Remote kinematic e-training for patients with chronic neck pain: A randomised controlled trial

Background: Neck pain is a common health disorder in adults. An important function of the neck is to be able to quickly and accurately move the head to react to external stimuli. Deficits in this ability, termed kinematic impairments, such as reduced velocity and smoothness of motion, were found in patients with chronic neck pain as compared with control. The potential benefits kinematic training for neck pain using virtual reality (VR) are that it can be tailored to the individual, providing real-time feedback, and thus can be delivered remotely. Ultimately this type of self-training could have important implications for future use in telemedicine and remote e-health.

Purpose: This research aimed to evaluate the efficacy of kinematic home based training in patients with chronic neck pain as compared tp controls.

Methods: This study was designed as a 3-armed randomised controlled trial, with assessor blinding. Inclusion criteria to the 2 intervention groups included prolonged neck pain>3 months; Neck Disability Index (NDI)>12%, and pain intensity (VAS)>30 mm. Exclusion criteria included existing vestibular pathology; cervical fracture/dislocation; systemic diseases affecting physical performance; inability to provide informed consent; or pregnancy. Eligible participants were randomised into either control, laser or virtual reality training using a concealed allocation procedure. Each participant in the intervention groups was provided with a training plan directed towards increasing range, velocity and accuracy of neck motion. Patients were instructed to exercise 20 minutes a day, 5 times a week for 4 weeks. One follow up meeting via phone was conducted each week with the physiotherapist to progress their training difficulty level, and help solving problems. The control participants received no treatment during a waiting period of 4 weeks, while the intervention groups received training. Following their waiting period, control participants were randomised to one of the two treatments. Outcome measures included global perceived effect, quality of life, neck disability, kinesiophobia and pain intensity. Objective measures included range, velocity, smoothness and accuracy of neck motion. Statistical analysis explored the within and between group differences of the post-pre change using 2-way ANOVA.

Results: Preliminary results include data from 49/90 participants: 17 in the VR group, 17 in laser, and 15 controls. To date 2 individuals dropped out pre-intervention due to simulator sickness and failure to complete the assessment. Current mid-trial results show significant within group change (Post-intervention improvement) in kinematics and pain intensity (VAS) in both the VR and laser group. There was also a clinically significant improvement in NDI in the VR group. There were no differences seen in the control group. There were no significant between group differences to date, likely due to sample size. Results from the full dataset will be presented at the conference.

Conclusion: Preliminary mid-trial results suggest that both types of remote kinematic training (VR and laser) can be effective in improving velocity and pain intensity, with VR possibly more effective in improving neck pain and disability. Further research should look into the value of combined individual physiotherapy with kinematic self-training, which is what is commonly provided in practice.

Implications: Current results suggest that home VR kinematic training may help neck pain intensity and selected kinematics, but may not be sufficient in the total management of chronic neck pain.