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

下背痛是第二个最常见的就医原因，仅在美国每年的直接医疗费用就超过900亿美元。这些成本主要由7-10%的患者驱动，他们患有可持续多年的慢性疼痛疾病。慢性下腰痛患者的一个基本临床问题是限制腰椎运动的运动模式的显著改变。 这种对腰椎活动的限制在“运动恐惧症”患者中尤其明显;运动恐惧症伊萨由于可能的损伤或再损伤而害怕运动。因此，我们提出了一种新的方法，在游戏环境中操纵运动反馈，以改善脊柱运动，并降低慢性腰痛和高运动恐惧症参与者的疼痛和伤害的预期。我们将比较这个游戏的能力，以增加腰椎运动相比，没有治疗控制条件。游戏条件下的参与者将连续五天完成实验室课程。第1阶段（基线）将用于评估标准化伸手任务期间的腰椎活动以及疼痛和伤害预期。在实验课2到4中，参与者将玩虚拟躲避球游戏。他们将配备传感器，以真实的时间跟踪他们的身体运动，并将其显示在屏幕上的化身。该游戏有4个难度级别，适合每个参与者的基线腰椎屈曲。第5阶段（测试后）将用于重新评估腰椎活动以及限制和非限制性伸展过程中的疼痛和伤害预期。在控制条件下的参与者将完成基线和测试后的标准化达到任务，但不会玩游戏在中间的三天。目标1将决定 对腰椎运动的游戏以及对疼痛和伤害的预期，目标2将确定改变的运动增益对腰椎屈曲的影响。游戏环境的使用是一种创新的方法，可以解决运动恐惧症患者对运动的恐惧和腰椎运动减少的问题，这项概念验证研究代表了评估慢性背痛有前途的新方法的关键第一步，并将提供评估全面随机临床试验功效所需的数据。

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.