Effects of Virtual Reality versus Exercise on Pain, Functional, Somatosensory and Psychosocial Outcomes in Patients with Non-specific Chronic Neck Pain: A Randomized Clinical Trial

Abstract

Background: Virtual reality (VR) applied to patients with neck pain is a promising intervention to produce positive effects when used alone or combined with exercise. Therefore, the objective of this manuscript is to compare the effects of VR versus exercise treatment on pain intensity, conditioned pain modulation (CPM), temporal summation (TS) and functional and somatosensory outcomes in patients with non-specific chronic neck pain (NS-CNP). Methods: A single-blinded, randomized clinical trial was carried out. A total sample of 44 patients with NS-CNP was randomized into a VR treatment group or neck exercises group. The intervention consisted of two treatment sessions per week, for four weeks and eight sessions. Four measurement moments (at baseline, immediately, 1 month, and 3 months after intervention) were considered. Pain intensity, CPM, TS, functional and somatosensory outcomes were measured. Results: Statistically significant differences were revealed for time factor (F = 16.40, p < 0.01, ηp2 = 0.28) and group*time interaction for kinesiophobia (F = 3.89, p = 0.01, ηp2 = 0.08) showing post-hoc differences in favor of the VR group at 3 months (p < 0.05, d = 0.65). Significant effects were shown for time factor (p < 0.05) but not for the group*time interaction (p > 0.05) for pain intensity, rotation range of motion (ROM), Neck Disability Index, pain catastrophizing, fear-avoidance beliefs, left side pressure pain threshold (PPT) and anxiety. Statistically significant differences were not found for time factor (p > 0.05) and neither in group*time interaction (p > 0.05) for CPM, TS, right side PPT, flexo-extension and lateral-flexion ROM. Conclusions: Kinesiophobia was the only outcome that showed differences between VR and exercise at 3 months. Nevertheless, pain intensity, CPM, TS, ROM, neck disability, pain catastrophizing, fear-avoidance beliefs, PPT and anxiety did not show differences between both interventions.

A Serious Game for Performing Task-Oriented Cervical Exercises Among Older Adult Patients With Chronic Neck Pain: Development, Suitability, and Crossover Pilot Study

“…On the one hand, the results of this study appear to support the findings of another recent study that suggested that performing exercises with immersive VR is not superior to exercises alone without VR among young adult patients with neck pain [ 48 ]. On the other hand, the results of this research are not supported by those found in another study that compared nonimmersive VR exercises with proprioceptive training in patients with neck pain, using eight sessions over a period of 4 weeks.…”

Virtual Reality in the Neurosciences: Current Practice and Future Directions

“…The study demonstrates that patients immersed within an ideal virtual waiting area had significantly decreased subjective pain ratings compared to those who had a virtual waiting area depicting a typical hospital waiting environment. However, a study using VR for patients with chronic neck and back pain showed no significant difference in pain intensity in individuals using VR when compared to patients carrying out physical neck exercises (82,83). The lack of significant results in the latter study could be due the study being under-powered due to loss of participants to follow up.…”

Physiotherapist beliefs and perspectives on virtual reality–supported rehabilitation for the assessment and management of musculoskeletal shoulder pain: a focus group study protocol

“…Matheve et al, 2020 47 used non-immersive VR to reduce pain intensity and time spent thinking about pain, in a group of individuals with CLBP during a single supervised session. For individuals with neck pain, VR has been shown to have potential as a platform for rehabilitation 48,49 with improvements in outcomes lasting up to three months. A small number of studies have investigated the effectiveness of VR rehabilitation for musculoskeletal shoulder pain, specifically frozen shoulder 50 and subacromial pain syndrome 51 .…”