Virtual Immersive Gaming to Optimize Recovery in Low Back Pain

摘要 下背痛是第二个最常见的原因去看医生，直接医疗费用超过 仅在美国每年就有900亿美元。这些费用主要由7-10%的患者驱动， 发展成一种可以持续多年的慢性疼痛紊乱。对运动的恐惧（即，运动恐惧症）由于 对疼痛和伤害的预期是持续性疼痛发展的重要风险指标， 残疾，研究一致表明，高度恐惧是向残疾过渡的最强预测因素之一。 慢性腰痛（CLBP）具体来说，恐惧会鼓励人们采用适应不良的运动模式 其中日常生活任务是在腰椎屈曲减少和 膝关节、髋关节和臂肩关节屈曲。虽然避免腰部屈曲可能有利于这些背痛患者， 短期内通过减少自己对损伤的恐惧，在长期内限制腰椎屈曲成为一种根深蒂固的 模式，可导致脊柱关节周围结缔组织缩短，周围肌肉变化， 增加慢性病的风险。 在NIH R21的支持下，我们最近完成了沉浸式虚拟现实躲避球的第一阶段试验 游戏设计专门增加与CLBP和高度害怕运动的个人腰椎屈曲。 这项概念验证研究的结果表明，每天3次虚拟躲避球是安全的， 不会加剧现有的背痛，参与者对它的评价很高，在治疗过程中增加了腰椎屈曲度。 玩法我们现在提出了一项II期随机对照试验，以确定为期9周的虚拟治疗的疗效。 躲避球，以减少疼痛和残疾。CLBP参与者将被随机分配到两个版本中的一个 我们的虚拟现实游戏。在实验组中，游戏将促进腰椎的渐进性增加， 屈运动控制组将玩同样的沉浸式视频游戏，但游戏的参数将 修改后，仅需要腰椎屈曲的小偏移即可成功完成游戏。的 将在第1、6、12、24和48周时评估疼痛和残疾变化的共同主要临床结局 后处理。此外，还将评估预期疼痛、预期伤害和腰椎屈曲度的个体差异。 在治疗前基线和每次随访间隔时在实验室中测量。最后，参与者 在每次随访实验室访视后，将对其在自然环境中的活动进行为期7天的监测。 我们开发了一种创新的沉浸式视频游戏，可以安全地降低对疼痛/伤害的预期， 增加CLBP患者的腰椎屈曲度。拟议的第二阶段试验将产生重大影响 通过测试这种独特的干预措施激励CLBP患者重新参与公共卫生的能力， 促进恢复和维持这些治疗收益所需的特定脊柱运动。

Abstract 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. Fear of movement (i.e., kinesiophobia) due to expectations of pain and harm is an important risk indicator for the development of persistent pain and disability, with studies consistently showing that high fear is one of the strongest predictors of the transition to chronic low back pain (CLBP). Specifically, fear encourages the adoption of maladaptive movement patterns wherein tasks of daily living are performed with reduced lumbar spine flexion and compensatory increases of knee, hip, and arm shoulder flexion. While avoidance of lumbar flexion may benefit these back pain sufferers in the short-term by reducing their fear of injury, in the long-term limited lumbar flexion becomes an entrenched pattern that can lead to shortening of spinal peri-articular connective tissues, changes in surrounding muscles, and increased risk for chronicity. With the support of an NIH R21, we recently completed a Phase I trial of an immersive virtual reality dodgeball game designed specifically to increase lumbar flexion among individuals with CLBP and high fear of movement. The results of this proof-of-concept study demonstrated that 3 daily sessions of virtual dodgeball was safe, did not exacerbate existing back pain, was highly rated by participants, and increased lumbar spine flexion during gameplay. We now propose a Phase II RCT to determine the efficacy of a 9–week course of treatment of virtual dodgeball to reduce pain and disability. CLBP participants will be randomly assigned to play one of two versions of our virtual reality game. In the experimental group, gameplay will promote progressive increases in lumbar flexion. The control group will play the same immersive video game, but the parameters of the game will be modified such that only small excursions of lumbar flexion are needed to successfully complete gameplay. The co-primary clinical outcomes of changes in pain and disability will be assessed at 1-, 6-, 12-, 24-, and 48-weeks post-treatment. Additionally, individual differences in expected pain, expected harm, and lumbar flexion will be measured at pre-treatment baseline and at each of the follow-up intervals in the laboratory. Finally, participant activity in their natural environment will be monitored for 7 days following each follow-up laboratory visit. We have developed an innovative immersive video game that safely reduces expectations of pain/harm and increases lumbar flexion among individuals with CLBP. The proposed Phase II trial will have a significant impact on public health by testing the ability of this unique intervention to motivate CLBP sufferers to re-engage in the specific spinal motions necessary to promote recovery and to maintain these treatment gains.