Effects of Virtual Reality Exercises on Chronic Low Back Pain: Quasi-Experimental Study

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Abstract

Background

Low back pain is a common health problem globally. Based on the duration of pain, it is classified as acute, subacute, or chronic low back pain. Different treatment strategies are available to reduce chronic low back pain. Virtual reality (VR) is a novel approach in back pain rehabilitation.

Objective

This study aimed to compare the effects of VR games on chronic low back pain.

Methods

This quasi-experimental study was conducted among 40 patients with chronic low back pain. The data were collected using a nonprobability, convenient sampling technique. Patients visiting the Department of Physiotherapy, Government Services Hospital, Lahore, Pakistan, were recruited and equally divided into 4 groups. Group A received the Reflex Ridge game; group B received the Body Ball game; group C combined the 2 games without back-strengthening exercises; and group D combined the 2 games with back-strengthening exercises. The participants received 8 treatment sessions, with 3 sessions/wk. The outcomes were pre- and posttest measurements of pain intensity, low back disability, and lumbar range of motion. The repeated measurement ANOVA was used for inter- and intragroup comparison, with significance at P≤.05.

Results

The study comprised a sample of 40 patients with low back pain; 12 (40%) were female and 28 (60%) were male, with a mean age of 37.85 (SD 12.15) years. The pre- and posttest mean pain scores were 7.60 (SD 1.84) and 4.20 (SD 1.62) in group A, 6.60 (SD 1.776) and 5.90 (SD 1.73) in group B, 6.90 (SD 1.73) and 5.40 (SD 1.07) in group C, and 7.10 (SD 1.53) and 3.60 (SD 0.97) in group D, respectively. The mean pain score differences of group D (combining the Reflex Ridge and Body Ball games with back-strengthening exercises) compared to groups A, B, and C were –.60 ( P=.76), –2.30 ( P<.001), and –1.80 ( P=.03), respectively. Regarding the range of motion, the forward lumbar flexion mean differences of group D compared to groups A, B, and C were 3.80 ( P=.21), 4.80 ( P=.07), and 7.40 ( P<.001), respectively. Similarly, the right lateral lumbar flexion mean differences of group D compared to groups A, B, and C were 2.80 ( P=.04), 5.20 ( P<.001), and 4.80 ( P<.001), respectively. The left lateral lumbar flexion mean differences of group D compared to groups A, B, and C were 2.80 ( P<.001), 4.80 ( P=.02), and 2.20 ( P<.001). respectively, showing significant pre- and posttreatment effects.

Conclusions

VR exercises had statistically significant effects on improving pain, low back disability, and range of motion in all groups, but the combination of Reflex Ridge and Body Ball games with back-strengthening exercises had dominant effects compared to the other groups.

Trial Registration

Iranian Registry of Clinical Trial IRCT20200330046895N1; https://en.irct.ir/trial/46916

Related collections

Most cited references 34

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What low back pain is and why we need to pay attention

Paulo Ferreira, Manuela Ferreira, Peter Croft … (2018)

Low back pain is a very common symptom. It occurs in high-income, middle-income, and low-income countries and all age groups from children to the elderly population. Globally, years lived with disability caused by low back pain increased by 54% between 1990 and 2015, mainly because of population increase and ageing, with the biggest increase seen in low-income and middle-income countries. Low back pain is now the leading cause of disability worldwide. For nearly all people with low back pain, it is not possible to identify a specific nociceptive cause. Only a small proportion of people have a well understood pathological cause-eg, a vertebral fracture, malignancy, or infection. People with physically demanding jobs, physical and mental comorbidities, smokers, and obese individuals are at greatest risk of reporting low back pain. Disabling low back pain is over-represented among people with low socioeconomic status. Most people with new episodes of low back pain recover quickly; however, recurrence is common and in a small proportion of people, low back pain becomes persistent and disabling. Initial high pain intensity, psychological distress, and accompanying pain at multiple body sites increases the risk of persistent disabling low back pain. Increasing evidence shows that central pain-modulating mechanisms and pain cognitions have important roles in the development of persistent disabling low back pain. Cost, health-care use, and disability from low back pain vary substantially between countries and are influenced by local culture and social systems, as well as by beliefs about cause and effect. Disability and costs attributed to low back pain are projected to increase in coming decades, in particular in low-income and middle-income countries, where health and other systems are often fragile and not equipped to cope with this growing burden. Intensified research efforts and global initiatives are clearly needed to address the burden of low back pain as a public health problem.

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Prevalence of chronic low back pain: systematic review

Rodrigo Dalke Meucci, Anaclaudia Gastal Fassa, Neice Müller Xavier Faria (2015)

OBJECTIVE To estimate worldwide prevalence of chronic low back pain according to age and sex. METHODS We consulted Medline (PubMed), LILACS and EMBASE electronic databases. The search strategy used the following descriptors and combinations: back pain, prevalence, musculoskeletal diseases, chronic musculoskeletal pain, rheumatic, low back pain, musculoskeletal disorders and chronic low back pain. We selected cross-sectional population-based or cohort studies that assessed chronic low back pain as an outcome. We also assessed the quality of the selected studies as well as the chronic low back pain prevalence according to age and sex. RESULTS The review included 28 studies. Based on our qualitative evaluation, around one third of the studies had low scores, mainly due to high non-response rates. Chronic low back pain prevalence was 4.2% in individuals aged between 24 and 39 years old and 19.6% in those aged between 20 and 59. Of nine studies with individuals aged 18 and above, six reported chronic low back pain between 3.9% and 10.2% and three, prevalence between 13.1% and 20.3%. In the Brazilian older population, chronic low back pain prevalence was 25.4%. CONCLUSIONS Chronic low back pain prevalence increases linearly from the third decade of life on, until the 60 years of age, being more prevalent in women. Methodological approaches aiming to reduce high heterogeneity in case definitions of chronic low back pain are essential to consistency and comparative analysis between studies. A standard chronic low back pain definition should include the precise description of the anatomical area, pain duration and limitation level.

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Real-world incidence and prevalence of low back pain using routinely collected data

Francis Fatoye, Tadesse Gebrye, Isaac A.O. Odeyemi (2019)

Low back pain (LBP) is a common health problem among adults of working age population, and its prevalence or incidence increases with increasing in age. The purpose of this review was to examine the real-world prevalence or incidence of LBP. A systematic review of the literature was conducted in accordance to the PRISMA guideline. Allied and Complementary Medicine Database, Cumulative Index of Nursing and Allied Health Literature, MEDLINE, SportDiscuss and Scopus electronic databases were searched using specifically developed search strategies to identify studies using patients' electronic medical records published in English up to February 2019. The quality of the included studies was assessed using a tool that consists of ten items addressing a risk of bias. The search yielded 756 published studies, of which 13 were deemed relevant and were included in this review. The included studies reported incidence or prevalence data from Canada, United States of America (USA), Sweden, Belgium, Finland, Israel, and Netherlands. All the included studies were assessed to be methodologically sound (low risk of bias). The prevalence and incidence of LBP ranged from 1.4 to 20.0% and 0.024-7.0%, respectively. Three studies reported that the Odds of LBP in male patient was higher than their female counterparts (odds ratio > 1; range 1.11-17.29). Nine studies identified the risk factors of LBP to be age, sex, and race. The remaining four studies also listed high intensity of physical activity, high spinal load, lifting, bending, and twisting as the risk factors for LBP. The results of this study highlighted there is a substantial difference within studies that estimated the prevalence and incidence of LBP. This finding could inform healthcare policy makers to critically examine the data sources of prevalence and incidence studies; this in return might help for resource allocation to manage the condition.PROSPERO registration number: CRD42017078598, https://www.crd.york.ac.uk/prospero/ .

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Author and article information

Contributors

M Waqar Afzal:

ORCID: https://orcid.org/0000-0001-5496-5949

Department of Physical TherapyUniversity of Lahore1-Km Defence Roadnear Bhuptian ChowkLahore, 54000Pakistan92 42 111 865 865 ext 6115waqarafzal621@gmail.com

Journal

Journal ID (nlm-ta): JMIR Rehabil Assist Technol

Journal ID (iso-abbrev): JMIR Rehabil Assist Technol

Journal ID (publisher-id): JRAT

Title: JMIR Rehabilitation and Assistive Technologies

Publisher: JMIR Publications (Toronto, Canada )

ISSN (Electronic): 2369-2529

Publication date Collection: 2023

Publication date (Electronic): 15 September 2023

Volume: 10

Electronic Location Identifier: e43985

Affiliations

[1 ] Department of Physical Therapy University of Lahore Lahore Pakistan

[2 ] Department of Public Health Institute of Social & Cultural Studies University of the Punjab Lahore Pakistan

[3 ] Faculty of Allied Health Sciences University of Lahore Lahore Pakistan

Author notes

Corresponding Author: M Waqar Afzal waqarafzal621@ 123456gmail.com

Author information

M Waqar Afzal https://orcid.org/0000-0001-5496-5949

Ashfaq Ahmad https://orcid.org/0000-0002-1965-6224

Hafiz Muhammad Bilal Hanif https://orcid.org/0000-0002-3786-9645

Nauman Chaudhary https://orcid.org/0000-0003-0852-9120

Syed Amir Gilani https://orcid.org/0000-0002-2996-0764

Article

Publisher ID: v10i1e43985

DOI: 10.2196/43985

PMC ID: 10541639

PubMed ID: 37713252

SO-VID: b7ae0035-ad97-49b6-959c-250e01d2ca56

Copyright © ©M Waqar Afzal, Ashfaq Ahmad, Hafiz Muhammad Bilal Hanif, Nauman Chaudhary, Syed Amir Gilani. Originally published in JMIR Rehabilitation and Assistive Technology (https://rehab.jmir.org), 15.09.2023.

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Rehabilitation and Assistive Technology, is properly cited. The complete bibliographic information, a link to the original publication on https://rehab.jmir.org/, as well as this copyright and license information must be included.

History

Date received : 1 November 2022

Date revision requested : 15 March 2023

Date revision received : 15 April 2023

Date accepted : 15 August 2023

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