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Development of immersive virtual reality intervention for patients with chronic low back pain: mixed-methods study

Astek, Anfal 2023. Development of immersive virtual reality intervention for patients with chronic low back pain: mixed-methods study. PhD Thesis, Cardiff university.
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Background: Chronic low back pain (CLBP) is a leading cause of disability worldwide. Immersive virtual reality (IVR) enables interaction with a virtual environments (VE) via a head mounted display (HMD) and is widely used for chronic pain (CP) management, however with little pre-development investigation, and its effectiveness for CP/CLBP management is inconclusive. Therefore, this thesis aims to adopt the Medical Research Council Framework to inform IVR development and implementation for CLBP management. Methods: Three parts were conducted, using mixed-methods design: Part 1: scoping review to map underpinning theories of IVR mechanisms of action in CP management and key features including software and dose. Part 2 engaged global stakeholders (healthcare practitioners and technology developers) to understand the use of IVR in CP management, adopting a sequential-explanatory study of two phases, Phase 1 an online survey, which informed Phase 2, online interviews with subset of surveyed stakeholders. Part 3: online focus groups explored physiotherapists’ opinions regarding IVR for CLBP management. Results: Part 1: several IVR mechanisms were noted, with little theoretical basis. Customised software was frequently used, with diverse HMDs, and no optimal dose consensus. Implementation in a clinical setting was common, with adverse effects of motion sickness and HMD discomfort being noted. Part 2: the perceived IVR benefits for CP included combatting fear of movement, with VE personalisation to patient needs and culture being critical. To avoid risks, pre-screening, the initial session being a supervised clinic session and gradual dose build up were recommended. Part3: IVR was viewed as suitable for CLBP patients with low motivation to exercise, however, skills’ transferability to the real world and falls risk were concerns. Part 2 and 3 found cost, practitioner acceptance and training critical to IVR adoption. Conclusion and future implications: IVR might be valuable alternative treatment for CLBP patients. Future work is needed to establish the effective working mechanism reflecting on CLBP heterogeneity. Personalisation, safety, workforce training, financial resources and collaboration between practitioners, technology developers and patients are key considerations.

Item Type: Thesis (PhD)
Date Type: Completion
Status: Unpublished
Schools: Healthcare Sciences
Date of First Compliant Deposit: 12 September 2023
Last Modified: 12 Sep 2023 11:00

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