# Virtual Immersive Gaming to Optimize Recovery in Low Back Pain

> **NIH NIH R01** · VIRGINIA COMMONWEALTH UNIVERSITY · 2022 · $503,011

## Abstract

Abstract
Low back pain is the second most common reason for a visit to a physician, with direct medical costs exceeding
$90 billion per year in the United States alone. These costs are driven primarily by 7-10% of patients who
develop a chronic pain disorder that can last for many years. Fear of movement (i.e., kinesiophobia) due to
expectations of pain and harm is an important risk indicator for the development of persistent pain and
disability, with studies consistently showing that high fear is one of the strongest predictors of the transition to
chronic low back pain (CLBP). Specifically, fear encourages the adoption of maladaptive movement patterns
wherein tasks of daily living are performed with reduced lumbar spine flexion and compensatory increases of
knee, hip, and arm shoulder flexion. While avoidance of lumbar flexion may benefit these back pain sufferers in
the short-term by reducing their fear of injury, in the long-term limited lumbar flexion becomes an entrenched
pattern that can lead to shortening of spinal peri-articular connective tissues, changes in surrounding muscles,
and increased risk for chronicity.
With the support of an NIH R21, we recently completed a Phase I trial of an immersive virtual reality dodgeball
game designed specifically to increase lumbar flexion among individuals with CLBP and high fear of movement.
The results of this proof-of-concept study demonstrated that 3 daily sessions of virtual dodgeball was safe, did
not exacerbate existing back pain, was highly rated by participants, and increased lumbar spine flexion during
gameplay. We now propose a Phase II RCT to determine the efficacy of a 9–week course of treatment of virtual
dodgeball to reduce pain and disability. CLBP participants will be randomly assigned to play one of two versions
of our virtual reality game. In the experimental group, gameplay will promote progressive increases in lumbar
flexion. The control group will play the same immersive video game, but the parameters of the game will be
modified such that only small excursions of lumbar flexion are needed to successfully complete gameplay. The
co-primary clinical outcomes of changes in pain and disability will be assessed at 1-, 6-, 12-, 24-, and 48-weeks
post-treatment. Additionally, individual differences in expected pain, expected harm, and lumbar flexion will be
measured at pre-treatment baseline and at each of the follow-up intervals in the laboratory. Finally, participant
activity in their natural environment will be monitored for 7 days following each follow-up laboratory visit.
We have developed an innovative immersive video game that safely reduces expectations of pain/harm and
increases lumbar flexion among individuals with CLBP. The proposed Phase II trial will have a significant impact
on public health by testing the ability of this unique intervention to motivate CLBP sufferers to re-engage in the
specific spinal motions necessary to promote recovery and to maintain these treatmen...

## Key facts

- **NIH application ID:** 10074574
- **Project number:** 5R01HD088417-06
- **Recipient organization:** VIRGINIA COMMONWEALTH UNIVERSITY
- **Principal Investigator:** Christopher R France
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $503,011
- **Award type:** 5
- **Project period:** 2018-11-01 → 2023-11-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10074574

## Citation

> US National Institutes of Health, RePORTER application 10074574, Virtual Immersive Gaming to Optimize Recovery in Low Back Pain (5R01HD088417-06). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10074574. Licensed CC0.

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