# The Effects of Virtual Immersive Gaming to Optimize Recovery (VIGOR) in Low Back Pain: A Phase II Randomized Controlled Trial

## TL;DR

A VR-based game helped reduce chronic low back pain and fear of movement, with benefits lasting up to 48 weeks.

## Contribution

VR gaming can sustainably reduce pain and disability by modifying fear of movement, not just physical motion.

## Key findings

- VR interventions significantly reduced pain and disability in participants with chronic low back pain.
- Improvements in pain and disability were maintained for 48 weeks after treatment.
- Changes in expectations of pain and harm, not physical movement, were linked to treatment success.

## Abstract

What are the main findings?
Pain and disability can be reduced by inducing people with chronic low back pain and fear of movement to bend their back.The reductions in pain and disability were maintained over the 48-week follow-up.

Pain and disability can be reduced by inducing people with chronic low back pain and fear of movement to bend their back.

The reductions in pain and disability were maintained over the 48-week follow-up.

What is the implication of the main finding?
Treatment of kinesiophobia and/or chronic low back pain could benefit from gamification and gradually inducing lumbar flexion movements.

Treatment of kinesiophobia and/or chronic low back pain could benefit from gamification and gradually inducing lumbar flexion movements.

Background: Chronic low back pain (cLBP) with kinesiophobia is difficult to treat, and traditional graded activity approaches often show limited adherence and short-term effects. Virtual reality (VR) may enhance treatment engagement by providing immersive game-based environments that encourage therapeutic movement. This randomized controlled trial aimed to examine the effects of VR interventions designed to promote lumbar spine flexion in individuals with cLBP and elevated movement-related fear. Methods: Participants were randomized to one of two nine-week VR game conditions that differed only in the amount of lumbar flexion required. Primary outcomes were changes in pain intensity and disability from baseline to one-week post-treatment. Secondary analyses examined lumbar flexion and expectations of pain/harm as potential mediators. Follow-up assessments were conducted at multiple time points through 48 weeks to assess maintenance of treatment gains. Results: Both VR groups showed significant and clinically meaningful reductions in pain and disability at post-treatment. Improvements were maintained throughout the 48-week follow-up period. Depression symptoms continued to improve during follow-up. Expectations of pain and harm decreased significantly during treatment and remained reduced, whereas objective lumbar flexion did not change appreciably over time. Mediator analyses indicated that improved expectations of pain/harm, rather than increased lumbar flexion, were more closely associated with treatment response. Conclusions: Immersive VR gaming produced sustained reductions in pain, disability, and movement-related fear in individuals with cLBP and kinesiophobia. Findings suggest that VR may enhance rehabilitation outcomes by modifying maladaptive expectations rather than altering lumbar motion. VR-based interventions represent a promising and engaging approach for long-term cLBP management.