Feasibility of an Augmented Reality Novel Approach for the Rehabilitation of Chronic Low Back Pain Patients With Kinesiophobia

Background and Scientific Rationale Chronic low back pain (CLBP) is frequently associated with kinesiophobia, an irrational and debilitating fear of physical movement rooted in the anticipation of pain. This fear often leads to avoidance behaviors, which further limit functional recovery and perpetuate disability. While traditional physical therapy is the standard of care, it often struggles to bypass these psychological barriers. This study explores the use of "AnReal," a novel rehabilitation system that integrates augmented reality (AR) and computer vision to facilitate movement through sensory recalibration.

The AnReal Technology The intervention utilizes an Android-based mobile application paired with a low-cost virtual reality headset. The system employs computer vision algorithms to track the patient's spinal flexion in real-time. The core technical innovation is a visual feedback loop: as the patient performs a forward bending motion, the AR interface generates a visual illusion-via a synchronized video-showing the patient's body continuing the movement beyond their actual physical limit.

Study Procedures

Healthy participants and low back pain patients undergo a session consisting of 10 to 12 repetitions of spinal forward bending guided by the AnReal system. During each repetition, the technology tracks the peak angle of flexion and provides real-time visual cues to encourage progress. Following the physical task, a mixed-methods approach is used to evaluate the experience:

• Quantitative Assessment: Evaluation of cybersickness symptoms and user experience scores.
• Qualitative Assessment: Semi-structured interviews to capture perceptions of safety, movement harmony, and the convincing nature of the visual illusion.

This pilot trial focuses on establishing the feasibility and safety of this task-specific AR tool as a potential complement to traditional physical therapy

Inclusion criteria

• Participants must be over 18 years old.
• For the pilot phase: Healthy volunteers with no chronic pathologies or musculoskeletal conditions
• For the clinical phase: Diagnosis of non-specific chronic low back pain (CLBP) lasting longer than three months.
• For the clinical phase: Presence of less than 40 degrees of spinal forward bending movement.

Exclusion criteria

• History of spine surgery.
• Diagnosis of vestibular disorders.
• Diagnosis of Meniere's syndrome