目的:急性骨科创伤性肌肉骨骼损伤普遍存在,昂贵的,并经常导致持续性疼痛和功能限制。心理风险因素(疼痛灾难和焦虑)加剧了这些结果,但在急性骨科护理中经常被忽视。解决当前治疗方法中的差距,这项混合方法试点研究探索了治疗性虚拟现实(VR;RelieVRx)的使用,整合正念和认知行为疗法,骨科受伤后在家中进行疼痛自我管理。
方法:我们从MassGeneralBrigham医疗保健系统内的1级创伤诊所招募了10名最近骨科受伤,疼痛灾难或疼痛焦虑加剧的成年人。参与者每天在家完成RelieVRx课程,为期8周,其中包括疼痛教育,放松,正念,游戏,和动态呼吸生物反馈。主要结果是先验可行性,适当性,可接受性,满意,和安全。次要结果是疼痛的前后测量,物理功能,睡眠,抑郁症,和机制(疼痛自我效能,正念,和应对)。
结果:VR和研究程序达到或超过了所有基准。我们观察到疼痛的初步改善,身体机能,睡眠,抑郁症,和机制。定性退出访谈证实了对RelieVRx的高度满意度,并提出了促进骨科患者基于VR的试验的建议。
结论:结果支持RelieVRx与假安慰剂对照的更大的随机临床试验,以复制研究结果并探索机制。自我引导VR有可能促进基于证据的疼痛管理策略,并解决急性骨科损伤后患者的严重精神健康护理差距。
OBJECTIVE: Acute orthopedic traumatic musculoskeletal injuries are prevalent, costly, and often lead to persistent pain and functional limitations. Psychological risk factors (eg, pain catastrophizing and anxiety) exacerbate these outcomes but are often overlooked in acute orthopedic care. Addressing gaps in current treatment approaches, this mixed-methods pilot study explored the use of a therapeutic virtual reality (VR; RelieVRx ), integrating principles of mindfulness and cognitive-behavioral therapy, for pain self-management at home following orthopedic injury.
METHODS: We enrolled 10 adults with acute orthopedic injuries and elevated pain catastrophizing or pain anxiety from Level 1 Trauma Clinics within the Mass General Brigham health care system. Participants completed daily RelieVRx sessions at home for 8 weeks, which included pain education, relaxation, mindfulness, games, and dynamic breathing biofeedback. Primary outcomes were a priori feasibility, appropriateness, acceptability, satisfaction, and safety. Secondary outcomes were pre-post measures of pain, physical function, sleep, depression, and hypothesized mechanisms (pain self-efficacy, mindfulness, and coping).
RESULTS: The VR and study procedures met or exceeded all benchmarks. We observed preliminary improvements in pain, physical functioning, sleep, depression, and mechanisms. Qualitative exit interviews confirmed high satisfaction with RelieVRx and yielded recommendations for promoting VR-based trials with orthopedic patients.
CONCLUSIONS: The results support a larger randomized clinical trial of RelieVRx versus a sham placebo control to replicate the findings and explore mechanisms. There is potential for self-guided VR to promote evidence-based pain management strategies and address the critical mental health care gap for patients following acute orthopedic injuries.