Optimizing the Use of Virtual Reality in Rehabilitation for Individuals With Persistent Shoulder Pain

Condition(s) studied

Investigational drug(s) / intervention(s)

Virtual reality unimanual distraction task: Unimanual tasks (performed with the affected limb) with unaltered visual feedback will involve distraction exercises in which participants move a tray toward targets while keeping a ball balanced on the tray. Three trials with varying levels of friction between the ball and tray will be presented to manipulate the task's difficulty.

Virtual reality bimanual distraction task: Bimanual tasks with unaltered visual feedback (targets positioned based on the affected limb) will involve distraction exercises in which participants move a tray toward targets while keeping a ball balanced on the tray. Three trials with varying levels of friction between the ball and tray will be presented to adjust task difficulty.

Virtual reality unimanual reaching tasks with augmented visual feedback: Three trials with varying levels of visual feedback alteration will be performed, corresponding to a 0%, 25%, or 50% amplification of movement in the virtual environment compared to the real world. While virtual targets will appear farther apart, the actual movement required to reach them will remain the same across all trials.

Virtual reality unimanual reaching tasks with decreased visual feedback: Three trials with varying levels of visual feedback alteration will be performed, corresponding to a 0%, 17%, or 33% reduction in movement in the virtual environment compared to the real world. Although the virtual targets will appear closer together, the actual movement required to reach them will remain the same across all trials.

Study summary

The primary objective of this clinical trial is to investigate the effect of a block of four specific virtual reality (VR) exercises on upper limb function, pain, kinesiophobia, and pain catastrophizing in individuals with rotator cuff-related shoulder pain (RCRSP). The secondary objective is to examine participants' tolerability of different VR interventions.

Study Procedures:

Participants will:

* Attend a face-to-face assessment to confirm eligibility and receive a standardized pain neurophysiology education session (week 0).
* Visit the clinic once weekly for four weeks to undergo the VR interventions and review pain education concepts (Weeks 5 to 8).
* Complete online questionnaires evaluating upper limb function, kinesiophobia, pain, sense of presence, and cybersickness.

Interventions

Four VR interventions will be tested:

* Unimanual distraction task with normal visual feedback
* Bimanual distraction task with normal visual feedback
* Unimanual reaching task with augmented visual feedback
* Unimanual reaching task with diminished visual feedback

Findings will guide clinicians in selecting the most effective VR interventions for shoulder impairment and assess the feasibility of implementing VR in a private physiotherapy clinic for individuals with RCRSP.

Eligibility

Primary outcome measure(s)

• Symptoms and functional limitations specific to the upper limbs — post-intervention (week 8)
  The QuickDASH is an 11-item questionnaire, validated in individuals with rotator cuff-related shoulder pain, addressing the level of difficulty in performing daily activities and the severity of the symptoms of the upper limbs. Higher scores indicate greater pain and functional limitations.

Trial sites (1)

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