Development of a Virtual Reality-Based Rehabilitation Program for Chronic Lower Back Pain

Thesis Abstract

Chronic lower back pain (CLBP) remains a pervasive and debilitating condition that significantly impacts individuals' functional capacity and quality of life, posing substantial challenges to conventional physiotherapy approaches. Despite the availability of various rehabilitative interventions, adherence and engagement levels often remain suboptimal, partly due to the monotony of traditional therapy and limited patient motivation. This study aims to develop and evaluate a virtual reality (VR)-based rehabilitation program tailored specifically for individuals suffering from CLBP, with the hypothesis that immersive VR interventions can enhance patient engagement, adherence, and therapeutic outcomes. The specific objectives include designing an evidence-based VR rehabilitation protocol grounded in contemporary physiotherapy principles, assessing its usability and acceptability among CLBP patients, and measuring its effectiveness relative to standard physiotherapy in reducing pain intensity, improving functional capacity, and enhancing psychological well-being. A mixed-methods research design was adopted, combining quantitative and qualitative approaches to comprehensively evaluate the VR intervention. The study population comprised 120 adult patients diagnosed with CLBP attending outpatient physiotherapy clinics in metropolitan hospitals. A stratified random sampling technique was employed to allocate participants into experimental (VR-based therapy) and control (standard physiotherapy) groups, each containing 60 patients. Data collection instruments included validated questionnaires such as the Numeric Pain Rating Scale (NPRS), the Oswestry Disability Index (ODI), and the Tampa Scale of Kinesiophobia (TSK) to measure pain, functional disability, and fear of movement, respectively. Additionally, a bespoke usability questionnaire and semi-structured interviews assessed user experience, acceptability, and engagement levels. The quantitative data were analyzed using SPSS software employing descriptive statistics, independent-samples t-tests to compare baseline and post-intervention scores, and repeated-measures ANOVA to assess within-group progress over time. Multiple regression analyses examined predictors of treatment efficacy, incorporating demographic and psychological variables. Qualitative data from interviews were subjected to thematic analysis, following Braun and Clarke's framework, to extract key themes related to user experience and adherence barriers. The development phase involved iterative piloting of the VR protocol using the TIDieR checklist to ensure fidelity and replicability of the intervention. It is anticipated that the VR-based rehabilitation program will demonstrate statistically significant improvements over standard physiotherapy in reducing pain intensity (p < 0.01), decreasing disability scores, and mitigating fear of movement. The program is also expected to garner high usability ratings and positive user feedback, indicating strong acceptability in the patient cohort. Theoretically, the study draws on the Self-Determination Theory to explain increased motivation and engagement through immersive and interactive therapy sessions and employs the Biopsychosocial Model to contextualize the multifactorial benefits observed. The findings are poised to contribute novel insights into the application of immersive virtual reality technology within physiotherapy for CLBP, addressing a critical gap in current therapeutic paradigms. By systematically demonstrating the feasibility, acceptability, and effectiveness of VR interventions, this research advances knowledge on integrating ICT solutions into mainstream rehabilitation. The study concludes that VR-based programs can serve as a complementary modality to traditional physiotherapy, enhancing adherence and therapeutic outcomes. Recommendations include the adoption of personalized VR protocols in clinical practice, further evaluation through larger multicenter trials, and exploration of long-term outcomes. The research also underscores the importance of multidisciplinary collaboration in developing engaging, evidence-based, and scalable VR interventions for chronic musculoskeletal conditions.