Forward Versus Backward Walking Combined with Gamified Virtual Reality on Pain, Proprioception and Disability for Non-Specific Neck Pain - A Randomized Clinical Trial

Abstract

Background: Non-specific neck pain (NSNP) occurs with no significant structural pathology, and pain is localized in the posterolateral region of the neck without any neurological symptoms. Gamified Virtual Reality (VR) based therapy, forward and backward walking (BW), have individually shown effectiveness for neck pain when given along with physiotherapy. However, no studies have compared backward and forward walking (FW) when combined with virtual reality for neck pain. The objective of study was to compare the effects of FW versus BW combined with virtual reality on pain, proprioception, and disability in individuals with NSNP. Methods-Fifty-six participants aged 18-40 years with NSNP were randomly divided into two study groups. Group A/FWV (n=28) received forward walking while group B/BWV (n=28) received backward walking for 5 days. Both groups received VR, TENS and exercises as common intervention. Pre(1stday) and post (5thday) intervention analysis for pain using Visual Analogue Scale (VAS), proprioception using cervical joint position sense error (JPSE) test, and functional disability using neck disability index (NDI) was done. Results-Significant difference(p<0.05) was seen within both groups for all the outcomes. When compared between group, BWV showed more difference in terms of decrease in pain (effect size:4.36, p<0.001), improvement in functional disability (effect size:5.57, p<0.001) and neck proprioception (effect size:4.09, p<0.001). Conclusion-BW combined with gamified virtual reality had more impact on reducing pain, neck disability and improving neck proprioception. The findings of this research could contribute to the development of technology-enhanced rehabilitation protocols for patients suffering from NSNP.