Reviewed by: Zachary Stango, SPT; Bridget Collier, PT, DPT

The increase in virtual reality and gamification has been implemented in numerous aspects of our daily lives, and the area of rehab is one realm in which advancements in technology have the possibility to make tremendous impacts on patient outcomes. The randomized controlled trial conducted by Afzal et al. (2022) aimed to analyze the effects of implementing virtual reality exercises into a physical therapy routine, on pain and perceived disability, in patients with chronic low back pain.

The inclusion criteria for this study consisted of participants aged 25-50 with a history of chronic low back pain, which the study defined as pain persisting for greater than 12 weeks. Patients were randomly assigned to a group receiving conventional physical therapy, consisting of a moist heat pack, hamstring stretching, and loading and stretching of the lumbar spine musculature. The experimental group underwent the same therapeutic interventions, with the addition of two virtual reality interventions: the reflex ridge and body ball game. The reflex ridge made participants complete movements such as trunk side bending, sitting, and jumping to avoid obstacles on the screen. The body ball game included arm movements while kicking a ball displayed on the device. Each group underwent their respective interventions three times a week for a total of 12 weeks, with metrics analyzed after every quarter completion of the study. The 84 participants had their pain levels  measured using the Visual Analogue Scale (VAS) and their perceived disability measured through the Modified Oswestry Disability Index (MODI). Both of the groups displayed significant improvements in their levels of pain and subjective disability, with the group undergoing the additional virtual reality interventions exhibited significant reductions in their scores compared to the conventional group, correlating with better outcomes.

Clinical Bottom Line:

Virtual reality allows for the participants to dive into their own world of adventure, and the rehabilitative world can use this tool to allow patients the opportunity to actively complete tasks in their animated realm, which could translate to completion of these tasks in everyday life. Even though the activities in this study that were completed in virtual reality did not necessarily mimic activities of daily living for every participant, the motions can serve as a starting point to progress these to add in loading of the lower back. Individuals with chronic low back pain often show signs of fear avoidance of specific movements and the results of this study suggest that virtual reality can aid in helping these individuals regain the confidence to complete previously avoided movements and return to their prior level of function.


Afzal MW, Ahmad A, Mohseni Bandpei MA, Gilani SA, Hanif A, Waqas MS. Effects of virtual reality exercises and routine physical therapy on pain intensity and functional disability in patients with chronic low back pain. J Pak Med Assoc. 2022;72(3):413-417. doi:10.47391/JPMA.3424