Chronic low back pain (CLBP) is a leading cause of disability worldwide. Contemporary treatment of CLBP is suboptimal, with small/moderate effect sizes and high relapse rates. Virtual reality (VR) is an increasingly accessible technology that can improve adherence to exercise programs through gamification. Using VR to facilitate exercise adherence and enjoyment may improve clinical outcomes. This study aimed to evaluate the effects of a gamified VR graded activity intervention in people with CLBP, using commercially available and bespoke VR programs. A sequentially replicated, multiple baseline, randomised AB single-case experimental design was undertaken in 10 people with CLBP. Outcomes were assessed daily and included pain intensity (primary), and pain catastrophising, pain-related fear, and anxiety/worry (secondary). The effect of the intervention on the primary outcome was evaluated using a multi-level model, nonparametric randomisation test. The VR graded activity intervention resulted in a significant reduction in pain intensity (effect estimate = -1.0, standard error = 0.27, p<.001) with four participants achieving ≥30% pain reduction (minimum important change). There was a significant effect of the intervention on pain catastrophising, but not pain-related fear or anxiety/worry measures. These findings provide preliminary support for a VR graded activity program to reduce pain in people with CLBP. PERSPECTIVE: This novel, virtual reality graded activity intervention reduced pain intensity and catastrophising in people with chronic low back pain. The intervention also had high adherence and enjoyment. Given that this intervention involved two freely available virtual reality programs, it can be easily translated into clinical practice.
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