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Pezzica C1, Kragting M1,2, Schuiling S1, Voogt L2,3, Coppieters M1,4, Pool-Goudzwaard A1,5
1Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Faculty of Behavioural and Movement Sciences, Amsterdam, Netherlands, 2Rotterdam University of Applied Sciences, Rotterdam, Netherlands, 3Pain in Motion International Research Group, Rotterdam, Netherlands, 4The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia, 5SOMT University of Physiotherapy, Amersfoort, Netherlands
Background: Patients with neck pain often experience a reduction in cervical range of motion (ROM). A subset of patients also experiences psychosocial risk factors for the development of persistent pain. Common psychosocial risk factors include depression and anxiety, such as kinesiophobia and fear-avoidance. Given the complex interactions between motor, visual, proprioceptive and cognitive processes associated with a pain experience, using Virtual Reality (VR) may be a novel approach to alter neck pain and improve mobility. Being immersed in VR might reduce the amount of attention available for conscious pain processing. By providing an immersive and interactive experience, the patient's attention may be diverted away from the noxious stimulus (i.e., cervical movement), which is an “internal focus”, and directed to an “external focus” (i.e., the VR environment).
Purpose:
(1) To analyse the effect of a distraction task using an immersive VR environment on cervical ROM, versus a task with an internal focus;
(2) To reveal whether the novel distraction task affects patients' mobility differently between those with and without anxiety.
Methods: A cross-sectional multi-centre study was conducted. Neck mobility was assessed by tracking head movements, using the built-in sensors of the head-mounted Oculus Rift VR display (Oculus VR, Irvine, California) while controlling trunk movements with a fixation belt. Neck ROM was assessed during two tasks which were performed in random order: (1) a bird-seeking exercise within a VR environment (external focus), with further immersion offered by background music; and (2) three maximal head movements in 4 directions (rotations to the right and left, flexion and extension) with the VR goggles mounted, but without displaying imagery (black screen) and without music (internal focus). Unity 5.3.1 (Unity Technologies, San Francisco, California) was used to create and display the external and internal focus contexts on the Oculus Rift. Calculation of cervical ROM was performed separately in the transverse (right/left rotation) and sagittal planes (flexion/extension) with a custom-written MatLab program. Anxiety was assessed with the Tampa Scale for Kinesiophobia and the Fear-Avoidance Belief Questionnaire-Physical Activity (FABQ-PA). Four separate two-way mixed design ANOVAs were used to analyse the effect of distraction and anxiety on neck ROM.
Results: Twenty-five patients completed the study, of which 12 met the threshold for anxiety on either the Tampa Scale (N=7) or FABQ-PA (N=5). Neck rotation was significantly larger during the external focus task, regardless the presence of kinesiophobia (p .001, η2=.567) or fear avoidance (p .001, η2=.386). The fear avoidance group achieved significantly less neck rotation (p=.023, η2=.205) and flexion-extension (p=.021, η2=.211) than the group without anxiety. The interaction between pain distraction and the presence of kinesiophobia or fear-avoidance was non-significant in both rotation (p=.441, η2=.026; p=.119, η2=.103) and flexion-extension (p=.539, η2=.017; p=.953, η2=.000).
Conclusion(s): Neck ROM was significantly larger while performing a task with an external focus within VR. However, our hypothesis that kinesiophobic and fear-avoidant patients would benefit more from distraction was not confirmed.
Implications: The evidence that cervical ROM increased in patients with non-specific neck pain while immersed in VR should stimulate further research and explore future treatment options.
Keywords: Non-specific neck pain, Anxiety, Virtual Reality
Funding acknowledgements: This study was supported by Vrije Universiteit, Amsterdam, The Netherlands.
Purpose:
(1) To analyse the effect of a distraction task using an immersive VR environment on cervical ROM, versus a task with an internal focus;
(2) To reveal whether the novel distraction task affects patients' mobility differently between those with and without anxiety.
Methods: A cross-sectional multi-centre study was conducted. Neck mobility was assessed by tracking head movements, using the built-in sensors of the head-mounted Oculus Rift VR display (Oculus VR, Irvine, California) while controlling trunk movements with a fixation belt. Neck ROM was assessed during two tasks which were performed in random order: (1) a bird-seeking exercise within a VR environment (external focus), with further immersion offered by background music; and (2) three maximal head movements in 4 directions (rotations to the right and left, flexion and extension) with the VR goggles mounted, but without displaying imagery (black screen) and without music (internal focus). Unity 5.3.1 (Unity Technologies, San Francisco, California) was used to create and display the external and internal focus contexts on the Oculus Rift. Calculation of cervical ROM was performed separately in the transverse (right/left rotation) and sagittal planes (flexion/extension) with a custom-written MatLab program. Anxiety was assessed with the Tampa Scale for Kinesiophobia and the Fear-Avoidance Belief Questionnaire-Physical Activity (FABQ-PA). Four separate two-way mixed design ANOVAs were used to analyse the effect of distraction and anxiety on neck ROM.
Results: Twenty-five patients completed the study, of which 12 met the threshold for anxiety on either the Tampa Scale (N=7) or FABQ-PA (N=5). Neck rotation was significantly larger during the external focus task, regardless the presence of kinesiophobia (p .001, η2=.567) or fear avoidance (p .001, η2=.386). The fear avoidance group achieved significantly less neck rotation (p=.023, η2=.205) and flexion-extension (p=.021, η2=.211) than the group without anxiety. The interaction between pain distraction and the presence of kinesiophobia or fear-avoidance was non-significant in both rotation (p=.441, η2=.026; p=.119, η2=.103) and flexion-extension (p=.539, η2=.017; p=.953, η2=.000).
Conclusion(s): Neck ROM was significantly larger while performing a task with an external focus within VR. However, our hypothesis that kinesiophobic and fear-avoidant patients would benefit more from distraction was not confirmed.
Implications: The evidence that cervical ROM increased in patients with non-specific neck pain while immersed in VR should stimulate further research and explore future treatment options.
Keywords: Non-specific neck pain, Anxiety, Virtual Reality
Funding acknowledgements: This study was supported by Vrije Universiteit, Amsterdam, The Netherlands.
Topic: Musculoskeletal: spine; Pain & pain management; Human movement analysis
Ethics approval required: Yes
Institution: Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam
Ethics committee: Scientific and Ethical Review Board (VCWE)
Ethics number: File number VCWE-2018-049
All authors, affiliations and abstracts have been published as submitted.
