Wednesday, September 26, 2018 2:00 PM – 3:00 PM Integrating Technology into Practice: 2015 Research Grant: Development of a virtual reality graded exposure intervention for chronic low back pain: initial findings and future directions

BACKGROUND CONTEXT Back pain is the leading cause of disability, in the United States. Most acute low back pain (LBP) remits within a few weeks, but up to 10% of individuals develop a chronic condition characterized by long-term pain, disability, and resource cost. Maladaptive beliefs about pain and physical activity (ie, pain-related fear) contribute to poor outcomes following back injury. High fear individuals are more likely to avoid back-stressing physical activities, which they feel may exacerbate injury/damage, thus reinforcing a cycle of pain, functional disability, and potentially further injury. Graded exposure is a leading cognitive behavioral intervention to challenge fearful pain beliefs and gradually promote physical activity. PURPOSE As part of the North American Spine Society Young Investigator Grant, the current research team developed a virtual reality (VR) gaming interface as a flexible interactive platform to deliver graded-exposure intervention for high fear individuals with CLBP. A recently completed pilot study examined the safety and feasibility of this prototype, designed to challenge fearful pain beliefs and gradually promote physical activity. STUDY DESIGN/SETTING Repeated-measures lab-based intervention protocol. PATIENT SAMPLE Participants were 34 men (n=17) and women (n=17) with CLBP who reported high pain/movement-related fear, as measured by the Tampa Scale of Kinesiophobia. OUTCOME MEASURES Participants completed measures of pain intensity, perceived disability, and pain-related fear prior to and following intervention. Participants also completed a measure of treatment acceptability at the conclusion of the intervention period. METHODS The gaming interface allows participants to control a customizable robot avatar via motion-tracking features of the Microsoft Kinect system. Player movement is mirrored by the movement of the robot avatar. A brief psychoeducation session preceded the VR game-play, which occurred over 3 days. Participants were asked to guide the robot through progressively more difficult, back-challenging tasks (eg, watering plants, setting up shelter) to help prepare a new planet for habitation. The tasks were graded in difficulty and derived from traditional graded exposure treatment. RESULTS Repeated-measures analyses revealed a marginal decline in pain intensity scores and a significant decline in scores on the measure of pain/movement-related fear. No significant change was observed in participant ratings of disability related to low back pain. Mean scores on the treatment evaluation inventory indicated that participants reported above moderate levels of perceived treatment acceptability and overall positive interest in the intervention. CONCLUSIONS Findings support the safety and feasibility of a VR gaming intervention model designed to deliver cognitive behavioral treatment for maladaptive pain beliefs while promoting physical activity among individuals with CLBP. The intervention tested thus far will be extended and adapted across settings. Future validation efforts will focus on reduction of pain-related disability and assessment of the longevity of observed effects. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.