Emedoli D1, Locatelli M1, Tettamanti A1,2, Alemanno F1, Houdayer E1, Iannaccone S1,2
1San Raffaele Scientific Institute, Department of Rehabilitation and Functional Recovery, Milan, Italy, 2Vita-Salute San Raffaele University, Milan, Italy
Background: Chronic non-specific low back pain (CLBP) is defined as an unpleasant sensory and emotional experience lasting for at least 12 weeks. Non-specific Low Back Pain has been reported as the most common type of low back pain and is defined as pain not attributed to a recognizable or specific pathology.
Previous studies have demonstrated that people with CLBP may have impairments in the control of the deep trunk muscles, maladaptive changes in sensory information processing and loss of cortical representation of the lumbar spine. CLBP subjects might have a decreased sensory acuity, related to body perception and subsequent altered function of the lumbar spine.
Purpose: According to the above mentioned framework, motor control exercises provided with a Virtual Reality (VR) augmented feedback were proposed with the aim to (i) assess the effect of VR motor control rehabilitation on pain in subjects with CLBP and (ii) evaluate subjects' participation, function and proprioception.
Methods: Twenty subjects aged between 18 and 75 (11 female, mean age 47.5 ± 15.3 years old) with CLBP were recruited. Exclusion criteria were (i) contraindication to exercise, (ii) recent spinal surgery in last year, (iii) spinal pathology or (iv) pregnancy.
Treatments consisted in 12 one-hour sessions, twice a week, for 6 consecutive weeks of VR augmented feedback motor control exercises. Subjects saw on a screen an avatar moving in accordance with their body thanks to the electromagnetic field generated by Polhemus G4 and two sensors positioned on subject's sternum and pelvis. Subjects were asked to perform exercises, such as trunk rotation, in different condition (standing, sitting on instable surface, half knee) with the aim to regain a correct body motor control by isolating the trunk's movements.
Outcome measures were compared using either Student's t-test or Wilcoxon test, depending on the normality of data distribution, evaluated by the Shapiro-Wilk test.
Results: All chronic low back pain subjects improved in participation (P=0.001), trunk function (Rotation: Maximal P=0.015; Average P=0.008), proprioception (Rotation: Repetition Index P=0.008) and had a reduction in pain perception (P=0.001).
Scales about pain, such as Numeric Rating Scale (NRS), and participation, such as Roland and Morris Disability Questionnaire (RMDQ), reached a clinical relevance of change, improving more than their minimal clinically important difference (MCID). The improvements for the NRS were on average 3.3 points (MCID 2.5 points) and for the RMDQ the improvements were on average 4 points (MCID 3.5).
Conclusion(s): A training of the trunk movements with VR augmented feedback seems to be useful in reducing pain perception and improving participation, body proprioception and function in people with CLBP.
Implications: Findings from this study may help clinicians during the management of chronic pain subjects. This pilot study suggests that Randomized Controlled Trials are needed in order to verify our hypothesis and to conclude about the effectiveness of the VR in CLBP.
Keywords: Chronic Low Back Pain, Virtual Reality, Motor Control Exercise
Funding acknowledgements: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Previous studies have demonstrated that people with CLBP may have impairments in the control of the deep trunk muscles, maladaptive changes in sensory information processing and loss of cortical representation of the lumbar spine. CLBP subjects might have a decreased sensory acuity, related to body perception and subsequent altered function of the lumbar spine.
Purpose: According to the above mentioned framework, motor control exercises provided with a Virtual Reality (VR) augmented feedback were proposed with the aim to (i) assess the effect of VR motor control rehabilitation on pain in subjects with CLBP and (ii) evaluate subjects' participation, function and proprioception.
Methods: Twenty subjects aged between 18 and 75 (11 female, mean age 47.5 ± 15.3 years old) with CLBP were recruited. Exclusion criteria were (i) contraindication to exercise, (ii) recent spinal surgery in last year, (iii) spinal pathology or (iv) pregnancy.
Treatments consisted in 12 one-hour sessions, twice a week, for 6 consecutive weeks of VR augmented feedback motor control exercises. Subjects saw on a screen an avatar moving in accordance with their body thanks to the electromagnetic field generated by Polhemus G4 and two sensors positioned on subject's sternum and pelvis. Subjects were asked to perform exercises, such as trunk rotation, in different condition (standing, sitting on instable surface, half knee) with the aim to regain a correct body motor control by isolating the trunk's movements.
Outcome measures were compared using either Student's t-test or Wilcoxon test, depending on the normality of data distribution, evaluated by the Shapiro-Wilk test.
Results: All chronic low back pain subjects improved in participation (P=0.001), trunk function (Rotation: Maximal P=0.015; Average P=0.008), proprioception (Rotation: Repetition Index P=0.008) and had a reduction in pain perception (P=0.001).
Scales about pain, such as Numeric Rating Scale (NRS), and participation, such as Roland and Morris Disability Questionnaire (RMDQ), reached a clinical relevance of change, improving more than their minimal clinically important difference (MCID). The improvements for the NRS were on average 3.3 points (MCID 2.5 points) and for the RMDQ the improvements were on average 4 points (MCID 3.5).
Conclusion(s): A training of the trunk movements with VR augmented feedback seems to be useful in reducing pain perception and improving participation, body proprioception and function in people with CLBP.
Implications: Findings from this study may help clinicians during the management of chronic pain subjects. This pilot study suggests that Randomized Controlled Trials are needed in order to verify our hypothesis and to conclude about the effectiveness of the VR in CLBP.
Keywords: Chronic Low Back Pain, Virtual Reality, Motor Control Exercise
Funding acknowledgements: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Topic: Pain & pain management; Musculoskeletal: spine; Robotics & technology
Ethics approval required: Yes
Institution: San Raffaele Scientific Institute
Ethics committee: Human Research Ethics Committee of San Raffaele Scientific Institute
Ethics number: 114/int/2017
All authors, affiliations and abstracts have been published as submitted.
