Application of Virtual Reality to Home-Visit Rehabilitation for Patients With Chronic Musculoskeletal Pain: A Single-Group Pre-post Comparison Study

Abstract

Objective Virtual reality (VR) is increasingly used to alleviate pain during the rehabilitation of patients with chronic musculoskeletal pain. Previous studies on the application of VR to rehabilitation have reported improvements in pain, functional impairment, and psychological status of patients. However, the focus of many previous studies was on short-term effects and rehabilitation in hospitals. Studies that report home-based rehabilitation for mid- to long-term periods are lacking. Hence, the aim of the study was to investigate the feasibility and safety of applying VR for the home-visit rehabilitation of these patients. Methods A single-group pre-post comparative study was conducted at two home healthcare agencies in Japan. Six female participants (mean age: 76.5 years) with chronic musculoskeletal pain underwent 10 sessions of VR-applied home rehabilitation over 10 weeks. In the intervention, a standalone VR headset (MetaQuest 2^TM; Meta Platforms Inc., Menlo Park, CA, USA) was used to view natural landscape content during rehabilitation. Pain levels, heart rate variability (HRV), motivation for rehabilitation, mood states, Pain Catastrophizing Scale (PCS) scores, and quality of life (QoL) were measured at various time points before, during, and after the VR interventions. All variables were summarized as means and standard deviations, medians and interquartile ranges, or frequencies and percentages, as appropriate. Results All participants completed the rehabilitation sessions without dropping out or experiencing adverse effects, thereby supporting the feasibility and safety of the intervention. Pain levels during rehabilitation significantly decreased compared with baseline levels, showing reductions of more than 4.5 points on the Numerical Rating Scale (NRS; 0-10). The HRV values showed inconsistent trends: an increase and a decrease in the parasympathetic and sympathetic nerve indices, respectively, between the baseline and the first intervention point, revealing a shift towards parasympathetic dominance, whereas no clear trend was observed from the 2nd to the 10th interventions. The motivation for rehabilitation in all patients remained strong, and intrinsic regulation was the dominant factor. The mood states of all patients remained stable within the healthy range throughout the study period. PCS scores initially increased; however, they decreased with time. Regarding QoL, mental health scores remained high, whereas physical and social functioning declined and improved, respectively. Conclusions The VR-applied home-visit rehabilitation is a feasible and safe approach for patients with chronic musculoskeletal pain. The intervention may reduce pain during rehabilitation; however, its effects did not persist long enough to improve constant baseline pain or other psychological factors. Further studies with larger sample sizes and appropriate control groups are required to confirm the effectiveness and long-term benefits of this approach.

Keywords: chronic musculoskeletal pain; feasibility study; home-visit rehabilitation; homebound patient; virtual reality.

Figure 1. A participant wearing a VR device

Image showing a participant wearing the MetaQuest 2^TM during the home-visit rehabilitation procedure that she usually receives. Image credit: This figure is an original creation by the author, Hiroki Funao. The image was created using photography. VR, Virtual reality

Figure 2. Typical VR contents viewed with the VR device

These images show typical VR contents that the participants watched with the MetaQuest 2^TM in this study, which included landscapes such as flower fields, beaches, forests, and plateaus (Youtube VR^TM) [22]. Image credit: This figure is an original creation by the author, Hiroki Funao. The images were created by capturing an application screen using the screenshot function on the MetaQuest 2^TM. VR, Virtual reality

Figure 3. Degree of pain in home-visit rehabilitation

Pain was measured at each home visit rehabilitation session and also at three time points during the rehabilitation session (before, during, and after the session). The median of the "during" value at the second rehabilitation is 0. The interquartile ranges of the "during" value at the second rehabilitation and the "before" values at the fourth and fifth rehabilitations are 0. Hence, those values were not visible. Pre, Pre-intervention