Short-Term Psychological and Hormonal Effects of Virtual Reality Training on Chronic Low Back Pain in Soccer Players

Abstract

Objective: To find the short-term psychological and hormonal effects of virtual reality training on chronic low back pain in American soccer players. Design, Setting, Participants: The 3-block random sampling method was used on 54 university American soccer players with chronic low back pain, and they were allocated into 3 groups: virtual reality training (VRT; n = 18), combined physical rehabilitation (n = 18), and control (n = 18) groups at University Hospital. They underwent different balance training exercises for 4 weeks. The participants and the therapist who is assessing the outcomes were blinded. Psychological (pain intensity and kinesiophobia) and hormonal (glucose, insulin, Homeostatic Model Assessment of Insulin Resistance, growth hormone, prolactin, adrenocorticotropic hormone, and cortisol) values were measured at baseline, after 4 weeks, and after 6 months. Results: The baseline demographic, psychological, and hormonal data between the VRT, combined physical rehabilitation, and control groups show no statistical difference (P ≥ .05). Four weeks following training, the VRT group shows more significant changes in pain intensity and kinesiophobia than the combined physical rehabilitation and control groups (P < .001), and the improvement was noted in the 6-month follow-up. All the hormonal variables (glucose, insulin, growth hormone, prolactin, adrenocorticotropic hormone, and cortisol) show significant changes at 4-week training (P < .001), except for the Homeostatic Model Assessment of Insulin Resistance (P = .075) between the 3 groups. At 6-month follow-up glucose, prolactin, adrenocorticotropic hormone, and cortisol show more significant difference in the VRT group than the other 2 groups (P < .001). At the same time, insulin (P = .694), Homeostatic Model Assessment of Insulin Resistance (P = .272), and growth hormone (P = .145) failed to show significant changes between the groups. Conclusion: Training through virtual reality is an effective treatment program when compared with conventional exercise training programs from a psychological and hormonal analysis perspective in American soccer players with chronic low back pain.

Virtual Reality in the Treatment of Adults with Chronic Low Back Pain: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

“…Six studies were conducted in South Korea [26][27][28][29][30][31], one in Brazil [32], one in the USA [33], one in Australia [7], three in Saudi Arabia [34][35][36], one in Turkey [37], and one in Japan [38]. The total number of participants was 765.…”

“…All studies measured pain intensity. It was measured using VAS in nine studies [26][27][28][29]31,[34][35][36]38], 11-point Numeric Pain Rating Scale (11-NPRS) in four studies [7,30,32,37], and The Defense and Veterans Pain Rating Scale (DVPRS) in one study [33]. Four studies measured disability associated with low back pain using the Oswestry Disability Index (ODI) [29][30][31]37], four studies measured kinesiophobia using the 17-item Tampa Scale of Kinesiophobia (17-TSK) [7,35,36,38], and four studies measured body composition using bioelectrical impedance analysis method [27,28,31,38].…”

“…It was measured using VAS in nine studies [26][27][28][29]31,[34][35][36]38], 11-point Numeric Pain Rating Scale (11-NPRS) in four studies [7,30,32,37], and The Defense and Veterans Pain Rating Scale (DVPRS) in one study [33]. Four studies measured disability associated with low back pain using the Oswestry Disability Index (ODI) [29][30][31]37], four studies measured kinesiophobia using the 17-item Tampa Scale of Kinesiophobia (17-TSK) [7,35,36,38], and four studies measured body composition using bioelectrical impedance analysis method [27,28,31,38]. Other variables assessed more frequently were severity of disability with Roland Morris Disability Questionnaire (RMDQ) in two studies [7,30], isokinetic trunk flexion/extension with a dynamometer in three studies [27,28,31], pain self-efficacy with the 10-item Pain Self-Efficacy (10-PSEQ) in two studies [7,38], pain catastrophizing with Pain Catastrophizing Scale (PCS) in two studies [33,38], and blood serum levels of stress hormones in two studies [35,36].…”

“…Variables were assessed before and after the intervention in all articles. Five studies included followup, one at 8 weeks and 6 months [34], other at 3 and 6 months [7], and three only at 6 months [30,35,36]. In addition, one of these studies included a midterm assessment after 4 weeks [30], and one study assessed outcomes during intervention [33].…”

“…In two studies, comparisons consisted of VR versus physiotherapy [30,37]. In addition, three studies combined VR + physiotherapy versus physiotherapy alone [26,29,32], and four studies combined those interventions and compared them with no VR exercises and physiotherapy [26,[34][35][36].…”