Virtual Reality Program for Managing Chronic Neck Pain

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).

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