Effect of a Behavioral Therapy-Based Virtual Reality Application on Quality of Life in Chronic Low Back Pain

Groenveld, Tjitske; Smits, Merlijn L M; Knoop, J.; Kallewaard, Jan Willem; Staal, J. Bart; Vries, M. de; Goor, Harry van

doi:10.1097/ajp.0000000000001110

Cited by 14 publications

(12 citation statements)

References 47 publications

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“…Several studies state that the integration of VR modules within physiotherapy could be more effective than stand-alone VR modules. 20 , 53 This is in line with the physiotherapy guideline that states that therapeutic eHealth could support physiotherapy treatment. 27…”

Section: Resultssupporting

confidence: 67%

Development of a Multimodal, Personalized Intervention of Virtual Reality Integrated Within Physiotherapy for Patients With Complex Chronic Low-Back Pain

Slatman,

Groenveld,

Ostelo

et al. 2024

Journal of Medical Extended Reality

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Background: Chronic low-back pain (CLBP) is the leading cause of years lived with disability. Physiotherapy is the most common treatment option for CLBP, but effects are often unsatisfactory. Virtual reality (VR) offers possibilities to enhance the effectiveness of physiotherapy treatment. Primary aim was to develop and test a personalized VR intervention integrated within a physiotherapy treatment for patients with CLBP. Methods: This study describes an intervention development process using mixed methods design that followed the Medical Research Council (MRC) framework. This involved a cocreation process with patients, physiotherapists, and researchers. A draft intervention was constructed based on a literature review and focus groups, and subsequently tested in a feasibility study and evaluated in focus groups. Focus group data were analyzed using thematic analysis. This intervention development process resulted in a final intervention. Results: Focus group data showed that VR and physiotherapy can strengthen each other when they are well integrated, and that VR needs to be administered under the right conditions including flawless technology, physiotherapists with sufficient affinity and training, and the right expectations from patients. The draft intervention was considered feasible after evaluation by four patients and three physiotherapists and was further complemented by expanding the training for physiotherapists and improving the protocols for physiotherapists and patients. The final intervention consisted of a 12-week physiotherapy treatment with three integrated VR modules: pain education, physical exercise, and relaxation. Conclusion: Using the MRC framework in cocreation with the end users, a personalized VR intervention integrated within a physiotherapy treatment for patients with CLBP was developed. This intervention was found to be feasible and will subsequently be evaluated for (cost-)effectiveness in a cluster randomized controlled trial.

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Section: Resultssupporting

confidence: 67%

Development of a Multimodal, Personalized Intervention of Virtual Reality Integrated Within Physiotherapy for Patients With Complex Chronic Low-Back Pain

Slatman,

Groenveld,

Ostelo

et al. 2024

Journal of Medical Extended Reality

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“…In total, 8 studies investigated the efficacy of virtual reality–based training on disability using the ODI ( Figure 5 [ 19 , 20 , 50 , 51 , 58 , 61 , 62 , 64 ]). There were statistically significant differences between virtual reality–based training and conventional treatments in terms of the ODI in the immediate term (MD –11.50; 95% CI –20.00 to –3.01; I 2 =95%; P =.008) but not in the short term (MD –1.28; 95% CI –4.47 to 1.90; I 2 =0%; P =.43).…”

Section: Resultsmentioning

confidence: 99%

Virtual Reality–Based Training in Chronic Low Back Pain: Systematic Review and Meta-Analysis of Randomized Controlled Trials

Li,

Kong

et al. 2024

J Med Internet Res

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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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“…A total of 50 RCTs 33 – 36 , 38 , 40 , 41 , 43 – 46 , 48 , 49 , 51 – 54 , 56 – 62 , 64 , 65 , 67 – 70 , 72 , 74 – 76 , 78 – 84 , 88 – 91 , 93 – 95 , 97 , 98 involving 3733 participants and 7 categories of interventions were included in the NMA for depression with eight loops (Fig. 3 ).…”

Section: Resultsmentioning

confidence: 99%

“…In the NMA involving 24 RCTs 34 – 38 , 43 , 45 , 49 , 51 , 52 , 54 , 59 , 68 – 70 , 72 , 75 – 79 , 84 , 88 , 97 , 1722 participants, and 7 categories of interventions with six loops (Fig. 4 ), mind body therapy (pooled SMD = −1.35, 95% CI: −1.90 to −0.80), multicomponent intervention (pooled SMD = −0.47, 95% CI: −0.88 to −0.06), and biopsychosocial approach (pooled SMD = −0.46, 95% CI: −0.79 to −0.14) were superior to the control group in managing anxiety.…”

Section: Resultsmentioning

confidence: 99%

Comparative effectiveness of nonpharmacological interventions in reducing psychological symptoms among patients with chronic low back pain

Zhou,

Zhang,

Shang

et al. 2023

International Journal of Surgery

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Objectives: Chronic low back pain (CLBP) can seriously impair the quality of life of patients and has a remarkable comorbidity with psychological symptoms, which, in turn, can further exacerbate the symptoms of CLBP. Psychological treatments are critical and nonnegligent for the management of CLBP, and thus, should attract sufficient attention. However, current evidence does not suggest the superiority and effectiveness of non-pharmacological interventions in reducing psychological symptoms among patients with CLBP. Thus, this study was designed to compare the effectiveness of non-pharmacological interventions for depression, anxiety, and mental health among patients with CLBP and to recommend preferred strategies for attenuating psychological symptoms in clinical practice. Methods: In this systematic review and network meta-analysis (NMA), PubMed, Embase Database, Web of Science, and Cochrane Library were searched from database inception until March 2022. Randomized clinical trials (RCTs) that compare different non-pharmacological interventions for depression, anxiety, and mental health among patients with CLBP were eligible. The Preferred Reporting Items for Systematic Reviews and Meta-analyses statement was used. Four reviewers in pairs and divided into two groups independently performed literature selection, data extraction, and risk of bias and certainty of evidence assessments. This NMA was conducted with a random effects model under a frequentist framework. The major outcomes were depression, anxiety, and mental health presented as the standardized mean difference (SMD) with the corresponding 95% confidence interval (CI). Results: A total of 66 RCTs that randomized 4806 patients with CLBP met the inclusion criteria. The quality of evidence was typically low or some risks of bias (47 out of 66 trials, 71.3%), and the precision of summary estimates for effectiveness varied substantially. In addition, 7 categories of interventions with 26 specific treatments were evaluated. For depression, mind body therapy (pooled SMD = −1.20, 95% CI: −1.63 to −0.78), biopsychosocial approach (pooled SMD = −0.41, 95% CI: −0.70 to −0.12), and physical therapy (pooled SMD = −0.26, 95% CI: −0.50 to −0.02) exhibited remarkable effectiveness in reducing depression compared with the control group. For managing anxiety, mind body therapy (pooled SMD = −1.35, 95% CI: −1.90 to −0.80), multicomponent intervention (pooled SMD = −0.47, 95% CI: −0.88 to −0.06), and biopsychosocial approach (pooled SMD = −0.46, 95% CI: −0.79 to −0.14) were substantially superior to the control group. For improving mental health, multicomponent intervention (pooled SMD = 0.77, 95% CI: 0.14 to 1.39), exercise (pooled SMD = 0.60, 95% CI: 0.08 to 1.11), and physical therapy (pooled SMD = 0.47, 95% CI: 0.02 to 0.92) demonstrated statistically substantial effectiveness compared with the control group. The rank probability indicated that mind body therapy achieved the highest effectiveness in reducing depression and anxiety among patients with CLBP. Besides, the combined results should be interpreted cautiously based on the results of analyses evaluating the inconsistency and certainty of the evidence. Conclusion: This systemic review and NMA suggested that non-pharmacological interventions show promise for reducing psychological symptoms among patients with CLBP. In particular, mind body therapy and biopsychosocial approach show considerable promise, and mind body therapy can be considered a priority choice in reducing depression and anxiety. These findings can aid clinicians in assessing the potential risks and benefits of available treatments for CLBP comorbidity with psychological symptoms and provide evidence for selecting interventions in clinical practice. More RCTs involving different interventions with rigorous methodology and adequate sample size should be conducted in future research.

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Effect of a Behavioral Therapy-Based Virtual Reality Application on Quality of Life in Chronic Low Back Pain

Cited by 14 publications

References 47 publications

Development of a Multimodal, Personalized Intervention of Virtual Reality Integrated Within Physiotherapy for Patients With Complex Chronic Low-Back Pain

Development of a Multimodal, Personalized Intervention of Virtual Reality Integrated Within Physiotherapy for Patients With Complex Chronic Low-Back Pain

Virtual Reality–Based Training in Chronic Low Back Pain: Systematic Review and Meta-Analysis of Randomized Controlled Trials

Comparative effectiveness of nonpharmacological interventions in reducing psychological symptoms among patients with chronic low back pain

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