Virtual Reality in the Treatment of Adults with Chronic Low Back Pain: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Beatriz Brea-Gómez, Irene Torres-Sánchez, Araceli Ortiz-Rubio, Andrés Calvache-Mateo, Irene Cabrera-Martos, Laura López-López, Marie Carmen Valenza, Beatriz Brea-Gómez, Irene Torres-Sánchez, Araceli Ortiz-Rubio, Andrés Calvache-Mateo, Irene Cabrera-Martos, Laura López-López, Marie Carmen Valenza

Abstract

Virtual reality (VR) can present advantages in the treatment of chronic low back pain. The objective of this systematic review and meta-analysis was to analyze the effectiveness of VR in chronic low back pain. This review was designed according to PRISMA and registered in PROSPERO (CRD42020222129). Four databases (PubMed, Cinahl, Scopus, Web of Science) were searched up to August 2021. Inclusion criteria were defined following PICOS recommendations. Methodological quality was assessed with the Downs and Black scale and the risk of bias with the Cochrane Risk of Bias Assessment Tool. Fourteen studies were included in the systematic review and eleven in the meta-analysis. Significant differences were found in favor of VR compared to no VR in pain intensity postintervention (11 trials; n = 569; SMD = -1.92; 95% CI = -2.73, -1.11; p < 0.00001) and followup (4 trials; n = 240; SDM = -6.34; 95% CI = -9.12, -3.56; p < 0.00001); and kinesiophobia postintervention (3 trials; n = 192; MD = -8.96; 95% CI = -17.52, -0.40; p = 0.04) and followup (2 trials; n = 149; MD = -12.04; 95% CI = -20.58, -3.49; p = 0.006). No significant differences were found in disability. In conclusion, VR can significantly reduce pain intensity and kinesiophobia in patients with chronic low back pain after the intervention and at followup. However, high heterogeneity exists and can influence the consistency of the results.

Keywords: chronic low back pain; horse simulator riding; physical therapy; rehabilitation; videogames; virtual reality.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flow diagram: database and clinical trials register search and other sources.
Figure 2
Figure 2
Risk of bias summary.
Figure 3
Figure 3
Risk of bias graph.
Figure 4
Figure 4
Effect of virtual reality versus no virtual reality in chronic low back pain for pain intensity postintervention (a) and at the six month followup (b) based on the type of intervention. CBT: conventional balance training; IKT: isokinetic training; CPR: combined physical rehabilitation; VR: virtual reality.
Figure 4
Figure 4
Effect of virtual reality versus no virtual reality in chronic low back pain for pain intensity postintervention (a) and at the six month followup (b) based on the type of intervention. CBT: conventional balance training; IKT: isokinetic training; CPR: combined physical rehabilitation; VR: virtual reality.
Figure 5
Figure 5
Effect of virtual reality versus no virtual reality in chronic low back pain for disability postintervention based on the type of intervention. VR: virtual reality.
Figure 6
Figure 6
Effect of virtual reality versus no virtual reality in chronic low back pain for kinesiophobia postintervention (a) and at the six month followup (b) based on the type of intervention. IKT: isokinetic training; CBT: conventional balance training; CPR: combined physical rehabilitation; VR: virtual reality.
Figure 7
Figure 7
Effect of virtual reality versus no virtual reality in chronic low back pain for pain intensity postintervention (a) and at the six months followup (b) based on the type of virtual reality intervention. CBT: conventional balance training; IKT: isokinetic training; CPR: combined physical rehabilitation; VR: virtual reality.
Figure 7
Figure 7
Effect of virtual reality versus no virtual reality in chronic low back pain for pain intensity postintervention (a) and at the six months followup (b) based on the type of virtual reality intervention. CBT: conventional balance training; IKT: isokinetic training; CPR: combined physical rehabilitation; VR: virtual reality.
Figure 8
Figure 8
Effect of virtual reality versus no virtual reality in chronic low back pain for disability postintervention based on the type of virtual reality intervention. VR: virtual reality.
Figure 9
Figure 9
Effect of virtual reality versus no virtual reality in chronic low back pain for kinesiophobia postintervention (a) and at the six month followup (b) based on the type of virtual reality intervention. IKT: isokinetic training; CBT: conventional balance training; CPR: combined physical rehabilitation; VR: virtual reality.
Figure 9
Figure 9
Effect of virtual reality versus no virtual reality in chronic low back pain for kinesiophobia postintervention (a) and at the six month followup (b) based on the type of virtual reality intervention. IKT: isokinetic training; CBT: conventional balance training; CPR: combined physical rehabilitation; VR: virtual reality.
Figure 10
Figure 10
Effect of virtual reality versus no virtual reality in chronic low back pain for pain intensity postintervention (a) and at the six month followup (b) based on the duration of the intervention. CBT: conventional balance training; IKT: isokinetic training; CPR: combined physical rehabilitation; VR: virtual reality.
Figure 11
Figure 11
Effect of virtual reality versus no virtual reality in chronic low back pain for disability postintervention based on the duration of the intervention. VR: virtual reality.
Figure 12
Figure 12
Effect of virtual reality versus no virtual reality in chronic low back pain for kinesiophobia postintervention (a) and at the six month followup (b) based on the duration of the intervention. IKT: isokinetic training; CBT: conventional balance training; CPR: combined physical rehabilitation; VR: virtual reality.

References

    1. Hoy D., Bain C., Williams G., March L., Brooks P., Blyth F., Woolf A., Vos T., Buchbinder R. A systematic review of the global prevalence of low back pain. Arthritis Rheum. 2012;64:2028–2037. doi: 10.1002/art.34347.
    1. Hartvigsen J., Hancock M., Kongsted A., Louw Q., Ferreira M.L., Genevay S., Hoy D., Karppinen J., Pransky G., Sieper J., et al. What low back pain is and why we need to pay attention. Lancet. 2018;391:2356–2367. doi: 10.1016/S0140-6736(18)30480-X.
    1. Hoy D., Brooks P., Blyth F., Buchbinder R. The Epidemiology of low back pain. Best Pr. Res. Clin. Rheumatol. 2010;24:769–781. doi: 10.1016/j.berh.2010.10.002.
    1. GBD 2015 Disease and Injury Incidence and Prevalence Collaborators Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: A systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388:1545–1602. doi: 10.1016/S0140-6736(16)31678-6.
    1. Delitto A., George S.Z., Van Dillen L.R., Whitman J.M., Sowa G., Shekelle P., Denninger T.R., Godges J.J. Low back pain. J. Orthop. Sports Phys. Ther. 2012;42:1–57. doi: 10.2519/jospt.2012.42.4.A1.
    1. Chou R., Qaseem A., Snow V., Casey D., Cross J.T., Shekelle P., Owens D.K. American Pain Society Low Back Pain Guidelines for the Clinical Efficacy Assessment Subcommittee of the American College of Physicians and the American College of Physicians/American Pain Society Low Back Pain Guidelines Panel. Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society. Ann. Intern. Med. 2007;147:478–491. doi: 10.7326/0003-4819-147-7-200710020-00006.
    1. Zadro J., Shirley D., Simic M., Mousavi S.J., Ceprnja D., Maka K., Sung J., Ferreira P. Video-Game–Based Exercises for Older People with Chronic Low Back Pain: A Randomized Controlledtable Trial (GAMEBACK) Phys. Ther. 2018;99:14–27. doi: 10.1093/ptj/pzy112.
    1. Kato P.M. Video Games in Health Care: Closing the Gap. Rev. Gen. Psychol. 2010;14:113–121. doi: 10.1037/a0019441.
    1. Pereira M.F., Prahm C., Kolbenschlag J., Oliveira E., Rodrigues N.F. Application of AR and VR in hand rehabilitation: A systematic review. J. Biomed. Inform. 2020;111:103584. doi: 10.1016/j.jbi.2020.103584.
    1. De Miguel-Rubio A., Rubio M.D., Alba-Rueda A., Salazar A., Moral-Munoz J.A., Lucena-Anton D. Virtual Reality Systems for Upper Limb Motor Function Recovery in Patients with Spinal Cord Injury: Systematic Review and Meta-Analysis. JMIR mHealth uHealth. 2020;8:e22537. doi: 10.2196/22537.
    1. Vlaeyen J.W., Linton S.J. Fear-avoidance model of chronic musculoskeletal pain: 12 years on. Pain. 2012;153:1144–1147. doi: 10.1016/j.pain.2011.12.009.
    1. Matheve T., Bogaerts K., Timmermans A. Virtual reality distraction induces hypoalgesia in patients with chronic low back pain: A randomized controlled trial. J. Neuroeng. Rehabil. 2020;17:1–12. doi: 10.1186/s12984-020-00688-0.
    1. Li L., Yu F., Shi D., Shi J., Tian Z., Yang J., Wang X., Jiang Q. Application of virtual reality technology in clinical medicine. Am. J. Transl. Res. 2017;9:3867–3880.
    1. Gumaa M., Youssef A.R. Is Virtual Reality Effective in Orthopedic Rehabilitation? A Systematic Review and Meta-Analysis. Phys. Ther. 2019;99:1304–1325. doi: 10.1093/ptj/pzz093.
    1. Ahern M.M., Dean L.V., Stoddard C.C., Agrawal A., Kim K., Cook C.E., Garcia A.N. The Effectiveness of Virtual Reality in Patients with Spinal Pain: A Systematic Review and Meta-Analysis. Pain Pr. 2020;20:656–675. doi: 10.1111/papr.12885.
    1. Bordeleau M., Stamenkovic A., Tardif P.-A., Thomas J. The Use of Virtual Reality in Back Pain Rehabilitation: A Systematic Review and Meta-Analysis. J. Pain. 2021 doi: 10.1016/j.jpain.2021.08.001. in press.
    1. Page M.J., McKenzie J.E., Bossuyt P.M., Boutron I., Hoffmann T.C., Mulrow C.D., Shamseer L., Tetzlaff J.M., Akl E.A., Brennan S.E. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. doi: 10.1136/bmj.n71.
    1. Furlan A., Malmivaara A., Chou R., Maher C., A Deyo R., Schoene M.L., Bronfort G., van Tulder M. 2015 Updated Method Guideline for Systematic Reviews in the Cochrane Back and Neck Group. Spine. 2015;40:1660–1673. doi: 10.1097/BRS.0000000000001061.
    1. Downs S.H., Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J. Epidemiol. Community Health. 1998;52:377–384. doi: 10.1136/jech.52.6.377.
    1. Deeks J.J., Dinnes J., D’Amico R., Sowden A.J., Sakarovitch C., Song F., Petticrew M., Altman D.G. Evaluating non-randomized intervention studies. Health Technol. Assess. 2003;7:iii-173. doi: 10.3310/hta7270.
    1. Saunders L.D., Soomro G.M., Buckingham J., Jamtvedt G., Raina P. Assessing the Methodological Quality of Nonrandomized Intervention Studies. West. J. Nurs. Res. 2003;25:223–237. doi: 10.1177/0193945902250039.
    1. Sánchez I.T., Salmerón Y.M., López L.L., Ortiz-Rubio A., Torres J.R., Valenza M.C. Videogames in the Treatment of Obstructive Respiratory Diseases: A Systematic Review. Games Health J. 2019;8:237–249. doi: 10.1089/g4h.2018.0062.
    1. Silverman S.R., Schertz L.A., Yuen H.K., Lowman J.D., Bickel C.S. Systematic review of the methodological quality and outcome measures utilized in exercise interventions for adults with spinal cord injury. Spinal Cord. 2012;50:718–727. doi: 10.1038/sc.2012.78.
    1. Hooper P., Jutai J., Strong G., Russell-Minda E. Age-related macular degeneration and low-vision rehabilitation: A systematic review. Can. J. Ophthalmol. 2008;43:180–187. doi: 10.3129/i08-001.
    1. Higgins J.P.T., Altman D.G., Gøtzsche P.C., Jüni P., Moher D., Oxman A.D., Savović J., Schulz K.F., Weeks L., Sterne J.A.C., et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928. doi: 10.1136/bmj.d5928.
    1. Park J.-H., Lee S.-H., Ko D.-S. The Effects of the Nintendo Wii Exercise Program on Chronic Work-related Low Back Pain in Industrial Workers. J. Phys. Ther. Sci. 2013;25:985–988. doi: 10.1589/jpts.25.985.
    1. Oh H.-W., Lee M.-G., Jang J.-Y., Jin J.-J., Cha J.-Y., Jin Y.-Y., Jee Y.-S. Time-effects of horse simulator exercise on psychophysiological responses in men with chronic low back pain. Isokinet. Exerc. Sci. 2014;22:153–163. doi: 10.3233/IES-140533.
    1. Yoo J.-H., Kim S.-E., Lee M.-G., Jin J.-J., Hong J., Choi Y.-T., Kim M.-H., Jee Y.-S. The effect of horse simulator riding on visual analogue scale, body composition and trunk strength in the patients with chronic low back pain. Int. J. Clin. Pr. 2014;68:941–949. doi: 10.1111/ijcp.12414.
    1. Chen S.-Y., Kim S.-K., Kim K.-H., Lee I.-S., Hwangbo G. Effects of Horse Riding Simulator on Pain, Oswestry Disability Index and Balance in Adults with Nonspecific Chronic Low Back Pain. J. Korean Soc. Phys. Med. 2016;11:79–84. doi: 10.13066/kspm.2016.11.4.79.
    1. Kim T., Lee J., Oh S., Kim S., Yoon B. Effectiveness of Simulated Horseback Riding for Patients with Chronic Low Back Pain: A Randomized Controlled Trial. J. Sport Rehabil. 2020;29:179–185. doi: 10.1123/jsr.2018-0252.
    1. Park S., Park S., Min S., Kim C.-J., Jee Y.-S. A Randomized Controlled Trial Investigating the Effects of Equine Simulator Riding on Low Back Pain, Morphological Changes, and Trunk Musculature in Elderly Women. Medicina. 2020;56:610. doi: 10.3390/medicina56110610.
    1. Monteiro-Junior R.S., De Souza C.P., Lattari E., Rocha N., Mura G., Machado S., Da Silva E.B. Wii-Workouts on Chronic Pain, Physical Capabilities and Mood of Older Women: A Randomized Controlled Double Blind Trial. CNS Neurol. Disord. Drug Targets. 2015;14:1157–1164. doi: 10.2174/1871527315666151111120131.
    1. Garcia L.M., Birckhead B.J., Krishnamurthy P., Sackman J., Mackey I.G., Louis R.G., Salmasi V., Maddox T., Darnall B.D. An 8-Week Self-Administered At-Home Behavioral Skills-Based Virtual Reality Program for Chronic Low Back Pain: Double-Blind, Randomized, Placebo-Controlled Trial Conducted During COVID-19. J. Med Internet Res. 2021;23:e26292. doi: 10.2196/26292.
    1. Nambi G., AbdelBasset W.K., Elsayed S.H., Alrawaili S.M., Abodonya A.M., Saleh A.K., Elnegamy T.E. Comparative Effects of Isokinetic Training and Virtual Reality Training on Sports Performances in University Football Players with Chronic Low Back Pain-Randomized Controlled Study. Evid. Based Complement. Altern. Med. 2020;2020:1–10. doi: 10.1155/2020/2981273.
    1. Nambi G., Abdelbasset W.K., Alrawaili S.M., Alsubaie S.F., Abodonya A.M., Saleh A.K. Virtual reality or isokinetic training; its effect on pain, kinesiophobia and serum stress hormones in chronic low back pain: A randomized controlled trial. Technol. Health Care. 2021;29:155–166. doi: 10.3233/THC-202301.
    1. Nambi G., Abdelbasset W.K., Alsubaie S.F., Saleh A.K., Verma A., Abdelaziz M.A., Alkathiry A.A. Short-Term Psychological and Hormonal Effects of Virtual Reality Training on Chronic Low Back Pain in Soccer Players. J. Sport Rehabil. 2021;30:884–893. doi: 10.1123/jsr.2020-0075.
    1. Tomruk M.S., Kara B., Erbayraktar R.S. The Effect of Computer-Based Training on Postural Control in Patients with Chronic Low Back Pain: A Randomized Controlled Trial. J. Basic Clin. Health Sci. 2020;4:329–334. doi: 10.30621/jbachs.2020.1150.
    1. Sato T., Shimizu K., Shiko Y., Kawasaki Y., Orita S., Inage K., Shiga Y., Suzuki M., Sato M., Enomoto K., et al. Effects of Nintendo Ring Fit Adventure Exergame on Pain and Psychological Factors in Patients with Chronic Low Back Pain. Games Health J. 2021;10:158–164. doi: 10.1089/g4h.2020.0180.
    1. Bahat H.S., Croft K., Carter C., Hoddinott A., Sprecher E., Treleaven J. Remote kinematic training for patients with chronic neck pain: A randomized controlled trial. Eur. Spine J. 2018;27:1309–1323. doi: 10.1007/s00586-017-5323-0.
    1. Rezaei I., Razeghi M., Ebrahimi S., Kayedi S., Zadeh A.R. A Novel Virtual Reality Technique (Cervigame®) Compared to Conventional Proprioceptive Training to Treat Neck Pain: A Randomized Controlled Trial. J. Biomed. Phys. Eng. 2019;9:355–366. doi: 10.31661/jbpe.v9i3Jun.556.
    1. Bahat H.S., Takasaki H., Chen X., Bet-Or Y., Treleaven J. Cervical kinematic training with and without interactive VR training for chronic neck pain—A randomized clinical trial. Man. Ther. 2015;20:68–78. doi: 10.1016/j.math.2014.06.008.
    1. Polat M., Kahveci A., Muci B., Günendi Z., Karataş G.K. The Effect of Virtual Reality Exercises on Pain, Functionality, Cardiopulmonary Capacity, and Quality of Life in Fibromyalgia Syndrome: A Randomized Controlled Study. Games Health J. 2021;10:165–173. doi: 10.1089/g4h.2020.0162.
    1. Gulsen C., Soke F., Eldemir K., Apaydin Y., Ozkul C., Guclu-Gunduz A., Akcali D.T. Effect of fully immersive virtual reality treatment combined with exercise in fibromyalgia patients: A randomized controlled trial. Assist. Technol. 2020:1–8. doi: 10.1080/10400435.2020.1772900.
    1. Joo Y., Kim E.-K., Song H.-G., Jung H., Park H., Moon A.J.Y. Effectiveness of virtual reality immersion on procedure-related pain and anxiety in outpatient pain clinic: An exploratory randomized controlled trial. Korean J. Pain. 2021;34:304–314. doi: 10.3344/kjp.2021.34.3.304.
    1. McSherry T., Atterbury M., Gartner S., Helmold E., Searles D.M., Schulman C. Randomized, Crossover Study of Immersive Virtual Reality to Decrease Opioid Use during Painful Wound Care Procedures in Adults. J. Burn. Care Res. 2017;39:278–285. doi: 10.1097/BCR.0000000000000589.
    1. Pazzaglia C., Imbimbo I., Tranchita E., Minganti C., Ricciardi D., Monaco R.L., Parisi A., Padua L. Comparison of virtual reality rehabilitation and conventional rehabilitation in Parkinson’s disease: A randomised controlled trial. Physiotherapy. 2020;106:36–42. doi: 10.1016/j.physio.2019.12.007.
    1. Santos P., Machado T., Santos L., Ribeiro N., Melo A. Efficacy of the Nintendo Wii combination with Conventional Exercises in the rehabilitation of individuals with Parkinson’s disease: A randomized clinical trial. NeuroRehabilitation. 2019;45:255–263. doi: 10.3233/NRE-192771.
    1. Marques-Sule E., Arnal-Gómez A., Buitrago-Jiménez G., Suso-Martí L., Cuenca-Martínez F., Espí-López G.V. Effectiveness of Nintendo Wii and Physical Therapy in Functionality, Balance, and Daily Activities in Chronic Stroke Patients. J. Am. Med. Dir. Assoc. 2021;22:1073–1080. doi: 10.1016/j.jamda.2021.01.076.
    1. Park Y.-S., An C.-S., Lim C.-G. Effects of a Rehabilitation Program Using a Wearable Device on the Upper Limb Function, Performance of Activities of Daily Living, and Rehabilitation Participation in Patients with Acute Stroke. Int. J. Environ. Res. Public Health. 2021;18:5524. doi: 10.3390/ijerph18115524.
    1. Saeedi S., Ghazisaeedi M., Rezayi S. Applying Game-Based Approaches for Physical Rehabilitation of Poststroke Patients: A Systematic Review. J. Health Eng. 2021;2021:1–27. doi: 10.1155/2021/9928509.
    1. Thomas J.S., France C.R., Applegate M.E., Leitkam S.T., Walkowski S. Feasibility and Safety of a Virtual Reality Dodgeball Intervention for Chronic Low Back Pain: A Randomized Clinical Trial. J. Pain. 2016;17:1302–1317. doi: 10.1016/j.jpain.2016.08.011.
    1. Collado-Mateo D., Lavín-Pérez A., García J.F., García-Gordillo M., Villafaina S. Effects of Equine-Assisted Therapies or Horse-Riding Simulators on Chronic Pain: A Systematic Review and Meta-Analysis. Medicina. 2020;56:444. doi: 10.3390/medicina56090444.
    1. Ren C., Liu T., Zhang J. Horse-riding simulators in treatment of chronic low back pain: A meta-analysis. Int. J. Clin. Pr. 2021;75:e14198. doi: 10.1111/ijcp.14198.

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