Highlights
- •This was a virtual dodgeball intervention to elicit increased lumbar spine flexion.
- •Virtual dodgeball increased lumbar flexion within and across gameplay sessions.
- •Safety and feasibility of novel intervention for back pain was shown.
- •Brief intervention did not translate to movements outside of the virtual environment.
- •This study provided support for a clinical trial with a longer intervention period.
Abstract
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.
Key words
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Article info
Publication history
Published online: September 08, 2016
Accepted:
August 30,
2016
Received in revised form:
August 29,
2016
Received:
June 7,
2016
Footnotes
This study was registered with ClinicalTrials.gov (NCT02301741).
Research reported in this publication was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under Award Number R21AR064430. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
The authors have no conflicts of interest to declare.
Identification
Copyright
© 2016 by the American Pain Society
