161833 20251017144554.0 doi 10.1186/s12984-025-01664-2 sideral 144487 ART-2025-144487 eng Jordán-López, Jaime Modifying lumbar flexion pain thresholds in patients with chronic low back pain through visual-proprioceptive manipulation with virtual reality: a cross-sectional study 2025 Access copy available to the general public Unrestricted Study design. Cross-sectional study. Background. Movement-evoked pain may serve as a protective response influenced by visual-proprioceptive cues signaling potentially threatening movements. This study aimed to assess the impact of manipulating visual-proprioceptive feedback using virtual reality (VR) during lumbar flexion on movement-evoked pain thresholds. Additionally, we explored whether individuals with elevated pain, kinesiophobia, and catastrophizing were more susceptible to visual-proprioceptive manipulation. Methods. Fifty participants with non-specific chronic low back pain (cLBP) were included. We assessed lumbar flexion-evoked pain thresholds alongside pain levels, pain interference, kinesiophobia, and catastrophizing. Participants performed lumbar flexion movements in three conditions: (1) without VR (control, F), (2) with a virtual illusion shortening the perceived arm length by 20% (understated condition, F−), and (3) with a virtual illusion elongating arm length by 20% (overstated condition, F +). Range of motion (ROM) was measured using an electro-goniometer. One-way ANOVA with Bonferroni post-hoc tests examined differences among conditions, and three two-sample t-tests explored whether individuals with higher pain, kinesiophobia, and catastrophizing were more affected by visual-proprioceptive manipulation. Results. Understating the flexion task (F−) led to a 5% increase in movement compared to the control (P = 0.04; 95% CI [0.6%, 10.7%]) and a 7% increase compared to the overstated condition (F +) (P < 0.001; 95% CI [2.6%, 11.6%]). Additionally, individuals with higher pain levels and pain interference, exhibited a more pronounced response to the understated condition (F−). Conclusions. Manipulating visual-proprioceptive feedback through VR significantly influenced pain thresholds during lumbar flexion in cLBP patients. The understated condition (F−) extended pain-free movement, delaying pain onset. Furthermore, pain intensity and interference modulated susceptibility to visual feedback manipulation. These findings enhance our understanding of how visual-proprioceptive feedback influences pain perception and movement patterns in cLBP. They suggest new avenues for pain assessment, therapeutic interventions, and clinical strategies, particularly for individuals with high pain levels, interference, kinesiophobia, and catastrophizing. info:eu-repo/grantAgreement/ES/MCINN/PID2020-115609RB-C22 info:eu-repo/semantics/openAccess by-nc-nd https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion Arguisuelas, María D. Doménech, Julio Peñalver-Barrios, M. Lourdes Miragall, Marta Herrero, Rocío Universidad de Zaragoza (orcid)0000-0001-6987-6607 Baños, Rosa M. Amer-Cuenca, Juan J. Lisón, Juan F. 4009 680 Universidad de Zaragoza Dpto. Psicología y Sociología Área Person.Eval.Trat.Psicoló. 22, 1 (2025), 11 pp. J. neuroeng. rehabilitat. Journal of NeuroEngineering and Rehabilitation 1743-0003 1257432 http://zaguan.unizar.es/record/161833/files/texto_completo.pdf Versión publicada 2230824 http://zaguan.unizar.es/record/161833/files/texto_completo.jpg?subformat=icon icon Versión publicada oai:zaguan.unizar.es:161833 articulos driver 2025-10-17-14:12:39 ARTICLE