RESUMEN
BACKGROUND: Chronic musculoskeletal (MSK) pain is a prominent health concern, resulting in pain-related disability, loss of functioning, and high health care costs. Physiotherapy rehabilitation is a gold-standard treatment for improving functioning in youth with chronic MSK pain. However, increasing physical activity can feel unattainable for many adolescents because of pain-related fear and movement avoidance. Virtual reality (VR) offers an immersive experience that can interrupt the fear-avoidance cycle and improve engagement in physiotherapy. Despite promising initial findings, data are limited and often lack the rigor required to establish VR as an evidence-based treatment for MSK pain. OBJECTIVE: This trial evaluates physiorehabilitation with VR in adolescents with MSK pain. This protocol outlines the rationale, design, and implementation of a randomized controlled trial enhanced with a single-case experimental design. METHODS: This study is a 2-group randomized controlled trial assessing the use of physiorehabilitation with VR in adolescents with MSK pain. The authors will collaborate with physical therapists to integrate VR into their standard clinical care. For participants enrolled in standard physiotherapy, there will be no VR integrated into their physical therapy program. Primary outcomes include physical function and engagement in VR. Secondary outcomes include pain-related fear and treatment adherence. Moreover, we will obtain clinician perspectives regarding the feasibility of integrating the intervention into the flow of clinical practice. RESULTS: The pilot study implementing physiorehabilitation with VR demonstrated that high engagement and use of physiorehabilitation with VR were associated with improvements in pain, fear, avoidance, and function. Coupled with qualitative feedback from patients, families, and clinicians, the pilot study results provide support for this trial to evaluate physiorehabilitation with VR for youth with chronic MSK pain. Analysis of results from the main clinical trial will begin as recruitment progresses, and results are expected in early 2024. CONCLUSIONS: Significant breakthroughs for treating MSK pain require mechanistically informed innovative approaches. Physiorehabilitation with VR provides exposure to progressive challenges, real-time feedback, and reinforcement for movement and can include activities that are difficult to achieve in the real world. It has the added benefit of sustaining patient motivation and adherence while enabling clinicians to use objective benchmarks to influence progression. These findings will inform the decision of whether to proceed with a hybrid effectiveness-dissemination trial of physiorehabilitation with VR, serving as the basis for potential large-scale implementation of physiorehabilitation with VR. TRIAL REGISTRATION: ClinicalTrials.gov NCT04636177; https://clinicaltrials.gov/ct2/show/NCT04636177. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/40705.
RESUMEN
OBJECTIVE: Virtual reality facilitates physical therapy via improved engagement. Although shown to benefit specific patient populations, such as stroke patients, it is less established in otherwise healthy adults and children receiving outpatient physical therapy. The primary objective was to compare total physical therapy-guided movement supplemented with virtual reality with physical therapy-guided movement alone without virtual reality. DESIGN: This pragmatic, randomized, crossover study compared physical therapy-guided movement supplemented with virtual reality with physical therapy-guided movement alone without virtual reality in outpatients (ages 6-80 yrs). This community sample had variable physical therapy indications (injury, postoperative, chronic pain), and in pre-existing conditions, therefore, participants served as their own controls. Participants received 10 mins of both physical therapy-guided movement supplemented with virtual reality and physical therapy-guided movement alone without virtual reality separated by 5 mins. The primary outcome was differences in aggregate movement of physical therapy-guided exercises. Secondary outcomes explored OMNI rating of perceived exertion and participant and physical therapist satisfaction. Paired t tests, χ2 tests, and regression models were used to analyze differences. RESULTS: The 41 participants (17 pediatric and 24 adult) moved significantly more during physical therapy-guided movement supplemented with virtual reality compared with physical therapy-guided movement alone without virtual reality (1120.88 vs. 672.65 m, P < 0.001), regardless of which intervention was completed first. Physical therapy-guided movement supplemented with virtual reality treatment was associated with more movement of the target limbs, lower body (P < 0.001), and upper body (P < 0.05). The OMNI rating of perceived exertion scores did not differ between those who started with physical therapy-guided movement supplemented with virtual reality or physical therapy-guided movement alone without virtual reality, and physical therapist and patient surveys endorsed physical therapy-guided movement supplemented with virtual reality. CONCLUSIONS: Patients completed more physical therapy-guided movement during physical therapy-guided movement supplemented with virtual reality than physical therapy-guided movement alone without virtual reality, and therapists and patients supported its use. Future studies will examine finer tracking of movements.
