COMPARATIVE EFFICACY OF VIRTUAL REALITY THERAPY, TELEREHABILITATION, AND CONVENTIONAL PHYSIOTHERAPY FOR PAIN MANAGEMENT IN CHRONIC LOW BACK PAIN: A RANDOMIZED PARALLEL-GROUP TRIAL

Abstract

Background/Context: Chronic low back pain is a leading cause of disability worldwide, and structured exercise remains first-line care. However, evidence comparing virtual reality therapy, telerehabilitation, and conventional physiotherapy is scarce, particularly in Indian settings, warranting this three-arm randomized trial. Methods: This prospective three-arm parallel-group randomized controlled trial enrolled 66 adults aged 25–45 years with chronic low back pain (>12 weeks). Participants were randomized equally to virtual reality therapy, telerehabilitation, or conventional physiotherapy, all receiving an identical six-week exercise protocol delivered via each modality. Pain intensity (Numeric Pain Rating Scale, 0–10) was assessed at baseline and Week 6 by a blinded assessor. Results/Findings: cross arms (Kruskal–Wallis H = 11.22, p = 0.0037; ε²R = 0.146). Virtual reality therapy produced the largest median reduction (4.0 NPRS points; 56.5%), exceeding conventional physiotherapy by 1.00 point (95% CI 1.00–2.00; p = 0.0019) — the only pairwise comparison surviving Bonferroni correction. Telerehabilitation (3.0 points; 54.4%) and conventional physiotherapy (3.0 points; 44.7%) did not differ significantly from either comparator arm, though all three arms improved from baseline (p < 0.001). Conclusion/Implications: Virtual reality therapy significantly outperformed conventional physiotherapy for chronic low back pain, with telerehabilitation offering comparable benefit. Digital-first delivery is clinically effective and scalable, informing guideline development and resource allocation for pain management where access to in-person rehabilitation is limited.