Investigation of the Effect of a Virtual Reality-Based Back School Program on Pain, Functionality, and Kinesiophobia

Hacettepe University

Status: Completed

Conditions: Chronic Back and Leg Pain

Treatments: Other: Back school education integrated with a VR headset

Study type: Interventional

Funder types: Other

Identifiers

NCT07492784

Back School

Details and patient eligibility

About

This study investigates the effects of a 4-week virtual reality (VR)-based back school program on pain, disability, fear of movement, and lumbar joint position sense (JPS) in individuals with chronic low back pain. Thirty-nine participants are allocated to either a VR-based back school group or a conventional back school group. Both groups perform supervised low back exercises. Pain, disability, proprioception, kinesiophobia, and perceived cognitive deficits are assessed before and after the intervention.

Full description

Background and Aim:

Chronic low back pain (CLBP) is a multidimensional condition associated with functional limitations, fear of movement, and proprioceptive impairments. Contemporary rehabilitation approaches, such as back school programs, are based on a biopsychosocial model and aim to enhance patient engagement. Virtual reality (VR) applications may further support these interventions by increasing motivation and providing enriched sensory feedback. This study aims to investigate the effects of a 4-week VR-based back school program on pain, disability, fear of movement, and joint position sense (JPS) in individuals with CLBP.

Methods:

The study includes 39 participants allocated into an experimental group (n=20) and a control group (n=19). The control group receives back school training through verbal instruction delivered by a physiotherapist, while the experimental group receives the same training integrated with a VR headset. Following the education sessions, both groups perform standard low back exercises under physiotherapist supervision.

Outcome measures include:

Pain intensity assessed using the Visual Analog Scale (VAS)

Disability assessed using the Oswestry Disability Index (ODI)

Lumbar joint position sense measured using a goniometric method

Fear of movement assessed using the Tampa Scale for Kinesiophobia (TSK)

Cognitive function assessed using the Perceived Deficits Questionnaire (PDQ)

All outcomes are evaluated before and after the 4-week intervention period.

Enrollment: 39 patients

Sex: All

Ages: 18 to 65 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Age between 18 and 65 years
• Presence of chronic low back pain for at least three months
• A resting pain intensity of 3 to 7 on the Visual Analog Scale (VAS)
• The cognitive ability to follow physiotherapy instructions
• Any physical therapy program within the previous 6 months

Exclusion criteria

• Neurological deficits
• Vestibular pathologies
• Major trauma
• Active infections
• Tumors,
• Inflammatory diseases
• They declined to participate.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

---

39 participants in 5 patient groups

Pain intensity

Experimental group

Description:

In this scale, the starting point is defined as "0 = no pain" and the end point as "10 = unbearable pain." Participants were asked to mark their current pain levels on this line. Pain levels were assessed separately at rest, during activity, and at night.

Treatment:

Other: Back school education integrated with a VR headset

Lumbar joint position sense

Experimental group

Description:

Participants were comfortably positioned, and the assessor passively moved their lumbar spine into a specific angle of flexion or extension. After holding the target angle for 3 seconds to allow proprioceptive encoding, participants were asked to actively replicate the position. The absolute error between the passively given angle and the actively replicated angle was recorded in degrees.

Treatment:

Other: Back school education integrated with a VR headset

Tampa Scale for Kinesiophobia

Experimental group

Description:

This 17-item questionnaire utilizes a 4-point Likert-type scale (1 = strongly disagree, 4 = strongly agree) to evaluate kinesiophobia and movement avoidance following an injury. After reverse-scoring items 4, 8, 12, and 16, a total score ranging from 17 to 68 is calculated, with higher scores indicating greater kinesiophobia.

Treatment:

Other: Back school education integrated with a VR headset

Functional disability

Experimental group

Description:

Functional disability was measured with the Oswestry Disability Index (ODI) (17, 18). The ODI consists of 10 sections related to daily living activities such as personal care, lifting, walking, sitting, standing, and sleeping. Each section is scored from 0 to 5. The total score ranges from 0 to 50, categorized as no disability (0-4), mild (5-14), moderate (15-24), severe (25-34), and complete disability (35-50).

Treatment:

Other: Back school education integrated with a VR headset

Perceived Deficits Questionnaire

Experimental group

Description:

Subjective cognitive function was evaluated using the Perceived Deficits Questionnaire (PDQ) developed by Sullivan et al. (19). This 20-item scale assesses different domains of cognitive function, including attention/concentration, retrospective memory, prospective memory, and planning/organization. It is scored on a 5-point Likert-type scale (0 = never, 4 = almost always). Total scores range from 0 to 80, with higher scores reflecting greater perceived cognitive impairment over the past four weeks.

Treatment:

Other: Back school education integrated with a VR headset