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Dierick F, Hage R, Estievenart W, Bruno J, Nocent O, Bertucci W, Buisseret F. Evaluating cervical spine mobility and Fitt's law compliance: The DidRen laser test adapted for virtual reality with age and sex effects. Hum Mov Sci 2024; 97:103270. [PMID: 39208696 DOI: 10.1016/j.humov.2024.103270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 08/13/2024] [Accepted: 08/14/2024] [Indexed: 09/04/2024]
Abstract
Cervical spine mobility assessment is crucial in rehabilitation to monitor patient progress. This study introduces the DidRen VR test, a virtual reality (VR) adaptation of the conventional DidRen laser test, aimed at evaluating cervical spine mobility. We conducted a cross-sectional study involving fifty healthy participants that underwent the DidRen VR test. The satisfaction of Fitts' law within this VR adaptation was examined and we analyzed the effects of age and sex on the sensorimotor performance metrics. Our findings confirm that Fitts' law is satisfied, demonstrating a predictable relationship between movement time and the index of difficulty, which suggest that the DidRen VR test can simulate real-world conditions. A clear influence of age and sex on performance was observed, highlighting significant differences in movement efficiency and accuracy across demographics, which may necessitate personalized assessment strategies in clinical rehabilitation practices. The DidRen VR test presents an effective tool for assessing cervical spine mobility, validated by Fitts' law. It offers a viable alternative to real-world method, providing precise control over test conditions and enhanced engagement for participants. Since age and sex significantly affect sensorimotor performance, personalized assessments are essential. Further research is recommended to explore the applicability of the DidRen VR test in clinical settings and among patients with neck pain.
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Affiliation(s)
- Frédéric Dierick
- Centre National de Rééducation Fonctionnelle et de Réadaptation - Rehazenter, RehaLAB, Rue André Vésale 1, 2674 Luxembourg, Luxembourg; UCLouvain, Faculté des Sciences de la Motricité, Place Pierre de Coubertin 1-2, 1348 Ottignies-Louvain-la-Neuve, Belgium.
| | - Renaud Hage
- UCLouvain, Faculté des Sciences de la Motricité, Place Pierre de Coubertin 1-2, 1348 Ottignies-Louvain-la-Neuve, Belgium; Haute Ecole Louvain en Hainaut, CeREF Technique, Chaussée de Binche 159, 7000 Mons, Belgium; Traitement Formation Thérapie Manuelle (TFTM), Private Physiotherapy/Manual Therapy Center, Avenue des Cerisiers 211A, 1200 Brussels, Belgium
| | - Wesley Estievenart
- Haute Ecole Louvain en Hainaut, CeREF Technique, Chaussée de Binche 159, 7000 Mons, Belgium
| | - Joey Bruno
- Université de Reims Champagne Ardenne, PSMS, UFR Sciences et Techniques des Activités Physiques et Sportives, Moulin de la Housse, 51867 Reims, France
| | - Olivier Nocent
- Université de Reims Champagne Ardenne, PSMS, UFR Sciences et Techniques des Activités Physiques et Sportives, Moulin de la Housse, 51867 Reims, France
| | - William Bertucci
- Université de Reims Champagne Ardenne, PSMS, UFR Sciences et Techniques des Activités Physiques et Sportives, Moulin de la Housse, 51867 Reims, France
| | - Fabien Buisseret
- Haute Ecole Louvain en Hainaut, CeREF Technique, Chaussée de Binche 159, 7000 Mons, Belgium; Haute Ecole Louvain en Hainaut, Laboratoire Forme et Fonctionnement Humain (FFH), Rue Trieu Kaisin 136, 6061 Montignies-sur-Sambre, Belgium; Université de Mons, Service de Physique Nucléaire et Subnucléaire, Research Institute for Complex Systems, Place du Parc 20, 7000 Mons, Belgium
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Hao J, He Z, Chen Z, Remis A. Virtual reality training versus conventional rehabilitation for chronic neck pain: A systematic review and meta-analysis. PM R 2024; 16:1143-1153. [PMID: 38545691 DOI: 10.1002/pmrj.13158] [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: 05/09/2023] [Revised: 12/27/2023] [Accepted: 01/22/2024] [Indexed: 10/10/2024]
Abstract
OBJECTIVE To identify, critically appraise, and quantitatively synthesize current randomized controlled trials to compare the effects of virtual reality and dose-matched conventional exercises in patients with chronic neck pain. LITERATURE SEARCH PubMed, Embase, CINAHL, PsycINFO, and Scopus were searched for studies published prior to April 15, 2023. The search strategies combined controlled vocabularies and title/abstract keywords on search themes of virtual reality and neck pain. METHODS A systematic review and meta-analysis of randomized controlled trials was conducted. Two independent reviewers conducted study selection, data extraction, and quality assessment. Methodological quality was assessed using the Physiotherapy Evidence Database scale. Meta-analyses were performed using random-effects models. SYNTHESIS Six randomized controlled trials including 243 participants with chronic neck pain met the inclusion criteria. Four studies were evaluated as good quality and two as fair. Pooled analysis revealed that virtual reality demonstrated significantly better improvements in the Neck Disability Index in both the short term (mean difference [MD] = -2.16; 95% confidence interval [CI]: -3.50 to -0.82) and long term (MD = -2.95; 95% CI: -4.93 to -0.97), and pain intensity in the short term (MD = -0.94, 95% CI: -1.31 to -0.58). No significant between-group differences were found in pain in the long term and kinesiophobia. CONCLUSIONS Virtual reality is a promising intervention to address disability and pain in patients with chronic neck pain. This review supports the clinical significance of augmenting conventional exercise with virtual reality as part of conservative management of chronic neck pain.
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Affiliation(s)
- Jie Hao
- College of Allied Health Professions, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Zhengting He
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ziyan Chen
- School of Basic Medical Sciences, Capital Medical University, Beijing, China
| | - Andréas Remis
- Gate Parkway Primary Care Center, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Jacksonville, Florida, USA
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Forsberg K, Jirlén J, Jacobson I, Röijezon U. Cervical Sensorimotor Function Tests Using a VR Headset-An Evaluation of Concurrent Validity. SENSORS (BASEL, SWITZERLAND) 2024; 24:5811. [PMID: 39275722 PMCID: PMC11397787 DOI: 10.3390/s24175811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2024] [Revised: 08/07/2024] [Accepted: 09/04/2024] [Indexed: 09/16/2024]
Abstract
Sensorimotor disturbances such as disturbed cervical joint position sense (JPS) and reduced reaction time and velocity in fast cervical movements have been demonstrated in people with neck pain. While these sensorimotor functions have been assessed mainly in movement science laboratories, new sensor technology enables objective assessments in the clinic. The aim was to investigate concurrent validity of a VR-based JPS test and a new cervical reaction acuity (CRA) test. Twenty participants, thirteen asymptomatic and seven with neck pain, participated in this cross-sectional study. The JPS test, including outcome measures of absolute error (AE), constant error (CE), and variable error (VE), and the CRA test, including outcome measures of reaction time and maximum velocity, were performed using a VR headset and compared to a gold standard optical motion capture system. The mean bias (assessed with the Bland-Altman method) between VR and the gold standard system ranged from 0.0° to 2.4° for the JPS test variables. For the CRA test, reaction times demonstrated a mean bias of -19.9 milliseconds (ms), and maximum velocity a mean bias of -6.5 degrees per seconds (°/s). The intraclass correlation coefficients (ICCs) between VR and gold standard were good to excellent (ICC 0.835-0.998) for the JPS test, and excellent (ICC 0.931-0.954) for reaction time and maximum velocity for the CRA test. The results show acceptable concurrent validity for the VR technology for assessment of JPS and CRA. A slightly larger bias was observed in JPS left rotation which should be considered in future research.
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Affiliation(s)
- Karin Forsberg
- Department of Health, Education, and Technology, Luleå University of Technology, 97187 Luleå, Sweden
| | - Johan Jirlén
- Department of Health, Education, and Technology, Luleå University of Technology, 97187 Luleå, Sweden
| | - Inger Jacobson
- Department of Health, Education, and Technology, Luleå University of Technology, 97187 Luleå, Sweden
| | - Ulrik Röijezon
- Department of Health, Education, and Technology, Luleå University of Technology, 97187 Luleå, Sweden
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Lo HHM, Zhu M, Zou Z, Wong CL, Lo SHS, Chung VCH, Wong SYS, Sit RWS. Immersive and Nonimmersive Virtual Reality-Assisted Active Training in Chronic Musculoskeletal Pain: Systematic Review and Meta-Analysis. J Med Internet Res 2024; 26:e48787. [PMID: 39159449 PMCID: PMC11369537 DOI: 10.2196/48787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 06/20/2024] [Accepted: 07/04/2024] [Indexed: 08/21/2024] Open
Abstract
BACKGROUND Virtual reality (VR) in different immersive conditions has been increasingly used as a nonpharmacological method for managing chronic musculoskeletal pain. OBJECTIVE We aimed to assess the effectiveness of VR-assisted active training versus conventional exercise or physiotherapy in chronic musculoskeletal pain and to analyze the effects of immersive versus nonimmersive VR on pain outcomes. METHODS This systematic review of randomized control trials (RCTs) searched PubMed, Scopus, and Web of Science databases from inception to June 9, 2024. RCTs comparing adults with chronic musculoskeletal pain receiving VR-assisted training were included. The primary outcome was pain intensity; secondary outcomes included functional disability and kinesiophobia. Available data were pooled in a meta-analysis. Studies were graded using the Cochrane Risk-of-Bias Tool version 2. RESULTS In total, 28 RCTs including 1114 participants with some concerns for a high risk of bias were identified, and 25 RCTs were included in the meta-analysis. In low back pain, short-term outcomes measured post intervention showed that nonimmersive VR is effective in reducing pain (standardized mean difference [SMD] -1.79, 95% CI -2.72 to -0.87; P<.001), improving disability (SMD -0.44, 95% CI -0.72 to -0.16; P=.002), and kinesiophobia (SMD -2.94, 95% CI -5.20 to -0.68; P=.01). Intermediate-term outcomes measured at 6 months also showed that nonimmersive VR is effective in reducing pain (SMD -8.15, 95% CI -15.29 to -1.01; P=.03), and kinesiophobia (SMD -4.28, 95% CI -8.12 to -0.44; P=.03) compared to conventional active training. For neck pain, immersive VR reduced pain intensity (SMD -0.55, 95% CI -1.02 to -0.08; P=.02) but not disability and kinesiophobia in the short term. No statistical significances were detected for knee pain or other pain regions at all time points. In addition, 2 (8%) studies had a high risk of bias. CONCLUSIONS Both nonimmersive and immersive VR-assisted active training is effective in reducing back and neck pain symptoms. Our study findings suggest that VR is effective in alleviating chronic musculoskeletal pain. TRIAL REGISTRATION PROSPERO CRD42022302912; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=302912.
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Affiliation(s)
- Hermione Hin Man Lo
- Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Mengting Zhu
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Zihui Zou
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Cho Lee Wong
- Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Suzanne Hoi Shan Lo
- Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Vincent Chi-Ho Chung
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Samuel Yeung-Shan Wong
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Regina Wing Shan Sit
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
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Emedoli D, Alemanno F, Iannaccone S, Houdayer E, Castellazzi P, Zangrillo F, Gasperotti F, Locatelli M, Tettamanti A. Sensory-motor training with virtual reality as a complementary intervention to manual therapy for persistent non-specific neck pain: a randomized controlled trial. Eur J Phys Rehabil Med 2024; 60:680-690. [PMID: 38922315 PMCID: PMC11391397 DOI: 10.23736/s1973-9087.24.08115-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
BACKGROUND Persistent non-specific neck pain (NP) is a widespread condition described as a complex biopsychosocial disorder, characterized by physical and psychological symptoms. Virtual reality (VR) shows promise in NP treatment, potentially reducing pain, kinesiophobia, and improving range of motion (ROM) and motor control. AIM The primary aim of the study was to assess the effectiveness of VR sensorimotor training, combined with manual therapy, in reducing the level of disability in persistent non-specific NP individuals. The secondary aim was to determine if this VR-enhanced approach also contributes to improvement in overall function, pain perception and kinesiophobia. DESIGN Monocentric, single-blind, randomized controlled trial. SETTING We conducted this trial at San Raffaele Scientific Institute, Department of Rehabilitation and Functional Recovery, Milan, Italy. POPULATION Forty NP participants were enrolled in the study and randomly allocated into two groups. METHODS The study involved a 6-week rehabilitation program, comprising 12 sessions of 45 minutes each, twice weekly. Both intervention groups underwent manual therapy as a consistent component of their treatment. The Experimental Group (VRT) was additionally engaged in sensorimotor rehabilitation exercises using Virtual Reality, whereas the Control Group (CT) performed the same exercises without VR. We assessed subjects at baseline (T0) and after six weeks of rehabilitation (T1). The primary outcome was the disability (Neck Disability Index) while the secondary outcomes were: pain perception (Numeric Rating Scale, NP and Disability Scale, Central Sensitization Inventory) function (Cervical Kinematics) and kinesiophobia (Tampa Scale of Kinesiophobia). RESULTS Both groups demonstrated significant reduction in level of disability, pain perception, and kinesiophobia. Significant advancements in kinematics were observed: VRT group showed enhanced ROM during craniocervical rotation (P=0.039), lateral bending (P=0.001), flexion-extension (P=0.009), and mean velocity across movements (P<0.001), whereas CT group improved in maximal ROM during lateral bending rotation (P=0.001). Between-group analysis, after Bonferroni's correction for multiple comparisons, revealed that VRT group had significantly better outcomes in ROM during rotation (P=0.040), ratio of the primary over the secondary movement while performing rotation (P=0.021), and mean velocity during lateral bending (P=0.031). CONCLUSIONS Sensorimotor training, combined with manual therapy, could enhance kinematic outcomes for NP patients, supporting the potential of VR in rehabilitation. CLINICAL REHABILITATION IMPACT This study highlighted that both groups demonstrated significant reduction in level of disability, pain perception, and kinesiophobia after sensorimotor training combined with manual therapy. It is important to underscore that in terms of reducing the level of neck disability, both interventions proved to be equally effective. This parity in efficacy is a critical finding, reaffirming the robustness of our therapeutic approaches for this specific outcome.
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Affiliation(s)
- Daniele Emedoli
- Department of Rehabilitation and Functional Recovery, IRCCS San Raffaele Hospital, Milan, Italy -
- Vita-Salute San Raffaele University, Milan, Italy -
| | - Federica Alemanno
- Department of Rehabilitation and Functional Recovery, IRCCS San Raffaele Hospital, Milan, Italy
| | - Sandro Iannaccone
- Department of Rehabilitation and Functional Recovery, IRCCS San Raffaele Hospital, Milan, Italy
| | - Elise Houdayer
- Department of Rehabilitation and Functional Recovery, IRCCS San Raffaele Hospital, Milan, Italy
| | - Paola Castellazzi
- Department of Rehabilitation and Functional Recovery, IRCCS San Raffaele Hospital, Milan, Italy
| | - Federica Zangrillo
- Department of Rehabilitation and Functional Recovery, IRCCS San Raffaele Hospital, Milan, Italy
| | - Filippo Gasperotti
- Department of Rehabilitation and Functional Recovery, IRCCS San Raffaele Hospital, Milan, Italy
| | - Matteo Locatelli
- Department of Rehabilitation and Functional Recovery, IRCCS San Raffaele Hospital, Milan, Italy
| | - Andrea Tettamanti
- Department of Rehabilitation and Functional Recovery, IRCCS San Raffaele Hospital, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
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Ragnarsdottir H, Peterson G, Gislason MK, Oddsdottir GL, Peolsson A. The effect of a neck-specific exercise program on cervical kinesthesia for patients with chronic whiplash-associated disorders: a case-control study. BMC Musculoskelet Disord 2024; 25:346. [PMID: 38693515 PMCID: PMC11064421 DOI: 10.1186/s12891-024-07427-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 04/09/2024] [Indexed: 05/03/2024] Open
Abstract
INTRODUCTION Cervical kinesthesia is an important part of movement control and of great importance for daily function. Previous research on kinesthesia in whiplash-associated disorders (WAD) has focused on grades I-II. More research is needed on WAD grade III. The aim of this study was to investigate cervical kinesthesia in individuals with WAD grades II-III before and after a neck-specific exercise intervention and compare them to healthy controls. METHODS A prospective, case-control study with a treatment arm (n = 30) and a healthy control arm (n = 30) was conducted in Sweden. The WAD group received a neck-specific exercise program for 12 weeks. The primary outcome to evaluate kinesthesia was neck movement control (the Fly test). Secondary outcomes were neck disability, dizziness and neck pain intensity before and after the Fly test. Outcomes were measured at baseline and post-treatment. The control arm underwent measurements at baseline except for the dizziness questionnaire. A linear mixed model was used to evaluate difference between groups (WAD and control) and over time, with difficulty level in the Fly test and gender as factors. RESULTS Between-group analysis showed statistically significant differences in three out of five kinesthetic metrics (p = 0.002 to 0.008), but not for the WAD-group follow-up versus healthy control baseline measurements. Results showed significant improvements for the WAD-group over time for three out of five kinaesthesia metrics (p < 0.001 to 0.008) and for neck disability (p < 0.001) and pain (p = 0.005), but not for dizziness (p = 0.70). CONCLUSIONS The exercise program shows promising results in improving kinesthesia and reducing neck pain and disability in the chronic WAD phase. Future research might benefit from focusing on adding kinesthetic exercises to the exercise protocol and evaluating its beneficial effects on dizziness or further improvement in kinesthesia. IMPACT STATEMENT Kinesthesia can be improved in chronic WAD patients without the use of specific kinesthetic exercises. TRIAL REGISTRATION ClinicalTrials.gov (NCT03664934), first registration approved 11/09/2018.
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Affiliation(s)
- Harpa Ragnarsdottir
- Research Centre of Movement Science, Department of Physiotherapy, University of Iceland, Stapi v/Hringbraut 31, Reykjavik, 101, IS, Iceland
- Elja Physiotherapy, Hafnafjordur, Iceland
| | - Gunnel Peterson
- Department of Health, Medicine and Caring Sciences, Unit of Physiotherapy, Linköping University, Linköping, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Magnus K Gislason
- Institute of Biomedical and Neural Engineering, Reykjavik University, Reykjavik, Iceland
| | - Gudny L Oddsdottir
- Research Centre of Movement Science, Department of Physiotherapy, University of Iceland, Stapi v/Hringbraut 31, Reykjavik, 101, IS, Iceland
| | - Anneli Peolsson
- Department of Health, Medicine and Caring Sciences, Unit of Physiotherapy, Linköping University, Linköping, Sweden.
- Occupational and Environmental Medicine Center, Department of Health, Medicine and Caring Sciences, Clinical Medicine, Linköping University, Linköping, Sweden.
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Guo Q, Zhang L, Han LL, Gui C, Chen G, Ling C, Wang W, Gao Q. Effects of Virtual Reality Therapy Combined With Conventional Rehabilitation on Pain, Kinematic Function, and Disability in Patients With Chronic Neck Pain: Randomized Controlled Trial. JMIR Serious Games 2024; 12:e42829. [PMID: 38656775 PMCID: PMC11079768 DOI: 10.2196/42829] [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: 09/20/2022] [Revised: 10/16/2023] [Accepted: 03/17/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Neck pain is a common condition that leads to neck motor dysfunction and subsequent disability, with a significant global health care burden. As a newly emerging tool, virtual reality (VR) technology has been employed to address pain and reduce disability among patients with neck pain. However, there is still a lack of high-quality studies evaluating the efficacy of VR therapy combined with conventional rehabilitation for patients with chronic neck pain, particularly in terms of kinematic function. OBJECTIVE This study aims to investigate the effect of VR therapy combined with conventional rehabilitation on pain, kinematic function, and disability in patients with chronic neck pain. METHODS We conducted an assessor-blinded, allocation-concealed randomized controlled trial. Sixty-four participants experiencing chronic neck pain were randomly allocated into the experimental group that underwent VR rehabilitation plus conventional rehabilitation or the control group receiving the same amount of conventional rehabilitation alone for 10 sessions over 4 weeks. Pain intensity, disability, kinematic function (cervical range of motion, proprioception, and mean and peak velocity), degree of satisfaction, and relief of symptoms were evaluated at 3 timepoints (baseline, postintervention, and at 3 months follow-up). A 2*3 mixed repeated measures analysis of variance was utilized for analyzing the difference across indicators, with a significant difference level of .05. RESULTS Both groups demonstrated significant improvements in pain, disability, and kinematic functions (P<.05) at postintervention and at 3-month follow-up. The experimental group showed superior therapeutic outcomes compared to the control group in pain reduction (mean difference from the baseline: 5.50 vs 1.81 at posttreatment; 5.21 vs 1.91 at the 3-month follow-up, respectively; P<.001), disability improvement (mean difference from baseline: 3.04 vs 0.50 at posttreatment; 3.20 vs 0.85 at the 3-month follow-up, respectively; P<.001), and enhanced kinematic functions (P<.05). Moreover, participants in the experimental group reported better satisfaction and relief of symptoms than the control group (P<.05), with better initiative for exercising during the follow-up period. However, there was no between-group difference of improvement in proprioception. No adverse events were reported or observed in our research. CONCLUSIONS The findings of our study support the efficacy of combining VR therapy with conventional rehabilitation in alleviating pain, enhancing kinematic function, and reducing disability of patients with chronic neck pain. Future research should focus on refining the therapeutic protocols and dosages for VR therapy as well as on optimizing its application in clinical settings for improved convenience and effectiveness. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2000040132; http://www.chictr.org.cn/showproj.aspx?proj=64346.
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Affiliation(s)
- Qifan Guo
- West China Hospital, Sichuan University, Chengdu, China
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Liming Zhang
- West China Hospital, Sichuan University, Chengdu, China
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Leo Lianyi Han
- Biostatistics Group, State Key Laboratory of Genetic Engineering, Greater Bay Area Institute of Precision Medicine (Guangzhou), Fudan University, Guangzhou, China
| | - Chenfan Gui
- West China Hospital, Sichuan University, Chengdu, China
| | - Guanghui Chen
- Department of Traumatology and Orthopedics of Traditional Chinese Medicine, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, China
| | - Chunyan Ling
- Department of Acupuncture and Tuina, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, China
| | - Wei Wang
- Department of Acupuncture and Tuina, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, China
| | - Qiang Gao
- West China Hospital, Sichuan University, Chengdu, China
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
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Majcen Rosker Z, Rosker J. Cervicocephalic kinaesthesia reveals novel subgroups of motor control impairments in patients with neck pain. Sci Rep 2024; 14:8383. [PMID: 38600120 PMCID: PMC11006834 DOI: 10.1038/s41598-024-57326-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 03/18/2024] [Indexed: 04/12/2024] Open
Abstract
Cervical-spine sensorimotor control is associated with chronicity and recurrence of neck pain (NP). Tests used to measure sensorimotor impairments lack consistency in studied parameters. Interpretation is often based on either a handful or numerous parameters, without considering their possible interrelation. Different aspects of motor-control could be studied with different parameters, but this has not yet been addressed. The aim of this study was to determine if different parameters of cervical position (JPE) and movement (Butterfly) sense tests represent distinct components of motor-control strategies in patients with chronic NP. Principal component analysis performed on 135 patients revealed three direction-specific (repositioning from flexion, extension or rotations) and one parameter-specific (variability of repositioning) component for JPE, two difficulty-specific (easy or medium and difficult trajectory) and one movement-specific (undershooting a target) component for Butterfly test. Here we report that these components could be related to central (neck repositioning and control of cervical movement) and peripheral sensorimotor adaptations (variability of repositioning) present in NP. New technologies allow extraction of greater number of parameters of which hand-picking could lead to information loss. This study adds towards better identification of diverse groups of parameters offering potentially clinically relevant information and improved functional diagnostics for patients with NP.
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Affiliation(s)
| | - Jernej Rosker
- Faculty of Health Sciences, University of Primorska, Koper, Slovenia.
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Nast I, Scheermesser M, Ernst M, Sommer B, Schmid P, Weisenhorn M, E B, Gomez D, Iten P, von Wartburg A, Frey W, Lünenburger L, Bauer C. Usability of a visual feedback system to assess and improve movement disorders related to neck pain: Perceptions of physical therapists and patients. Heliyon 2024; 10:e26931. [PMID: 38434337 PMCID: PMC10907800 DOI: 10.1016/j.heliyon.2024.e26931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 02/19/2024] [Accepted: 02/21/2024] [Indexed: 03/05/2024] Open
Abstract
A prototype visual feedback system has been developed to assess and improve movement disorders related to neck pain. The aim of this study was to assess the usability of the prototype in a rehabilitation setting. Twelve physical therapists integrated the device into their regular therapy programs for 24 neck pain patients with movement disorders. Each patient performed three individual therapy sessions with the device under physical therapist supervision. Usability was assessed by the physical therapists and patients using therapy diaries, the System Usability Scale, and focus group or personal interviews. Based on an overall usability rating of marginally acceptable, the visual feedback system was generally found to be a device with the potential to assess and train neck pain patients but needs improvement. To become a useful adjunct to regular physical therapy, improvements in the hardware and software, and further system developments are required.
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Affiliation(s)
- I. Nast
- Zurich University of Applied Sciences, School of Health Professions, Institute of Physiotherapy, Katharina-Sulzer-Platz 9, 8401, Winterthur, Switzerland
| | - M. Scheermesser
- Zurich University of Applied Sciences, School of Health Professions, Institute of Physiotherapy, Katharina-Sulzer-Platz 9, 8401, Winterthur, Switzerland
| | - M.J. Ernst
- Zurich University of Applied Sciences, School of Health Professions, Institute of Physiotherapy, Katharina-Sulzer-Platz 9, 8401, Winterthur, Switzerland
| | - B. Sommer
- Zurich University of Applied Sciences, School of Health Professions, Institute of Physiotherapy, Katharina-Sulzer-Platz 9, 8401, Winterthur, Switzerland
| | - P. Schmid
- Zurich University of Applied Sciences, School of Engineering, Institute of Signal Processing and Wireless Communications, Technikumstrasse 71, 8400, Winterthur, Switzerland
| | - M. Weisenhorn
- Zurich University of Applied Sciences, School of Engineering, Institute of Signal Processing and Wireless Communications, Technikumstrasse 71, 8400, Winterthur, Switzerland
| | - Bärtschi E
- Balgrist University Hospital, Forchstrasse 340, 8008, Zürich, Switzerland
| | - D. Gomez
- Cantonal Hospital, Winterthur Brauerstrasse 15, 8401, Winterthur, Switzerland
| | - P. Iten
- Cantonal Hospital, Winterthur Brauerstrasse 15, 8401, Winterthur, Switzerland
- Physiowerk Aadorf, Hauptstrasse 47, 8355, Aadorf, Switzerland
| | - A. von Wartburg
- Hocoma AG, Industriestrasse 4, 8604, Volketswil, Switzerland
| | - W.O. Frey
- Balgrist University Hospital, Forchstrasse 340, 8008, Zürich, Switzerland
- Clinic Hirslanden, Klinik Hirslanden, Dr. med. Walter O. Frey, Witellikerstrasse 40, 8032, Zürich, Switzerland
| | - L. Lünenburger
- Hocoma AG, Industriestrasse 4, 8604, Volketswil, Switzerland
| | - C.M. Bauer
- Zurich University of Applied Sciences, School of Health Professions, Institute of Physiotherapy, Katharina-Sulzer-Platz 9, 8401, Winterthur, Switzerland
- Lake Lucerne Institute, Seestrasse 18, 6354, Vitznau, Switzerland
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10
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Saby A, Alvarez A, Smolins D, Petros J, Nguyen L, Trujillo M, Aygün O. Effects of Embodiment in Virtual Reality for Treatment of Chronic Pain: Pilot Open-Label Study. JMIR Form Res 2024; 8:e34162. [PMID: 38363591 PMCID: PMC10907942 DOI: 10.2196/34162] [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: 10/22/2021] [Revised: 07/13/2022] [Accepted: 09/21/2023] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Chronic pain has long been a major health burden that has been addressed through numerous forms of pharmacological and nonpharmacological treatment. One of the tenets of modern medicine is to minimize risk while providing efficacy. Further, because of its noninvasive nature, virtual reality (VR) provides an attractive platform for potentially developing novel therapeutic modalities. OBJECTIVE The purpose of this study was to determine the feasibility of a novel VR-based digital therapy for the treatment of chronic pain. METHODS An open-label study assessed the feasibility of using virtual embodiment in VR to treat chronic pain. In total, 24 patients with chronic pain were recruited from local pain clinics and completed 8 sessions of a novel digital therapeutic that combines virtual embodiment with graded motor imagery to deliver functional rehabilitation exercises over the course of 4 weeks. Pain intensity as measured by a visual analog scale before and after each virtual embodiment training session was used as the primary outcome measure. Additionally, a battery of patient-reported pain questionnaires (Fear-Avoidance Beliefs Questionnaire, Oswestry Low Back Pain Disability Questionnaire, Pain Catastrophizing Scale, and Patient Health Questionnaire) were administered before and after 8 sessions of virtual embodiment training as exploratory outcome measures to assess if the measures are appropriate and warrant a larger randomized controlled trial. RESULTS A 2-way ANOVA on session × pre- versus postvirtual embodiment training revealed that individual virtual embodiment training sessions significantly reduced the intensity of pain as measured by the visual analog scale (P<.001). Perceived disability due to lower back pain as measured by the Oswestry Low Back Pain Disability Questionnaire significantly improved (P=.003) over the 4-week course of virtual embodiment regimen. Improvement was also observed on the helplessness subscale of the Pain Catastrophizing Scale (P=.02). CONCLUSIONS This study provides evidence that functional rehabilitation exercises delivered in VR are safe and may have positive effects on alleviating the symptoms of chronic pain. Additionally, the virtual embodiment intervention may improve perceived disability and helplessness of patients with chronic pain after 8 sessions. The results support the justification for a larger randomized controlled trial to assess the extent to which virtual embodiment training can exert an effect on symptoms associated with chronic pain. TRIAL REGISTRATION ClinicalTrials.gov NCT04060875; https://clinicaltrials.gov/ct2/show/NCT04060875.
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Affiliation(s)
- Adam Saby
- Department of Emergency Medicine, Occupational Health Division, University of California Los Angeles, Los Angeles, CA, United States
| | | | | | - James Petros
- Allied Pain and Spine, San Jose, CA, United States
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11
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Zhang T, Li X, Zhou X, Zhan L, Wu F, Huang Z, Sun Y, Feng Y, Du Q. Virtual Reality Therapy for the Management of Chronic Spinal Pain: Systematic Review and Meta-Analysis. JMIR Serious Games 2024; 12:e50089. [PMID: 38345832 PMCID: PMC10897798 DOI: 10.2196/50089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 12/01/2023] [Accepted: 01/07/2024] [Indexed: 03/01/2024] Open
Abstract
BACKGROUND The effectiveness of virtual reality (VR) therapy in adults with chronic spinal pain (CSP) is unclear. OBJECTIVE This study was conducted to compare the effectiveness of VR therapy and other therapies in adults with CSP, especially patients with inflammation-related pain. METHODS PubMed, Web of Science, Cochrane Library, Embase, and CINAHL databases were searched up to November 11, 2023. Randomized controlled trials (RCTs) comparing adults with CSP receiving VR therapy with those receiving other therapies were included. The trial registration platform as well as the reference lists of included studies and previous systematic reviews and meta-analyses were manually searched. Two independent reviewers performed study selection, data extraction, risk-of-bias assessment, and evaluation of the quality of the evidence. The weighted mean difference (WMD) was used as the effect size used to synthesize the outcome measure. RESULTS In total, 16 RCTs involving 800 participants were included in this meta-analysis. The pooled data from 15 (94%) RCTs including 776 (97%) participants showed that VR therapy was superior in improving pain intensity (WMD=-1.63, 95% CI -2.11 to -1.16, P<.001, I2=90%) and reducing inflammatory markers, including C-reactive protein (WMD=-0.89, 95% CI -1.07 to -0.70, P<.001, I2=0%), tumor necrosis factor-alpha (WMD=-6.60, 95% CI -8.56 to -4.64, P<.001, I2=98%), and interleukin-6 (WMD=-2.76, 95% CI -2.98 to -2.53, P<.001, I2=0%). However, no significant differences were found in terms of the spinal range of motion (ROM), disability level, or fear of movement. In addition, 10 (63%) of the included RCTs had a high risk of bias. CONCLUSIONS VR therapy may be an effective and safe intervention for reducing symptoms in patients with CSP, as it is shown to exert significant analgesic effects and beneficial improvements in inflammatory factor levels. However, this approach may not have significant effects on the spinal ROM, disability level, or fear of movement. Notably, the quality of the evidence from the RCTs included in this study ranged from moderate to low. Therefore, we recommend that readers interpret the results of this study with caution. TRIAL REGISTRATION PROSPERO CRD42022382331; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=382331.
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Affiliation(s)
- Tongtong Zhang
- Department of Rehabilitation, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Xin Li
- Department of Rehabilitation, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Xuan Zhou
- Department of Rehabilitation, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lixia Zhan
- The Second People's Hospital of Beihai, Beihai, China
| | - Fan Wu
- Department of Rehabilitation, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zefan Huang
- Department of Rehabilitation, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuxun Sun
- College of Rehabilitation Sciences, Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Yufei Feng
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Qing Du
- Department of Rehabilitation, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Chongming Hospital, Shanghai University of Medicine & Health Sciences, Shanghai, China
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12
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Li LW, Beng MH, Singh PA, Koo SH, Sng BL. Evaluating simulator sickness and acceptability of virtual reality prototype in pain management in hospitalized patients. Pain Manag 2024; 14:53-63. [PMID: 38357747 DOI: 10.2217/pmt-2023-0072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024] Open
Abstract
Aim: Acute and chronic noncancer pain is a common healthcare problem locally and globally, and remains under treated and poorly controlled. We created a virtual reality (VR)-based prototype with customization of content to our local population. Materials & methods: This was an open-label, single center, single-arm study to examine the safety, acceptability and tolerability of the use of VR as an adjunctive tool for pain relief in hospitalized patients. The participants rated their baseline and post-VR pain and anxiety scores. Results & conclusion: All 50 patients completed the VR sessions with good tolerability and safety. Preliminary exploration of pain reduction indicated a positive effect (for pain and anxiety visual analog scale scores; p < 0.001). We believe VR is a potentially beneficial tool for use in pain management.
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Affiliation(s)
- Lydia Weiling Li
- Department of Anaesthesia & Surgical Intensive Care, Changi General Hospital, Singapore
- Duke-NUS Graduate Medical School, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Michael Hock Beng
- Department of Anaesthesia & Surgical Intensive Care, Changi General Hospital, Singapore
| | - Prit Anand Singh
- Department of Anaesthesia & Surgical Intensive Care, Changi General Hospital, Singapore
- Duke-NUS Graduate Medical School, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Seok Hwee Koo
- Research Laboratory, Changi General Hospital, Singapore
| | - Ban Leong Sng
- Duke-NUS Graduate Medical School, Singapore
- KK Women's & Children's Hospital, Singapore
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13
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Forsberg K, Jirlén J, Jacobson I, Röijezon U. Concurrent Validity of Cervical Movement Tests Using VR Technology-Taking the Lab to the Clinic. SENSORS (BASEL, SWITZERLAND) 2023; 23:9864. [PMID: 38139710 PMCID: PMC10747215 DOI: 10.3390/s23249864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/12/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023]
Abstract
Reduced cervical range of motion (ROM) and movement velocity are often seen in people with neck pain. Objective assessment of movement characteristics is important to identify dysfunction, to inform tailored interventions, and for the evaluation of the treatment effect. The purpose of this study was to investigate the concurrent validity of a newly developed VR technology for the assessment of cervical ROM and movement velocity. VR technology was compared against a gold-standard three-dimensional optical motion capture system. Consequently, 20 people, 13 without and 7 with neck pain, participated in this quantitative cross-sectional study. ROM was assessed according to right/left rotation, flexion, extension, right/left lateral flexion, and four diagonal directions. Velocity was assessed according to fast cervical rotation to the right and left. The correlations between VR and the optical system for cervical ROM and velocity were excellent, with intraclass correlation coefficient (ICC) values > 0.95. The mean biases between VR and the optical system were ≤ 2.1° for the ROM variables, <12°/s for maximum velocity, and ≤3.0°/s for mean velocity. In conclusion, VR is a useful assessment device for ROM and velocity measurements with clinically acceptable biases. It is a feasible tool for the objective measurement of cervical kinematics in the clinic.
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Affiliation(s)
- Karin Forsberg
- Department of Health, Education, and Technology, Luleå University of Technology, 97187 Luleå, Sweden; (J.J.); (I.J.); (U.R.)
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Chaplin E, Karatzios C, Benaim C. Clinical Applications of Virtual Reality in Musculoskeletal Rehabilitation: A Scoping Review. Healthcare (Basel) 2023; 11:3178. [PMID: 38132067 PMCID: PMC10742848 DOI: 10.3390/healthcare11243178] [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: 10/31/2023] [Revised: 12/04/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023] Open
Abstract
(1) Background: VR is based on a virtual world that creates sounds effects and videos that replace the real environment. Arising literature shows VR efficacy in the field of neurological rehabilitation (NR) and that its use is also taking a place in musculoskeletal rehabilitation (MSR), as a treatment of various disorders that cause disability and chronic pain. (2) Aim: We discuss the role of VR in MSR, presenting its use and development on acute and chronic musculoskeletal disorders, based on the most recent literature. (3) Design and Methods: Literature searches were conducted in the databases Pubmed and Medline up to 30 September 2023. The PRISMA-Scr Checklist was followed. (4) Results: A total of 51 records were included. The analysed studies were conducted within a variety of populations, musculoskeletal disorders, settings, and VR technologies. Only a few studies could statistically affirm the efficacy of VR in MSR, as mentioned for the rehabilitation of the upper limb. Nevertheless, the observed trend is an improvement of the global perceived effect compared to traditional rehabilitation. (5) Conclusion: VR allows for the personalisation of treatment with an adaptable treatment platform, which may improve the participation of the patient and increase acceptability and adherence to long-term rehabilitation programs. We provide recommendations and suggestions for future research and use of VR in musculoskeletal rehabilitation.
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Affiliation(s)
- Elizabeth Chaplin
- Division of Physical Medicine and Rehabilitation, Orthopaedic Hospital, University Hospital of Lausanne, 1011 Lausanne, Switzerland; (C.K.); (C.B.)
| | - Christos Karatzios
- Division of Physical Medicine and Rehabilitation, Orthopaedic Hospital, University Hospital of Lausanne, 1011 Lausanne, Switzerland; (C.K.); (C.B.)
| | - Charles Benaim
- Division of Physical Medicine and Rehabilitation, Orthopaedic Hospital, University Hospital of Lausanne, 1011 Lausanne, Switzerland; (C.K.); (C.B.)
- Department of Medical Research, Clinique Romande de Réadaptation, Suvacare, 1950 Sion, Switzerland
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15
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McGirt MJ, Holland CM, Farber SH, Zuckerman SL, Spertus MS, Theodore N, Pfortmiller D, Stanley G. Remote cognitive behavioral therapy utilizing an in-home virtual reality toolkit (Vx Therapy) reduces pain, anxiety, and depression in patients with chronic cervical and lumbar spondylytic pain: A potential alternative to opioids in multimodal pain management. NORTH AMERICAN SPINE SOCIETY JOURNAL 2023; 16:100287. [PMID: 38033880 PMCID: PMC10684389 DOI: 10.1016/j.xnsj.2023.100287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/15/2023] [Accepted: 10/16/2023] [Indexed: 12/02/2023]
Abstract
Background Context Virtual reality (VR) reduces pain through visual and auditory distraction without narcotic-related side effects or dependency. Cognitive behavioral therapy (CBT) improves pain-related disability and quality of life, but patient access remains a challenge. We hypothesized that in-home weekly CBT coordinated with daily use of a proprietary VR toolkit will reduce pain, anxiety, and depression for patients with non-operative chronic cervical and lumbar spondylitic pain with and without radiculopathy. Methods A total of 145 patients with chronic spondylitic pain (63 cervical, 46 noradicular lumbar, 36 radicular lumbar) were enrolled into a guided 14-week VR+CBT program (Vx Therapy) consisting of weekly encounters with a trained therapist and 50 modules. Pain/anxiety severity scores and time to pain recurrence were recorded prospectively by patients. PROMIS measures of overall daily pain intensity, behavior, interference, anxiety, and depression were recorded at baseline and conclusion of the program. Results A total of 52% of the 145 patients were male. The average (SD) age of the cohort was 51 (10.7) years (range: 24-76 years). Mean score for all PROMIS domains were significantly improved after 14 weeks of Vx Therapy (pain intensity 36±24 vs. 28±21, interference 39±25 vs. 24±21, behavior 35±21 vs. 25±16, anxiety 51±28 vs. 41±26, depression 58±32 vs. 48±32) for the entire cohort and each diagnosis group. Virtual reality acutely reduced pain on average by 33% (4.5±2.5 vs. 6.7±2.2, p<.05) across all 14 weeks, lasting a mean 2.8 hours after use. Duration of pain relief increased by the final vs. first month (4.5 hours vs. 2.5 hours, p<.05). Virtual reality acutely reduced anxiety on average by 46% (3.5±3 vs. 6.4±2, p<.05) across all 14 weeks lasting a mean 2.7 hours after use. The effect was similar for all 3 groups. Conclusions Fourteen weeks of a remote CBT guided in-home VR toolkit provided effective and sustained pain, anxiety, and depression relief in patients with chronic degenerative neck/back pain with and without radiculopathy. The non-invasive, non-pharmacological nature of Vx Therapy makes it an ideal option for pain management in the post-opioid epidemic era.
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Affiliation(s)
- Matthew J. McGirt
- Carolina Neurosurgery & Spine Associates, Atrium-Wake Forest University, 225 Baldwin Ave, Charlotte, NC 28205, USA
| | - Christopher M. Holland
- Carolina Neurosurgery & Spine Associates, Atrium-Wake Forest University, 225 Baldwin Ave, Charlotte, NC 28205, USA
| | - S. Harrison Farber
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 W. Thomas Rd. Phoenix, AZ 85013, USA
| | - Scott L. Zuckerman
- Department of Neurosurgery, Vanderbilt University, 1211 Medical Center, Nashville, TN 37232, USA
| | - Michael S. Spertus
- Whole Health in Pain Medicine, Miami Veterans Affairs Healthcare System, 1201 NW 16th St., Miami, FL 33125, USA
| | - Nicholas Theodore
- Department of Neurosurgery, Johns Hopkins University, 1800 Orleans St., Baltimore, MD 21287, USA
| | - Deborah Pfortmiller
- Carolina Neurosurgery & Spine Associates, Atrium-Wake Forest University, 225 Baldwin Ave, Charlotte, NC 28205, USA
| | - Gerry Stanley
- Harvard Med Tech, 6280 S. Valley View Blvd., Las Vegas, NV 89118, USA
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16
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Gavish L, Weissberger O, Barzilay Y. Gamification of Cervical Spine Physiotherapy by Virtual Reality Software: Is This Real Rehabilitation? Games Health J 2023; 12:468-471. [PMID: 37486726 DOI: 10.1089/g4h.2023.0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023] Open
Abstract
Objective: Physical rehabilitation by virtual reality (VR) gamification is gaining acceptance. This study was designed to verify whether neck movements invoked by a fully immersive VR game environment may be physiotherapist-prescribed rehabilitation exercise. Methods: This was a single-visit prospective clinical trial (NCT03104647). Healthy participants put on VR headsets and entered a fully immersive game environment (VRPhysio, XRHealth, Tel Aviv, Israel) that prompted neck movement (flexion, extension, rotation, lateral bend, and combinations repeated twice in random order) accompanied by feedback encouraging correct performance. Four board-certified physiotherapists independently viewed videotapes recorded during the session, identified movements, and determined whether they were recommended as neck rehabilitation exercises. Results: Twenty (n = 20) participants (male-female ratio = 13:7; age = 38 ± 14 years old) completed the training session (16 movements per participant). All movements were identified correctly and determined to be appropriate for neck rehabilitation. No adverse events were reported. Conclusions: The VRPhysio software invoked movements identified by board-certified physiotherapists as appropriate for neck rehabilitation. The potential advantage of home-based VR gamification of cervical spine rehabilitation programs over common practice in motivating patient adherence warrants evaluation by randomized controlled trials.
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Affiliation(s)
- Lilach Gavish
- Institute for Research in Military Medicine (IRMM), Faculty of Medicine, The Hebrew University of Jerusalem and the Israel Defense Forces Medical Corps, Jerusalem, Israel
| | | | - Yair Barzilay
- Department of Orthopedic Surgery, Shaare Zedek Medical Center, Jerusalem, Israel
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17
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Özden F, Özkeskin M, Tümtürk İ, Yalın Kılınç C. The effect of exercise and education combination via telerehabilitation in patients with chronic neck pain: A randomized controlled trial. Int J Med Inform 2023; 180:105281. [PMID: 37924590 DOI: 10.1016/j.ijmedinf.2023.105281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 10/25/2023] [Accepted: 10/30/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND A limited number of studies have investigated the effect of telerehabilitation in individuals with chronic neck pain (CNP). OBJECTIVE The study aimed to evaluate the effectiveness of holistic exercise and education combination via telerehabilitation on pain, disability, kinesiophobia, exercise adherence, quality of life and patient satisfaction in individuals with CNP. METHODS A two-armed, randomized controlled study was conducted with 40 participants with CNP. Patients were randomized into two groups: Telerehabilitation (TR) (n = 20) and Standard Rehabilitation (SR) (n = 20). The TR group was provided with exercise and education videos online. The same protocol was given to the SR group in the clinical setting. Patients were evaluated at baseline and after eight weeks of intervention. Satisfaction and usability levels of the TR group were assessed at week 8. RESULTS TR group demonstrated better improvement in function, quality of life (including bodily pain, general health, social function), kinesiophobia and exercise adherence. The TR group was not superior to the SR group in pain and other quality-of-life subscores. A vast majority of the TR group had high satisfaction and usability. CONCLUSION Comprehensive rehabilitation via TR increases satisfaction and participation in patients with CNP. Besides, TR provides more positive effects on function and kinesiophobia. Further studies should focus on the impact of telerehabilitation on pain and quality of life in CNP with a long-term follow-up.
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Affiliation(s)
- Fatih Özden
- Muğla Sıtkı Koçman University, Köyceğiz Vocational School of Health Services, Department of Health Care Services, Muğla, Turkey
| | - Mehmet Özkeskin
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Ege University, İzmir, Turkey.
| | - İsmet Tümtürk
- Institute of Health Sciences, Department of Physiotherapy and Rehabilitation, Süleyman Demirel University, İzmir, Turkey
| | - Cem Yalın Kılınç
- Faculty of Medicine, Department of Orthopedics and Traumatology, Muğla Sıtkı Koçman University, Muğla, Turkey
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18
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Cho WS, Park CB, Kim BG. Effects of exercise therapy on pain and disability in patients with non-specific neck pain: A systematic review and meta-analysis. J Bodyw Mov Ther 2023; 36:213-220. [PMID: 37949563 DOI: 10.1016/j.jbmt.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/07/2023] [Accepted: 07/04/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Existing systematic reviews and meta-analyses have only focused on patients with chronic non-specific neck pain (NNP), analyzing exercise therapy (ET) only as therapeutic exercise. Therefore, it is necessary to comprehensively review the effects of ET through a meta-analysis comprising a wide range of ETs that are not limited to therapeutic exercise. OBJECTIVES This study aimed to investigate the effects of ET on pain and disability in patients with NNP. DESIGN Systematic review and meta-analysis. METHOD The studies selected for this study were based on the PICO-SD tool as follows: P (patient)-acute, subacute, and chronic NNP patents, I (intervention)-ET, C (comparison)-control and other therapy groups, O (outcome)-pain and disability, and SD (study design)-randomized controlled trial. RESULTS Twenty-one studies were included. The effects of ET on pain and disability in patients with chronic NNP were significantly different (pain: SMD -1.47, 95% CI: -1.89 to -1.06, I2: 94%; disability: SMD -1.79, 95% CI: -2.31 to -1.27, I2: 94%). The effects of ET on pain (ET vs control: SMD: -1.60, 95% CI: -2.09 to -1.11, I2: 94%; ET vs sham therapy: SMD: -8.75, 95% CI: -10.71 to -6.79) and disability (ET vs control: SMD: -2.16, 95% CI: -2.80 to -1.52, I2: 94%; ET vs sham therapy: SMD: -1.73, 95% CI: -2.42 to -1.05) in NNP patients were significantly different. CONCLUSIONS This study verified the efficacy of ET in improving pain and disability in patients with chronic NNP. However, evidence supporting the efficacy of ET in patients with acute and subacute NNP is still lacking.
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Affiliation(s)
- Woon Su Cho
- Department of Physical Therapy, Nambu University, Gwangju, 62271, South Korea
| | - Chi Bok Park
- Department of Physical Therapy, Nambu University, Gwangju, 62271, South Korea
| | - Byeong Geun Kim
- Department of Physical Therapy, Nambu University, Gwangju, 62271, South Korea; Bareun Physiotherapy Research Institute, Gwangju, 62271, South Korea.
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Bilika P, Karampatsou N, Stavrakakis G, Paliouras A, Theodorakis Y, Strimpakos N, Kapreli E. Virtual Reality-Based Exercise Therapy for Patients with Chronic Musculoskeletal Pain: A Scoping Review. Healthcare (Basel) 2023; 11:2412. [PMID: 37685446 PMCID: PMC10487144 DOI: 10.3390/healthcare11172412] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/25/2023] [Accepted: 08/26/2023] [Indexed: 09/10/2023] Open
Abstract
This scoping review aimed to identify interventions utilizing virtual-reality-based exercise therapy in patients with chronic musculoskeletal pain. Searches were conducted in four databases using descriptors related to virtual reality, exercise, and chronic musculoskeletal pain. Two reviewers screened the titles and abstracts of the studies to assess eligibility, with a third author resolving any discrepancies. Data were extracted and summarized in a narrative format by three independent raters. Clinical trials were evaluated using the PEDro scale to assess the effectiveness of virtual-reality-based exercise therapy in chronic musculoskeletal pain patients. A total of 162 articles were identified from the databases. After applying the inclusion criteria, nine articles were considered suitable for analysis, including six randomized clinical trials. The selected articles were categorized based on study characteristics, virtual-reality-based exercise therapy interventions (including technologies and equipment used), exercise interventions, outcome measures, and effectiveness. The findings indicate that virtual-reality-based exercise therapy shows promising results in reducing pain, improving disability, enhancing range of motion, and increasing treatment satisfaction in patients with chronic musculoskeletal pain. However, it is not possible to conclude that virtual-reality-based exercise therapy is superior to other treatments due to the limited number of available studies, heterogeneity in application protocols, and varying methodological quality. Further research is needed to draw more definitive conclusions.
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Affiliation(s)
- Paraskevi Bilika
- Clinical Exercise Physiology and Rehabilitation Research Laboratory, Physiotherapy Department, Faculty of Health Sciences, University of Thessaly, 35100 Lamia, Greece (G.S.); (A.P.); (E.K.)
| | - Natalia Karampatsou
- Clinical Exercise Physiology and Rehabilitation Research Laboratory, Physiotherapy Department, Faculty of Health Sciences, University of Thessaly, 35100 Lamia, Greece (G.S.); (A.P.); (E.K.)
| | - Giorgos Stavrakakis
- Clinical Exercise Physiology and Rehabilitation Research Laboratory, Physiotherapy Department, Faculty of Health Sciences, University of Thessaly, 35100 Lamia, Greece (G.S.); (A.P.); (E.K.)
| | - Achilleas Paliouras
- Clinical Exercise Physiology and Rehabilitation Research Laboratory, Physiotherapy Department, Faculty of Health Sciences, University of Thessaly, 35100 Lamia, Greece (G.S.); (A.P.); (E.K.)
| | - Yannis Theodorakis
- Exercise Psychology & Quality of Life Research Laboratory, Department of Physical Education and Sport Science, University of Thessaly, 42100 Trikala, Greece
| | - Nikolaos Strimpakos
- Health Assessment and Quality of Life Research Laboratory, Physiotherapy Department, Faculty of Health Sciences, University of Thessaly, 35100 Lamia, Greece
- Division of Musculoskeletal & Dermatological Sciences, Honorary Research Associate, University of Manchester, Manchester M13 9PL, UK
| | - Eleni Kapreli
- Clinical Exercise Physiology and Rehabilitation Research Laboratory, Physiotherapy Department, Faculty of Health Sciences, University of Thessaly, 35100 Lamia, Greece (G.S.); (A.P.); (E.K.)
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Favre J, Cantaloube A, Jolles BM. Rehabilitation for Musculoskeletal Disorders: The Emergence of Serious Games and the Promise of Personalized Versions Using Artificial Intelligence. J Clin Med 2023; 12:5310. [PMID: 37629350 PMCID: PMC10455669 DOI: 10.3390/jcm12165310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 07/26/2023] [Indexed: 08/27/2023] Open
Abstract
According to the World Health Organization (WHO), musculoskeletal conditions are among the most common health problems, affecting approximately 1 [...].
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Affiliation(s)
- Julien Favre
- Swiss BioMotion Lab, Lausanne University Hospital, University of Lausanne (CHUV-UNIL), CH-1011 Lausanne, Switzerland
- The Sense Innovation and Research Center, CH-1007 Lausanne, Switzerland
| | - Alexis Cantaloube
- Swiss BioMotion Lab, Lausanne University Hospital, University of Lausanne (CHUV-UNIL), CH-1011 Lausanne, Switzerland
| | - Brigitte M. Jolles
- Swiss BioMotion Lab, Lausanne University Hospital, University of Lausanne (CHUV-UNIL), CH-1011 Lausanne, Switzerland
- Institute of Electrical and Micro Engineering, Ecole Polytechnique Fédérale Lausanne (EPFL), CH-1015 Lausanne, Switzerland
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Mueller J, Weinig J, Niederer D, Tenberg S, Mueller S. Resistance, Motor Control, and Mindfulness-Based Exercises Are Effective for Treating Chronic Nonspecific Neck Pain: A Systematic Review With Meta-Analysis and Dose-Response Meta-Regression. J Orthop Sports Phys Ther 2023; 53:420–459. [PMID: 37339388 DOI: 10.2519/jospt.2023.11820] [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] [Indexed: 06/22/2023]
Abstract
OBJECTIVE: We aimed to analyze the effects and dose-response relationship of the most effective exercises for improving pain and disability in people with chronic nonspecific neck pain. DESIGN: Intervention systematic review with meta-analysis. LITERATURE SEARCH: We searched the PubMed, PEDro, and CENTRAL databases from their inception to September 30, 2022. STUDY SELECTION CRITERIA: We included randomized controlled trials that involved people with chronic neck pain adopting a longitudinal exercise intervention and assessed one pain and/or disability outcome. DATA SYNTHESIS: Restricted maximum-likelihood random-effects meta-analyses were modeled separately for resistance, mindfulness-based, and motor control exercises; standardized mean differences (Hedge's g, standardized mean difference [SMD]) were effect estimators. Meta-regressions (dependent variable: effect sizes of the interventions; independent variables: training dose and control group effects) were conducted to explore the dose-response relationship for therapy success of any exercise type. RESULTS: We included 68 trials. Compared to true control, effects on pain and disability were significantly larger for resistance exercise (pain: SMD, -1.27; 95% confidence interval [CI]: -2.26, -0.28; |2 = 96%; disability: SMD, -1.76; 95% CI: -3.16, -0.37; |2 = 98%), motor control exercise (pain: SMD, -2.29; 95% CI: -3.82, -0.75; |2 = 98%; disability: SMD, -2.42; 95% CI: -3.38, -1.47; |2 = 94%), and Yoga/Pilates/Tai Chi/Qui Gong exercise (pain: SMD, 1.91; 95% CI:-3.28, -0.55; |2 = 96%; disability: SMD, -0.62; 95% CI: -0.85, -0.38; |2 = 0%). Yoga/Pilates/Tai Chi/Qui Gong exercise was more effective than other exercises (SMD, -0.84; 95% CI: -1.553, -0.13; |2 = 86%) for reducing pain. For disability, motor control exercise was superior to other exercises (SMD, -0.70; 95% CI: -1.23, -0.17; |2 = 98%). There was no dose-response relationship for resistance exercise (R2 = 0.32). Higher frequencies (estimate = -0.10) and longer durations (estimate = -0.11) of motor control exercise had larger effects on pain (R2 = 0.72). Longer sessions (estimate = -0.13) of motor control exercise had larger effects on disability (R2 = 0.61). CONCLUSION: Resistance, mindfulness-based, and motor control exercises were effective for reducing neck pain (very low- to moderate-certainty evidence). Higher frequencies and longer duration of sessions had a significant effect on pain for motor control exercise. J Orthop Sports Phys Ther 2023;53(8):1-41. Epub: 20 June 2023. doi:10.2519/jospt.2023.11820.
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22
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Guo Q, Zhang LIM, Gui C, Chen G, Chen Y, Tan H, Su W, Zhang R, Gao Q. Virtual Reality Intervention for Patients With Neck Pain: Systematic Review and Meta-analysis of Randomized Controlled Trials. J Med Internet Res 2023; 25:e38256. [PMID: 37010891 PMCID: PMC10131665 DOI: 10.2196/38256] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/31/2022] [Accepted: 02/27/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Neck pain is a prevalent condition that causes an enormous health care burden due to the lack of efficient therapies. As a promising technology, virtual reality (VR) has shown advantages in orthopedic rehabilitation. However, there is no meta-analysis evaluating the effectiveness of VR in neck pain management. OBJECTIVE This study aims to review original randomized controlled trials (RCTs) evaluating the effectiveness of VR for neck pain and to provide evidence for the clinical application of a new alternative approach for pain management. METHODS A total of 9 electronic databases were systematically searched for relevant articles published from inception to October 2022. RCTs in English or Chinese that investigated VR therapy for participants with neck pain were included. The methodological quality and the evidence level were assessed using the Cochrane Back and Neck Risk of Bias tool and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) guideline, respectively. RESULTS A total of 8 studies with 382 participants were included for the final analysis. For the pain intensity, the overall pooled effect size was 0.51, with a standardized mean difference (SMD) of -0.51 (95% CI -0.91 to -0.11; GRADE: moderate), favoring VR therapy compared with controls. Subgroups analyses revealed that significant differences in pain intensity were found in the multimodal intervention (VR in combination with other therapies) than in other interventions (SMD -0.45, 95% CI -0.78 to -0.13; GRADE: moderate), and better analgesic effects were also observed in patients with chronic neck pain receiving VR intervention (SMD -0.70, 95% CI -1.08 to -0.32; GRADE: moderate) and patients treated in the clinic or research unit (SMD -0.52, 95% CI -0.99 to -0.05; GRADE: moderate) than controls. Regarding other health outcomes, the VR experienced less disability, lower kinesiophobia, and greater kinematic function (cervical range of motion, mean and peak velocity). Nevertheless, the follow-up effects of VR therapy on pain intensity and disability were not found. CONCLUSIONS Existing moderate evidence support VR as a beneficial nonpharmacological approach to improve pain intensity in patients with neck pain, with advantages to multimodal intervention, people with chronic neck pain, and clinic or research unit-based VR therapy. However, the limited quantity and high heterogeneity of the articles limit our findings. TRIAL REGISTRATION PROSPERO CRD42020188635; https://tinyurl.com/2839jh8w.
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Affiliation(s)
- Qifan Guo
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - LIMing Zhang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Chenfan Gui
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Guanghui Chen
- Department of Traumatology and Orthopedics of Traditional Chinese Medicine, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, China
| | - Yi Chen
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Huixin Tan
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Su
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Ruishi Zhang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Qiang Gao
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
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23
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Kantha P, Lin JJ, Hsu WL. The Effects of Interactive Virtual Reality in Patients with Chronic Musculoskeletal Disorders: A Systematic Review and Meta-Analysis. Games Health J 2023; 12:1-12. [PMID: 36706260 DOI: 10.1089/g4h.2022.0088] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Objective: Interactive virtual reality (iVR) has been widely used for treatment purposes in patients with chronic musculoskeletal disorders. However, no consensus has been reached on the effects of iVR on pain, psychological distress, and functional disability. Therefore, this study aims to investigate the effects of iVR on pain, psychological distress, and functional disability in patients with chronic musculoskeletal disorders compared with no rehabilitation and conventional rehabilitation. Methods: Five electronic databases (PubMed, Cochrane CENTRAL, Scopus, EMBASE, and Web of Science) were searched from January 2016 to December 2021. All randomized controlled trials using iVR for treating pain, psychological distress, and functional disability in patients with chronic musculoskeletal disorders were included. A subgroup analysis was conducted to compare the effects of nonimmersive and immersive types of iVR on the outcomes of interest. Results: Our study provides good quality evidence that iVR reduced overall pain by 9.28 points as compared with no rehabilitation and by 8.09 points as compared with conventional rehabilitation. In the subgroup analysis, nonimmersive iVR showed a reduction in psychological distress (standardized mean differences = -0.35) as compared with no rehabilitation. However, no statistically significant difference in the outcomes existed between nonimmersive and immersive iVR. Furthermore, there were no statistically significant differences in the outcomes of functional disability. Conclusions: iVR is recommended for reducing pain intensity more than no rehabilitation or conventional rehabilitation. Meanwhile, nonimmersive iVR has been proposed for psychological distress improvement, with effects similar to those of conventional rehabilitation. However, iVR may not be an effective intervention in the case of functional disability.
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Affiliation(s)
- Phunsuk Kantha
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jiu-Jenq Lin
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.,Division of Physical Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Li Hsu
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.,Physical Therapy Center, National Taiwan University Hospital, Taipei, Taiwan
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Janela D, Costa F, Weiss B, Areias AC, Molinos M, Scheer JK, Lains J, Bento V, Cohen SP, Correia FD, Yanamadala V. Effectiveness of biofeedback-assisted asynchronous telerehabilitation in musculoskeletal care: A systematic review. Digit Health 2023; 9:20552076231176696. [PMID: 37325077 PMCID: PMC10262679 DOI: 10.1177/20552076231176696] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 05/02/2023] [Indexed: 06/17/2023] Open
Abstract
Background Musculoskeletal conditions are the leading cause of disability worldwide. Telerehabilitation may be a viable option in the management of these conditions, facilitating access and patient adherence. Nevertheless, the impact of biofeedback-assisted asynchronous telerehabilitation remains unknown. Objective To systematically review and assess the effectiveness of exercise-based asynchronous biofeedback-assisted telerehabilitation on pain and function in individuals with musculoskeletal conditions. Methods This systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The search was conducted using three databases: PubMed, Scopus, and PEDro. Study criteria included articles written in English and published from January 2017 to August 2022, reporting interventional trials evaluating exercise-based asynchronous telerehabilitation using biofeedback in adults with musculoskeletal disorders. The risks of bias and certainty of evidence were appraised using the Cochrane tool and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE), respectively. The results are narratively summarized, and the effect sizes of the main outcomes were calculated. Results Fourteen trials were included: 10 using motion tracker technology (N = 1284) and four with camera-based biofeedback (N = 467). Telerehabilitation with motion trackers yields at least similar improvements in pain and function in people with musculoskeletal conditions (effect sizes: 0.19-1.45; low certainty of evidence). Uncertain evidence exists for the effectiveness of camera-based telerehabilitation (effect sizes: 0.11-0.13; very low evidence). No study found superior results in a control group. Conclusions Asynchronous telerehabilitation may be an option in the management of musculoskeletal conditions. Considering its potential for scalability and access democratization, additional high-quality research is needed to address long-term outcomes, comparativeness, and cost-effectiveness and identify treatment responders.
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Affiliation(s)
| | | | - Brandon Weiss
- Lake Erie College of Osteopathic Medicine, Erie, PA, USA
| | | | | | - Justin K. Scheer
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Jorge Lains
- Rovisco Pais Medical and Rehabilitation Centre, Tocha, Portugal
- Faculty of Medicine, Coimbra University, Coimbra, Portugal
| | | | - Steven P. Cohen
- Departments of Anesthesiology & Critical Care Medicine, Physical Medicine and Rehabilitation, Neurology, and Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Departments of Anesthesiology and Physical Medicine and Rehabilitation and Anesthesiology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Fernando Dias Correia
- Sword Health, Inc, Draper, UT, USA
- Neurology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Vijay Yanamadala
- Sword Health, Inc, Draper, UT, USA
- Department of Surgery, Quinnipiac University Frank H. Netter School of Medicine, Hamden, CT, USA
- Department of Neurosurgery, Hartford Healthcare Medical Group, Westport, CT, USA
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Cetin H, Kose N, Oge HK. Virtual reality and motor control exercises to treat chronic neck pain: A randomized controlled trial. Musculoskelet Sci Pract 2022; 62:102636. [PMID: 35952621 DOI: 10.1016/j.msksp.2022.102636] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 07/21/2022] [Accepted: 07/25/2022] [Indexed: 12/14/2022]
Abstract
AIM To compare the effects of virtual reality (VR) and motor control (MC) exercises. METHODS Forty-one participants with chronic neck pain (CNP) were randomized into the VR or MC group. Both groups performed 18 sessions over 6 weeks. The primary outcomes were pain intensity (visual analogue scale), pain pressure thresholds (PPTs), joint position sense error (JPSE), and muscle performance. The secondary outcomes were the Profile Fitness Mapping Questionnaire (ProFitMap-Neck), Hospital Anxiety-Depression Scale (HADS), and quality of life (SF-36). Data were analysed using T-Tests, and Fisher's Exact Test. Mean (standard deviation), median (interquartile range), effect size and %95 confidence interval (CI) were reported. RESULTS The results of Independent T-Tests showed that VR was advantageous in terms of PPTs of the C1/C2 and C5/C6 articular pillar bilaterally and large effect size (Cohen's d > 0.8, p < 0.05). Moreover, VR was more effective in decreasing JPSE (Cohen's d > 0.08; mean difference changes between -2.91 and -1.24, %95 CI -4.47 to 0.80) and functional limitation (ProFitMap-Neck) (Cohen's d = 0.7, mean difference 8.27, %95 CI 0.20 to 16.35). The results of T-Tests demonstrated that neither intervention was superior in terms of pain intensity, muscle performance, symptoms (ProFitMap-Neck), HADS, or SF-36 (Cohen's d < 0.5). CONCLUSIONS VR can be applied for improving proprioception and for decreasing cervical articular pain in CNP patients. In addition, VR may be more effective for decreasing functional limitations in patients. Clinicians can choose MC exercises with or without VR for improving pain, muscle performance, symptoms, anxiety/depression, and quality of life.
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Affiliation(s)
- Hatice Cetin
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey.
| | - Nezire Kose
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Halil Kamil Oge
- Department of Neurosurgery, Medical Faculty, Hacettepe University, Ankara, Turkey
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Luc A, Tamer S, Hage R, Detrembleur C, Pitance L. Do the kinematics and sensorimotor control of people with chronic non-specific neck pain differ from those of healthy individuals when assessed in an immersive virtual reality environment? A systematic review. PHYSICAL THERAPY REVIEWS 2022. [DOI: 10.1080/10833196.2022.2143211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Alexandre Luc
- Neuro Musculo Skeletal Lab, Institut de Recherche Expérimentale et Clinique, Secteur des Sciences de la Santé, Université Catholique de Louvain, Brussels, Belgium
| | - Stephany Tamer
- Faculté des Sciences de la Motricité, Secteur des Sciences de la Santé, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Renaud Hage
- Neuro Musculo Skeletal Lab, Institut de Recherche Expérimentale et Clinique, Secteur des Sciences de la Santé, Université Catholique de Louvain, Brussels, Belgium
- Centre de Recherche et de Formation (CeREF), HELHa, Mons, Belgium
| | - Christine Detrembleur
- Neuro Musculo Skeletal Lab, Institut de Recherche Expérimentale et Clinique, Secteur des Sciences de la Santé, Université Catholique de Louvain, Brussels, Belgium
- Faculté des Sciences de la Motricité, Secteur des Sciences de la Santé, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Laurent Pitance
- Neuro Musculo Skeletal Lab, Institut de Recherche Expérimentale et Clinique, Secteur des Sciences de la Santé, Université Catholique de Louvain, Brussels, Belgium
- Faculté des Sciences de la Motricité, Secteur des Sciences de la Santé, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
- Cliniques Universitaires Saint-Luc, Stomatologie et Chirurgie Maxillo-Faciale, Université Catholique de Louvain, Brussels, Belgium
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Effectiveness of Virtual Reality-Based Interventions for Managing Chronic Pain on Pain Reduction, Anxiety, Depression and Mood: A Systematic Review. Healthcare (Basel) 2022; 10:healthcare10102047. [PMID: 36292493 PMCID: PMC9602273 DOI: 10.3390/healthcare10102047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/09/2022] [Accepted: 10/12/2022] [Indexed: 11/23/2022] Open
Abstract
(1) Background: Patients diagnosed with chronic pain suffer from long-term pain, which negatively affects their daily lives and mental health. Virtual reality (VR) technologies are considered a therapeutic tool to manage pain perception and mental health conditions. This systematic review aimed to appraise the efficacy of VR in improving pain intensity, anxiety, depression and mood among patients with chronic pain; (2) Methods: Five electronic databases were systematically searched using the terms representing VR and chronic pain. Quality assessment was conducted using Cochrane Collaboration’s tool and Newcastle-Ottawa scale; (3) Results: Seventeen peer-reviewed articles were included in this review. It was found that VR was able to reduce pain intensity in patients with phantom limb pain, chronic headache, chronic neck pain and chronic low-back pain. The effects of VR on the improvement of anxiety, depression and mood were not determined due to the inadequate amount of clinical evidence; (4) Conclusions: VR, especially immersive VR, improves pain outcomes and its effects may vary depending on the approach and study design. More research is still needed to investigate the clinical use of VR in patients with chronic pain.
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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: 0.5] [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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Lukacs MJ, Salim S, Katchabaw MJ, Yeung E, Walton DM. Virtual reality in physical rehabilitation: a narrative review and critical reflection. PHYSICAL THERAPY REVIEWS 2022. [DOI: 10.1080/10833196.2022.2105077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Michael J. Lukacs
- Health and Rehabilitation Sciences, Western University, Canada
- Bone and Joint Institute, Western University, Canada
| | - Shahan Salim
- Public Health and Health Systems, University of Waterloo, Canada
| | | | - Euson Yeung
- Physical Therapy, University of Toronto, Canada
| | - David M. Walton
- Bone and Joint Institute, Western University, Canada
- School of Physical Therapy, Western University, Canada
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Röijezon U, Jull G, Blandford C, Daniels A, Michaelson P, Karvelis P, Treleaven J. Proprioceptive Disturbance in Chronic Neck Pain: Discriminate Validity and Reliability of Performance of the Clinical Cervical Movement Sense Test. FRONTIERS IN PAIN RESEARCH 2022; 3:908414. [PMID: 35875476 PMCID: PMC9299354 DOI: 10.3389/fpain.2022.908414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/08/2022] [Indexed: 11/18/2022] Open
Abstract
Chronic neck pain is associated with sensorimotor dysfunctions, which may develop symptoms, affect daily activities, and prevent recovery. Feasible, reliable, and valid objective methods for the assessment of sensorimotor functions are important to identify movement impairments and guide interventions. The aim of this study was to investigate the discriminative validity of a clinical cervical movement sense test, using a laser pointer and an automatic video-based scoring system. Individuals with chronic neck pain of idiopathic onset (INP), traumatic onset (TNP), and healthy controls (CON) were tested. Associations between movement sense and neck disability were examined and the repeatability of the test was investigated. A total of 106 participants (26 INP, 28 TNP, and 52 CON) were included in a cross-sectional study. Acuity, Speed, Time, and NormAcuity (i.e., normalized acuity by dividing acuity with movement time) were used as outcome measures. ANOVAs were used for group comparisons and Pearson correlations for associations between movement sense variables and neck disability index (NDI). Notably, 60 of the participants (30 CON, 17 INP, and 13 TNP) performed the test on a second occasion to explore test-retest reliability. Results revealed a reduced NormAcuity for both INP and TNP compared with CON (p < 0.05). The neck pain groups had similar Acuity but longer Time compared with CON. Among TNP, there was a fair positive correlation between Acuity and NDI, while there was a negative correlation between Acuity and NDI among INP. Reliability measures showed good to excellent ICC values between tests, but standard error of measurements (SEM) and minimal detectable change (MDC) scores were high. The results showed that NormAcuity is a valuable measure to identify disturbed cervical movement sense among INP and TNP. While Acuity was similar between the groups, different strategies, such as longer Time, to perform the task among neck patient groups were used. Few differences were identified between the neck pain groups, but altered strategies may exist. Reliability was acceptable, and the test is feasible to perform in the clinic. However, the technical complexity of the automated image analysis is a concern. Future developments will provide more feasible solutions.
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Affiliation(s)
- Ulrik Röijezon
- Division of Health, Medicine and Rehabilitation, Department of Health, Education and Technology, Luleå University of Technology, Luleå, Sweden
| | - Gwendolen Jull
- Division of Health, Medicine and Rehabilitation, Department of Health, Education and Technology, Luleå University of Technology, Luleå, Sweden
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD, Australia
| | - Christian Blandford
- Division of Health, Medicine and Rehabilitation, Department of Health, Education and Technology, Luleå University of Technology, Luleå, Sweden
| | - Anna Daniels
- Division of Health, Medicine and Rehabilitation, Department of Health, Education and Technology, Luleå University of Technology, Luleå, Sweden
| | - Peter Michaelson
- Division of Health, Medicine and Rehabilitation, Department of Health, Education and Technology, Luleå University of Technology, Luleå, Sweden
| | - Petros Karvelis
- Department of Informatics and Telecommunications, University of Ioannina, Arta, Greece
| | - Julia Treleaven
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD, Australia
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A network analysis reveals the interaction between fear and physical features in people with neck pain. Sci Rep 2022; 12:11304. [PMID: 35787648 PMCID: PMC9253153 DOI: 10.1038/s41598-022-14696-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 06/10/2022] [Indexed: 12/02/2022] Open
Abstract
Although neck pain is known to be a complex and multifactorial condition characterised by the interplay between physical and psychological domains, a comprehensive investigation examining the interactions across multiple features is still lacking. In this study, we aimed to unravel the structure of associations between physical measures of neuromuscular function and fear of movement in people with a history of neck pain. One hundred participants (mean age 33.3 ± 9.4) were assessed for this cross-sectional study, and the neuromuscular and kinematic features investigated were the range of motion, velocity of neck movement, smoothness of neck movement, neck proprioception (measured as the joint reposition error), and neck flexion and extension strength. The Tampa Scale for Kinesiophobia was used to assess fear of movement. A network analysis was conducted to estimate the associations across features, as well as the role of each feature in the network. The estimated network revealed that fear of movement and neuromuscular/kinematic features were conditionally dependent. Higher fear of movement was associated with a lower range of motion, velocity, smoothness of neck movement, neck muscle strength, and proprioception (partial correlations between − 0.05 and − 0.12). Strong interactions were also found between kinematics features, with partial correlations of 0.39 and 0.58 between the range of motion and velocity, and between velocity and smoothness, respectively. The velocity of neck movement was the most important feature in the network since it showed the highest strength value. Using a novel approach to analysis, this study revealed that fear of movement can be associated with a spectrum of neuromuscular/kinematic adaptations in people with a history of neck pain.
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Huang J, Xu Y, Xuan R, Baker JS, Gu Y. A Mixed Comparison of Interventions for Kinesiophobia in Individuals With Musculoskeletal Pain: Systematic Review and Network Meta-Analysis. Front Psychol 2022; 13:886015. [PMID: 35846681 PMCID: PMC9277051 DOI: 10.3389/fpsyg.2022.886015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/30/2022] [Indexed: 11/28/2022] Open
Abstract
Objective This systematic review aims to make a mixed comparison of interventions for kinesiophobia and individuals with musculoskeletal pain. Methods A comprehensive search strategy was conducted in the database of PubMed, MEDLINE, and Web of Science with the inclusion criteria: (1) randomized controlled design; (2) patients with musculoskeletal pain as participants; (3) treatments protocols of kinesiophobia as interventions or comparisons; (4) the score of Tampa Scale Kinesiophobia (TSK) as outcome measures. A network meta-analysis was used to synthesize the data after checking the model consistency. The risk of bias was assessed by the Cochrane Collaboration Risk of Bias Assessment Tool. Results Thirty-one studies were included in this review after a comprehensive search strategy with a low risk of bias and good consistency. According to the results of the network meta-analysis, a multi-modal treatment protocol had the highest probability to become the best choice in dealing with kinesiophobia caused by musculoskeletal pain, whereas psychological treatment protocols also showed a potentially positive effect on musculoskeletal pain-induced kinesiophobia. Conclusion Multi-modal protocols could be recommended as the preferred option when dealing with kinesiophobia caused by musculoskeletal pain. However, it is still worth mentioning that there are also potentially positive therapeutic effects of psychological interventions. Since the concept of kinesiophobia is based on the fear-avoidance model, the psychological mechanism should be paid enough attention to during treatment. Registration Number CRD42021286450.
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Affiliation(s)
- Jialu Huang
- Faculty of Sports Science, Ningbo University, Ningbo, China
| | - Yining Xu
- Faculty of Sports Science, Ningbo University, Ningbo, China
| | - Rongrong Xuan
- The Affiliated Hospital of Medical School of Ningbo University, Ningbo, China
| | - Julien S. Baker
- Department of Sport and Physical Education, Hong Kong Baptist University, Kowloon, Hong Kong SAR, China
| | - Yaodong Gu
- Faculty of Sports Science, Ningbo University, Ningbo, China
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Gava V, Fialho HRF, Calixtre LB, Barbosa GM, Kamonseki DH. Effects of Gaming on Pain-Related Fear, Pain Catastrophizing, Anxiety, and Depression in Patients with Chronic Musculoskeletal Pain: A Systematic Review and Meta-Analysis. Games Health J 2022; 11:369-384. [PMID: 35613404 DOI: 10.1089/g4h.2021.0232] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The aim was to systematically review the effects of gaming on pain-related fear, pain catastrophizing, anxiety, and depression in patients with chronic musculoskeletal pain. Databases (Medline, EMBASE, PsycInfo, CINAHL, Cochrane Central Register for Controlled Trials [CENTRAL], Web of Science, and SCOPUS) were searched from inception up to October 2021. Two reviewers independently selected randomized controlled trials that compared the effects of any gaming modality with other interventions or no treatment on pain-related fear, pain catastrophizing, anxiety, and depression. For data synthesis, Standardized Mean Differences (SMDs) and 95% confidence interval (CI) were calculated using a random-effects inverse variance model for meta-analysis according to the outcome of interest, comparison group, and follow-up period. The level of evidence was synthesized using Grading of Recommendations, Assessment, Development, and Evaluations (GRADE). Thirteen studies were included with a total sample of 680 patients. Gaming was superior to other treatments and no treatment on reducing pain-related fear (SMD: -1.23; 95% CI: -2.02 to -0.44) and anxiety (SMD: -0.55; 95% CI: -1.01 to -0.09), respectively. Gaming was not superior to other treatments on reducing pain catastrophizing, anxiety, and depression, and it was not superior to no treatment on reducing pain-related fear, pain catastrophizing, and depression. Those findings were based on very low or low-quality evidence. In a conclusion, gaming modalities may have positive effects on some mental health outcomes. However, there were conflicting results with low-quality evidence, which indicates that more high-quality randomized controlled trials are needed.
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Affiliation(s)
- Vander Gava
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil
| | - Hilmaynne Renaly Fonseca Fialho
- Postgraduate Program in Rehabilitation Sciences, Faculty of Health Sciences of Trairi, Federal University of Rio Grande do Norte, Santa Cruz, Brazil
| | | | - Germanna Medeiros Barbosa
- Postgraduate Program in Rehabilitation Sciences, Faculty of Health Sciences of Trairi, Federal University of Rio Grande do Norte, Santa Cruz, Brazil
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Goudman L, Jansen J, Billot M, Vets N, De Smedt A, Roulaud M, Rigoard P, Moens M. Virtual Reality Applications in Chronic Pain Management: Systematic Review and Meta-analysis. JMIR Serious Games 2022; 10:e34402. [PMID: 35536641 PMCID: PMC9131143 DOI: 10.2196/34402] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 02/18/2022] [Accepted: 03/16/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Virtual reality (VR) is a computer technology that immerses a user in a completely different reality. The application of VR in acute pain settings is well established. However, in chronic pain, the applications and outcome parameters influenced by VR are less clear. OBJECTIVE This review aimed to systematically identify all outcome parameters that are reported in relation to VR in patients with chronic pain. METHODS A total of 4 electronic databases (PubMed, Scopus, Web of Science, and Embase) were searched for relevant studies. Multilevel random-effect meta-analyses were performed, whereby the standardized mean difference was chosen as the effect size to denote the difference between measurements before and after a VR intervention. RESULTS The initial database search identified 1430 studies, of which 41 (2.87%) were eventually included in the systematic review. Evidence has been found for the effects of VR on pain, functioning, mobility, functional capacity, psychological outcomes, quality of life, neuropsychological outcomes, and physical sensations. The overall effect size (a total of 194 effect sizes from 25 studies) based on a three level meta-analysis was estimated at 1.22 (95% CI 0.55-1.89; z=3.56; P<.001), in favor of improvements after a VR intervention. When categorizing effect sizes, the overall effect sizes were reported as follows: 1.60 (95% CI 0.83-2.36; z=4.09; P<.001) for the effect of VR on pain (n=31), 1.40 (95% CI 0.13-2.67; z=2.17; P=.03) for functioning (n=60), 0.49 (95% CI -0.71 to 1.68; z=0.80; P=.42) for mobility (n=24), and 0.34 (95% CI -1.52 to 2.20; z=0.36; P=.72) for functional capacity (n=21). CONCLUSIONS This systematic review revealed a broad range of outcome variables influenced by an intervention of VR technology, with statistically significant pain relief and improvements in functioning. These findings indicate that VR not only has applications in acute pain management but also in chronic pain settings, whereby VR might be able to become a promising first-line intervention as complementary therapy for patients with chronic pain. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42021227016; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=227016.
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Affiliation(s)
- Lisa Goudman
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Jette, Belgium.,STIMULUS, Vrije Universiteit Brussel, Jette, Belgium.,Center for Neurosciences, Vrije Universiteit Brussel, Jette, Belgium.,Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Jette, Belgium.,Research Foundation-Flanders, Brussel, Belgium
| | - Julie Jansen
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Jette, Belgium.,STIMULUS, Vrije Universiteit Brussel, Jette, Belgium
| | - Maxime Billot
- PRISMATICS, Poitiers University Hospital, Poitiers, France
| | - Nieke Vets
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Jette, Belgium.,STIMULUS, Vrije Universiteit Brussel, Jette, Belgium
| | - Ann De Smedt
- STIMULUS, Vrije Universiteit Brussel, Jette, Belgium.,Center for Neurosciences, Vrije Universiteit Brussel, Jette, Belgium.,Department of Physical Medicine and Rehabilitation, Universitair Ziekenhuis Brussel, Jette, Belgium
| | - Manuel Roulaud
- PRISMATICS, Poitiers University Hospital, Poitiers, France
| | - Philippe Rigoard
- PRISMATICS, Poitiers University Hospital, Poitiers, France.,Department of Spine Surgery & Neuromodulation, Poitiers University Hospital, Poitiers, France.,Pprime Institute, University of Poitiers, Chasseneuil-du-Poitou, France
| | - Maarten Moens
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Jette, Belgium.,STIMULUS, Vrije Universiteit Brussel, Jette, Belgium.,Center for Neurosciences, Vrije Universiteit Brussel, Jette, Belgium.,Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Jette, Belgium.,Department of Radiology, Universitair Ziekenhuis Brussel, Jette, Belgium
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35
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Conventional Cervical Exercises Compared with a Mixed-Reality-Based Game in Asymptomatic Subjects: An Exploratory Crossover Pilot Study. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12073657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Mixed reality presents itself as a potential technological tool for the management of people with musculoskeletal disorders, without having as many adverse side effects as immersive virtual reality. The objective of this study was to explore the possibilities of a mixed-reality game, performing task-oriented cervical exercises compared to conventional therapeutic exercises in sensorimotor outcome measures in asymptomatic subjects. A randomized crossover pilot study was performed with two intervention groups: a mixed-reality group (MRG) and a conventional exercise group (CEG). The cervical joint position error test (CJPET) and deep cervical flexor endurance test (DCFET) were measured as sensorimotor outcomes. Statistically significant differences were found in the pre–post comparison in the DCFET for both groups (MRG: t = −3.87, p < 0.01; CEG: t = −4.01, p < 0.01) and in the extension of the CJPET for the MRG (t = 3.50, p < 0.01). The rest of the measurements showed no significant differences comparing both groups pre- and postintervention (p > 0.05). Mixed reality has apparently the same positive effects as conventional exercises in sensorimotor outcomes in asymptomatic subjects. These results could help in future studies with mixed virtual reality in the management of people with musculoskeletal disorders.
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36
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Grassini S. Virtual Reality Assisted Non-Pharmacological Treatments in Chronic Pain Management: A Systematic Review and Quantitative Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:4071. [PMID: 35409751 PMCID: PMC8998682 DOI: 10.3390/ijerph19074071] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/19/2022] [Accepted: 03/22/2022] [Indexed: 01/14/2023]
Abstract
Virtual reality (VR) is a developing technology that has recently attracted the attention of healthcare practitioners. Recently, VR systems have been used to treat pain symptoms. The present study aims to evaluate the VR effectiveness on chronic pain management. A systematic literature search was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Keywords were used to discover the potentially eligible studies. The primary focus of the present investigation was to evaluate the possible effect of VR-assisted treatments on chronic pain, especially in the commonly occurring low back and neck pain. Nine studies reporting randomized controlled trials were included in the present study. VR-mediated interventions demonstrated significant improvement for pain symptoms in patients experiencing chronic pain. In addition, VR-mediated therapy decreased pain intensity and disability in the case of chronic neck pain compared to control conditions. However, the VR interventions showed a statistically non-significant improvement in chronic low back pain when experimental groups were compared with controls. VR therapy positive effect on chronic pain did not differ from the one reported for other types of interventions for pain management, as physical exercise and laser therapy. Taken together, these findings showed that currently available lines of evidence on the effect of VR-mediated therapy in chronic pain management, despite pointing towards possible therapeutical benefits of the VR-based intervention, are overall inconclusive and that more research on VR-assisted therapy for chronic pain is needed.
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Affiliation(s)
- Simone Grassini
- Department of Social Studies, University of Stavanger, 4021 Stavanger, Norway;
- Department of Psychology, NTNU–Norwegian University of Science and Technology, 7491 Trondheim, Norway
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37
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Franov E, Straub M, Bauer CM, Ernst MJ. Head kinematics in patients with neck pain compared to asymptomatic controls: a systematic review. BMC Musculoskelet Disord 2022; 23:156. [PMID: 35172799 PMCID: PMC8848642 DOI: 10.1186/s12891-022-05097-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 02/08/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Neck pain is one of the most common musculoskeletal disorders encountered by healthcare providers. A precise assessment of functional deficits, including sensorimotor control impairment, is regarded necessary for tailored exercise programmes. Sensorimotor control can be measured by kinematic characteristics, such as velocity, acceleration, smoothness, and temporal measures, or by assessing movement accuracy. This systematic review aims to identify movement tasks and distinct outcome variables used to measure kinematics and movement accuracy in patients with neck pain and present their results in comparison to asymptomatic controls. METHODS Electronic searches were conducted in MEDLINE, PEDro, Cochrane Library and CINAHL databases from inception to August 2020. Risk of bias of included studies was assessed. Movement tasks and specific outcome parameters used were collated. The level of evidence for potential group differences in each outcome variable between patients with neck pain and controls was evaluated. RESULTS Twenty-seven studies examining head kinematics and movement accuracy during head-aiming, functional and unconstrained movement tasks of the head were included. Average Risk of Bias of included studies was moderate. In total, 23 different outcome variables were assessed. A strong level of evidence for an increased movement time and for an increased number of errors during head aiming tasks was found. Moderate evidence was found in traumatic neck pain for a decreased mean velocity, peak acceleration, and reaction time, and for point deviation and time on target during head aiming tasks. Moderate evidence was found for decreased acceleration during unconstrained movements, too. Results on the remaining movement task and outcome variables showed only limited, very limited or even conflicting level of evidence for patients with neck pain to differ from controls. CONCLUSIONS Sensorimotor control in NP in the way of kinematic and movement accuracy characteristics of head motion was examined in head aiming, functional or unconstrained movement tasks. The results from this review indicate that for some characteristics that describe sensorimotor control, patients with NP differ from healthy controls. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number: CRD42020139083.
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Affiliation(s)
- Esther Franov
- Zurich University of Applied Sciences, School of Health Professions, Institute of Physiotherapy, Katharina-Sulzer-Platz 9, 8400, Winterthur, Switzerland
| | - Matthias Straub
- Zurich University of Applied Sciences, School of Health Professions, Institute of Physiotherapy, Katharina-Sulzer-Platz 9, 8400, Winterthur, Switzerland
| | - Christoph M Bauer
- Zurich University of Applied Sciences, School of Health Professions, Institute of Physiotherapy, Katharina-Sulzer-Platz 9, 8400, Winterthur, Switzerland
| | - Markus J Ernst
- Zurich University of Applied Sciences, School of Health Professions, Institute of Physiotherapy, Katharina-Sulzer-Platz 9, 8400, Winterthur, Switzerland.
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38
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Beltran-Alacreu H, Navarro-Fernández G, Godia-Lledó D, Graell-Pasarón L, Ramos-González Á, Raya R, Martin-Pintado Zugasti A, Fernandez-Carnero J. A Serious Game for Performing Task-Oriented Cervical Exercises Among Older Adult Patients With Chronic Neck Pain: Development, Suitability, and Crossover Pilot Study. JMIR Serious Games 2022; 10:e31404. [PMID: 35103608 PMCID: PMC8848226 DOI: 10.2196/31404] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 10/15/2021] [Accepted: 11/13/2021] [Indexed: 12/22/2022] Open
Abstract
Background There is sparse research on the effectiveness of therapeutic exercise for the treatment of neck pain in older adult populations. Moreover, there is a lack of research on the use of serious games or virtual reality for the treatment of neck pain in this population. Objective The primary aim of this study was to develop and assess the suitability of a serious game for performing task-oriented cervical exercises in patients with neck pain. Methods A serious game was designed based on the key features identified by previous studies that designed serious video games for physical and cognitive rehabilitation or exercise. The game in this study was designed to provide an interactive scenario, with the main functionality of the software solution to control a virtual airplane to reach targets using head motions. At the end of the exercise, the application stores the targets reached and missed and the airplane’s trajectory. A crossover pilot study was carried out for preliminary evaluation of the suitability of the technology in the older adult population. Men and women over 65 years of age with chronic neck pain were included. Subjects were randomly assigned to two study arms; each arm consisted of a sequence of two 4-week treatments with an intermediate washout period of 4 weeks. The total study duration was 16 weeks due to a final follow-up measure 4 weeks after the end of all treatments. Treatment A consisted of the use of the serious game developed in this study, and treatment B consisted of conventional exercises. Subjects allocated to the A-B study arm received treatment A first, followed by treatment B, and vice versa in the B-A arm. The following variables were assessed: Suitability Evaluation Questionnaire (SEQ) scores, Visual Analog Scale scores, and the number of targets reached in the serious game. Results A total of 18 subjects were assessed for eligibility. A total of 13 subjects, aged between 71 and 92 years (mean 81.85, SD 6.82), were finally included and completed the study protocol. The global mean SEQ score was 50.38 (SD 5.35) out of 65 points, showing good suitability of the serious game. Most patients considered the experience very enjoyable and “real” in terms of the virtual environment and found the information provided to be clear. Also, they believed that the game could be very helpful for their rehabilitation. None of the patients felt any neck pain or discomfort when playing the game, and only 2 patients out of 13 (15%) reported some degree of dizziness, eye discomfort, or disorientation, which did not limit their capacity to finish the session. Conclusions The serious game developed in this study showed good suitability for use in adults over 70 years of age with chronic neck pain. The game was a safe method for performing task-oriented cervical exercises, and patients reported very high levels of satisfaction and acceptance after the use of this technology.
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Affiliation(s)
- Hector Beltran-Alacreu
- Toledo Physiotherapy Research Group, Faculty of Physical Therapy and Nursing, Universidad de Castilla-La Mancha, Toledo, Spain.,CranioSPain Research Group, Centro Superior de Estudios Universitarios La Salle, Madrid, Spain
| | - Gonzalo Navarro-Fernández
- CranioSPain Research Group, Centro Superior de Estudios Universitarios La Salle, Madrid, Spain.,Innovation and Research Unit, Galeneo, Madrid, Spain
| | - Daniela Godia-Lledó
- Physiotherapy Department, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | - Lucas Graell-Pasarón
- Physiotherapy Department, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | - Álvaro Ramos-González
- Physiotherapy Department, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | - Rafael Raya
- Departamento de Ingeniería de Sistemas de Información, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain.,Werium Solutions, Madrid, Spain
| | | | - Josue Fernandez-Carnero
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, Madrid, Spain.,Grupo Multidisciplinar de Investigación y Tratamiento del Dolor, Grupo de Excelencia Investigadora Universidad Rey Juan Carlos-Banco de Santander, Madrid, Spain
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39
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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: 0.5] [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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40
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Austin PD. The Analgesic Effects of Virtual Reality for People with Chronic Pain: A Scoping Review. PAIN MEDICINE 2022; 23:105-121. [PMID: 34260724 DOI: 10.1093/pm/pnab217] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Although virtual reality is shown to have short-term analgesic effects in acute pain settings, its long-term efficacy in chronic pain conditions has not been established. This scoping review aims to provide a summary of virtual reality approaches explored in chronic primary and secondary pain conditions as defined by the International Association for the Study of Pain. METHODS A systematic literature search in Ovid PubMed and Ovid Embase was conducted between January 5 and January 10, 2021, with the use of the Arksey and O'Malley six-step scoping review criteria. Articles were searched via search terms and keywords relating to International Classification of Diseases-defined primary and secondary chronic pain conditions, virtual reality, virtual illusion, distraction, and effects on levels of pain. RESULTS Of the 2,118 articles located, 44 were included, which covered a range of primary and secondary chronic pain conditions and used a variety of different computer screen and headset protocols, including gaming, mindfulness, exercise, relaxation, and proprioceptive skills. CONCLUSIONS Studies show virtual reality to be an effective analgesic intervention for people with chronic pain. Given user satisfaction, a lack of side effects such as cybersickness, and relief of comorbid symptoms, virtual reality has potential as a worthwhile adjunct to chronic pain management programs, thus enabling patients to take control of their symptoms.
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Affiliation(s)
- Philip D Austin
- Department of Palliative Care, HammondCare, Greenwich Hospital, Sydney, New South Wales, Australia
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Lin YJ, Hsu WC, Hsieh LF, Chang KC, Kuo YC, Hsieh TL. The effect of giving verbal feedback during neck stabilisation exercise as an addition to physical therapy in patients with chronic neck pain: A randomised controlled trial. Clin Rehabil 2021; 36:230-239. [PMID: 34791911 DOI: 10.1177/02692155211044138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To study the addition of feedback-guided neck strength home exercise to physical therapy as an enhanced rehabilitation programme in the treatment of patients with chronic neck pain. DESIGN A prospective randomised controlled trial. SETTING Rehabilitation department of an academic hospital. SUBJECTS Patients with chronic neck pain. INTERVENTIONS The patients in both groups received supervised physical therapy sessions 3 times a week for 12 weeks. Patients in Group A (N = 38) used the neck strengthening exerciser device for 20 min daily at home for 6 weeks and patients in Group B (N = 20) performed 20 min of daily regular neck exercise at home for 6 weeks. OUTCOME MEASURES Neck disability index, pain visual analogue scale, active range of motion of the neck, Patient Global Assessment and patient evaluation of treatment effect. All subjects were assessed at baseline as well as at 6- and 12-week follow-ups. RESULTS At the 6-week follow-up, Group A exhibited significantly greater improvements (P < 0.05) in pain Visual Analogue Scale (Group A: 2.97 ± 1.57; Group B: 4.20 ± 1.82), neck disability index (Group A: 13.95 ± 8.07; Group B: 20.07 ± 9.14) and active cervical extension (Group A: 65.26 ± 12.76; Group B: 51.45 ± 11.78). At 12-week follow-up, Group A also exhibited significantly greater active cervical extension (Group A: 67.74 ± 11.94; Group B: 53.85 ± 14.09; P < 0.05). CONCLUSION Adding neck strengthening exerciser home training to physical therapy was demonstrated to be more effective than physical therapy alone for patients with chronic neck pain.
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Affiliation(s)
- Yi-Jia Lin
- Graduate Institute of Biomedical Engineering, 34878National Taiwan University of Science and Technology, Taipei, Taiwan
| | - Wei-Chun Hsu
- Graduate Institute of Biomedical Engineering, 34878National Taiwan University of Science and Technology, Taipei, Taiwan
| | - Lin-Fen Hsieh
- Department of Physical Medicine and Rehabilitation, 38029Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.,School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | | | - Ying-Chen Kuo
- Department of Physical Medicine and Rehabilitation, 38029Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.,School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Tien-Lee Hsieh
- Department of Physical Medicine and Rehabilitation, 38029Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
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Brea-Gómez B, Torres-Sánchez I, Ortiz-Rubio A, Calvache-Mateo A, Cabrera-Martos I, López-López L, Valenza MC. Virtual Reality in the Treatment of Adults with Chronic Low Back Pain: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182211806. [PMID: 34831562 PMCID: PMC8621053 DOI: 10.3390/ijerph182211806] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/05/2021] [Accepted: 11/07/2021] [Indexed: 12/12/2022]
Abstract
Virtual reality (VR) can present advantages in the treatment of chronic low back pain. The objective of this systematic review and meta-analysis was to analyze the effectiveness of VR in chronic low back pain. This review was designed according to PRISMA and registered in PROSPERO (CRD42020222129). Four databases (PubMed, Cinahl, Scopus, Web of Science) were searched up to August 2021. Inclusion criteria were defined following PICOS recommendations. Methodological quality was assessed with the Downs and Black scale and the risk of bias with the Cochrane Risk of Bias Assessment Tool. Fourteen studies were included in the systematic review and eleven in the meta-analysis. Significant differences were found in favor of VR compared to no VR in pain intensity postintervention (11 trials; n = 569; SMD = −1.92; 95% CI = −2.73, −1.11; p < 0.00001) and followup (4 trials; n = 240; SDM = −6.34; 95% CI = −9.12, −3.56; p < 0.00001); and kinesiophobia postintervention (3 trials; n = 192; MD = −8.96; 95% CI = −17.52, −0.40; p = 0.04) and followup (2 trials; n = 149; MD = −12.04; 95% CI = −20.58, −3.49; p = 0.006). No significant differences were found in disability. In conclusion, VR can significantly reduce pain intensity and kinesiophobia in patients with chronic low back pain after the intervention and at followup. However, high heterogeneity exists and can influence the consistency of the results.
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Sarkar U, Lee JE, Nguyen KH, Lisker S, Lyles CR. Barriers and Facilitators to the Implementation of Virtual Reality as a Pain Management Modality in Academic, Community, and Safety-Net Settings: Qualitative Analysis. J Med Internet Res 2021; 23:e26623. [PMID: 34550074 PMCID: PMC8495579 DOI: 10.2196/26623] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/26/2021] [Accepted: 05/25/2021] [Indexed: 12/23/2022] Open
Abstract
Background Prior studies have shown that virtual reality (VR) is an efficacious treatment modality for opioid-sparing pain management. However, the majority of these studies were conducted among primarily White, relatively advantaged populations and in well-resourced settings. Objective We conducted a qualitative, theory-informed implementation science study to assess the readiness for VR in safety-net settings. Methods Using the theoretical lens of the Consolidated Framework for Implementation Research (CFIR) framework, we conducted semistructured interviews with current VR users and nonusers based in safety-net health systems (n=15). We investigated barriers and facilitators to a commercially available, previously validated VR technology platform AppliedVR (Los Angeles, CA, USA). We used deductive qualitative analysis using the overarching domains of the CFIR framework and performed open, inductive coding to identify specific themes within each domain. Results Interviewees deemed the VR intervention to be useful, scalable, and an appealing alternative to existing pain management approaches. Both users and nonusers identified a lack of reimbursement for VR as a significant challenge for adoption. Current users cited positive patient feedback, but safety-net stakeholders voiced concern that existing VR content may not be relevant or appealing to diverse patients. All respondents acknowledged the challenge of integrating and maintaining VR in current pain management workflows across a range of clinical settings, and this adoption challenge was particularly acute, given resource and staffing constraints in safety-net settings. Conclusions VR for pain management holds interest for frontline pain management clinicians and leadership in safety-net health settings but will require significant tailoring and adaption to address the needs of diverse populations. Integration into complex workflows for pain management is a significant barrier to adoption, and participants cited structural cost and reimbursement concerns as impediments to initial implementation and scaling of VR use.
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Affiliation(s)
- Urmimala Sarkar
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States.,Center for Vulnerable Populations, University of California San Francisco, San Francisco, CA, United States
| | - Jane E Lee
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States.,Center for Vulnerable Populations, University of California San Francisco, San Francisco, CA, United States
| | - Kim H Nguyen
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States.,Center for Vulnerable Populations, University of California San Francisco, San Francisco, CA, United States.,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, United States
| | - Sarah Lisker
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States.,Center for Vulnerable Populations, University of California San Francisco, San Francisco, CA, United States
| | - Courtney R Lyles
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States.,Center for Vulnerable Populations, University of California San Francisco, San Francisco, CA, United States.,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, United States
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Glavare M, Stålnacke BM, Häger CK, Löfgren M. Virtual Reality Exercises in an Interdisciplinary Rehabilitation Programme for Persons with Chronic Neck Pain: a Feasibility Study. JOURNAL OF REHABILITATION MEDICINE - CLINICAL COMMUNICATIONS 2021; 4:1000067. [PMID: 34527201 PMCID: PMC8404524 DOI: 10.2340/20030711-1000067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/23/2021] [Indexed: 11/16/2022]
Abstract
Objective To investigate the feasibility of a virtual reality exercise intervention within an interdisciplinary rehabilitation programme for persons with chronic neck pain. The effects of the intervention on symptom severity, variables related to chronic neck pain, and patients' experience of exercises were assessed. Methods Nine women and 3 men participated in a 6-week virtual reality exercise intervention during an interdisciplinary rehabilitation programme. Symptom severity was rated before and after each session of virtual reality exercise, using questionnaires before and after the interdisciplinary rehabilitation programme, and questions about participants' experiences. Results Neck pain symptoms increased temporarily during the exercises, but no lasting deterioration was found after the interdisciplinary rehabilitation programme. Depression, pain interference, pain control, sleep and kinesiophobia improved significantly after the programme. Participants experienced that the virtual reality exercises increased motivation to exercise and provided a focus other than pain. However, the equipment was heavy; and exercising was tiring and reminded them of their challenges. Conclusion This study indicates that virtual reality exercises as part of an interdisciplinary rehabilitation programme are feasible and safe for patients with chronic neck pain. Pain symptoms may increase temporarily during the exercises. Virtual reality exercises may support participants by increasing motivation to exercise and providing helpful feedback. Further research into the added value of virtual reality exercises in an interdisciplinary rehabilitation programme for patients with chronic neck pain is warranted.
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Affiliation(s)
- Maria Glavare
- Department of Rehabilitation Medicine, Danderyd University Hospital
| | - Britt-Marie Stålnacke
- Karolinska Institutet, Department of Clinical Sciences, Division of Rehabilitation Medicine, Danderyd Hospital, Stockholm.,Department of Community Medicine and Rehabilitation, Rehabilitation Medicine
| | - Charlotte K Häger
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Monika Löfgren
- Department of Rehabilitation Medicine, Danderyd University Hospital.,Karolinska Institutet, Department of Clinical Sciences, Division of Rehabilitation Medicine, Danderyd Hospital, Stockholm
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Brady N, McVeigh JG, McCreesh K, Rio E, Dekkers T, Lewis JS. Exploring the effectiveness of immersive Virtual Reality interventions in the management of musculoskeletal pain: a state-of-the-art review. PHYSICAL THERAPY REVIEWS 2021. [DOI: 10.1080/10833196.2021.1903209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Niamh Brady
- Discipline of Physiotherapy, School of Clinical Therapies, College of Medicine and Health, University College Cork, Cork, Ireland
- Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
- Evolve Health, Physiotherapy and Rehabilitation Clinic, Cork, Ireland
| | - Joseph G. McVeigh
- Discipline of Physiotherapy, School of Clinical Therapies, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Karen McCreesh
- School of Allied Health, University of Limerick, Limerick, Ireland
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Ebonie Rio
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, VIC, Australia
| | - Thomas Dekkers
- Evolve Health, Physiotherapy and Rehabilitation Clinic, Cork, Ireland
- Gaelic Sports Research Centre, Technological University Dublin, Dublin, Ireland
| | - Jeremy S. Lewis
- School of Health and Social Work, University of Hertfordshire, Hatfield, UK
- Therapy Department, Central London Community Healthcare National Health Service Trust, London, UK
- Department of Physical Therapy and Rehabilitation Science, Qatar University, Doha, Qatar
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46
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Zauderer J, Lefèvre-Colau MM, Davoine É, Hocquart M, Rannou F, Roby-Brami A, Nguyen C, Roren A. Exercise therapy program using immersive virtual reality for people with non-specific chronic neck pain: a 3-month retrospective open pilot and feasibility study. Ann Phys Rehabil Med 2021; 65:101527. [PMID: 33930580 DOI: 10.1016/j.rehab.2021.101527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 12/21/2020] [Accepted: 02/13/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Jennifer Zauderer
- Service de rééducation et de réadaptation de l'appareil locomoteur et des pathologies du rachis, AP-HP, Groupe hospitalier AP-HP, Centre-Université de Paris, Hôpital Cochin, 75014 Paris, France
| | - Marie-Martine Lefèvre-Colau
- Service de rééducation et de réadaptation de l'appareil locomoteur et des pathologies du rachis, AP-HP, Groupe hospitalier AP-HP, Centre-Université de Paris, Hôpital Cochin, 75014 Paris, France; Faculté de santé, Université de Paris, UFR médecine Paris Descartes, 75006 Paris, France; INSERM UMR-S 1153, Centre de recherche épidemiologie et statistique Paris Sorbonne Cité, ECaMO Team, 75004 Paris, France; Institut fédératif de recherche sur le handicap, 75013 Paris, France
| | - Élise Davoine
- Service de rééducation et de réadaptation de l'appareil locomoteur et des pathologies du rachis, AP-HP, Groupe hospitalier AP-HP, Centre-Université de Paris, Hôpital Cochin, 75014 Paris, France
| | - Maryvonne Hocquart
- Faculté de santé, Université de Paris, UFR médecine Paris Descartes, 75006 Paris, France
| | - François Rannou
- Service de rééducation et de réadaptation de l'appareil locomoteur et des pathologies du rachis, AP-HP, Groupe hospitalier AP-HP, Centre-Université de Paris, Hôpital Cochin, 75014 Paris, France; Faculté de santé, Université de Paris, UFR médecine Paris Descartes, 75006 Paris, France; Institut fédératif de recherche sur le handicap, 75013 Paris, France; Faculté des sciences fondamentales et biomédicales, Université de Paris, Sorbonne Paris Cité, INSERM UMR-S 1124, Toxicité environnementale, cibles thérapeutiques, signalisation cellulaire et biomarqueurs (T3S), 75006 Paris, France
| | - Agnès Roby-Brami
- Service de rééducation et de réadaptation de l'appareil locomoteur et des pathologies du rachis, AP-HP, Groupe hospitalier AP-HP, Centre-Université de Paris, Hôpital Cochin, 75014 Paris, France; Institut fédératif de recherche sur le handicap, 75013 Paris, France; CNRS UMR 7222, INSERM U 1150, Institut des systèmes intelligents et de robotique, 75013 Paris, France
| | - Christelle Nguyen
- Service de rééducation et de réadaptation de l'appareil locomoteur et des pathologies du rachis, AP-HP, Groupe hospitalier AP-HP, Centre-Université de Paris, Hôpital Cochin, 75014 Paris, France; Faculté de santé, Université de Paris, UFR médecine Paris Descartes, 75006 Paris, France; Faculté des sciences fondamentales et biomédicales, Université de Paris, Sorbonne Paris Cité, INSERM UMR-S 1124, Toxicité environnementale, cibles thérapeutiques, signalisation cellulaire et biomarqueurs (T3S), 75006 Paris, France
| | - Alexandra Roren
- Service de rééducation et de réadaptation de l'appareil locomoteur et des pathologies du rachis, AP-HP, Groupe hospitalier AP-HP, Centre-Université de Paris, Hôpital Cochin, 75014 Paris, France; Faculté de santé, Université de Paris, UFR médecine Paris Descartes, 75006 Paris, France; INSERM UMR-S 1153, Centre de recherche épidemiologie et statistique Paris Sorbonne Cité, ECaMO Team, 75004 Paris, France; Institut fédératif de recherche sur le handicap, 75013 Paris, France.
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Treleaven J, Dillon M, Fitzgerald C, Smith C, Wright B, Sarig-Bahat H. Change in a clinical measure of cervical movement sense following four weeks of kinematic training. Musculoskelet Sci Pract 2021; 51:102312. [PMID: 33272876 DOI: 10.1016/j.msksp.2020.102312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 10/29/2020] [Accepted: 11/23/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Training targeted towards improving cervical movement accuracy is an effective strategy in the management of neck pain. Relatively complex measures have been validated to measure this in research although a simple clinical measure using a head mounted laser tracing a standardised pattern has been shown to be reliable. It is not known if this method demonstrate clinically meaningful change to training. OBJECTIVE To assess change responsiveness of the clinical cervical movement sense (CCMS) test following home kinematic training (KT). STUDY DESIGN Pre-post treatment observational study. METHODS The CCMS measure was assessed in 56 patients with chronic neck pain (41 intervention, 15 control) at baseline and 4 weeks post intervention by blinded assessors. Task completion time and error number were assessed reviewing video of the performances. Change pre-post intervention was compared between groups. RESULTS There was a significantly greater mean improvement in the intervention (-9.2 ± 9.3) seconds) for completion time and combined time and error (-13.3 ± 16) compared to the control group for time (-2.0 ± 9.8) and combined time and error (-1.8 ± 14) with moderate to high effect sizes (Cohen's d 0.76). There was a non-significant trend for decreased number of errors in the intervention (-4.1 ± 9.0) compared to control group (0.2 ± 8.3). CONCLUSION Completion time of the CCMS test appears to be able to demonstrate meaningful change following four weeks of KT. This further supports its clinical utility as a measure of cervical movement accuracy and provides direction for future clinical use.
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Affiliation(s)
- J Treleaven
- Neck Pain and Whiplash Research Unit, SHRS, University of QLD, Brisbane, Australia.
| | - M Dillon
- Neck Pain and Whiplash Research Unit, SHRS, University of QLD, Brisbane, Australia
| | - C Fitzgerald
- Neck Pain and Whiplash Research Unit, SHRS, University of QLD, Brisbane, Australia
| | - C Smith
- Neck Pain and Whiplash Research Unit, SHRS, University of QLD, Brisbane, Australia
| | - B Wright
- Neck Pain and Whiplash Research Unit, SHRS, University of QLD, Brisbane, Australia
| | - H Sarig-Bahat
- Neck Pain and Whiplash Research Unit, SHRS, University of QLD, Brisbane, Australia
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Kotelnikova AV, Pogonchenkova IV, Daminov VD, Kukshina AA, Rassulova MA. [Effectiveness evaluation of the psychological support inclusion in the correction of pain syndrome in patients with movement disorders at the stage of medical rehabilitation using the virtual reality technology]. VOPROSY KURORTOLOGII, FIZIOTERAPII, I LECHEBNOI FIZICHESKOI KULTURY 2021; 98:11-17. [PMID: 34223750 DOI: 10.17116/kurort20219803111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Evaluation of the comparative effectiveness of various methods of psychological support in the correction of pain syndrome in patients with degenerative-dystrophic diseases of big joints and spine in the process of medical rehabilitation. MATERIAL AND METHODS In conditions of hospital, the 70 patients with degenerative-dystrophic diseases of the big joints and spine who received drug and non-drug treatment were examined. The dynamics of the psycho-emotional state, subjective assessment of well-being and pain was studied in three groups: the main group (24 patients) where the psycho-correction plan included classes with a medical psychologist using a high-tech VR tool - «Vive Focus Plus EEA virtual reality helmet». A comparison group (24 patients) who received a standard format of psychological support within the patient-centered approach. The control group (22 patients) where only psycho-diagnostic measures were carried out. The «Tamp Kinesiophobia Scale», «Visual Analogue Scale of Well-Being Evaluation», «McGill Pain Questionnaire» were used as diagnostic tools. When comparing the effects of the interventions the nociceptive or mixed nature of pain was taken into account. RESULTS AND CONCLUSION It has been shown that psychological support improves the effectiveness of pain therapy while the inclusion of a high-tech VR tool in psycho-correctional programs is expedient for overcoming the fear of movement and pain of neuropathic and mixed genesis but ineffective for relieving nociceptive pain, i.e. pain where there is no psychological component.
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Affiliation(s)
- A V Kotelnikova
- Moscow Scientific and Practical Center for Medical Rehabilitation, Rehabilitation and Sports Medicine, Moscow, Russia
| | - I V Pogonchenkova
- Moscow Scientific and Practical Center for Medical Rehabilitation, Rehabilitation and Sports Medicine, Moscow, Russia
| | - V D Daminov
- N.I. Pirogov National Medical and Surgical Center, Moscow, Russia
| | - A A Kukshina
- Moscow Scientific and Practical Center for Medical Rehabilitation, Rehabilitation and Sports Medicine, Moscow, Russia
| | - M A Rassulova
- Moscow Scientific and Practical Center for Medical Rehabilitation, Rehabilitation and Sports Medicine, Moscow, Russia
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Bahat HS, German D, Palomo G, Gold H, Nir YF. Self-Kinematic Training for Flight-Associated Neck Pain: a Randomized Controlled Trial. Aerosp Med Hum Perform 2020; 91:790-797. [PMID: 33187565 DOI: 10.3357/amhp.5546.2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND: Flight-associated neck pain (FANP) is a serious problem in fighter pilots. Despite the high impact of FANP there is little evidence for effective management. However, self-kinematic training showed a positive effect in the general population. The purpose of this study was to investigate the effectiveness of a self-kinematic training program using virtual reality in improving neck pain in fighter pilots.METHODS: There were 45 pilots with FANP who were randomized to a control group (N 23) or a training group (N 22). Training participants were instructed to exercise using a personalized self-training program, for 20 min/wk, for 4 wk. Primary outcome measures were neck disability (NDI%) and mean velocity ( s1), and secondary were pain, health status, accuracy, and isometric strength. Assessments were conducted by a blinded assessor and intention-to-treat analysis by a blinded statistician.RESULTS: There were 40 pilots who completed the postintervention assessments, and 35 completed the 6-mo follow-up. Baseline measurements showed mild pain and disability (mean VAS 43 22.73, NDI 17.76 9.59%) and high kinematic performance. Compliance with self-training was poor. No differences were observed in self-reported measures and strength. Exercise duration was correlated with NDI% improvement.DISCUSSION: This self-kinematic training promoted kinematic performance, but was ineffective in engaging the pilots to exercise, and consequently did not improve pain and disability. Poor compliance was previously reported in self-training for FANP, suggesting further studies should prioritize supervised training. Considering the high baseline kinematic performance, kinematics does not seem to be a key factor in FANP, and future exercise research should aim for intense strengthening to increase endurance to the high Gz pilots experience.Sarig Bahat H, German D, Palomo G, Gold H, Frankel Nir Y. Self-kinematic training for flight-associated neck pain: a randomized controlled trial. Aerosp Med Hum Perform. 2020; 91(10):790797.
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50
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Hanel J, Owen PJ, Held S, Tagliaferri SD, Miller CT, Donath L, Belavy DL. Effects of Exercise Training on Fear-Avoidance in Pain and Pain-Free Populations: Systematic Review and Meta-analysis. Sports Med 2020; 50:2193-2207. [PMID: 32946074 DOI: 10.1007/s40279-020-01345-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Fear of pain and movement is an important factor in the development of hypervigilance and avoidance behaviours. OBJECTIVE We examined the effectiveness of exercise training on improving fear-avoidance beliefs. METHODS A systematic review (data sources: MEDLINE, CINAHL, SPORTDiscus, EMBASE, CENTRAL) and metaanalysis of randomised controlled/clinical trials of exercise training in adults versus relevant nonexercise comparators that quantified fear-avoidance was conducted. RESULTS After screening 4603 identified records, 17 (2014 participants) and 13 (1152 participants) studies were eligible for qualitative and quantitative synthesis, respectively. Pairwise meta-analysis showed exercise training was more effective than all non-exercise comparators (standardised mean difference (SMD) [95% CI] - 0.378 [- 0.623, - 0.133], P = 0.002, Grading of Recommendations Assessment, Development and Evaluation [GRADE]: very low) for reducing fear-avoidance. Exercise training was more effective than true control for reducing fear avoidance (- 0.407 [- 0.750, - 0.065], P = 0.020, GRADE: very low), however it was not more effective than other interventions (- 0.243 [- 0.614, 0.128], P = 0.199, GRADE: very low). In people with low back pain, exercise training was more effective than non-exercise comparator groups for reducing fear-avoidance (- 0.530 [- 0.755, - 0.304], P < 0.001, GRADE: very low). For individuals with neck pain, exercise training was not more effective than non-exercise comparator groups for reducing fear-avoidance (0.061 [- 0.360, 0.482], P = 0.777, GRADE: very low). CONCLUSION There is very low to low-quality evidence that exercise training is effective for reducing fear-avoidance, including in people with low back pain. Exercise training may be more effective than no intervention for reducing fear avoidance, but there is very low-quality evidence that non-exercise interventions are as effective as exercise for fear avoidance. Few studies with low risk of bias is a limitation. TRAIL REGISTRATION PROSPERO Registration Number: CRD42019139678.
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Affiliation(s)
- Joshua Hanel
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Geelong, VIC, 3125, Australia
| | - Patrick J Owen
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Geelong, VIC, 3125, Australia
| | - Steffen Held
- German Sports University Cologne, Am Sportpark Müngersdorf 6, 50933, Cologne, Germany
| | - Scott D Tagliaferri
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Geelong, VIC, 3125, Australia
| | - Clint T Miller
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Geelong, VIC, 3125, Australia
| | - Lars Donath
- German Sports University Cologne, Am Sportpark Müngersdorf 6, 50933, Cologne, Germany
| | - Daniel L Belavy
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Geelong, VIC, 3125, Australia.
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