Thomas James S, France Christopher R, Applegate Megan E, Leitkam Samuel T, Walkowski Stevan
School of Rehabilitation and Communication Studies, Division of Physical Therapy, Ohio University, Athens, Ohio.
Department of Psychology, Ohio University, Athens, Ohio.
J Pain. 2016 Dec;17(12):1302-1317. doi: 10.1016/j.jpain.2016.08.011. Epub 2016 Sep 9.
UNLABELLED: Whereas the fear-avoidance model of chronic low back pain (CLBP) posits a generic avoidance of movement that is perceived as threatening, we have repeatedly shown that individuals with high fear and CLBP specifically avoid flexion of the lumbar spine. Accordingly, we developed a virtual dodgeball intervention designed to elicit graded increases in lumbar spine flexion while reducing expectations of fear and harm by engaging participants in a competitive game that is entertaining and distracting. We recruited 52 participants (48% female) with CLBP and high fear of movement and randomized them to either a game group (n = 26) or a control group (n = 26). All participants completed a pregame baseline and a follow-up assessment (4-6 days later) of lumbar spine motion and expectations of pain and harm during standardized reaches to high (easier), middle, and low (hardest to reach) targets. For 3 consecutive days, participants in the game group completed 15 minutes of virtual dodgeball between baseline and follow-up. For the standardized reaching tests, there were no significant effects of group on changes in lumbar spine flexion, expected pain, or expected harm. However, virtual dodgeball was effective at increasing lumbar flexion within and across gameplay sessions. Participants reported strong positive endorsement of the game, no increases in medication use, pain, or disability, and no adverse events. Although these findings indicate that very brief exposure to this game did not translate to significant changes outside the game environment, this was not surprising because graded exposure therapy for fear of movement among individuals with low back pain typically last 8 to 12 sessions. Because of the demonstration of safety, feasibility, and ability to encourage lumbar flexion within gameplay, these findings provide support for a clinical trial wherein the treatment dose is more consistent with traditional graded exposure approaches to CLBP. PERSPECTIVE: This study of a virtual reality dodgeball intervention provides evidence of feasibility, safety, and utility to encourage lumbar spine flexion among individuals with CLBP and high fear of movement.
未标注:慢性下腰痛(CLBP)的恐惧回避模型假定,人们会普遍回避被视为有威胁的动作,但我们反复表明,恐惧程度高且患有CLBP的个体特别会避免腰椎前屈。因此,我们开发了一种虚拟躲避球干预措施,旨在通过让参与者参与一场有趣且分散注意力的竞技游戏,引发腰椎前屈程度的逐步增加,同时降低对恐惧和伤害的预期。我们招募了52名患有CLBP且对动作高度恐惧的参与者(48%为女性),并将他们随机分为游戏组(n = 26)或对照组(n = 26)。所有参与者在标准化伸手够到高(较容易)、中、低(最难够到)目标的过程中,完成了腰椎运动以及疼痛和伤害预期的赛前基线评估和随访评估(4 - 6天后)。连续3天,游戏组的参与者在基线和随访之间完成15分钟的虚拟躲避球游戏。对于标准化伸手测试,组间对腰椎前屈变化、预期疼痛或预期伤害均无显著影响。然而,虚拟躲避球在游戏过程中和不同游戏场次中均能有效增加腰椎前屈。参与者对该游戏给予了强烈的积极认可,药物使用、疼痛或残疾均未增加,也未出现不良事件。尽管这些结果表明,非常短暂地接触这款游戏并未转化为游戏环境之外的显著变化,但这并不奇怪,因为针对下腰痛患者运动恐惧的分级暴露疗法通常持续8至12次疗程。鉴于已证明该游戏具有安全性、可行性以及在游戏过程中促使腰椎前屈的能力,这些结果为一项临床试验提供了支持,在该试验中治疗剂量与传统的CLBP分级暴露方法更为一致。 观点:这项关于虚拟现实躲避球干预的研究为鼓励患有CLBP且对动作高度恐惧的个体进行腰椎前屈提供了可行性、安全性和实用性的证据。
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