Effects of Virtual Walking on Chronic Pain and Psychological Distress for Individuals With Severe Mobility Impairment

Background: Severe mobility impairment (SMI) negatively impacts lifespan and quality oflife, especially through chronic pain and emotional issues such as depressive symptoms.Researchers have developed treatments including pharmacological interventions, physicalactivities, complementary and alternative medicine, and psychological treatment to treatchronic pain and emotional issues. However, these approaches have limitations. Virtualwalking interventions utilize arm‐swing locomotion to create the illusion of walking,allowing individuals to experience walking in virtual natural scenes. These interventionshave shown feasibility and preliminary effects on mood and pain reduction in people withspinal cord injury. However, prior work varies in locomotion design (e.g., passiveobserving, trigger‐based, or arm‐swing), dosage (session length and total dose), and afew studies incorporate objective biomarkers like EEG to test neurological mechanisms.Thus, this study aims to examine the effects of virtual walking on chronic pain andpsychological distress and to explore the neurological mechanisms of virtual walkingusing the resting‐state and task‐based EEG.Design:This study will be a single‐blind, two‐arm, parallel‐group pilot randomized controlledtrial (RCT).Participants and Subgroup Stratification:Forty‐eight participants experiencing chronic pain will be recruited from the Hong KongPolytechnic University. At baseline, all recruited participants will be screened forneuropathic pain using the Douleur Neuropathique 4 Questions (DN4) questionnaire.Participants who score ≥4 will be classified into a neuropathic pain subgroup. Tofacilitate mechanism‐based subgroup analysis in the EEG data processing, onlyparticipants in this specific subgroup will undergo an additional Quantitative SensoryTesting (QST, Medoc) at baseline. Besides, another healthy control group will be added toprovide a normative reference for exploratory mechanistic analyses.Interventions:Participants will be randomly assigned to one of two arms: ‐ Virtual walking group: Participants will engage in an arm‐swing virtual walkingintervention. This consists of a 13‐minute session daily for 10 days. ‐ Control group: Participants will receive a time‐matched passive video observingcontrol, watching walking videos for 13 minutes daily for 10 days.Instruments: Validated questionnaires, 64‐channel EEG, and HRV monitoring.Qualitative Evaluation:Following the completion of the intervention, qualitative semi‐structured interviews willbe conducted with participants to explore their perceived effects, strengths, andlimitations of the intervention.