Tuck Natalie, Pollard Catherine, Good Clinton, Williams Caitlin, Lewis Gwyn, Hames Murray, Aamir Tipu, Bean Debbie
The Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand.
The Pain Management Unit, Department of Anaesthesiology and Perioperative Medicine, Waitematā District Health Board, Auckland, New Zealand.
JMIR Form Res. 2022 Jul 13;6(7):e38366. doi: 10.2196/38366.
The modern management of chronic pain is largely focused on improving functional capacity (often despite ongoing pain) by using graded activation and exposure paradigms. However, many people with chronic pain find functional activation programs aversive, and dropout rates are high. Modern technologies such as virtual reality (VR) could provide a more enjoyable and less threatening way for people with chronic pain to engage in physical activity. Although VR has been successfully used for pain relief in acute and chronic pain settings, as well as to facilitate rehabilitation in conditions such as stroke and cerebral palsy, it is not known whether VR can also be used to improve functional outcomes in people with chronic pain.
This study aimed to assess the feasibility of conducting an adequately powered randomized controlled trial (RCT) to test the efficacy of VR in a chronic pain treatment center and assess the acceptability of an active VR treatment program for patients in this setting.
For this mixed methods pilot study, which was designed to test the feasibility and acceptability of the proposed study methods, 29 people seeking treatment for chronic pain were randomized to an active VR intervention or physiotherapy treatment as usual (TAU). The TAU group completed a 6-week waitlist before receiving standard treatment to act as a no-treatment control group. The VR intervention comprised twice-weekly immersive and embodied VR sessions using commercially available gaming software, which was selected to encourage movement. A total of 7 VR participants completed semistructured interviews to assess their perception of the intervention.
Of the 99 patients referred to physiotherapy, 53 (54%) were eligible, 29 (29%) enrolled, and 17 (17%) completed the trial, indicating that running an adequately powered RCT in this setting would not be feasible. Despite this, those in the VR group showed greater improvements in activity levels, pain intensity, and pain interference and reported greater treatment satisfaction and perceived improvement than both the waitlist and TAU groups. Relative effect sizes were larger when VR was compared with the waitlist (range small to very large) and smaller when VR was compared with TAU (range none to medium). The qualitative analysis produced the following three themes: VR is an enjoyable alternative to traditional physiotherapy, VR has functional and psychological benefits despite continued pain, and a well-designed VR setup is important.
The active VR intervention in this study was highly acceptable to participants, produced favorable effects when compared with the waitlist, and showed similar outcomes as those of TAU. These findings suggest that a confirmatory RCT is warranted; however, substantial barriers to recruitment indicate that incentivizing participation and using a different treatment setting or running a multicenter trial are needed.
慢性疼痛的现代管理主要侧重于通过采用分级激活和暴露范式来提高功能能力（通常尽管疼痛仍在持续）。然而，许多慢性疼痛患者认为功能激活计划令人厌恶，且退出率很高。虚拟现实（VR）等现代技术可以为慢性疼痛患者提供一种更有趣且威胁性更小的方式来进行体育活动。尽管VR已成功用于急性和慢性疼痛环境中的疼痛缓解，以及促进中风和脑瘫等疾病的康复，但尚不清楚VR是否也可用于改善慢性疼痛患者的功能结局。
本研究旨在评估在慢性疼痛治疗中心进行一项有足够效力的随机对照试验（RCT）以测试VR疗效的可行性，并评估在此环境中积极的VR治疗方案对患者的可接受性。
对于这项混合方法的试点研究，旨在测试所提议研究方法的可行性和可接受性，将29名寻求慢性疼痛治疗的患者随机分为积极的VR干预组或常规物理治疗（TAU）组。TAU组在接受标准治疗前完成6周的等待期，作为无治疗对照组。VR干预包括每周两次使用市售游戏软件进行沉浸式和具身化的VR训练，选择该软件以鼓励运动。共有7名VR参与者完成了半结构化访谈，以评估他们对干预的看法。
在转介至物理治疗的99名患者中，53名（54%）符合条件，29名（29%）入组，17名（17%）完成试验，这表明在这种环境中进行一项有足够效力的RCT是不可行的。尽管如此，VR组在活动水平、疼痛强度和疼痛干扰方面的改善更大，并且与等待期组和TAU组相比，报告的治疗满意度和感知改善更高。与等待期组相比，VR的相对效应大小更大（范围从小到非常大），与TAU组相比则较小（范围从无到中等）。定性分析产生了以下三个主题：VR是传统物理治疗的一种有趣替代方案，尽管疼痛持续存在，VR仍具有功能和心理益处，以及精心设计的VR设置很重要。
本研究中的积极VR干预对参与者具有高度可接受性，与等待期组相比产生了有利效果，并且与TAU组的结果相似。这些发现表明有必要进行一项验证性RCT；然而，招募方面的重大障碍表明需要激励参与并使用不同的治疗环境或进行多中心试验。
