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Kragting M1,2, Schuiling S2, Voogt L3,4, Coppieters M2,5, Pool-Goudzwaard A2,6
1Rotterdam University of Applied Sciences, Physiotherapy, Rotterdam, Netherlands, 2Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam, Netherlands, 3Rotterdam University of Applied Science, Physiotherapy, Rotterdam, Netherlands, 4Pain in Motion International Research Group, Brussel, Belgium, 5Griffith University, The Hopkins Centre, Menzies Health Institute Queensland, Gold Coast, Australia, 6Somt University of Physiotherapy, Amersfoort, Netherlands
Background: In patients with neck pain, the occurrence of pain throughout the range of rotation (ROR) might be a protective response, influenced by visual cues which suggest that the patient is moving towards a threatening position. Harvie and colleagues (2015) showed that modifying visual feedback in a virtual reality (VR) environment influenced the pain-free ROR in patients with neck pain. There was however a large variability between participants in the size of the effect of feedback manipulation on changes in pain-free ROR. This suggests that some patients are more prone to visual feedback manipulation than others. We hypothesised that fear of motion may play a role.
Purpose: The current study aimed:
(1) To determine whether pain-free ROR increased and decreased when visual feedback understated and overstated true rotation;
(2) To explore whether this effect was more pronounced in patients with fear of movement.
Methods: Two experiments were conducted in patients with non-specific neck pain. In both experiments, patients wore VR-goggles and were asked to rotate their head to the left and the right until the onset of pain. Visual feedback about the amount of movement was either less, equal or greater than their true rotation. The order of the three conditions was randomized. In the first experiment (N=71), the amount of visual feedback manipulation was +/- 20% and the participants were positioned in different locations in the same VR environment. In the second experiment (N=32), the amount of manipulation was +/- 30% and a fixed starting point was used in six different VR environments. Maximal pain-free ROR was measured using the sensors in the VR-goggles. Participants completed the Tampa scale of Kinesiophobia and the Fear-Avoidance Beliefs Questionnaire. A mixed design ANOVA was used to determine the effect of visual manipulation on pain-free ROR and to identify whether patients with fear of movement were more prone to this effect. The study was approved by the insitution's Ethics Committee.
Results: The effects of visual feedback manipulation on pain-free ROR were different in the two experiments. In experiment 1: There was no significant effect (p=0.123), whereas in experiment 2, the effect was significant (p=0.04). In experiment 2 the mean pain-free ROR when rotation was overstated was 5 degrees less than in the understated condition. Fear of movement did not influence the effect of visual feedback manipulation (Exp.1: p=0.842; Exp.2: p=0.488).
Conclusion(s): These experiments revealed an effect of visual feedback manipulation on pain free ROR, but only in certain VR conditions. There was no difference between patients with or without fear of movement regarding this effect.
Implications: The results of this study support the view that the range of motion when pain occurs can be influenced by our visual perception of the amount of rotation. Susceptibility to modified visual feedback depends on the characteristics of the VR environment. However, a mean difference of 5 degrees between the understated and overstated condition may not be clinically useful.
Keywords: Neck pain, Virtual Reality, Visual feedback
Funding acknowledgements: This study was supported by Rotterdam University of Applied Sciences and VU Amsterdam.
Purpose: The current study aimed:
(1) To determine whether pain-free ROR increased and decreased when visual feedback understated and overstated true rotation;
(2) To explore whether this effect was more pronounced in patients with fear of movement.
Methods: Two experiments were conducted in patients with non-specific neck pain. In both experiments, patients wore VR-goggles and were asked to rotate their head to the left and the right until the onset of pain. Visual feedback about the amount of movement was either less, equal or greater than their true rotation. The order of the three conditions was randomized. In the first experiment (N=71), the amount of visual feedback manipulation was +/- 20% and the participants were positioned in different locations in the same VR environment. In the second experiment (N=32), the amount of manipulation was +/- 30% and a fixed starting point was used in six different VR environments. Maximal pain-free ROR was measured using the sensors in the VR-goggles. Participants completed the Tampa scale of Kinesiophobia and the Fear-Avoidance Beliefs Questionnaire. A mixed design ANOVA was used to determine the effect of visual manipulation on pain-free ROR and to identify whether patients with fear of movement were more prone to this effect. The study was approved by the insitution's Ethics Committee.
Results: The effects of visual feedback manipulation on pain-free ROR were different in the two experiments. In experiment 1: There was no significant effect (p=0.123), whereas in experiment 2, the effect was significant (p=0.04). In experiment 2 the mean pain-free ROR when rotation was overstated was 5 degrees less than in the understated condition. Fear of movement did not influence the effect of visual feedback manipulation (Exp.1: p=0.842; Exp.2: p=0.488).
Conclusion(s): These experiments revealed an effect of visual feedback manipulation on pain free ROR, but only in certain VR conditions. There was no difference between patients with or without fear of movement regarding this effect.
Implications: The results of this study support the view that the range of motion when pain occurs can be influenced by our visual perception of the amount of rotation. Susceptibility to modified visual feedback depends on the characteristics of the VR environment. However, a mean difference of 5 degrees between the understated and overstated condition may not be clinically useful.
Keywords: Neck pain, Virtual Reality, Visual feedback
Funding acknowledgements: This study was supported by Rotterdam University of Applied Sciences and VU Amsterdam.
Topic: Musculoskeletal: spine; Pain & pain management
Ethics approval required: Yes
Institution: VU University Amsterdam
Ethics committee: Scientific and Ethical Review Board (VCWE)
Ethics number: VCWE-2016-218R1
All authors, affiliations and abstracts have been published as submitted.
