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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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Demeco A, Salerno A, Gusai M, Vignali B, Gramigna V, Palumbo A, Corradi A, Mickeviciute GC, Costantino C. The Role of Virtual Reality in the Management of Football Injuries. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1000. [PMID: 38929617 PMCID: PMC11205647 DOI: 10.3390/medicina60061000] [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: 05/14/2024] [Revised: 06/06/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024]
Abstract
Injuries represent a serious concern for football players, with a significant loss in terms of sport participation and long periods of rehabilitation. According to the 2019/20 UEFA Élite Club Injury Report, the average incidence of injuries during training is 2.8 per 1000 h of training, with an average absence from training of 20 days. In addition, injured athletes are 4 to 7 times more likely to relapse than uninjured athletes. High workloads and reduced recovery periods represent two of the most important modifiable risk factors. In this context, prevention and an adequate rehabilitation protocol are vital in managing injuries, reducing their incidence, and improving the return to competition. In recent years, technological development has provided new tools in rehabilitation, and Virtual reality (VR) has shown interesting results in treating neurologic and orthopedic pathologies. Virtual Reality (VR) technology finds application in the sports industry as a tool to examine athletes' technical movements. The primary objective is to detect the biomechanical risk factors associated with anterior cruciate ligament injury. Additionally, VR can be used to train athletes in field-specific techniques and create safe and controlled therapeutic environments for post-injury recovery. Moreover, VR offers a customizable approach to treatment based on individual player data. It can be employed for both prevention and rehabilitation, tailoring the rehabilitation and training protocols according to the athletes' specific needs.
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Affiliation(s)
- Andrea Demeco
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.S.); (M.G.); (B.V.); (A.C.)
| | - Antonello Salerno
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.S.); (M.G.); (B.V.); (A.C.)
| | - Marco Gusai
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.S.); (M.G.); (B.V.); (A.C.)
| | - Beatrice Vignali
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.S.); (M.G.); (B.V.); (A.C.)
| | - Vera Gramigna
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy; (V.G.); (A.P.)
| | - Arrigo Palumbo
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy; (V.G.); (A.P.)
| | - Andrea Corradi
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.S.); (M.G.); (B.V.); (A.C.)
| | - Goda Camille Mickeviciute
- Center of Rehabilitation, Physical and Sport Medicine, Vilnius University Hospital Santaros Klinikos, LT-08661 Vilnius, Lithuania;
| | - Cosimo Costantino
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.S.); (M.G.); (B.V.); (A.C.)
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Cerda IH, Therond A, Moreau S, Studer K, Donjow AR, Crowther JE, Mazzolenis ME, Lang M, Tolba R, Gilligan C, Ashina S, Kaye AD, Yong RJ, Schatman ME, Robinson CL. Telehealth and Virtual Reality Technologies in Chronic Pain Management: A Narrative Review. Curr Pain Headache Rep 2024; 28:83-94. [PMID: 38175490 DOI: 10.1007/s11916-023-01205-3] [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] [Accepted: 12/13/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE OF REVIEW This review provides medical practitioners with an overview of the present and emergent roles of telehealth and associated virtual reality (VR) applications in chronic pain (CP) management, particularly in the post-COVID-19 healthcare landscape. RECENT FINDINGS Accumulated evidence points to the efficacy of now well-established telehealth modalities, such as videoconferencing, short messaging service (SMS), and mobile health (mHealth) applications in complementing remote CP care. More recently, and although still in early phases of clinical implementation, a wide range of VR-based interventions have demonstrated potential for improving the asynchronous remote management of CP. Additionally, VR-associated technologies at the leading edge of science and engineering, such as VR-assisted biofeedback, haptic technology, high-definition three-dimensional (HD3D) conferencing, VR-enabled interactions in a Metaverse, and the use of wearable monitoring devices, herald a new era for remote, synchronous patient-physician interactions. These advancements hold the potential to facilitate remote physical examinations, personalized remote care, and innovative interventions such as ultra-realistic biofeedback. Despite the promise of VR-associated technologies, several limitations remain, including the paucity of robust long-term effectiveness data, heterogeneity of reported pain-related outcomes, challenges with scalability and insurance coverage, and demographic-specific barriers to patient acceptability. Future research efforts should be directed toward mitigating these limitations to facilitate the integration of telehealth-associated VR into the conventional management of CP. Despite ongoing barriers to widespread adoption, recent evidence suggests that VR-based interventions hold an increasing potential to complement and enhance the remote delivery of CP care.
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Affiliation(s)
- Ivo H Cerda
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.
| | - Alexandra Therond
- Department of Psychology, Université du Québec à Montréal, Montréal, QC, Canada
| | - Sacha Moreau
- Massachusetts Institute of Technology, Boston, MA, USA
| | - Kachina Studer
- Department of Earth and Planetary Science, Harvard University, Cambridge, MA, USA
- Department Mechanical Engineering, Cambridge, Massachusetts Institute of Technology (MIT), Cambridge, MA, USA
| | | | - Jason E Crowther
- Department of Anesthesiology and Perioperative Medicine, University of Massachusetts, Worcester, MA, USA
| | - Maria Emilia Mazzolenis
- Paulson School of Engineering and Applied Sciences, John A, Harvard University, Boston, MA, USA
| | - Min Lang
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Reda Tolba
- Pain Management Department in the Anesthesiology Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Christopher Gilligan
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Sait Ashina
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, USA
| | - R Jason Yong
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Michael E Schatman
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY, USA
- Department of Population Health-Division of Medical Ethics, NYU Grossman School of Medicine, New York, NY, USA
| | - Christopher L Robinson
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Li R, Li Y, Kong Y, Li H, Hu D, Fu C, Wei Q. Virtual Reality-Based Training in Chronic Low Back Pain: Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Med Internet Res 2024; 26:e45406. [PMID: 38407948 PMCID: PMC10928528 DOI: 10.2196/45406] [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: 12/29/2022] [Revised: 04/16/2023] [Accepted: 01/29/2024] [Indexed: 02/27/2024] Open
Abstract
BACKGROUND Low back pain is one of the most prevalent pain conditions worldwide. Virtual reality-based training has been used for low back pain as a new treatment strategy. Present evidence indicated that the effectiveness of virtual reality-based training for people with chronic low back pain is inconclusive. OBJECTIVE This study conducted a meta-analysis to evaluate the immediate- and short-term effects of virtual reality-based training on pain, pain-related fear, and disability in people with chronic low back pain. METHODS We searched the PubMed, Embase, Web of Science, PEDro, CENTRAL, and CINAHL databases from inception until January 2024. Only randomized controlled trials assessing the effects of virtual reality-based training on individuals with chronic low back pain were selected. The outcomes were focused on pain, pain-related fear measured by the Tampa Scale of Kinesiophobia, and disability measured by the Oswestry Disability Index. The immediate term was defined as the immediate period after intervention, and the short term was defined as 3 to 6 months after intervention. The Cochrane Risk of Bias tool and the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach were used to evaluate the quality of the methodology and evidence, respectively. RESULTS In total, 20 randomized controlled trials involving 1059 patients were eligible for analysis. Virtual reality-based training showed significant improvements in pain (mean difference [MD] -1.43; 95% CI -1.86 to -1.00; I2=95%; P<.001), pain-related fear using the Tampa Scale of Kinesiophobia (MD -5.46; 95% CI -9.40 to 1.52; I2=90%; P=.007), and disability using the Oswestry Disability Index (MD -11.50; 95% CI -20.00 to -3.01; I2=95%; P=.008) in individuals with chronic low back pain immediately after interventions. However, there were no significant differences observed in pain (P=.16), pain-related fear (P=.10), and disability (P=.43) in the short term. CONCLUSIONS These findings indicated that virtual reality-based training can be used effectively for individuals with chronic low back pain in the immediate term, especially to reduce pain, alleviate pain-related fear, and improve disability. However, the short-term benefits need more high-quality trials to be demonstrated. TRIAL REGISTRATION PROSPERO CRD42021292633; http://tinyurl.com/25mydxpz.
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Affiliation(s)
- Ran Li
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, China
| | - Yinghao Li
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Youli Kong
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, China
| | - Hanbin Li
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, China
| | - Danrong Hu
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, China
| | - Chenying Fu
- National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
- Aging and Geriatric Mechanism Laboratory, West China Hospital, Sichuan University, Chengdu, China
| | - Quan Wei
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, China
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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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Fan T, Wang X, Song X, Zhao G, Zhang Z. Research Status and Emerging Trends in Virtual Reality Rehabilitation: Bibliometric and Knowledge Graph Study. JMIR Serious Games 2023; 11:e41091. [PMID: 36877556 PMCID: PMC10028519 DOI: 10.2196/41091] [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] [Received: 07/19/2022] [Revised: 11/28/2022] [Accepted: 01/20/2023] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND Virtual reality (VR) technology has been widely used in rehabilitation training because of its immersive, interactive, and imaginative features. A comprehensive bibliometric review is required to help researchers focus on future directions based on the new definitions of VR technologies in rehabilitation, which reveal new situations and requirements. OBJECTIVE Herein, we aimed to summarize effective research methods for and potential innovative approaches to VR rehabilitation by evaluating publications from various countries to encourage research on efficient strategies to improve VR rehabilitation. METHODS The SCIE (Science Citation Index Expanded) database was searched on January 20, 2022, for publications related to the application of VR technology in rehabilitation research. We found 1617 papers, and we created a clustered network, using the 46,116 references cited in the papers. CiteSpace V (Drexel University) and VOSviewer (Leiden University) were used to identify countries, institutions, journals, keywords, cocited references, and research hot spots. RESULTS A total of 63 countries and 1921 institutes have contributed publications. The United States of America has taken the leading position in this field; it has the highest number of publications; the highest h-index; and the largest collaborative network, which includes other countries. The reference clusters of SCIE papers were divided into the following nine categories: kinematics, neurorehabilitation, brain injury, exergames, aging, motor rehabilitation, mobility, cerebral palsy, and exercise intensity. The research frontiers were represented by the following keywords: video games (2017-2021), and young adults (2018-2021). CONCLUSIONS Our study comprehensively assesses the current research state of VR rehabilitation and analyzes the current research hot spots and future trends in the field, with the aims of providing resources for more intensive investigation and encouraging more researchers to further develop VR rehabilitation.
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Affiliation(s)
- Ting Fan
- Department of Computer, School of Intelligent Medicine, China Medical University, Shenyang, China
| | - Xiaobei Wang
- Department of General Practice, The First Hospital of China Medical University, China Medical University, Shenyang, China
| | - Xiaoxi Song
- Liaoning Education Informatization Construction Center, LiaoNing Institute of Education, Shenyang, China
| | - Gang Zhao
- Department of Health Promotion, School of Intelligent Medicine, China Medical University, Shenyang, China
| | - Zhichang Zhang
- Department of Computer, School of Intelligent Medicine, China Medical University, Shenyang, China
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Lee GT, Himler P, Rhon DI, Young JL. Home Exercise Programs Are Infrequently Prescribed in Trials of Supervised Exercise for Individuals With Low Back Pain: A Scoping Review of 292 Randomized Controlled Trials. J Orthop Sports Phys Ther 2023; 53:120-142. [PMID: 36645192 DOI: 10.2519/jospt.2023.11448] [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: 01/17/2023]
Abstract
OBJECTIVES: To (1) determine how often home exercise programs (HEPs) are prescribed in supervised exercise trials for low back pain (LBP) and (2) describe characteristics of the HEP programs (design, purpose, dose, and adherence). DESIGN: Scoping review. LITERATURE SEARCH: PubMed, CINAHL, and Ovid MEDLINE were searched from January 1, 2010, to August 17, 2021. STUDY SELECTION CRITERIA: Randomized controlled trials that included adults with LBP who received exercise interventions. DATA SYNTHESIS: The presence or absence of a prescribed HEP and any details of the HEP including design, dose, and adherence were extracted and summarized. RESULTS: Of 2689 potentially relevant trials, 292 were eligible for inclusion. Ninety-four trials (32%) included a HEP. The most commonly prescribed home exercises were core stability, trunk strengthening, and motor control exercises. There was great variation in the frequency and duration with which HEPs were prescribed. Adherence to HEPs was measured in fewer than half of the trials, and the methods for measuring adherence were inconsistent. Adherence to HEPs ranged from 29% to 82% in the 21 trials that reported adherence. CONCLUSION: Home exercise programs are not regularly prescribed in supervised exercise trials for LBP. There was considerable variation in prescribing HEPs and monitoring exercise adherence in trials of exercise-based treatments for adults with LBP. There is no consistent method used to measure participants' adherence to HEPs, and adherence percentages vary widely. J Orthop Sports Phys Ther 2023;53(3):120-142. Epub: 16 January 2023. doi:10.2519/jospt.2023.11448.
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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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Basem JI, Haffey PR. Novel Therapies for Centralized Pain: a Brief Review. Curr Pain Headache Rep 2022; 26:805-811. [PMID: 36169808 DOI: 10.1007/s11916-022-01085-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW Centralized pain presents a complex pathology that many classic pharmacological agents for pain have not been able to sufficiently treat. To date, there are no clear guidelines for preferred treatment methods or comprehensive protocol that addresses confounding factors in this population. We sought to summarize the current field of knowledge around centrally mediated pain and to understand promising novel therapies. RECENT FINDINGS Many treatments currently used address not only the centralized pain phenotypem but the impact of central sensitization and the common comorbidities that reside within this population. Some novel therapies with promising evidence include the following: low-dose naltrexone, IV ketamine, acupuncture, aerobic activity, and laser therapy. Non-interventional treatment options include aerobic exercise, cognitive-behavioral therapy, mind-body therapies, virtual reality, and patient education on disease expectations. Much of the literature further emphasizes the importance of patient-level predictors, including factors like pain catastrophizing and social history, on treatment compliance and reported pain relief. We found that there are many potential treatment options for patients with centralized pain, particularly those that can be used as adjunct or combination therapies. The introduction of new approaches should occur in a carefully controlled, titrated manner to avoid exacerbation of pain symptoms. This is successfully conducted through patient-physician communication as this is a highly complex and personalized pain category. Our examination shows that while physicians have many options with proven success, there is a need for studies with longitudinal and larger patient populations to better articulate treatment guidelines.
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Affiliation(s)
- Jade I Basem
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - Paul Ryan Haffey
- Department of Rehabilitation and Regenerative Medicine, Columbia University College of Physicians and Surgeons, 180 Fort Washington Avenue, HRK 199, New York, NY, USA.
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Bordeleau M, Vincenot M, Lefevre S, Duport A, Seggio L, Breton T, Lelard T, Serra E, Roussel N, Neves JFD, Léonard G. Treatments for kinesiophobia in people with chronic pain: A scoping review. Front Behav Neurosci 2022; 16:933483. [PMID: 36204486 PMCID: PMC9531655 DOI: 10.3389/fnbeh.2022.933483] [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: 04/30/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
Kinesiophobia is associated with pain intensity in people suffering from chronic pain. The number of publications highlighting this relationship has increased significantly in recent years, emphasizing the importance of investigating and synthesizing research evidence on this topic. The purpose of this scoping review was to answer the following questions: (1) What types of interventions have been or are currently being studied in randomized controlled trials (RCTs) for the management of kinesiophobia in patients with chronic pain? (2) What chronic pain conditions are targeted by these interventions? (3) What assessment tools for kinesiophobia are used in these interventions? According to the studies reviewed, (1) physical exercise is the most commonly used approach for managing irrational fear of movement, (2) interventions for kinesiophobia have primarily focused on musculoskeletal pain conditions, particularly low back pain and neck pain, and (3) the Tampa Scale of Kinesiophobia is the most commonly used tool for measuring kinesiophobia. Future RCTs should consider multidisciplinary interventions that can help patients confront their irrational fear of movement while taking into account the patient’s personal biological, psychological, and social experiences with pain and kinesiophobia.
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Affiliation(s)
- Martine Bordeleau
- Research Centre on Aging, CIUSSS de l’Estrie – CHUS, Sherbrooke, QC, Canada
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
- *Correspondence: Martine Bordeleau,
| | - Matthieu Vincenot
- Research Centre on Aging, CIUSSS de l’Estrie – CHUS, Sherbrooke, QC, Canada
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Salomé Lefevre
- Research Centre on Aging, CIUSSS de l’Estrie – CHUS, Sherbrooke, QC, Canada
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
- UR UPJV 3300 APERE Adaptation Physiologiques à l’Exercice et Réadaptation à l’Effort, Université de Picardie Jules Verne, Amiens, France
- Institut d’Ingénierie pour la Santé, UFR de Médecine, Université de Picardie Jules Verne, Amiens, France
| | - Arnaud Duport
- Research Centre on Aging, CIUSSS de l’Estrie – CHUS, Sherbrooke, QC, Canada
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
- URePSSS – Unité de Recherche Pluridisciplinaire Sport, Santé, Société (ULR 7369), Université du Littoral Côte d’Opale, Université de Lille, Université d’Artois, Calais, France
| | - Lucas Seggio
- Research Centre on Aging, CIUSSS de l’Estrie – CHUS, Sherbrooke, QC, Canada
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Tomy Breton
- Research Centre on Aging, CIUSSS de l’Estrie – CHUS, Sherbrooke, QC, Canada
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Thierry Lelard
- UR UPJV 3300 APERE Adaptation Physiologiques à l’Exercice et Réadaptation à l’Effort, Université de Picardie Jules Verne, Amiens, France
- Institut d’Ingénierie pour la Santé, UFR de Médecine, Université de Picardie Jules Verne, Amiens, France
| | - Eric Serra
- Centre d’Etude et de Traitement de la Douleur, Center Hospitalier Universitaire Amiens-Picardie, Amiens, France
- Laboratoire PSITEC EA 4072, Université de Lille, Lille, France
| | - Nathalie Roussel
- Department of Rehabilitation Sciences and Physiotherapy (MOVANT), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Jeremy Fonseca Das Neves
- Centre d’Etude et de Traitement de la Douleur, Center Hospitalier Universitaire Amiens-Picardie, Amiens, France
- Psychiatrie de Liaison, Center Hospitalier Universitaire Amiens-Picardie, Amiens, France
| | - Guillaume Léonard
- Research Centre on Aging, CIUSSS de l’Estrie – CHUS, Sherbrooke, QC, Canada
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
- Guillaume Léonard,
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11
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Santos-Paz JA, Sánchez-Picot Á, Rojo A, Martín-Pintado-Zugasti A, Otero A, Garcia-Carmona R. A novel virtual reality application for autonomous assessment of cervical range of motion: development and reliability study. PeerJ 2022; 10:e14031. [PMID: 36124134 PMCID: PMC9482359 DOI: 10.7717/peerj.14031] [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: 04/19/2022] [Accepted: 08/17/2022] [Indexed: 01/19/2023] Open
Abstract
Background Neck pain, one of the most common musculoskeletal diseases, affects 222 million people worldwide. The cervical range of motion (CROM) is a tool used to assess the neck's state across three movement axes: flexo-extension, rotation, and lateral flexion. People with neck pain often have a reduced CROM, and they feel pain at the end-range and/or accompany neck movements with compensatory trunk movements. Virtual reality (VR) setups can track the movement of the head and other body parts in order to create the sensation of immersion in the virtual environment. Using this tracking position information, a CROM assessment can be performed using a VR setup that may be carried out autonomously from the user's home. The objectives of this study were to develop a VR experience that could be used to perform a CROM assessment, and to evaluate the intra-rater and inter-rater reliability of the CROM measures guided by this VR experience. To the best of our knowledge, a study of this type has not been carried out before. Materials & Methods A total of 30 asymptomatic adults were assessed using a VR device (HTC Vive Pro Eye™). Two raters provided support with the VR setup, and the participants were guided by the VR experience as they performed the movements. Each rater tested each subject twice, in random order. In addition to a head-mounted display (HMD), a tracker located on the subject's back was used to measure trunk compensatory movements. The CROM was estimated using only the HMD position and this measurement was corrected using the tracker data. The mean and standard deviation were calculated to characterize the CROM. To evaluate the reliability, the interclass correlation coefficients (ICC) were calculated for intra-rater and inter-rater analysis. The standard error of measurement and minimum detectable change were also calculated. The usability of the VR system was measured using the Spanish version of the System Usability Scale. Results The mean CROM values in each axis of movement were compatible with those described in the literature. ICC values ranged between 0.86 and 0.96 in the intra-rater analysis and between 0.83 and 0.97 in the inter-rater analysis; these values were between good and excellent. When applying the correction of the trunk movements, both the intra-rater and inter-rater ICC values slightly worsened except in the case of the lateral flexion movement, where they slightly improved. The usability score of the CROM assessment/VR system was 86 points, which is an excellent usability score. Conclusion The reliability of the measurements and the usability of the system indicate that a VR setup can be used to assess CROM. The reliability of the VR setup can be affected by slippage of the HMD or tracker. Both slippage errors are additive, i.e., only when the sum of these two errors is less than the compensatory movement do the measurements improve when considering the tracker data.
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Affiliation(s)
- Jose Angel Santos-Paz
- Escuela Politécnica Superior, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain
| | - Álvaro Sánchez-Picot
- Escuela Politécnica Superior, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain
| | - Ana Rojo
- Escuela Politécnica Superior, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain
| | | | - Abraham Otero
- Escuela Politécnica Superior, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain
| | - Rodrigo Garcia-Carmona
- Escuela Politécnica Superior, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain
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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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Nagpal AS, Raghunandan A, Tata F, Kibler D, McGeary D. Virtual Reality in the Management of Chronic Low Back Pain: A Scoping Review. FRONTIERS IN PAIN RESEARCH 2022; 3:856935. [PMID: 35295809 PMCID: PMC8915689 DOI: 10.3389/fpain.2022.856935] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 01/31/2022] [Indexed: 11/13/2022] Open
Abstract
Virtual reality (VR) is a burgeoning treatment option for chronic pain. Its use has been heterogenous in the literature. This scoping review assesses the current literature for the use of VR in the treatment of chronic low back pain (CLBP). The following themes were identified by the analysis: safety and feasibility of VR, quality of life associated with VR treatment for CLBP, efficacy of VR to treat CLBP, and efficacy of VR to treat functional changes associated with CLBP. Gaps were identified after analysis of the extant literature. Although the nascent research uncovered in this scoping review found good evidence for safety and tolerability of VR, more studies of safety, acceptance, and satisfaction are recommended including focused studies of spinal pain risks specific to use of VR. Overall, the methodological quality of studies reviewed in this scoping review was poor and outcomes were limited to short-term posttreatment outcomes.
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Affiliation(s)
- Ameet S. Nagpal
- Department of Anesthesiology, UT Health San Antonio, San Antonio, TX, United States
- *Correspondence: Ameet S. Nagpal
| | - Aditya Raghunandan
- Department of Rehabilitation Medicine, UT Health San Antonio, San Antonio, TX, United States
| | - Faye Tata
- Department of Rehabilitation Medicine, UT Health San Antonio, San Antonio, TX, United States
| | - Daniel Kibler
- Department of Rehabilitation Medicine, UT Health San Antonio, San Antonio, TX, United States
| | - Donald McGeary
- Department of Psychiatry, UT Health San Antonio, San Antonio, TX, United States
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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: 33] [Impact Index Per Article: 11.0] [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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