Efficacy of a Therapist-Guided Virtual Reality Exercise Program for Chronic Nonspecific Low Back Pain

Abstract

Background: Chronic nonspecific low back pain is a leading cause of disability worldwide and is associated with persistent pain, reduced functional capacity, and impaired quality of life. Although exercise therapy remains a cornerstone of management, maintaining patient engagement and adherence can be challenging. Virtual reality–based rehabilitation has emerged as a promising strategy to enhance motivation and improve treatment outcomes. Objective: To evaluate the efficacy of a therapist-guided virtual reality exercise program in reducing pain and improving function among individuals with chronic nonspecific low back pain. Methods: A parallel-group randomized controlled trial was conducted at a tertiary rehabilitation center in Central Punjab, Pakistan. Seventy-two participants with chronic nonspecific low back pain were randomly assigned to either a therapist-guided virtual reality exercise group (n=36) or a conventional exercise group (n=36). Both groups underwent supervised exercise sessions three times weekly for eight weeks. Primary outcomes included pain intensity measured by the Visual Analog Scale (VAS) and functional disability assessed using the Oswestry Disability Index (ODI). Secondary outcomes included lumbar range of motion and health-related quality of life assessed using the Short Form-12 questionnaire. Outcomes were measured at baseline and post-intervention. Results: Sixty-five participants completed the study (virtual reality group, n=33; conventional exercise group, n=32). The virtual reality group demonstrated significantly greater improvements in pain intensity (2.71 ± 1.01 vs. 4.63 ± 1.12; p<0.001) and functional disability (20.9 ± 5.8 vs. 31.8 ± 6.7; p<0.001) compared with the conventional exercise group. Significant time × group interactions were observed for both VAS (F=34.7, p<0.001) and ODI (F=41.2, p<0.001). Participants receiving virtual reality exercise also exhibited superior improvements in lumbar range of motion and quality-of-life measures. A significant positive correlation was observed between reductions in pain and improvements in disability (r=0.68, p<0.001). Conclusion: Therapist-guided virtual reality exercise was more effective than conventional exercise in reducing pain and disability while improving mobility and quality of life in individuals with chronic nonspecific low back pain. The findings support the integration of therapist-guided virtual reality interventions into contemporary rehabilitation programs.