OVERCOMING KINESIOPHOBIA TO RESTORE MOVEMENT CONFIDENCE: A RANDOMIZED CONTROLLED TRIAL

Abstract

Background: Chronic pain and kinesiophobia (fear of movement) are major barriers to functional recovery and quality of life. Emerging technologies like immersive virtual reality (VR) offer innovative avenues for non-pharmacological pain management, especially when combined with real-time physiological feedback.Objective: To evaluate the effectiveness of a personalized immersive VR intervention integrated with biofeedback in reducing pain perception and kinesiophobia, and in improving movement confidence in individuals with chronic musculoskeletal pain.Methods: In a randomized controlled trial, 60 participants with chronic musculoskeletal pain and high kinesiophobia were assigned to either an experimental group (personalized VR with biofeedback; n = 30) or a control group receiving standard physiotherapy (n = 30). Outcomes included pain intensity (VAS), kinesiophobia (Tampa Scale), pain self-efficacy (PSEQ), and heart rate variability (HRV), measured at baseline, 8 weeks, and 12 weeks.Results: The experimental group showed significantly greater improvements in pain reduction, decreased kinesiophobia, increased pain self-efficacy, and enhanced HRV compared to the control group (p < 0.01). The immersive VR environment, customized to patient-specific fear profiles and physical capacity, facilitated gradual exposure and motor engagement, while biofeedback supported real-time physiological regulation.Conclusion: Personalized immersive VR integrated with biofeedback is an effective adjunct to physiotherapy for chronic pain desensitization and movement confidence enhancement. These results highlight the potential of technology-driven interventions to address both the physical and psychological components of chronic pain.