The VIGOR Study - Virtual Immersive Gaming to Optimize Recovery in Low Back Pain

A fundamental clinical problem in individuals with chronic low back pain is the significant
alteration in movement patterns that restrict lumbar spine motion. This restriction of lumbar
motion is particularly evident in patients with kinesiophobia; that is, a fear of movement
due to possible injury or reinjury. For chronic back pain patients with kinesiophobia it is
critical to develop an effective intervention to increase spine motion while minimizing
concerns of pain and harm. Accordingly, we have developed a innovative video games that track
whole-body motion and are designed to encourage spinal flexion while reducing concerns of
pain and harm among individuals with low back pain. Our games have two distinct advantages.
First, within this video game environment, visual feedback can be altered by changing the
feedback gain of a given movement (e.g., the magnitude of a given joint movement could appear
on screen as either larger or smaller than the actual movement). Thus, gain manipulation will
result in progressively larger amounts of lumbar spine flexion during game play. Second,
video games are potent distractors that can reduce attention to pain.

Inclusion Criteria:

- 18-60 years of age

- Low back pain that has been ongoing for at least half the days in the last 6 months

- Average pain intensity of 3 or higher over the past week on a 0-10 Numerical Rating
Scale

- Disability >4 on Roland and Morris Disability Questionnaire

- Agrees with statement "It is not really safe for a person with my back problem to be
physically active"

- Has sought care or consultation from a health care provider for back pain

- Meets category < 4 on the Classification System of the Quebec Task Force on Spinal
Disorders,49 which reflects low back pain without neurological signs

- Working proficiency in English

Exclusion Criteria:

- Has a personal history of the following neurological disorders: Alzheimer's,
Amyotrophic Lateral Sclerosis, Multiple Sclerosis, Parkinson's, Neuropathy, Stroke,
Seizures

- Has a personal history of the following cardiorespiratory disorders: Congestive heart
failure, heart attack in past 2 years

- Has a personal history of the following musculoskeletal disorders: Rheumatoid
Arthritis, muscular dystrophy, pathologic fractures of the spine, avascular necrosis
or osteonecrosis, severe osteoarthritis

- History of spine surgery or a hip arthroplasty

- Has active cancer

- Has a chronic disease that may restrict movement or preclude safe participation

- Has used opioids or muscle relaxants within 30 days prior to study enrollment

- Reports being pregnant, lactating, or that they anticipate becoming pregnant within
2-months

- Reports pending litigation related to chronic low back pain

- Has current drug or alcohol use or dependence that, in the opinion of the PIs, would
interfere with adherence to study requirements

- Has significant visual impairment that would prevent virtual reality headset use

- Has significant motion sickness that would prevent virtual reality headset use