Integrating Telemedicine and Embodied Virtual Reality: A Novel Functional Training Intervention for Chronic Shoulder Pain.

Chronic shoulder pain is a common musculoskeletal pain condition that can have a profound impact on a sufferer's life and a large socioeconomic health care burden to society. The aim of this study was to investigate the effects of a functional rehabilitation therapy using virtual embodiment in VR, on chronic shoulder pain, delivered in a telemedicine format. Ten chronic shoulder pain patients were recruited from local pain clinics. Patients engaged in three rehabilitation sessions per week over the course of 8 weeks. Rehabilitation sessions were delivered using an Oculus Quest head-mounted display and hand controllers. Rehabilitation exercises (virtual embodiment training) leverage techniques from graded motor imagery, such as visual mirror feedback and augmentation of the virtual avatar's movements. Eight assessments on function and psychological aspects relevant to chronic pain were measured prior to the first session, at week 4, and at the end of 8 weeks in order to investigate the effect of the virtual embodiment training on the symptoms of chronic shoulder pain. Range of motion was measured within the virtual environment at each exercise session for shoulder flexion, scaption, and abduction. A one-way repeated measure analysis of variance revealed that virtual embodiment training improved symptoms of disability measured by the disabilities of the arm, shoulder and hand questionnaire (F(2, 9) = 8.054, p = 0.004). Virtual embodiment training improved function as measured by upper extremity functional index (F(2,9) = 6.506, p = 0.009), pain catastrophizing scale (F (2, 9) = 5.792, p = 0.013), fear avoidance beliefs questionnaire (F(2, 9) = 6.722, p = 0.008), pain self-efficacy questionnaire (F (2, 9) = 4.841, p = 0.023) and yellow flag risk form (F(2,9) = 6.563, p = 0.008). No significant effect was observed for the SF-36 questionnaire of quality of life, or the Tampa Scale of Kinesiophobia. These results indicate that telemedicine-enabled functional rehabilitation for chronic shoulder pain may improve chronic pain symptoms such as disability, function, pain catastrophizing, and fear avoidance in chronic pain patients.