Virtual Reality-Augmented Physiotherapy for Chronic Pain in Youth: Protocol for a Randomized Controlled Trial...

Area of Science:

• Rehabilitation Medicine
• Pediatric Pain Management
• Virtual Reality Applications

Background:

• Chronic musculoskeletal (MSK) pain significantly impacts adolescent functioning and incurs high healthcare costs.
• Physiotherapy is standard for improving function in youth with MSK pain, but fear of movement and avoidance hinder progress.
• Virtual reality (VR) offers immersive experiences to potentially disrupt the fear-avoidance cycle and boost engagement in physiotherapy.

Purpose of the Study:

• To evaluate the efficacy of physiorehabilitation incorporating VR in adolescents diagnosed with MSK pain.
• To outline the rationale, design, and implementation of a randomized controlled trial (RCT) augmented with a single-case experimental design.

Main Methods:

• A 2-group randomized controlled trial comparing standard physiotherapy with VR-enhanced physiotherapy for adolescents with MSK pain.
• VR will be integrated into standard clinical care by collaborating physical therapists.
• Primary outcomes include physical function and VR engagement; secondary outcomes assess pain-related fear and treatment adherence. Clinician perspectives on feasibility will also be gathered.

Main Results:

• A pilot study indicated that high engagement with VR-enhanced physiotherapy correlated with improvements in pain, fear, avoidance behaviors, and physical function.
• Qualitative feedback from patients, families, and clinicians supported the trial's premise.
• Results from the main clinical trial are anticipated in early 2024 as recruitment progresses.

Conclusions:

• Physiorehabilitation with VR offers innovative, mechanistically informed approaches for treating MSK pain.
• VR provides progressive challenges, real-time feedback, and reinforcement, enhancing motivation and adherence.
• Findings will guide decisions on a hybrid effectiveness-dissemination trial for potential large-scale implementation.