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VR dodgeball increases lumbar flexion in CLBP patients with fear of movement

15 Sep 2016

Virtual reality (VR) dodgeball game appears to be a feasible and effective intervention to promote increased lumbar spine flexion in chronic low back pain (CLBP) patients with high fear of movement, according to a study.

Individuals with CLBP with high fear of movement specifically avoid flexion of the lumbar spine, whereas the fear-model of CLBP suggest a general avoidance of movement that is perceived as threatening, the investigators said.

Led by Dr. James Thomas from the Ohio University, the investigators developed a VR intervention that would elicit graded increases in lumbar spine flexion while reducing expectations of fear and harm by engaging the patients in a competitive game designed to be both entertaining and distracting.

To test the efficacy of the game, Thomas and colleagues randomly assigned 52 patients (52 percent male) with CLBP and high fear of movement to either the game group (n=26) or control group (n=26). Patients in the game group engaged in 15 minutes of virtual dodgeball for 3 consecutive days.

Lumbar spine motion, as well as expectations of pain and harm during standardised high, middle, and low targets were evaluated at pregame baseline and at follow-up (4 to 6 days after the game).

Results revealed that the virtual dodgeball produced no changes in lumbar spine flexion, expected pain, or expected harm.

However, the intervention led to an increase in lumbar flexion within and across gameplay sessions.

There were no reports of increased medication use, pain, disability, or adverse events. The game received a positive endorsement from patients in the game group.

“Although these findings indicate that very brief exposure to this game did not translate to significant changes outside the game environment, this was not surprising given that graded exposure therapy for fear of movement among individuals with low back pain typically lasts 8 to 12 sessions,” Thomas said.

“Given the demonstration of safety, feasibility, and ability to encourage lumbar flexion within gameplay, these findings provide support for a clinical trial wherein the treatment dose is more consistent with traditional graded-exposure approaches to CLBP,” he added.

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