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Chronic Back and Leg PainNCT07492784

Investigation of the Effect of a Virtual Reality-Based Back School Program on Pain, Functionality, and Kinesiophobia

A study testing Back school education integrated with a VR headset in people with Chronic Back and Leg Pain, run by Hacettepe University at 1 site in Turkey (Türkiye).

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

This study investigates the effects of a 4-week virtual reality (VR)-based back school program on pain, disability, fear of movement, and lumbar joint position sense (JPS) in individuals with chronic low back pain. Read more about this study

Who is it for?
Ages 18 to 65 years
Conditions the study is for
Chronic Back and Leg Pain
What is being tested?
Back school education integrated with a VR headset
Could I receive a placebo?
No, everyone receives an active treatment
How many people
39 participants
Where
1 siteTurkey (Türkiye)
Study dates
1 Mar 2024to 1 Feb 2026
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 65 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Age between 18 and 65 years
  • Presence of chronic low back pain for at least three months
  • A resting pain intensity of 3 to 7 on the Visual Analog Scale (VAS)
  • The cognitive ability to follow physiotherapy instructions
  • Any physical therapy program within the previous 6 months

Who cannot join

  • Neurological deficits
  • Vestibular pathologies
  • Major trauma
  • Active infections
  • Tumors,
  • Inflammatory diseases
  • They declined to participate.

Trial locations and contacts

1 site in 1 country.

Turkey (Türkiye)1 site
  • Yozgat Bozok University

    Yozgat, Sarıkaya, 66650

Other trials in Turkey (Türkiye)

About this study

This study investigates the effects of a 4-week virtual reality (VR)-based back school program on pain, disability, fear of movement, and lumbar joint position sense (JPS) in individuals with chronic low back pain. Thirty-nine participants are allocated to either a VR-based back school group or a conventional back school group. Both groups perform supervised low back exercises. Pain, disability, proprioception, kinesiophobia, and perceived cognitive deficits are assessed before and after the intervention.

Read the detailed description

Background and Aim:

Chronic low back pain (CLBP) is a multidimensional condition associated with functional limitations, fear of movement, and proprioceptive impairments. Contemporary rehabilitation approaches, such as back school programs, are based on a biopsychosocial model and aim to enhance patient engagement. Virtual reality (VR) applications may further support these interventions by increasing motivation and providing enriched sensory feedback. This study aims to investigate the effects of a 4-week VR-based back school program on pain, disability, fear of movement, and joint position sense (JPS) in individuals with CLBP.

Methods:

The study includes 39 participants allocated into an experimental group (n=20) and a control group (n=19). The control group receives back school training through verbal instruction delivered by a physiotherapist, while the experimental group receives the same training integrated with a VR headset. Following the education sessions, both groups perform standard low back exercises under physiotherapist supervision.

Outcome measures include:

Pain intensity assessed using the Visual Analog Scale (VAS)

Disability assessed using the Oswestry Disability Index (ODI)

Lumbar joint position sense measured using a goniometric method

Fear of movement assessed using the Tampa Scale for Kinesiophobia (TSK)

Cognitive function assessed using the Perceived Deficits Questionnaire (PDQ)

All outcomes are evaluated before and after the 4-week intervention period.

Being tested
Back school education integrated with a VR headset
Keywords
Back school, exercise, pain, physiotherapy, virtual reality
Medical subject headings
Motor Activity, Pain

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Back school education integrated with a VR headsetOther

    Also called Low back pain exercises

    The intervention lasted for 4 weeks, comprising 2 sessions per week (8 sessions in total). Following baseline assessments, participants were randomly allocated to either the experimental or control group based on their resting pain levels. The experimental group received back school education integrated with a VR headset, whereas the control group received the standard back school education via verbal instruction from a physiotherapist. Following the education sessions, both groups performed supervised conventional low back exercises. The intervention was progressively structured over the 4-week period. Exercises were individualized according to each patient's clinical status and tolerance, following the principle of progressive overload, while strictly avoiding pain provocation.

Study groups in NCT07492784
Study groupRoleWhat they receive
Pain intensityExperimentalIn this scale, the starting point is defined as "0 = no pain" and the end point as "10 = unbearable pain." Participants were asked to mark their current pain levels on this line. Pain levels were assessed separately at rest, during activity, and at night.
Receives: Other: Back school education integrated with a VR headset
Lumbar joint position senseExperimentalParticipants were comfortably positioned, and the assessor passively moved their lumbar spine into a specific angle of flexion or extension. After holding the target angle for 3 seconds to allow proprioceptive encoding, participants were asked to actively replicate the position. The absolute error between the passively given angle and the actively replicated angle was recorded in degrees.
Receives: Other: Back school education integrated with a VR headset
Tampa Scale for KinesiophobiaExperimentalThis 17-item questionnaire utilizes a 4-point Likert-type scale (1 = strongly disagree, 4 = strongly agree) to evaluate kinesiophobia and movement avoidance following an injury. After reverse-scoring items 4, 8, 12, and 16, a total score ranging from 17 to 68 is calculated, with higher scores indicating greater kinesiophobia.
Receives: Other: Back school education integrated with a VR headset
Functional disabilityExperimentalFunctional disability was measured with the Oswestry Disability Index (ODI) (17, 18). The ODI consists of 10 sections related to daily living activities such as personal care, lifting, walking, sitting, standing, and sleeping. Each section is scored from 0 to 5. The total score ranges from 0 to 50, categorized as no disability (0-4), mild (5-14), moderate (15-24), severe (25-34), and complete disability (35-50).
Receives: Other: Back school education integrated with a VR headset
Perceived Deficits QuestionnaireExperimentalSubjective cognitive function was evaluated using the Perceived Deficits Questionnaire (PDQ) developed by Sullivan et al. (19). This 20-item scale assesses different domains of cognitive function, including attention/concentration, retrospective memory, prospective memory, and planning/organization. It is scored on a 5-point Likert-type scale (0 = never, 4 = almost always). Total scores range from 0 to 80, with higher scores reflecting greater perceived cognitive impairment over the past four weeks.
Receives: Other: Back school education integrated with a VR headset

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Pain intensity

    Pain intensity was evaluated using a 10-cm VAS developed by Price et al. In this scale, the starting point is defined as "0 = no pain" and the end point as "10 = unbearable pain." Participants were asked to mark their current pain levels on this line. Pain levels were assessed separately at rest, during activity, and at night.

    Measured: At baseline and immediately post-intervention (4 weeks)

  2. Lumbar joint position sense

    Lumbar joint position sense (JPS) was evaluated using a goniometric measurement method. Participants were comfortably positioned, and the assessor passively moved their lumbar spine into a specific angle of flexion or extension. After holding the target angle for 3 seconds to allow proprioceptive encoding, participants were asked to actively replicate the position. The absolute error between the passively given angle and the actively replicated angle was recorded in degrees.

    Measured: At baseline and immediately post-intervention (4 weeks)

  3. Tampa Scale for Kinesiophobia

    Fear of movement was assessed using the Turkish version of the Tampa Scale for Kinesiophobia (TSK). This 17-item questionnaire utilizes a 4-point Likert-type scale (1 = strongly disagree, 4 = strongly agree) to evaluate kinesiophobia and movement avoidance following an injury. After reverse-scoring items 4, 8, 12, and 16, a total score ranging from 17 to 68 is calculated, with higher scores indicating greater kinesiophobia.

    Measured: At baseline and immediately post-intervention (4 weeks)

  4. Functional disability

    Functional disability was measured with the Oswestry Disability Index (ODI). The ODI consists of 10 sections related to daily living activities such as personal care, lifting, walking, sitting, standing, and sleeping. Each section is scored from 0 to 5. The total score ranges from 0 to 50, categorized as no disability (0-4), mild (5-14), moderate (15-24), severe (25-34), and complete disability (35-50).

    Measured: At baseline and immediately post-intervention (4 weeks)

  5. Perceived Deficits Questionnaire

    Subjective cognitive function was evaluated using the Perceived Deficits Questionnaire (PDQ) developed by Sullivan et al. This 20-item scale assesses different domains of cognitive function, including attention/concentration, retrospective memory, prospective memory, and planning/organization. It is scored on a 5-point Likert-type scale (0 = never, 4 = almost always). Total scores range from 0 to 80, with higher scores reflecting greater perceived cognitive impairment over the past four weeks.

    Measured: At baseline and immediately post-intervention (4 weeks)

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted25 Mar 2026
  2. Study start1 Mar 2024
  3. Primary completion1 Dec 2025
  4. Study completion1 Feb 2026

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Participant
Enrolment
39 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07492784
Sponsor's protocol ID
Back School
Status last verified
Mar 2026
First submitted
14 Mar 2026
Last updated
25 Mar 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No: Individual participant data (IPD) will not be publicly available in order to protect participant confidentiality and in accordance with institutional and ethical data protection regulations.

Publications

  • Alvani E, Shirvani H, Shamsoddini A. Neuromuscular exercises on pain intensity, functional disability, proprioception, and balance of military personnel with chronic low back pain. J Can Chiropr Assoc. 2021 Aug;65(2):193-206.

    PubMed 34658391
  • Ibsen C, Schiottz-Christensen B, Vinther Nielsen C, Horder M, Schmidt AM, Maribo T. Assessment of functioning and disability in patients with low back pain - the low back pain assessment tool. Part 1: development. Disabil Rehabil. 2022 Aug;44(17):4841-4852. doi: 10.1080/09638288.2021.1913648. Epub 2021 May 4.

    PubMed 33945363
  • de Souza IMB, Merini LR, Rodrigues RSP, do Espirito Santo AS, Marques AP. Association of Functional Disability and Biopsychosocial Factors in Older Adults With Low Back Pain Who Live in the Amazonas State Brazil: A Cross-Sectional Study. J Manipulative Physiol Ther. 2022 Jan;45(1):45-56. doi: 10.1016/j.jmpt.2022.03.017. Epub 2022 Jun 24.

    PubMed 35753876
  • Shokri P, Zahmatyar M, Falah Tafti M, Fathy M, Rezaei Tolzali M, Ghaffari Jolfayi A, Nejadghaderi SA, Sullman MJM, Kolahi AA, Safiri S. Non-spinal low back pain: Global epidemiology, trends, and risk factors. Health Sci Rep. 2023 Sep 4;6(9):e1533. doi: 10.1002/hsr2.1533. eCollection 2023 Sep.

    PubMed 37674621
  • Harris JE, Boushey C, Bruemmer B, Archer SL. Publishing nutrition research: a review of nonparametric methods, part 3. J Am Diet Assoc. 2008 Sep;108(9):1488-96. doi: 10.1016/j.jada.2008.06.426.

    PubMed 18755321
  • Sullivan MJ, Hall E, Bartolacci R, Sullivan ME, Adams H. Perceived cognitive deficits, emotional distress and disability following whiplash injury. Pain Res Manag. 2002 Fall;7(3):120-6. doi: 10.1155/2002/502984.

    PubMed 12420020
  • Fisher K, Johnston M. Validation of the Oswestry low back pain disability questionnaire, its sensitivity as a measure of change following treatment and its relationship with other aspects of the chronic pain experience. Physiotherapy theory and practice. 1997;13(1):67-80.

  • Bayar K, Bayar B, Yakut E, Yakut Y. Reliability and construct validity of the Oswestry low back pain disability questionnaire in the elderly with low back pain. The Pain Clinic. 2003;15(1):55-9.

  • Lundberg MKE, Styf J, Carlsson SG. A psychometric evaluation of the Tampa Scale for Kinesiophobia - from a physiotherapeutic perspective. Physiotherapy Theory and Practice. 2004;20(2):121-33.

  • Yang QH, Wang XQ. Lumbar joint position sense measurement of patients with low back pain. EFORT Open Rev. 2023 Aug 1;8(8):639-650. doi: 10.1530/EOR-23-0077.

    PubMed 37526253
  • Price DD, McGrath PA, Rafii A, Buckingham B. The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain. 1983 Sep;17(1):45-56. doi: 10.1016/0304-3959(83)90126-4.

    PubMed 6226917
  • Poquet N, Lin CW, Heymans MW, van Tulder MW, Esmail R, Koes BW, Maher CG. Back schools for acute and subacute non-specific low-back pain. Cochrane Database Syst Rev. 2016 Apr 26;4(4):CD008325. doi: 10.1002/14651858.CD008325.pub2.

    PubMed 27113258
  • Ahern MM, Dean LV, Stoddard CC, Agrawal A, Kim K, Cook CE, Narciso Garcia A. The Effectiveness of Virtual Reality in Patients With Spinal Pain: A Systematic Review and Meta-Analysis. Pain Pract. 2020 Jul;20(6):656-675. doi: 10.1111/papr.12885. Epub 2020 May 21.

    PubMed 32196892
  • Li R, Li Y, Kong Y, Li H, Hu D, Fu C, Wei Q. Virtual Reality-Based Training in Chronic Low Back Pain: Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Med Internet Res. 2024 Feb 26;26:e45406. doi: 10.2196/45406.

    PubMed 38407948
  • Guo Q, Zhang L, Han LL, Gui C, Chen G, Ling C, Wang W, Gao Q. Effects of Virtual Reality Therapy Combined With Conventional Rehabilitation on Pain, Kinematic Function, and Disability in Patients With Chronic Neck Pain: Randomized Controlled Trial. JMIR Serious Games. 2024 Apr 24;12:e42829. doi: 10.2196/42829.

    PubMed 38656775

Questions about this trial

What is this clinical trial studying?

A study testing Back school education integrated with a VR headset in people with Chronic Back and Leg Pain, run by Hacettepe University at 1 site in Turkey (Türkiye).

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 5 inclusion and 7 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 25 Mar 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Turkey (Türkiye). Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Pain intensity (time frame: At baseline and immediately post-intervention (4 weeks)). The study lists 5 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT07492784, which also lists 23 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 25 Mar 2026.

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