Effect of Using VR Game-Based Training to Correct Lumbar Curve in Chronic Low Back Pain Patients: Randomized Controlled Trial

Abstract

Background: Chronic nonspecific low back pain (CNLBP) with lumbar hyperlordosis leads to pain, dysfunction, and poor quality of life. Virtual reality (VR)-based training may enhance exercise engagement and outcomes. This study compared VR-based pelvic rocking training with conventional pelvic rocking training exercises. Methods: A triple-blind randomized controlled trial enrolled 100 participants with CNLBP and hyperlordosis, who were randomly allocated into two groups: the group, which performed pelvic rocking exercises using the TBed VR system (TbG), and the conventional group (CG), which performed the same exercises without VR. Both groups completed three sessions per week for eight weeks. Primary outcomes included pain (Numerical Pain Rating Scale, NPRS), lumbar lordotic angle (LLA), lumbar range of motion (ROM), and functional disability (Oswestry Disability Index, ODI). Secondary outcomes were patient satisfaction and commitment to exercise sessions. Assessments were conducted at baseline, immediately post-intervention, and after a one-month follow-up. Results: Both groups showed significant improvements in all outcome measures post-treatment (p < 0.016). Furthermore, some outcomes—specifically pain, LLA, and extension ROM—continued to improve during the follow-up period. The TbG demonstrated significantly greater reductions in pain, greater ROM improvements, greater functional gains, and higher levels of satisfaction and commitment than the CG (p < 0.05). These between-group differences persisted at the one-month follow-up, particularly for pain and ROM, which remained statistically significantly better in the TbG. Moreover, all between-group differences demonstrated medium to high clinical effects (d ≥ 0.3). Conclusions: Pelvic rocking exercises using the TBed VR system were superior to conventional exercises in terms of pain, ROM, and function at the immediate and intermediate time points. Using TBed led to better patient satisfaction and higher exercise commitment.