Virtual Reality in Chronic Neck Pain

Official title

Effectiveness of Exercise Training and Virtual Reality on Disability, Pain and Joint Position Sense in Individuals With Chronic Neck Pain: A Randomized Controlled Study

Overview

The purpose of this study is to compare the effects of virtual reality, which encourages active neck movements, in individuals with chronic neck pain, with the control group receiving only neck exercises. Participants will be randomly divided into two groups; Half of them will be given only a neck exercises program, and the other half will be given neck exercises and virtual reality.

Detailed description

Individuals with chronic neck pain tend to have low levels of endurance in deep neck flexor muscles. Conservative treatments for neck pain, including posture education, strengthening, range of motion, motor control, flexibility, and proprioceptive training, are recommended in clinical guidelines. Virtual reality has been shown to be beneficial in the treatment of various issues related to pain in previous systematic reviews. Distracting attention is one of the mechanisms explaining the impact of virtual reality on pain. It is believed that virtual reality reduces pain perception by influencing pain pathways.

Interventions

• Other Experimental: VR and exercise
  Participants will perform a 20-minute exercise program consisting of neck joint mobility exercises, neck and scapulothoracic muscle strengthening exercises, and stretching exercises. Then, for the next 20 minutes, they will engage in active neck movements using the Oculus Quest2 headset with the Ocean Rift game.
• Other Sham Comparator: exercise
  The control group will perform a 40-minute same neck exercises.

Primary outcome measures

• Neck disability index [Time frame: 8 weeks]

Secondary outcome measures (7)

• Visual analog scale [Time frame: 8 weeks]
• Joint position sense error [Time frame: 8 weeks]
• Pressure pain threshold [Time frame: 8 weeks]
• joint range of motion [Time frame: 8 weeks]
• Bournemouth Neck Questionnaire [Time frame: 8 weeks]
• Tampa Scale for Kinesiophobia [Time frame: 8 weeks]
• Pittsburgh Sleep Quality Index [Time frame: 8 weeks]

Eligibility criteria

Inclusion criteria

• Ages 18 to 45
• Having a history of non-traumatic neck pain persisting for more than three months
• Having a Neck Disability Index score greater than 5 points
• Not having participated in a physiotherapy program for at least 3 months
• Being able to read and write in Turkish to understand, interpret, and respond to the questionnaires

Exclusion criteria

• Having a surgical history in the neck region
• Having cervical spine flexion, extension, and rotation range of motion <10 degrees
• Having a history of rheumatologic, vestibular, neurological, or cardiopulmonary diseases
• Vertigo associated with neck pain
• Osteoporosis, vertebral fractures,spinal tumors
• Presence of radiculopathy or myelopathy
• Traumatic spinal cord injury
• Neck pain associated with progressive neurological deficits or loss of strength

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Open label

Primary purpose

Treatment

Study locations

Turkey (Türkiye) · 1 center

• Koc University School of Medicine — Istanbul

Publications

• Ghamkhar L, Kahlaee AH. Are Ultrasonographic Measures of Cervical Flexor Muscles Correlated With Flexion Endurance in Chronic Neck Pain and Asymptomatic Participants? Am J Phys Med Rehabil. 2017 Dec;96(12):874-880. doi: 10.1097/PHM.0000000000000778. PMID 28644248
• Childs JD, Cleland JA, Elliott JM, Teyhen DS, Wainner RS, Whitman JM, Sopky BJ, Godges JJ, Flynn TW; American Physical Therapy Association. Neck pain: Clinical practice guidelines linked to the International Classification of Functioning, Disability, and Health from the Orthopedic Section of the American Physical Therapy Association. J Orthop Sports Phys Ther. 2008 Sep;38(9):A1-A34. doi: 10.2519/j PMID 18758050
• Audette I, Dumas JP, Cote JN, De Serres SJ. Validity and between-day reliability of the cervical range of motion (CROM) device. J Orthop Sports Phys Ther. 2010 May;40(5):318-23. doi: 10.2519/jospt.2010.3180. PMID 20436238
• Tousignant M, Smeesters C, Breton AM, Breton E, Corriveau H. Criterion validity study of the cervical range of motion (CROM) device for rotational range of motion on healthy adults. J Orthop Sports Phys Ther. 2006 Apr;36(4):242-8. doi: 10.2519/jospt.2006.36.4.242. PMID 16676874
• Reddy RS, Meziat-Filho N, Ferreira AS, Tedla JS, Kandakurti PK, Kakaraparthi VN. Comparison of neck extensor muscle endurance and cervical proprioception between asymptomatic individuals and patients with chronic neck pain. J Bodyw Mov Ther. 2021 Apr;26:180-186. doi: 10.1016/j.jbmt.2020.12.040. Epub 2020 Dec 31. PMID 33992242
• Wibault J, Vaillant J, Vuillerme N, Dedering A, Peolsson A. Using the cervical range of motion (CROM) device to assess head repositioning accuracy in individuals with cervical radiculopathy in comparison to neck- healthy individuals. Man Ther. 2013 Oct;18(5):403-9. doi: 10.1016/j.math.2013.02.004. Epub 2013 Mar 7. PMID 23473752
• Clark P, Lavielle P, Martinez H. Learning from pain scales: patient perspective. J Rheumatol. 2003 Jul;30(7):1584-8. PMID 12858463
• Bolton JE, Humphreys BK. The Bournemouth Questionnaire: a short-form comprehensive outcome measure. II. Psychometric properties in neck pain patients. J Manipulative Physiol Ther. 2002 Mar-Apr;25(3):141-8. doi: 10.1067/mmt.2002.123333. PMID 11986574

Identifiers

NCT: NCT06549166 · 2023.311.IRB1.107

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗