Patient perspectives on virtual reality-based rehabilitation after knee surgery: Importance of level of difficulty.

This article explored the perspectives of 25 patients regarding virtual reality (VR)-based rehabilitation following knee surgery and identified the important factors that allowed patients to immerse themselves in rehabilitation. Qualitative analysis of data collected via open-ended questionnaire and quantitative analysis of data from physical assessments and surveys were conducted. In the open-ended questionnaire, the majority of participants mentioned level of difficulty as the most common reason for selecting both the most and the least immersive exercise programs. Quantitative analysis showed that participants experienced a high level of flow (3.9 +/- 0.3 out of 5.0) and a high rate of expectation of therapeutic effect (96%) and intention of exercise adherence (96%). Further, participants with more severe pain or physical dysfunction tended to have more positive experiences (e.g., Difficulty-Skill Balance, Clear Goals, and Transformation of Time), leading to high levels of flow during VR-based rehabilitation. In conclusion, VR-based games are potentially acceptable as a motivational rehabilitation tool for patients following knee surgery. However, to best meet patients' needs, it might be useful to equip a VR program with varied levels of difficulty, taking into account the severity of the individual's knee injury. Additionally, severe pain or physical dysfunction might act as an indication rather than a contraindication for VR-based rehabilitation.

The hypoalgesic effect of remote tactile sensory modulation on the mechanical sensitivity of trigger points: A randomized controlled study.

BACKGROUND: Sensitivity of the myofascial trigger point (MTrP) can be inhibited by electrical stimulation of remote site. However, it remains unclear whether remote pain control of the MTrP occurs in the same spinal segment or in the supraspinal system. OBJECTIVES: The aims of this study were to identify whether the remote pain control occurs in the spinal segment corresponding to the MTrP or in the supraspinal system. METHODS: Test subjects (n = 10) received transcutaneous electrical nerve stimulation for 5 minutes, whereas control subjects (n = 10) received no intervention. The threshold for tactile sensory modulation at the lateral elbow was assessed using Von Frey filaments. The pressure sensitivities of MTrPs in both the infraspinatus and upper trapezius muscles were quantified by algometry. Measurements were performed at baseline and 1 and 15 minutes after the intervention. RESULTS: Increases of the tactile threshold at the remote site decreased the sensitivity of the MTrP innervated by same spinal segment. However, no changes were observed at MTrP sites innervated by contralateral fibers or those from different spinal segment. CONCLUSION: MTrP sensitivity is more strongly affected by interventions at remote ipsilateral sites in the same spinal segment than by stimulation of extra-segmental sites.