Using an interactive game to reduce fear & increase spine motion in low back pain

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DESCRIPTION (provided by applicant): Low back pain is the second most common reason for a visit to a physician, with direct medical costs exceeding $90 billion per year in the United States alone. These costs are driven primarily by 7-10% of patients who develop a chronic pain disorder that can last for many years. A fundamental clinical problem in individuals with chronic low back pain is the significant alteration in movement patterns that restrict lumbar spine motion. This restriction of lumbar motion is particularly evident in patients with "kinesiophobia"; that isa fear of movement due to possible injury or reinjure. Accordingly, we propose a novel approach that manipulates movement feedback in a gaming environment to improve spinal motion and decrease expectation of pain and harm in participants with chronic low back pain and high kinesiophobia. We will compare the ability of this game to increase lumbar motion when compared to a no treatment control condition. Participants in the game condition will complete laboratory sessions on five consecutive days. Session 1 (baseline) will be used to assess lumbar spine motion and expectations of pain and harm during standardized reaching tasks. In lab sessions 2 through 4 participants will play a game of virtual dodge ball. They will be instrumented with sensors that track their body movements in real time and display them as an on-screen avatar. The game has 4 levels of difficulty that are tailored to each participant's baseline lumbar spine flexion. Session 5 (post-test) will be used to reassess lumbar spine motion and expectations of pain and harm during constrained and unconstrained reaching. Participants in the control condition will complete baseline and post-test standardized reaching tasks, but will not play the game in the intervening three days. Aim 1 will determine the effect of game play on lumbar spine motion and expectations of pain and harm and Aim 2 will determine the effect of altered movement gain on lumbar spine flexion. The use of a gaming environment is an innovative approach to address fear of movement and reduced lumbar motion in chronic low back pain patients with kinesiophobia, and this proof-of-concept study represents the critical first step to evaluate a promising new approach for chronic back pain and will provide the data necessary to assess power for a full-scale randomized clinical trial.