Chronic Neck Pain
Conditions
Keywords
virtual reality, serious gaming, chronic, neck, pain, rehabilitation, conventional, technologic
Brief summary
The goal of this clinical trial is to find out if a virtual reality-based rehabilitation program developed by our team can help people with chronic neck pain. The main questions it aims to answer are: * Does the VR program reduce neck pain? * Does it improve daily function and quality of life? Participants will: * Take part in a supervised virtual reality exercise program for 8 weeks, attending 3 sessions per week (24 sessions in total). * Each session will last about 45 minutes. * Complete tests and questionnaires about their pain, disability, and overall well-being before and after the program.
Detailed description
This trial evaluates a virtual reality (VR)-based rehabilitation program developed by our team for people with chronic neck pain, compared against conventional therapy (CT) delivered as standard physiotherapy. Both programs share the same exercise components (breathing, stretching, range-of-motion, and posture-strengthening); the VR arm provides a game-adapted version in an immersive beach and ocean setting via a head-mounted display. Participants in both arms attend 20-minute sessions, twice per week over the intervention period.   VR-Based Rehabilitation (Intervention) The VR treatment module is structured into four components that run continuously within a beach-themed scenario: * Breathing component: Before gameplay, participants are taught diaphragmatic breathing. In VR, the avatar starts on a deck chair by the sea; on-screen prompts guide the participant to inhale while lifting the head toward the sky and exhale while lowering toward the sand (approx. 5 minutes).  * Stretching component: The avatar rides a jet-ski along the shoreline and the participant collects coins arranged bilaterally, promoting controlled neck movements within the stretching block.  * Range-of-motion component: Therapeutic tasks cue cervical flexion, extension, lateral flexion (right/left), and rotation (right/left) as part of the game flow, mirroring the clinical ROM targets.  * Posture-strengthening component: Gamified tasks reinforce postural and scapular control consistent with the conventional program's strengthening principles.  Overall, the VR arm delivers the same exercise content as CT, but as a game-adapted version in an immersive beach setting via VR glasses.  Conventional Therapy (Comparator) The CT arm performs the same exercise categories as standard, therapist-guided physiotherapy with predefined sets/repetitions: * Diaphragmatic breathing: 10 repetitions.  * Stretching: Trapezius (right and left) - 10 repetitions × 15 seconds each side.  * Neck ROM exercises: Flexion & extension; right/left lateral flexion; right/left rotation - 10 repetitions × 5 seconds per movement.  * Posture-strengthening: Proprioceptive Neuromuscular Facilitation (PNF)-based scapular retraction - 3 sets × 10 repetitions (with facilitation at the start of each series).  Dose & schedule: Both arms follow 20-minute sessions, twice weekly; outcomes (e.g., pain, disability, kinesiophobia, quality of life) are recorded pre-/post-intervention (detailed in the Outcomes section).
Interventions
A virtual reality-based rehabilitation program including breathing, stretching, cervical range-of-motion, and posture-strengthening tasks delivered in a gamified seaside environment using a head-mounted VR display. Sessions will last 20 minutes, performed twice per week for 8 weeks (16 sessions total) under supervision.
OTHERConventional Rehabilitation
Standard physiotherapy including diaphragmatic breathing, trapezius stretching, cervical range-of-motion, and posture-strengthening with proprioceptive neuromuscular facilitation. Sessions will last 20 minutes, performed twice per week for 8 weeks (16 sessions total) under supervision.
Sponsors
Hacettepe University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Intervention model description
Participants will be randomly assigned to one of two groups: (1) virtual reality-based rehabilitation or (2) conventional therapy. Both groups will complete the same categories of therapeutic exercises (breathing, stretching, cervical range-of-motion, and posture-strengthening), but the VR group performs a gamified version in an immersive virtual environment.
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Age 18-65 years * Diagnosis of chronic neck pain (≥ 6 months duration) * Ability to participate in rehabilitation sessions * Willingness to provide written informed consent
Exclusion criteria
* Previous adverse experience with virtual reality * Photophobia (UPSIS-12 score \> 12) * Migraine (≥ 2 positive responses on ID-Migraine questionnaire) * Presence of any neurological deficit * History of spinal surgery * Medical conditions interfering with participation, including orthopedic, inflammatory, cardiovascular, rheumatologic, or vestibular disorders * Pregnancy * Epilepsy or other neurological conditions causing photosensitivity * Congenital spinal cord malformations
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Proprioception | Baseline and at the end of the study. | Proprioceptive accuracy will be assessed by measuring joint position sense error in degrees using the CROM device. Higher error values indicate poorer position sense. |
| Pain Intensity | Baseline and at the end of the study. | Pain severity will be measured using the Visual Analog Scale (VAS), a 10-cm line ranging from 0 (no pain) to 10 (worst imaginable pain), where participants indicate their average neck pain intensity over the past week. Higher scores represent greater pain (worse outcome). |
| Neck Disability | Baseline and at the end of the study. | Functional disability will be evaluated using the Neck Disability Index (NDI), a 10-item self-report questionnaire assessing daily activities affected by neck pain. Each item is scored from 0 to 5, yielding a total score range of 0 (no disability) to 50 (maximum disability). Higher scores indicate greater disability (worse outcome). |
| Cervical Range of Motion | Baseline and at the end of the study. | Cervical range of motion (flexion, extension, right/left lateral flexion, and right/left rotation) will be measured using the CROM device. Higher values indicate greater mobility. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Life Quality | Baseline and at the end of the study. | Quality of life status will be measured using the Short Form-36 Health Survey (SF-36). Scores range from 0 (worst possible health status) to 100 (best possible health status). Higher scores indicate better health-related quality of life. |
| Kinesiophobia | Baseline and at the end of the study. | Fear of movement will be assessed using the Tampa Scale of Kinesiophobia (TSK), a 17-item self-report questionnaire. Each item is scored from 1 to 4, yielding a total score range of 17 (no kinesiophobia) to 68 (maximum kinesiophobia). Higher scores indicate more severe kinesiophobia (worse outcome). |
| Treatment Adherence | At the end of the study. | Attendance at scheduled sessions will be recorded to determine adherence to the VR or conventional therapy program. Higher percentages reflect better adherence. |
| Participant Satisfication | At the end of the study. | Perceived overall change will be evaluated using the Global Perceived Effect (GPE) Scale, a 7-point Likert-type scale assessing the participant's impression of improvement following the treatment program. Scores range from 1 (much worse) to 7 (much better), with 4 indicating no change. Higher scores indicate greater perceived improvement (better outcome). |
Countries
Turkey (Türkiye)
Contacts
Primary ContactHatice Cetin, PhD
Outcome results
None listed