OPINIONS AND VIEWS OF PHYSIOTHERAPISTS ON THE USE OF IMMERSIVE VIRTUAL REALITY FOR CHRONIC LOW BACK PAIN: A QUALITATIVE STUDY

A. Astek¹, V. Sparkes¹, L. Sheeran¹

¹Cardiff University, School of Healthcare Sciences, Cardiff, United Kingdom

Background: Immersive virtual reality (IVR) refers to technology where users wear head-mounted display (HMD) supported by software, which enables interaction with 3D virtual environment (VE). Several IVR technologies have been developed as an intervention for chronic low back pain (CLBP), mainly as a distraction from pain, a coping tool and motivation to exercise. However, pre-development work informing the key considerations of the intervention has never been conducted. Future development of IVR intervention needs gatekeeper input to determine key considerations to facilitate the use of IVR technology for CLBP.

Purpose: This qualitative study explored the views and opinions of physiotherapists regarding the use of IVR intervention for adults with CLBP. This includes 1) views on the potential benefits and concerns about IVR, 2) opinions on key considerations around technology (software/hardware), intervention dose and clinical context of IVR, 3) views on the perceived facilitators and barriers for future implementation of IVR.

Methods: The study was part of a multi-phase mixed methods design. This study involved four focus groups conducted online (via Zoom) for 1-hour. Sixteen UK physiotherapists (5, 4, 4 and 3 in each group), with between 2 -15 years of clinical experience treating patients with CLBP. All focus group data was transcribed verbatim and a summary of the group discussion was sent to a subset of the participants for data verification. The data were analysed using thematic analysis.

Results: IVR intervention was seen as a suitable adjunct for CLBP subgroup who are fearful of movement and reluctant to engage with rehabilitation. Motivation to perform challenging physical tasks at the start of rehabilitation was seen as beneficial. However, Safety, the possibility of addiction, and transferability of acquired skills from VE to the ‘real world’ and cross infection were concerns. Physiotherapists preferred IVR use to be under clinical supervision to monitor change and were concerned about the risk of falls particularly in the elderly. Personalisation to the patient’s goal and preference was suggested via designing VE to mimic daily activities, with gradual progression depending upon the patient's abilities. Positive feedback and rewards within the software and frequent sessions and rest in between virtual tasks were recommended. Technical knowledge and training of physiotherapists were seen as a facilitator, while cost and technology acceptance were barriers to future implementation.

Conclusions: IVR intervention could be an assistive tool for rehabilitation for patients with CLBP who are fearful of movement. Future IVR development would design personalised virtual scenarios relevant to the patient’s goal of rehabilitation. Application of behaviour change principles, such as rewards and pacing could optimise intervention benefits. Supervised intervention would be preferable for safety reasons and the possibility of addiction. Further research should investigate how successful achievement of skill training in VE could be transferred to real-life activities.

Implications: IVR could be used as an adjunct for CLBP patients who are poorly engaged in physical rehabilitation.Future IVR adoption will depend on acceptance, knowledge, physiotherapy training and cost-effectiveness of the intervention.

Funding acknowledgements: This work is funded by a scholarship from King Abdulaziz University, Government of Saudia Arabia.

Keywords:
Chronic low back pain
Immersive virtual reality
Physiotherapists

Topics:
Musculoskeletal: spine
Innovative technology: information management, big data and artificial intelligence

Did this work require ethics approval? Yes

Institution: Cardiff university

Committee: The School Of Healthcare Sciences Research Ethics Committee

Ethics number: REC658