Pain Rehabilitation Virtual Reality (PRVR): Innovations to enhance mobility in the presence of pain

疼痛康复虚拟现实 (PRVR)：增强疼痛时活动能力的创新

• 批准号: 10397145
• 负责人: LAURA E SIMONS
• 金额: $ 17.14万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-05-01 至 2024-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10397145
• 关键词: 3-Dimensional; Acute pain management; Adherence; Adolescence; Adolescent; Adult; Adverse event; Affect; Age; Analgesics; Anxiety; Benchmarking; Body Image; Childhood; Clinic; Clinical; Data; Diagnosis; Dizziness; Effectiveness; Emotional; Exercise; Exposure to; Feedback; Foundations; Fright; Funding; Future; Gender; Goals; Health Care Costs; Home; Hybrids; Immersion; Impairment; Intervention; Measures; Motion; Motivation; Movement; Musculoskeletal Pain; Opioid; Outcome; Pain; Pain intensity; Participant; Patient Self-Report; Patients; Physical Function; Physical Rehabilitation; Physical activity; Physical therapy; Population; Provider; Randomized Controlled Trials; Rehabilitation therapy; Reporting; Research; Research Personnel; Rewards; Self Efficacy; Technology; Therapeutic; Time; Work; actigraphy; arm; chronic musculoskeletal pain; chronic pain; daily functioning; diaries; dissemination trial; distraction; exercise program; experience; feasibility testing; follow-up; functional improvement; functional restoration; high risk; improved; improved mobility; innovation; kinematics; multidisciplinary; multisensory; neuroregulation; opioid misuse; pain outcome; pain rehabilitation; pain-related disability; patient engagement; prevent; primary outcome; public health relevance; response; retention rate; satisfaction; secondary outcome; social; societal costs; treatment response; virtual reality; virtual reality intervention

Project Summary / Abstract Chronic musculoskeletal (MSK) pain affects the lives of over a quarter of adolescents in the US each year with impacts into adulthood evidenced by lower educational attainment, poor vocational function, social impairments and higher risk for opioid misuse. Progressively increasing activity in the presence of pain is critical for effective functional restoration in chronic MSK pain with physiotherapy (PT) a foundational treatment. Despite the widespread use of PT, daring to increase movement while in pain can often feel physically and emotionally unattainable with fear of pain a particularly salient influence on pain outcomes, hindering clinical improvement. Virtual reality (VR) provides access to a multisensory, three-dimensional (3D) immersive experience that has the potential to break the vicious cycle of fear of movement and avoidance during PT. VR has been suggested as an alternative to opioids with the therapeutic mechanisms centered on distraction, neuromodulation of body perception, and graded exposure to feared/avoided movements. Moreover, VR can potentially enhance motivation and engagement, facilitate repetitive motions, and incorporate real-time and longitudinal feedback for the patient and clinician. From our preliminary data, user-centered iteratively developed Pain Rehabilitation Virtual Reality (PRVR) was deemed highly engaging and increased in-session movement when compared to Standard Physiotherapy Rehabilitation (SPR). Building on this pilot work, the proposed research is a randomized controlled trial of PRVR aimed at measuring changes in physical function and pain-related fear for adolescents with chronic MSK pain when compared to SPR. Aim 1 evaluates physical function (primary outcome) and pain related fear (secondary outcome) between PRVR and SPR. Aim 2 characterizes feasibility of a future hybrid effectiveness-dissemination trial of PRVR in routine PT practice. Significant breakthroughs in the treatment of MSK pain require mechanistically-informed innovative approaches. PRVR harnesses immersive technology to overcome the key barrier of fear of movement in the presence of pain, provides real-time feedback in a gamified context to sustain motivation and adherence, and purposefully captures both objective (kinematics, actigraphy) and subjective (self-report) daily functioning to define clinical endpoints and assess treatment progress in the clinic and at home. These findings will directly inform the decision of whether to proceed with a hybrid effectiveness-dissemination trial of PRVR, serving as the basis for potential large-scale implementation of PRVR.

项目摘要 /摘要 慢性肌肉骨骼（MSK）疼痛每年影响美国四分之一以上的青少年的生活 受教育程度较低，职业功能不良，社会障碍所证明的成年后的影响 以及更高的阿片类药物滥用风险。在疼痛的存在下逐渐增加活动对于有效 慢性MSK疼痛（PT）的功能恢复基础治疗。尽管有 PT的广泛使用，大胆地增加运动，而痛苦通常会在身体和情感上感觉 由于担心疼痛对疼痛结果的影响无法实现，阻碍了临床改善。 虚拟现实（VR）提供了具有具有多感觉的三维（3D）沉浸式体验的访问权限 破坏PT期间对运动和回避恐惧的恶性循环的潜力。 VR已被建议 具有分散注意力的治疗机制的阿片类药物的替代方法 感知，并分级暴露于恐惧/避免的运动。此外，VR可以潜在地增强 动机和参与，促进重复运动，并结合实时和纵向反馈 病人和临床医生。根据我们的初步数据，以用户为中心的迭代性疼痛康复 与虚拟现实（PRVR）相比 标准理疗康复（SPR）。拟议的研究是在这项试验工作的基础上，是一项随机的 PRVR的对照试验旨在衡量青少年的身体机能变化和与疼痛相关的恐惧的变化 与SPR相比，慢性MSK疼痛。 AIM 1评估身体功能（主要结果）和疼痛 PRVR和SPR之间的相关恐惧（次要结果）。 AIM 2是未来混合动力的可行性的特征 PRVR在常规PT实践中的有效性解散试验。在治疗中的重大突破 MSK疼痛需要机械化的创新方法。 PRVR利用沉浸技术 克服在疼痛面前对运动的关键障碍，在游戏中提供实时反馈 维持动力和依从性的背景，并有目的地捕捉客观（运动学，动作法） 和主观（自我报告）每日功能以定义临床终点并评估治疗进展 诊所和在家。这些发现将直接告知是否要进行混合动力 PRVR的有效性解散试验，是PRVR潜在大规模实施的基础。