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

疼痛康复虚拟现实 (PRVR)：增强疼痛时活动能力的创新

• 批准号: 10397145
• 负责人: LAURA E SIMONS
• 金额: $ 17.14万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-05-01 至 2024-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10397145
• 关键词: 3-Dimensional; Acute pain management; Adherence; Adolescence; Adolescent; Adult; Adverse event; Affect; Age; Analgesics; Anxiety; Benchmarking; Body Image; Childhood; Clinic; Clinical; Data; Diagnosis; Dizziness; Effectiveness; Emotional; Exercise; Exposure to; Feedback; Foundations; Fright; Funding; Future; Gender; Goals; Health Care Costs; Home; Hybrids; Immersion; Impairment; Intervention; Measures; Motion; Motivation; Movement; Musculoskeletal Pain; Opioid; Outcome; Pain; Pain intensity; Participant; Patient Self-Report; Patients; Physical Function; Physical Rehabilitation; Physical activity; Physical therapy; Population; Provider; Randomized Controlled Trials; Rehabilitation therapy; Reporting; Research; Research Personnel; Rewards; Self Efficacy; Technology; Therapeutic; Time; Work; actigraphy; arm; chronic musculoskeletal pain; chronic pain; daily functioning; diaries; dissemination trial; distraction; exercise program; experience; feasibility testing; follow-up; functional improvement; functional restoration; high risk; improved; improved mobility; innovation; kinematics; multidisciplinary; multisensory; neuroregulation; opioid misuse; pain outcome; pain rehabilitation; pain-related disability; patient engagement; prevent; primary outcome; public health relevance; response; retention rate; satisfaction; secondary outcome; social; societal costs; treatment response; virtual reality; virtual reality intervention

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.

项目总结/摘要 慢性肌肉骨骼（MSK）疼痛每年影响美国超过四分之一青少年的生活， 对成年期的影响表现为教育程度较低、职业功能差、社会障碍 滥用阿片类药物的风险更高。在疼痛存在的情况下逐渐增加活动对于有效的治疗至关重要。 物理治疗（PT）是慢性MSK疼痛的基础治疗。尽管 广泛使用PT，敢于增加运动，而在疼痛往往可以感受到身体和情感 由于害怕疼痛而无法达到，这对疼痛结果产生了特别显著的影响，阻碍了临床改善。 虚拟现实（VR）提供了对多感官、三维（3D）沉浸式体验的访问， 有可能打破PT期间害怕运动和回避的恶性循环。VR被认为是 阿片类药物的替代品，治疗机制以分散注意力、身体神经调节为中心， 感知和分级暴露于恐惧/避免的运动。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， 患者和临床医生。从我们的初步数据来看，以用户为中心的迭代开发的疼痛康复 虚拟现实（PRVR）被认为是高度参与，并增加了会话中的运动相比， 标准理疗康复（SPR）。在这项试点工作的基础上，拟议的研究是一项随机的 PRVR的对照试验，旨在测量青少年身体功能和疼痛相关恐惧的变化 与SPR相比，慢性MSK疼痛。目的1评价身体功能（主要结局）和疼痛 PRVR和SPR之间的相关恐惧（次要结局）。目标2描述了未来混合动力车的可行性 PRVR在常规PT实践中的有效性-传播试验。治疗的重大突破， MSK疼痛需要机械信息的创新方法。PRVR利用沉浸式技术， 克服了在疼痛的存在下对运动的恐惧的关键障碍，在游戏化的环境中提供实时反馈。 背景，以维持动机和坚持，并有目的地捕捉两个目标（运动学，活动记录） 和主观（自我报告）日常功能，以定义临床终点并评估治疗进展， 诊所和家里。这些调查结果将直接告知是否继续进行混合动力车的决定 PRVR的有效性传播试验，作为潜在的大规模实施PRVR的基础。