JMIR Publications

ABSTRACT

Background:

Chronic musculoskeletal (MSK) pain is a prominent health concern, resulting in pain-related disability, loss of functioning, and high healthcare costs. Physiotherapy rehabilitation is a gold standard treatment for improving functioning in youth with chronic MSK. However, increasing physical activity can feel unattainable for many adolescents due to pain related fear and movement avoidance. Virtual reality (VR) offers an immersive experience that can interrupt the fear-avoidance cycle and improve engagement in physiotherapy. Despite promising initial findings, data are limited and often lack the rigor required to establish VR as an evidence-based treatment for MSK pain.

Objective:

This trial evaluates physiorehabilitation with virtual reality (PRVR) for adolescents with MSK pain. This protocol paper outlines the rationale, design, and implementation of a randomized control trial (RCT) enhanced with single-case experimental design (SCED).

Methods:

This study is a two-group RCT to assess the use of PRVR for adolescents with MSK pain. The authors will collaborate with physical therapists to integrate VR into their standard clinical care. For participants enrolled in the standard physiotherapy, there will be no VR integrated into their physical therapy program. Primary outcomes include physical function and engagement in VR. Secondary outcomes include pain-related fear and treatment adherence. Moreover, we will obtain clinician perspectives regarding feasibility of integrating the intervention into the flow of clinical practice.

Results:

The pilot study implementing PRVR demonstrated high engagement and PRVR use was associated with improvements in pain, fear, avoidance, and function. Coupled with qualitative feedback from patient, families, and clinicians pilot study results provide support for the current trial to evaluate PRVR for youth with chronic MSK pain. Analysis of results from the main clinical trial will begin as recruitment progresses and results are expected in early 2024.

Conclusions:

Significant breakthroughs for treating MSK pain require mechanistically informed innovative approaches. PRVR provides exposure to progressive challenge, real-time feedback, reinforcement for movement, and can include activities difficult to achieve in the real world. It has the added benefits of sustaining patient motivation and adherence while enabling clinicians to use objective benchmarks to influence progression. These findings will inform the decision of whether to proceed with a hybrid effectiveness-dissemination trial of PRVR, serving as the basis for potential large-scale implementation of PRVR. Clinical Trial: Clinicaltrials.gov NCT04636177, https://clinicaltrials.gov/ct2/show/NCT04636177