Background

Immersive virtual reality (VR) demonstrates potential benefits in patients with chronic low back pain (CLBP). However, few studies have investigated the feasibility and the acceptability of introducing immersive VR for use with patients with CLBP and in the Kingdom of Saudi Arabia (KSA)

Most people experience low back pain (LBP) at least once in their lifetime. A minority goes on to develop persistent LBP causing significant socioeconomic costs. Aim of this study was to identify factors that influence the progression of acute to persistent LBP at an early stage (Hilfiker et al. 2007).

Prospective inception cohort study of patients attending a health practitioner for their first episode of acute LBP or recurrent LBP after a pain free period of at least six months. Patients were assessed at baseline addressing occupational and psychological factors as well as pain, disability, quality of life and physical activity, and followed up over six months. Baseline and follow-up questionnaires were based on the recommendations of the Multinational Musculoskeletal Inception Cohort Study (MMICS) Statement (Pincus et al. 2008). Variables were combined to the three indices ‘working condition’, ‘depression and maladaptive cognitions’ and ‘pain and quality of life’.

The index ‘depression and maladaptive cognitions’ comprising of depression, somatisation, a resigned attitude towards the job, fear-avoidance, catastrophizing and negative expectations on return to work was found to be a significant baseline predictor for persistent LBP up to six months (OR 5.1; 95%CI 1.04–25.1). The diagnostic accuracy of the predictor model had a sensitivity of 0.54 and a specificity of 0.90. Positive likelihood ratio was moderate with 5.3, negative likelihood ratio 0.5. Overall predictive accuracy of the model was 81%. The area under the curve in receiver operating characteristic (ROC) analysis of the index was 0.78 (CI95% 0.65–0.92), demonstrating a satisfactory quality of discrimination.

Psychological factors in patients with acute LBP in a primary care setting correlated with a progression to persistent LBP up to six months. The benefit of including factors such as ‘depression and maladaptive cognition’ in screening tools is that these factors can be addressed in primary and secondary prevention.

Background: Activity advice and prescription are commonly used in the management of low back pain (LBP). However, no research has assessed whether objective measurements of physical activity predict outcome, recovery and course of LBP.

Methods: One hundred and one patients with acute LBP were recruited into a longitudinal cohort study. Each participant completed the Roland Morris Disability Questionnaire (RMDQ), Visual Analogue Scale and a “simple” activity question, detailing whether they had resumed full “normal” activities (Y/N), at baseline (T0) and 3 months (T1); Baecke Physical Activity Questionnaire, Fear-Avoidance Beliefs Questionnaire and the 12-item General Health Questionnaire at T0. Physical activity was measured for 7 days at T0 and T1 with an RT3 accelerometer and the seven day physical activity recall questionnaire (7d-PAR).

Results: The only significant predictor of RMDQ change was RMDQ score at T0 (p < .0001). Physical activity change did not predict RMDQ change in both univariate (p = 0.82) and multivariate analysis (p = 0.84). Paired t-tests found a significant change in RMDQ (p < .0001) and return to full “normal” activities (p < .0001) from T0 to T1, but no significant change in activity levels measured with the RT3 (p = 0.56) or the 7d-PAR (p = 0.43). RMDQ change (OR 1.72, p = 0.01) and RMDQ at T1 (OR 0.65, p = 0.04) predicted return to full “normal” activities at T1.

Conclusions: These results question the role of physical activity in LBP recovery and the assumption that activity levels change as LBP symptoms resolve.

Conflicts of Interest: None

Sources of Funding: This research was supported by a University of Otago Establishment Grant