# Application of Virtual Reality to Home-Visit Rehabilitation for Patients With Chronic Musculoskeletal Pain: A Single-Group Pre-post Comparison Study

## TL;DR

This study shows that using virtual reality for home-based rehabilitation can safely reduce pain in elderly patients with chronic musculoskeletal pain.

## Contribution

The study demonstrates the feasibility and safety of long-term VR-based home rehabilitation for chronic musculoskeletal pain patients.

## Key findings

- All participants completed VR rehabilitation sessions without adverse effects, indicating feasibility and safety.
- Pain levels during rehabilitation decreased significantly by more than 4.5 points on the NRS scale.
- Motivation remained high, and mood states stayed stable, but physical functioning initially declined before improving.

## Abstract

Objective

Virtual reality (VR) is increasingly used to alleviate pain during the rehabilitation of patients with chronic musculoskeletal pain. Previous studies on the application of VR to rehabilitation have reported improvements in pain, functional impairment, and psychological status of patients. However, the focus of many previous studies was on short-term effects and rehabilitation in hospitals. Studies that report home-based rehabilitation for mid- to long-term periods are lacking. Hence, the aim of the study was to investigate the feasibility and safety of applying VR for the home-visit rehabilitation of these patients.

Methods

A single-group pre-post comparative study was conducted at two home healthcare agencies in Japan. Six female participants (mean age: 76.5 years) with chronic musculoskeletal pain underwent 10 sessions of VR-applied home rehabilitation over 10 weeks. In the intervention, a standalone VR headset (MetaQuest 2TM; Meta Platforms Inc., Menlo Park, CA, USA) was used to view natural landscape content during rehabilitation. Pain levels, heart rate variability (HRV), motivation for rehabilitation, mood states, Pain Catastrophizing Scale (PCS) scores, and quality of life (QoL) were measured at various time points before, during, and after the VR interventions. All variables were summarized as means and standard deviations, medians and interquartile ranges, or frequencies and percentages, as appropriate.

Results

All participants completed the rehabilitation sessions without dropping out or experiencing adverse effects, thereby supporting the feasibility and safety of the intervention. Pain levels during rehabilitation significantly decreased compared with baseline levels, showing reductions of more than 4.5 points on the Numerical Rating Scale (NRS; 0-10). The HRV values showed inconsistent trends: an increase and a decrease in the parasympathetic and sympathetic nerve indices, respectively, between the baseline and the first intervention point, revealing a shift towards parasympathetic dominance, whereas no clear trend was observed from the 2nd to the 10th interventions. The motivation for rehabilitation in all patients remained strong, and intrinsic regulation was the dominant factor. The mood states of all patients remained stable within the healthy range throughout the study period. PCS scores initially increased; however, they decreased with time. Regarding QoL, mental health scores remained high, whereas physical and social functioning declined and improved, respectively.

Conclusions

The VR-applied home-visit rehabilitation is a feasible and safe approach for patients with chronic musculoskeletal pain. The intervention may reduce pain during rehabilitation; however, its effects did not persist long enough to improve constant baseline pain or other psychological factors. Further studies with larger sample sizes and appropriate control groups are required to confirm the effectiveness and long-term benefits of this approach.