Pain Rehabilitation Virtual Reality (PRVR): Innovations to enhance mobility in the presence of pain

项目摘要/摘要 慢性肌肉骨骼疼痛(MSK)每年影响美国超过四分之一的青少年的生活， 对成年的影响，表现为受教育程度低、职业功能差、社会障碍 以及更高的阿片类药物滥用风险。在疼痛存在的情况下逐步增加活动量是有效的关键 物理疗法(PT)为基础治疗的慢性MSK疼痛的功能恢复。尽管 广泛使用PT，在疼痛时敢于增加运动，通常会在身体和情感上感觉到 对疼痛的恐惧是无法达到的，这对疼痛结果的影响尤其显著，阻碍了临床的改善。 虚拟现实(VR)提供了一种多感官、三维(3D)沉浸式体验，具有 有可能打破在PT期间害怕移动和回避的恶性循环。虚拟现实被认为是 一种替代阿片类药物的治疗机制以分散注意力和身体的神经调节为中心 知觉，并对害怕/避免的动作进行分级暴露。此外，VR还可以潜在地增强 激励和参与，促进重复运动，并结合实时和纵向反馈 病人和临床医生。根据我们的初步数据，以用户为中心的迭代开发的疼痛康复 虚拟现实(PRVR)被认为具有很高的吸引力，与 标准理疗康复(SPR)。在这项试点工作的基础上，拟议的研究是随机的 旨在测量青少年身体功能变化和疼痛相关恐惧的PRVR对照试验 与SPR相比，慢性MSK疼痛。目标1评估身体功能(主要结果)和疼痛 PRVR和SPR之间的相关恐惧(次要结果)。目标2描述了未来杂交的可行性 PRVR在常规PT实践中的有效性-推广试验。慢性阻塞性肺疾病治疗取得重大突破 MSK Pain需要机械地了解情况的创新方法。PRVR利用身临其境的技术 克服在疼痛存在的情况下害怕移动的关键障碍，在游戏化的 保持动力和坚守的背景，并有目的地捕捉这两个目标(运动学、动作学) 和主观(自我报告)日常功能，以确定临床终点和评估治疗进展 诊所和家里。这些发现将直接为是否继续开发混合动力车提供决策依据 PRVR的有效性传播试验，为PRVR的大规模实施奠定了基础。

Project Summary / Abstract Chronic musculoskeletal (MSK) pain affects the lives of over a quarter of adolescents in the US each year with impacts into adulthood evidenced by lower educational attainment, poor vocational function, social impairments and higher risk for opioid misuse. Progressively increasing activity in the presence of pain is critical for effective functional restoration in chronic MSK pain with physiotherapy (PT) a foundational treatment. Despite the widespread use of PT, daring to increase movement while in pain can often feel physically and emotionally unattainable with fear of pain a particularly salient influence on pain outcomes, hindering clinical improvement. Virtual reality (VR) provides access to a multisensory, three-dimensional (3D) immersive experience that has the potential to break the vicious cycle of fear of movement and avoidance during PT. VR has been suggested as an alternative to opioids with the therapeutic mechanisms centered on distraction, neuromodulation of body perception, and graded exposure to feared/avoided movements. Moreover, VR can potentially enhance motivation and engagement, facilitate repetitive motions, and incorporate real-time and longitudinal feedback for the patient and clinician. From our preliminary data, user-centered iteratively developed Pain Rehabilitation Virtual Reality (PRVR) was deemed highly engaging and increased in-session movement when compared to Standard Physiotherapy Rehabilitation (SPR). Building on this pilot work, the proposed research is a randomized controlled trial of PRVR aimed at measuring changes in physical function and pain-related fear for adolescents with chronic MSK pain when compared to SPR. Aim 1 evaluates physical function (primary outcome) and pain related fear (secondary outcome) between PRVR and SPR. Aim 2 characterizes feasibility of a future hybrid effectiveness-dissemination trial of PRVR in routine PT practice. Significant breakthroughs in the treatment of MSK pain require mechanistically-informed innovative approaches. PRVR harnesses immersive technology to overcome the key barrier of fear of movement in the presence of pain, provides real-time feedback in a gamified context to sustain motivation and adherence, and purposefully captures both objective (kinematics, actigraphy) and subjective (self-report) daily functioning to define clinical endpoints and assess treatment progress in the clinic and at home. These findings will directly inform the decision of whether to proceed with a hybrid effectiveness-dissemination trial of PRVR, serving as the basis for potential large-scale implementation of PRVR.