Immersive virtual reality versus cervical mobilization: The effects on joint position sense and pain for chronic neck pain - a randomized controlled trial

Background: Joint position sense (JPS) deficits and pain are among symptoms observed in patients with chronic neck pain (CNP). Objective: To examine the effects of immersive virtual reality (VR) and cervical mobilization (CM) on JPS and pain in patients with CNP. Methods: This randomized controlled study included 45 patients with CNP, aged 18 to 65. Patients were divided into three groups: VR+traditional exercise, CM+traditional exercise, and traditional exercise alone. The primary outcomes were JPS and pain. The secondary outcomes were balance, functional disability, global perceived effect, and quality of life. Balance outcomes included baropodometric outcomes, 10-meter walking test, four-square step test, and single leg stance test. All patients completed 10 treatment sessions, with outcomes measured before and after the intervention. Results: There were no statistically significant additional effects of VR or CM on improving JPS or pain relief when added to traditional exercises (p > 0.05). The changes in all balance outcomes, functional disability, and global perceived effect were also similar for the three groups (p > 0.05). The combination of CM or VR and traditional exercises resulted in greater improvement in social function quality of life compared to traditional exercises alone (MD = 21.15, 95 % CI: 9.46, 32.85, Cohen's d = 1.52). Conclusion: The addition of VR or CM to traditional exercises offers no additional benefits for JPS, pain, balance, and function, for individuals with CNP.