Background A key concern for people with chronic pain is experiencing increased pain and/or re-injury. Consequently, individuals with chronic pain can develop a maladaptive fear of movement that leads to adverse functional consequences. A primary goal of chronic pain rehabilitation is re-engagement in feared movements through exposure. This is often challenging since safe movement can be uncomfortable. Virtual environments provide a promising opportunity to safely and gradually expose Veterans to movements that are avoided in the real world. The current study will utilize multiple virtual reality (VR) applications (APPs) of varying the intensity levels ranging from passive distraction from pain to active exposure to feared movement. The primary aims of this pilot are to examine VR as an adjunctive nonpharmacological intervention to assist with the adoption and implementation of skills to decrease fear of movement and increase overall functioning among Veterans with chronic pain. Second, to build a hierarchy of VR APPs to assist in gradual exposure to feared movements. Methods This study will be conducted in the Chronic Pain Rehabilitation Program (CPRP) at the James A. Haley Veterans Hospital, a unique inpatient program within the VA system. Participants will include up to 20 Veterans who receive a VR intervention as part of their physical therapy. A rating form containing qualitative and quantitative experiences will be administered following each VR session to assess feasibility and to provide descriptive information for the proposed hierarchy. Effect sizes will be calculated from intake and discharge measures for the primary outcome fear of movement and secondary pain and functional outcomes. Discussion This study will inform the feasibility of a randomized controlled trial examining the clinical utility of using VR to reduce fear of movement and increase function among Veterans with chronic pain. VR has the advantage of being easily implemented both within VA healthcare settings as well as in Veterans' own residences, where engagement in ongoing self-management approaches is often most challenging. Presumably, VR that is matched to patient needs, progresses in intensity, immerses Veterans in the applications, and is perceived positively by Veterans, will result in positive functional outcomes.

中文翻译：

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对患有慢性疼痛的退伍军人的移动恐惧的虚拟现实干预：可行性研究方案。

背景 慢性疼痛患者的一个关键问题是疼痛加剧和/或再次受伤。因此，患有慢性疼痛的人会对运动产生不适应的恐惧，从而导致不良的功能后果。慢性疼痛康复的主要目标是通过暴露重新参与令人恐惧的运动。这通常具有挑战性，因为安全移动可能会让人不舒服。虚拟环境提供了一个有希望的机会，可以安全地逐步让退伍军人接触在现实世界中避免的运动。目前的研究将利用多个虚拟现实 (VR) 应用程序 (APP)，这些应用程序的强度水平从被动分散疼痛到主动暴露于恐惧运动不等。该试点项目的主要目的是将 VR 作为一种辅助性非药物干预措施，以帮助采用和实施技能，以减少对运动的恐惧并提高患有慢性疼痛的退伍军人的整体功能。其次，构建 VR APP 的层次结构，以帮助逐渐暴露于恐惧的动作。方法 这项研究将在 James A. Haley 退伍军人医院的慢性疼痛康复计划 (CPRP) 中进行，这是 VA 系统内独特的住院计划。参与者将包括多达 20 名在物理治疗中接受 VR 干预的退伍军人。每次 VR 会议后将管理包含定性和定量经验的评级表，以评估可行性并为提议的层次结构提供描述性信息。效应量将根据主要结果对运动的恐惧和次要疼痛和功能结果的摄入和排出量度来计算。讨论 本研究将告知一项随机对照试验的可行性，该试验检查使用 VR 来减少患有慢性疼痛的退伍军人对运动的恐惧并增强其功能的临床效用。VR 的优势在于可以在 VA 医疗机构和退伍军人自己的住所中轻松实施，在这些地方，参与持续的自我管理方法通常是最具挑战性的。据推测，与患者需求相匹配、强度不断提高、让退伍军人沉浸在应用程序中并被退伍军人积极感知的 VR 将产生积极的功能成果。