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.

项目概要/摘要 慢性肌肉骨骼 (MSK) 疼痛每年影响超过四分之一的美国青少年的生活 对成年期的影响表现为教育程度较低、职业功能较差、社会障碍 阿片类药物滥用的风险更高。在疼痛的情况下逐渐增加活动对于有效治疗至关重要 物理治疗 (PT) 是慢性 MSK 疼痛的功能恢复的基础治疗方法。尽管 PT 的广泛使用，敢于在疼痛时增加运动，通常可以感受到身体和情感上的变化 由于害怕疼痛而无法实现，这对疼痛结果产生特别显着的影响，阻碍临床改善。 虚拟现实 (VR) 提供多感官、三维 (3D) 沉浸式体验， 打破 PT 期间害怕运动和回避的恶性循环的潜力。 VR被建议为 阿片类药物的替代品，其治疗机制集中于分散注意力、身体神经调节 感知，以及分级暴露于害怕/避免的动作。此外，VR 还可以增强 动机和参与度，促进重复动作，并结合实时和纵向反馈 患者和临床医生。从我们的初步数据来看，以用户为中心迭代开发疼​​痛康复 与虚拟现实 (PRVR) 相比，虚拟现实 (PRVR) 被认为具有高度吸引力，并且增加了会话中的运动量 标准物理治疗康复 (SPR)。在此试点工作的基础上，拟议的研究是一项随机研究 PRVR 对照试验旨在测量青少年身体功能和疼痛相关恐惧的变化 与 SPR 相比，MSK 具有慢性疼痛。目标 1 评估身体功能（主要结果）和疼痛 PRVR 和 SPR 之间相关的恐惧（次要结果）。目标 2 描述了未来混合动力的可行性 PRVR 在常规 PT 实践中的有效性传播试验。治疗取得重大突破 MSK 斯隆的疼痛需要基于机械原理的创新方法。 PRVR 利用沉浸式技术 克服在疼痛的情况下对运动的恐惧的关键障碍，以游戏化的方式提供实时反馈 维持动机和坚持的背景，并有目的地捕捉两个目标（运动学、体动记录） 和主观（自我报告）日常功能来定义临床终点并评估治疗进展 诊所和家里。这些发现将直接影响是否继续进行混合动力的决定 PRVR 的有效性传播试验，作为潜在大规模实施 PRVR 的基础。