JMIR Publications

ABSTRACT

Background:

Chronic low back pain (cLBP) can interfere with daily activities, and individuals with elevated pain-related fear (aka., Kinesiophobia – or fear of injury due to movement) can develop worse long-term disability. Graded exposure (GEXP) protocols use successive participation in avoided activities to help individuals overcome fearful movement appraisals and encourage activity. We sought to develop a series of GEXP virtual reality (VR) walking and reaching scenarios to increase exposure and engagement of people with high kinesiophobia and cLBP.

Objective:

Our study aims were to 1) determine GEXP content validity of the VR application and 2) determine the feasibility of individuals with cLBP performing the locomotion-enabled physical activities.

Methods:

13 individuals with cLBP and high pain-related fear were recruited to experience six VR modules, with exposure to difficulty progressively graded over three sessions in a one-week period. At Session 1, participants ranked module activities by likelihood to avoid and assigned an expected pain and concern value for harming their back for each module. Ratings of perceived exertion (RPE) were recorded after each module. To test feasibility, the System Usability Scale (SUS) and Treatment Evaluation Inventory (TEI) were administered following the final session. Pain and pain-related fear were measured at baseline and follow-up.

Results:

The GEXP modules demonstrated content validity in that participants ranked the module activities as expected, assigning the lowest GEXP module with the lowest expected pain (mean 35.8; SD 26.8) and expected concern for harming their back (mean 40.0; SD 29.9) and the highest GEXP module the highest expected pain (mean 71.3; SD 23.4) and expected concern for harming their back (mean 72.9; SD 35.5). Average RPE slightly increased across sessions: Session 1 (mean 14.8; SD 2.3), Session 2 (mean 16.0; SD 2.3), Session 3 (mean 16.8; SD 2.2). The VR application showed positive feasibility for individuals with cLBP through acceptable SUS (mean 76.7; SD 13.0) and TEI (mean 32.5; SD 4.9) scores. Neither pain nor pain-related fear changed significantly across sessions.

Conclusions:

The GEXP VR modules provided intended progressive exposure to physical challenges and participants found the VR application acceptable and useable as a potential treatment option. Further, lack of significant change for pain and pain-related fear reflects that individuals with high-fear and cLBP were able to successfully complete the challenging activities without adverse consequences to their pain status.