Integrating Physical Therapy and Virtual Reality to Manage Pain-Related Fear of Movement in Patients With Chronic Pain: A Randomized Controlled Trial.

OBJECTIVES

This study aims to investigate the effect of virtual reality (VR) technology and physical therapy on pain-related fear of movement in patients with chronic pain.

METHODS

This randomized controlled trial included 73 patients with chronic pain. All participants underwent measurements using the Tampa Scale for Kinesiophobia (TSK), the Japanese version of the World Health Organization Health and Work Performance Questionnaire (WHO-HPQ), the Pain Self-Efficacy Questionnaire (PSEQ), the Numerical Rating Scale (NRS), the Hospital Anxiety and Depression Scale (HADS), the Pain Catastrophizing Scale (PCS), the International Physical Activity Questionnaire (IPAQ), the EuroQOL 5 Dimensions 5-Level (EQ-5D-5L), quadriceps muscle strength, the Timed Up and Go test (TUG), and the 30-s Chair Stand test (CS-30). The intervention group underwent three months of rehabilitation, incorporating VR and exercises administered by a physical therapist. The control group performed similar exercises guided by a physical therapist, with the only distinction being the absence of VR.

RESULTS

Sixty-six participants (32 males, mean age: 54.7±11.7 years) were included in the analysis. TSK scores improved at one-month post-intervention in the intervention group (ΔTSK: -12.4±2.1) compared to the control group (ΔTSK: -7.8±1.4) (p<0.05). The intervention group predominantly demonstrated improved TSK scores at one-month post-intervention. Multivariate logistic regression analysis at one-month post-intervention revealed significant associations between TSK scores and the intervention, PCS, PSEQ, and IPAQ scores (p<0.05).

DISCUSSION

This study revealed two significant findings: (i) combining physical therapy with VR effectively reduced pain-related fear of movement in patients at an early stage, and (ii) a change in the kinesiophobia scores in patients with chronic pain was associated with a change in pain catastrophizing, self-efficacy, and VR intervention. TSK scores in the intervention group significantly improved at one-month post-intervention compared to those in the control group. Combining VR with physical therapy effectively mitigated the excessive pain-related fear of movement. In this study, VR provided an exercise experience without physical pain for patients with chronic pain. This was intended to create a calming, distracting environment and thereby reduce the perceived threat of kinesiophobia. Furthermore, it is possible that there was a reduction in central sensitization. Multiple regression analysis revealed that ΔPCS, ΔPSEQ, and intervention were common elements of ΔTSK at one and three months post-intervention. These findings suggest that combined physical therapy with VR and improved PCS and PSEQ scores contributed to improved TSK scores. Therefore, VR could be beneficial in managing pain-related fear of movement by creating the illusion that exercise does not cause pain. This study had several limitations. First, pain assessment was subjective using questionnaires. Second, participants were limited to patients who underwent physical therapy, which may introduce selection bias. Third, findings were derived from a single pain clinic.

CONCLUSION

This study's findings indicated significant differences between the control and intervention groups, which combined physical therapy with VR, particularly in reducing pain-related fear of movement at an early stage.