Via Vito Volterra, Roma, 62, 00146, Italy
| | - Marco Bravi
- Research Unit of Physical and Rehabilitation Medicine, Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo, Roma, 200, 00128, Italy
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Roma, 00135, Italy
| | - Mohamed Saifeddine Hadj Sassi
- Department of Industrial, Electronic and Mechanical Engineering, University of Roma Tre, Via Vito Volterra, Roma, 62, 00146, Italy
| | - Fabio Santacaterina
- Research Unit of Physical and Rehabilitation Medicine, Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo, Roma, 200, 00128, Italy
| | - Marco Carli
- Department of Industrial, Electronic and Mechanical Engineering, University of Roma Tre, Via Vito Volterra, Roma, 62, 00146, Italy
| | - Emiliano Schena
- Laboratory of Measurement and Biomedical Instrumentation, Department of Engineering, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, Roma, 21, 00128, Italy
| | - Rocco Papalia
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo, Roma, 200, 00128, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Universit? Campus Bio-Medico di Roma, Via Álvaro del Portillo, Roma, 21, 00128, Italy
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Álvarez de la Campa Crespo M, Donegan T, Amestoy-Alonso B, Just A, Combalía A, Sanchez-Vives MV. Virtual embodiment for improving range of motion in patients with movement-related shoulder pain: an experimental study. J Orthop Surg Res 2023; 18:729. [PMID: 37752613 PMCID: PMC10523655 DOI: 10.1186/s13018-023-04158-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 09/02/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Recent evidence supports the use of immersive virtual reality (VR) as a means of delivering bodily illusions that may have therapeutic potential for the treatment of musculoskeletal conditions. We wanted to investigate whether a single session of an embodiment-based immersive VR training program influences pain-free range of motion in patients with shoulder pain. METHODS We designed a rehabilitation program based on developing ownership over a virtual body and then "exercising" the upper limb in immersive VR, while the real arm remains static. We then carried out a single-arm pre-post experiment in which 21 patients with movement-related musculoskeletal shoulder pain were exposed to the 15-min VR program and measured their active pain-free range of motion immediately before and afterwards. RESULTS We found that shoulder abduction and hand-behind-back movements, but not shoulder flexion, were significantly and clinically improved post-intervention and that the level of improvement correlated with the level of embodiment. Following this one session, at 1-week follow-up the improvements were not maintained. CONCLUSIONS Virtual embodiment may be a useful therapeutic tool to help improve range of motion in patients with movement-related shoulder pain in the short term, which in turn could expedite rehabilitation and recovery in these conditions.
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Affiliation(s)
| | - Tony Donegan
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Rosellón, 149, 08036, Barcelona, Spain
| | - Beñat Amestoy-Alonso
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Rosellón, 149, 08036, Barcelona, Spain
| | - Andrea Just
- Servicio de Rehabilitación y Fisioterapia, Quironsalud Barcelona, Plaça d'Alfonso Comín, 5, 08023, Barcelona, Spain
- Fundación Garcia Cugat, Quironsalud Barcelona, Plaça d'Alfonso Comín, 5, 08023, Barcelona, Spain
| | - Andrés Combalía
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Rosellón, 149, 08036, Barcelona, Spain
- Departament de Cirurgia i Especialitats Medicoquirúrgiques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Casanova, 143, 08036, Barcelona, Spain
- Servei de Cirurgia Ortopèdica i Traumatologia, Hospital Clínic de Barcelona, Universitat de Barcelona, Villarroel, 170, 08036, Barcelona, Spain
- Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Casanova, 143, Barcelona, Spain
| | - Maria V Sanchez-Vives
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Rosellón, 149, 08036, Barcelona, Spain.
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Passeig de Lluís Companys, 23, 08010, Barcelona, Spain.
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Núñez-Cortés R, Horment-Lara G, Tapia-Malebran C, Castro M, Barros S, Vera N, Pérez-Alenda S, Pablo Santelices J, Rivera-Lillo G, Cruz-Montecinos C. Role of kinesiophobia in the selective motor control during gait in patients with low back-related leg pain. J Electromyogr Kinesiol 2023; 71:102793. [PMID: 37285714 DOI: 10.1016/j.jelekin.2023.102793] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 05/18/2023] [Accepted: 05/24/2023] [Indexed: 06/09/2023] Open
Abstract
Fear of movement has been related to changes in motor function in patients with low back pain, but little is known about how kinesiophobia affects selective motor control during gait (ability of muscles performing distinct mechanical functions) in patients with low back-related leg pain (LBLP). The aim of the study was to determine the association between kinesiophobia and selective motor control in patients with LBLP. An observational cross-sectional study was performed on 18 patients. Outcome included: kinesiophobia using the Tampa Scale of Kinesiophobia; pain mechanism using Leeds Assessment of Neuropathic Signs and Symptoms; disability using Roland-Morris Disability Questionnaire; mechanosensitivity using Straight Leg Raise. Surface electromyography was used to assess selective motor control during gait by examining the correlation and coactivation in muscle pairs involved in the stance phase. Pairs included vastus medialis (VM) and medial gastrocnemius (MG), causing opposite moments around the knee joint, and gluteus medius (GM) and MG, as muscles with distinct mechanical functions (weight acceptance vs. propulsion). A strong association was observed between kinesiophobia and correlation (r = 0.63; p = 0.005) and coactivation (r = 0.69; p = 0.001) between VM versus MG. A moderate association was observed between kinesiophobia and correlation (r = 0.58; p = 0.011) and coactivation (r = 0.55; p = 0.019) between GM versus MG. No significant associations were obtained for other outcomes. A high kinesiophobia is associated with low selective motor control of the muscles involved in the weight acceptance and propulsion phases during gait in patients with LBLP. Fear of movement was better associated with decreased neuromuscular control than other clinical variables such as pain mechanism, disability, and mechanosensitivity.
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Affiliation(s)
- Rodrigo Núñez-Cortés
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile; Department of Physiotherapy, Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), University of Valencia, Valencia, Spain
| | - Giselle Horment-Lara
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Claudio Tapia-Malebran
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile; Department of Physical Therapy, Catholic University of Maule, Talca, Chile
| | - Martín Castro
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Sebastián Barros
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Nicolás Vera
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Sofía Pérez-Alenda
- Department of Physiotherapy, Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), University of Valencia, Valencia, Spain
| | - Juan Pablo Santelices
- Traumatology Unit, San José Hospital, Santiago, Chile; Traumatology Unit, Clínica Santa María, Santiago, Chile
| | - Gonzalo Rivera-Lillo
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile; Department of Neuroscience, Faculty of Medicine, University of Chile, Santiago, Chile; Research and Development Unit, Clínica Los Coihues, Santiago, Chile
| | - Carlos Cruz-Montecinos
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile; Section of Research, Innovation and Development in Kinesiology, Kinesiology Unit, San José Hospital, Santiago, Chile.
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Denche-Zamorano A, Rodriguez-Redondo Y, Barrios-Fernandez S, Mendoza-Muñoz M, Castillo-Paredes A, Rojo-Ramos J, Garcia-Gordillo MA, Adsuar JC. Rehabilitation Is the Main Topic in Virtual and Augmented Reality and Physical Activity Research: A Bibliometric Analysis. SENSORS (BASEL, SWITZERLAND) 2023; 23:2987. [PMID: 36991699 PMCID: PMC10056397 DOI: 10.3390/s23062987] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 02/22/2023] [Accepted: 02/28/2023] [Indexed: 06/19/2023]
Abstract
Researchers' interest in finding practical applications for virtual reality (VR) and augmented reality (AR) technologies has increased as new devices have become cheaper and more accessible, being used in entertainment, healthcare, and rehabilitation fields, among others. This study aims to provide an overview of the current state of scientific literature related to VR, AR, and physical activity (PA). A bibliometric analysis of studies published between 1994 and 2022 was conducted using The Web of Science (WoS), applying the traditional bibliometric laws and using the VOSviewer software for data and metadata processing. The results revealed an exponential increase in scientific production between 2009 and 2021 (R2 = 94%). The United States (USA) was the country/region with the most relevant co-authorship networks (72 papers); the most prolific author was Kerstin Witte, and the most prominent was Richard Kulpa. The most productive journal's core was composed of high-impact and open access journals. A great thematic diversity was found according to the most used keywords by the co-authors, highlighting concepts such as rehabilitation, cognition, training, and obesity. Then, the research related to this topic is in an exponential development phase, with great interest in the rehabilitation and sports sciences fields.
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Affiliation(s)
- Angel Denche-Zamorano
- Promoting a Healthy Society Research Group (PHeSO), Faculty of Sport Sciences, University of Extremadura, 10003 Caceres, Spain
| | - Yeray Rodriguez-Redondo
- Social Impact and Innovation in Health (InHEALTH), University of Extremadura, 06810 Mérida, Spain
| | - Sabina Barrios-Fernandez
- Occupation, Participation, Sustainability and Quality of Life (Ability Research Group), Nursing and Occupational Therapy College, University of Extremadura, 10003 Caceres, Spain
| | - María Mendoza-Muñoz
- Research Group on Physical and Health Literacy and Health-Related Quality of Life (PHYQOL), Faculty of Sport Sciences, University of Extremadura, 10003 Caceres, Spain
- Departamento de Desporto e Sauúde, Escola de Sauúde e Desenvolvimento Humano, Universidade de Eúvora, 7004-516 Eúvora, Portugal
| | - Antonio Castillo-Paredes
- Grupo AFySE, Investigación en Actividad Física y Salud Escolar, Escuela de Pedagogía en Educación Física, Facultad de Educación, Universidad de Las Américas, Santiago 8370040, Chile
| | - Jorge Rojo-Ramos
- Physical Activity for Education, Performance and Health, Faculty of Sport Sciences, University of Extremadura, 10003 Caceres, Spain
| | | | - Jose Carmelo Adsuar
- Promoting a Healthy Society Research Group (PHeSO), Faculty of Sport Sciences, University of Extremadura, 10003 Caceres, Spain
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Matthie NS, Giordano NA, Jenerette CM, Magwood GS, Leslie SL, Northey EE, Webster CI, Sil S. Use and efficacy of virtual, augmented, or mixed reality technology for chronic pain: a systematic review. Pain Manag 2022; 12:859-878. [PMID: 36098065 PMCID: PMC9517958 DOI: 10.2217/pmt-2022-0030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 08/24/2022] [Indexed: 01/11/2023] Open
Abstract
Aim: Characterize use and efficacy/effectiveness of virtual, augmented, or mixed reality (VR/AR/MR) technology as non-pharmacological therapy for chronic pain. Methods: Systematic search of 12 databases to identify empirical studies, of individuals who experience chronic pain or illness involving chronic pain, published between 1990 and 2021. JBI Critical Appraisal Checklists assessed study bias and a narrative synthesis was provided. Results: 46 studies, investigating a total of 1456 participants and including 19 randomized controlled trials (RCT), were reviewed. VR/AR/MR was associated with improved pain-related outcomes in 78% of the RCTs. Conclusion: While most studies showed effects immediately or up to one month post treatment, RCTs are needed to further evaluate VR/AR/MR, establish long-term benefits, and assess accessibility, especially among individuals who experience pain management disparities.
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Affiliation(s)
- Nadine S Matthie
- Nell Hodgson Woodruff School of Nursing, Emory University; Atlanta, GA 30322, USA
| | - Nicholas A Giordano
- Nell Hodgson Woodruff School of Nursing, Emory University; Atlanta, GA 30322, USA
| | | | - Gayenell S Magwood
- College of Nursing, Medical University of South Carolina; Charleston, SC 29425, USA
| | - Sharon L Leslie
- Woodruff Health Sciences Center Library, Emory University; Atlanta, GA 30322, USA
| | - Emily E Northey
- Nell Hodgson Woodruff School of Nursing, Emory University; Atlanta, GA 30322, USA
| | | | - Soumitri Sil
- School of Medicine, Emory University; Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta; Atlanta, GA 30322, USA
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Basem JI, Haffey PR. Novel Therapies for Centralized Pain: a Brief Review. Curr Pain Headache Rep 2022; 26:805-811. [PMID: 36169808 DOI: 10.1007/s11916-022-01085-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW Centralized pain presents a complex pathology that many classic pharmacological agents for pain have not been able to sufficiently treat. To date, there are no clear guidelines for preferred treatment methods or comprehensive protocol that addresses confounding factors in this population. We sought to summarize the current field of knowledge around centrally mediated pain and to understand promising novel therapies. RECENT FINDINGS Many treatments currently used address not only the centralized pain phenotypem but the impact of central sensitization and the common comorbidities that reside within this population. Some novel therapies with promising evidence include the following: low-dose naltrexone, IV ketamine, acupuncture, aerobic activity, and laser therapy. Non-interventional treatment options include aerobic exercise, cognitive-behavioral therapy, mind-body therapies, virtual reality, and patient education on disease expectations. Much of the literature further emphasizes the importance of patient-level predictors, including factors like pain catastrophizing and social history, on treatment compliance and reported pain relief. We found that there are many potential treatment options for patients with centralized pain, particularly those that can be used as adjunct or combination therapies. The introduction of new approaches should occur in a carefully controlled, titrated manner to avoid exacerbation of pain symptoms. This is successfully conducted through patient-physician communication as this is a highly complex and personalized pain category. Our examination shows that while physicians have many options with proven success, there is a need for studies with longitudinal and larger patient populations to better articulate treatment guidelines.
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Affiliation(s)
- Jade I Basem
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - Paul Ryan Haffey
- Department of Rehabilitation and Regenerative Medicine, Columbia University College of Physicians and Surgeons, 180 Fort Washington Avenue, HRK 199, New York, NY, USA.
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Dy M, Olazo K, Lisker S, Brown E, Saha A, Weinberg J, Sarkar U. Virtual Reality for Chronic Pain Management Among Historically Marginalized Populations: A Systematic Review of Usability Studies (Preprint). J Med Internet Res 2022. [DOI: 10.2196/40044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
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11
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Evaluation of MyRelief Serious Game for Better Self-Management of Health Behaviour Strategies on Chronic Low-Back Pain. INFORMATICS 2022. [DOI: 10.3390/informatics9020040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Low back pain is a leading cause of disability worldwide, putting a significant strain on individual sufferers, their families, and the economy as a whole. It has a significant economic impact on the global economy because of the costs associated with healthcare, lost productivity, activity limitation, and work absence. Self-management, education, and adopting healthy lifestyle behaviors, such as increasing physical activity, are all widely recommended treatments. Access to services provided by healthcare professionals who provide these treatments can be limited and costly. This evaluation study focuses on the application of the MyRelief serious game, with the goal of addressing such challenges by providing an accessible, interactive, and fun platform that incorporates self-management, behavior change strategies, and educational information consistent with recommendations for managing low-back pain, based on self-assessment models implemented through ontology-based mechanics. Functional disability measured using the Oswestry Disability Questionnaire showed the statistically significant (p < 0.001) improvement in subjects’ self-evaluation of their health status. System Usability Scale (SUS) test score of 77.6 also suggests that the MyRelief serious game can potentially influence patient enablement.
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Nagpal AS, Raghunandan A, Tata F, Kibler D, McGeary D. Virtual Reality in the Management of Chronic Low Back Pain: A Scoping Review. FRONTIERS IN PAIN RESEARCH 2022; 3:856935. [PMID: 35295809 PMCID: PMC8915689 DOI: 10.3389/fpain.2022.856935] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 01/31/2022] [Indexed: 11/13/2022] Open
Abstract
Virtual reality (VR) is a burgeoning treatment option for chronic pain. Its use has been heterogenous in the literature. This scoping review assesses the current literature for the use of VR in the treatment of chronic low back pain (CLBP). The following themes were identified by the analysis: safety and feasibility of VR, quality of life associated with VR treatment for CLBP, efficacy of VR to treat CLBP, and efficacy of VR to treat functional changes associated with CLBP. Gaps were identified after analysis of the extant literature. Although the nascent research uncovered in this scoping review found good evidence for safety and tolerability of VR, more studies of safety, acceptance, and satisfaction are recommended including focused studies of spinal pain risks specific to use of VR. Overall, the methodological quality of studies reviewed in this scoping review was poor and outcomes were limited to short-term posttreatment outcomes.
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Affiliation(s)
- Ameet S. Nagpal
- Department of Anesthesiology, UT Health San Antonio, San Antonio, TX, United States
| | - Aditya Raghunandan
- Department of Rehabilitation Medicine, UT Health San Antonio, San Antonio, TX, United States
| | - Faye Tata
- Department of Rehabilitation Medicine, UT Health San Antonio, San Antonio, TX, United States
| | - Daniel Kibler
- Department of Rehabilitation Medicine, UT Health San Antonio, San Antonio, TX, United States
| | - Donald McGeary
- Department of Psychiatry, UT Health San Antonio, San Antonio, TX, United States
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Brady N, Lewis J, McCreesh K, Dejaco B, McVeigh JG. Physiotherapist beliefs and perspectives on virtual reality-supported rehabilitation for the assessment and management of musculoskeletal shoulder pain: a focus group study protocol. HRB Open Res 2022; 4:40. [PMID: 35155988 PMCID: PMC8808320 DOI: 10.12688/hrbopenres.13239.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2022] [Indexed: 11/20/2022] Open
Abstract
Shoulder pain accounts for a large proportion of musculoskeletal disorders and years lived with disability. Musculoskeletal shoulder pain is challenging to manage and while research evidence suggests that exercise should be a cornerstone of shoulder pain rehabilitation, the exact type and dosage of exercise is unclear. Adherence is a barrier to successful outcomes with exercise-based management of musculoskeletal pain, especially for those with co-morbidities, high pain levels and reported boredom associated with competing prescribed exercise. Virtual reality (VR) may offer an effective platform for rehabilitation of musculoskeletal shoulder pain. Virtual Reality has been shown to be effective for management of acute and chronic pain conditions, for delivering education around various health conditions, and for supporting rehabilitation of neurological conditions. Therefore, it is possible that VR may have a role in the delivery of exercise and education for individuals with musculoskeletal shoulder pain. VR intervention design should involve several steps and begin with establishing early acceptability from users as to the suitability of the technology in clinical practice as well as potential barriers and facilitators to using the technology successfully. This study will therefore aim to explore physiotherapists beliefs and perspectives of immersive VR as a platform for assessment and rehabilitation in patients with musculoskeletal shoulder pain. Further, this study will inform the development of a VR intervention for use in the rehabilitation of musculoskeletal shoulder pain. A series of online focus groups will be conducted with physiotherapists in Ireland using a qualitative descriptive approach to data analysis. A six-phase process of data analysis will be carried out to identify important patterns and themes within the data. The current study will be the first to explore clinician's perspectives on the role of VR in musculoskeletal practice.
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Affiliation(s)
- Niamh Brady
- Discipline of Physiotherapy, University College Cork, Cork, Ireland
- Evolve Health, Cork, Ireland
| | - Jeremy Lewis
- School of Health and Social Work, University of Hertfordshire, Hatfield, Hertfordshire, UK
- Therapy Department, Central London Community Healthcare National Health Service Trust, London, UK
- Department of Physical Therapy and Rehabilitation Science, Qatar University, Doha, Qatar
| | - Karen McCreesh
- School of Allied Health, University of Limerick, Limerick, Ireland
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Beate Dejaco
- Sports Medical Centre Papendal, Arnhem, The Netherlands
- HAN University of Applied Sciences, Nijmegen, The Netherlands
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Bordeleau M, Stamenkovic A, Tardif PA, Thomas J. The Use of Virtual Reality in Back Pain Rehabilitation: A Systematic Review and Meta-Analysis. THE JOURNAL OF PAIN 2021; 23:175-195. [PMID: 34425250 DOI: 10.1016/j.jpain.2021.08.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/08/2021] [Accepted: 08/11/2021] [Indexed: 12/14/2022]
Abstract
This systematic review aimed to synthesize the existing evidence of extended reality (XR) on pain and motor function outcomes in patients with back pain. Following the Cochrane guidelines, relevant articles of any language were selected by 2 independent reviewers from CINAHL, Cochrane, Embase, Medline and Web of Knowledge databases. Of 2,050 unique citations, 24 articles were included in our review. These studies included a total of 900 back pain patients. Despite broader XR search, all interventions were virtual reality (VR) based and involved physical exercises (n = 17, 71%), hippotherapy (n = 4, 17%), motor imagery (n = 1, 4%), distraction (n = 1, 4%), and cognitive-behavior therapy (n = 1, 4%). Sixteen controlled studies were included in a meta-analysis which suggested that VR provides a significant improvement in terms of back pain intensity over control interventions (Mean Difference: -0.67; 95% CI: -1.12 to -0.23; I2 = 85%). Almost all included studies presented high risk of bias, highlighting the need to improve methodology in the examination of VR interventions. While the specific set of studies showed high heterogeneity across several methodological factors, a tentative conclusion could be drawn that VR was effective improving back pain intensity and tends to have a positive effect on improving other pain outcomes and motion function. PERSPECTIVE: Extended reality technologies have appeared as interesting nonpharmacological options for the treatment of back pain, with the potential to minimise the need for opioid medications. Our systematic review summarised existing applications of extended reality for back pain and proposed a few recommendations to direct further studies in the field.
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Affiliation(s)
- Martine Bordeleau
- Research Centre on Aging, Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke (CIUSSS de l'Estrie - CHUS), Sherbrooke, Quebec, Canada.
| | - Alexander Stamenkovic
- Department of Physical Therapy, Virginia Commonwealth University, Richmond, Virginia
| | - Pier-Alexandre Tardif
- Population Health and Optimal Health Practices Unit, Trauma-Emergency-Critical Care Medicine, CHU de Québec-Université Laval Research Center, Université Laval, Quebec City, Quebec, Canada
| | - James Thomas
- Department of Physical Therapy, Virginia Commonwealth University, Richmond, Virginia
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Cerritelli F, Chiera M, Abbro M, Megale V, Esteves J, Gallace A, Manzotti A. The Challenges and Perspectives of the Integration Between Virtual and Augmented Reality and Manual Therapies. Front Neurol 2021; 12:700211. [PMID: 34276550 PMCID: PMC8278005 DOI: 10.3389/fneur.2021.700211] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 06/07/2021] [Indexed: 12/17/2022] Open
Abstract
Virtual reality (VR) and augmented reality (AR) have been combined with physical rehabilitation and psychological treatments to improve patients' emotional reactions, body image, and physical function. Nonetheless, no detailed investigation assessed the relationship between VR or AR manual therapies (MTs), which are touch-based approaches that involve the manipulation of tissues for relieving pain and improving balance, postural stability and well-being in several pathological conditions. The present review attempts to explore whether and how VR and AR might be integrated with MTs to improve patient care, with particular attention to balance and to fields like chronic pain that need an approach that engages both mind and body. MTs rely essentially on touch to induce tactile, proprioceptive, and interoceptive stimulations, whereas VR and AR rely mainly on visual, auditory, and proprioceptive stimulations. MTs might increase patients' overall immersion in the virtual experience by inducing parasympathetic tone and relaxing the mind, thus enhancing VR and AR effects. VR and AR could help manual therapists overcome patients' negative beliefs about pain, address pain-related emotional issues, and educate them about functional posture and movements. VR and AR could also engage and change the sensorimotor neural maps that the brain uses to cope with environmental stressors. Hence, combining MTs with VR and AR could define a whole mind-body intervention that uses psychological, interoceptive, and exteroceptive stimulations for rebalancing sensorimotor integration, distorted perceptions, including visual, and body images. Regarding the technology needed to integrate VR and AR with MTs, head-mounted displays could be the most suitable devices due to being low-cost, also allowing patients to follow VR therapy at home. There is enough evidence to argue that integrating MTs with VR and AR could help manual therapists offer patients better and comprehensive treatments. However, therapists need valid tools to identify which patients would benefit from VR and AR to avoid potential adverse effects, and both therapists and patients have to be involved in the development of VR and AR applications to define truly patient-centered therapies. Furthermore, future studies should assess whether the integration between MTs and VR or AR is practically feasible, safe, and clinically useful.
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Affiliation(s)
| | | | - Marco Abbro
- Foundation COME Collaboration, Pescara, Italy
| | | | | | | | - Andrea Manzotti
- Foundation COME Collaboration, Pescara, Italy
- RAISE Lab, Foundation COME Collaboration, Milan, Italy
- SOMA Istituto Osteopatia Milano, Milan, Italy
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Brady N, Lewis J, McCreesh K, Dejaco B, McVeigh JG. Physiotherapist beliefs and perspectives on virtual reality-supported rehabilitation for the assessment and management of musculoskeletal shoulder pain: a focus group study protocol. HRB Open Res 2021; 4:40. [PMID: 35155988 PMCID: PMC8808320 DOI: 10.12688/hrbopenres.13239.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2021] [Indexed: 11/04/2023] Open
Abstract
Shoulder pain accounts for a large proportion of musculoskeletal disorders and years lived with disability. Musculoskeletal shoulder pain is challenging to manage and while research evidence suggests that exercise should be a cornerstone of shoulder pain rehabilitation, the exact type and dosage of exercise is unclear. Adherence is a barrier to successful outcomes with exercise-based management of musculoskeletal pain, especially for those with co-morbidities, high pain levels and reported boredom associated with competing prescribed exercise. Virtual reality (VR) may offer an effective platform for rehabilitation of musculoskeletal shoulder pain. VR has been shown to be effective for management of acute and chronic pain conditions, for delivering education around various health conditions, and for supporting rehabilitation of neurological conditions. Therefore, it is possible that VR may have a role in the delivery of exercise and education for individuals with musculoskeletal shoulder pain. VR intervention design should involve several steps and begin with establishing early acceptability from users as to the suitability of the technology in clinical practice as well as potential barriers and facilitators to using the technology successfully. This study will therefore aim to explore physiotherapists beliefs and perspectives of immersive VR as a platform for assessment and rehabilitation in patients with musculoskeletal shoulder pain. Further, this study will inform the development of a VR intervention for use in the rehabilitation of musculoskeletal shoulder pain. A series of online focus groups will be conducted with physiotherapists in Ireland using a qualitative descriptive approach to data analysis. A six-phase process of data analysis will be carried out to identify important patterns and themes within the data. The current study will be the first to explore clinician's perspectives on the role of VR in musculoskeletal practice.
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Affiliation(s)
- Niamh Brady
- Discipline of Physiotherapy, University College Cork, Cork, Ireland
- Evolve Health, Cork, Ireland
| | - Jeremy Lewis
- School of Health and Social Work, University of Hertfordshire, Hatfield, Hertfordshire, UK
- Therapy Department, Central London Community Healthcare National Health Service Trust, London, UK
- Department of Physical Therapy and Rehabilitation Science, Qatar University, Doha, Qatar
| | - Karen McCreesh
- School of Allied Health, University of Limerick, Limerick, Ireland
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Beate Dejaco
- Sports Medical Centre Papendal, Arnhem, The Netherlands
- HAN University of Applied Sciences, Nijmegen, The Netherlands
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de Villiers E, Stone T, Wang NW, Sarangi V, Pelah A, Shenker N. Virtual Environment Rehabilitation for Patients with Motor Neglect Trial (VERMONT): A Single-Center Randomized Controlled Feasibility Trial. Brain Sci 2021; 11:464. [PMID: 33917497 PMCID: PMC8067499 DOI: 10.3390/brainsci11040464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/18/2021] [Accepted: 03/27/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Motor neglect occurs in patients with chronic pain conditions. Virtual environments (VE) help rehabilitation through biofeedback and improving motivation. AIM To assess the feasibility of a VE for patients with motor neglect with chronic pain. METHODS 10 subjects with chronic pain (Fibromyalgia, Sciatica, and Complex Regional Pain Syndrome) underwent a treadmill task three times per week for two weeks. Groups were randomized to receive real-time biofeedback from the VE (intervention) or shown still images (control). Primary outcomes were: (i) distance walked at baseline compared to the final 5 min cycle of week 2; (ii) the Lower Extremity Functional Index (LEFI) questionnaire. A satisfaction questionnaire was used. Follow up was to 24 weeks. RESULTS Total distance walked was significantly higher in the intervention group (p < 0.05), and 33% (2/6) of the intervention group had a clinically important LEFI improvement compared to 0/4 in the control group at week 2. No secondary outcome measures demonstrated any significant differences. The intervention received high satisfaction scores, significantly greater than the control group at week 24. No harms were recorded. DISCUSSION This feasibility study showed that VE and treadmill-walking improved walking distances and function for subjects with motor neglect. This is a promising novel approach and requires further validation through larger study.
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Affiliation(s)
- Elsje de Villiers
- Department of Physiotherapy, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 0QQ, UK;
| | - Thomas Stone
- Department of Medical Physics, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 0QQ, UK;
| | - Nai-Wei Wang
- Hull York Medical School, John Hughlings Jackson Building, University Rd, Heslington, York YO10 5DD, UK;
| | - Viswadeep Sarangi
- Department of Electronic Engineering, University of York, York YO10 5DD, UK; (V.S.); (A.P.)
| | - Adar Pelah
- Department of Electronic Engineering, University of York, York YO10 5DD, UK; (V.S.); (A.P.)
- York Biomedical Research Institute, University of York, York YO10 5DD, UK
| | - Nicholas Shenker
- Rheumatology Research Unit, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 0QQ, UK
- Department of Medicine, University of Cambridge, Hills Road, Cambridge CB2 0QQ, UK
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