TITLE: Comparative Effect of virtual reality-based aerobic exercises and circuit-based interval training on endurance and neuropathic pain in person with paraplegia

BACKGROUND

Spinal cord injury (SCI) leads to loss of function, sensation, or movement below the level of injury. This often results in reduced endurance and commonly causes neuropathic pain. It affects 250,000 to 500,000 people globally, particularly males aged 16–30, and can be caused by both traumatic and non-traumatic factors. (1) Almost 60-70% of SCI individual suffered from neuropathic pain. 

Virtual Reality (VR) is a computer-generated simulation that creates immersive or non-immersive environments, allowing users to interact with a virtual world. In rehabilitation, VR provides repetitive, task-oriented, and personalized training that can enhance endurance by promoting sustained physical activity. Additionally, VR-based distraction and sensory feedback can help in neuropathic pain management by reducing pain perception.

Circuit-based interval training is an approach that includes a combination of wheelchair propulsion, punching bag boxing, and arm ergometer hand cycling. These are effective aerobic exercises that improve cardiovascular endurance, strength, coordination, and circulation, while also helping reduce neuropathic pain. Combined in a circuit, they provide a comprehensive approach to enhance endurance, strength, and pain management in spinal cord injury rehabilitation. 

While traditional Circuit-based interval training is an approach that includes a combination of wheelchair propulsion, punching bag boxing, and arm ergometer hand cycling exercises combined in a circuit are well-established in improving cardiorespiratory endurance and reducing neuropathic pain, VR-based rehabilitation offers an interactive and engaging approach that may enhance neuroplasticity, pain modulation, and adherence to therapy. However, there is limited research directly comparing these two methods, making it essential to determine which is more effective, sustainable, and beneficial for long-term rehabilitation. Therefore, this research is vital for advancing evidence-based interventions that enhance endurance and alleviate neuropathic pain for individuals with paraplegia.

OBJECTIVES

1.     To identify the effectiveness of virtual reality based aerobic exercise on endurance and neuropathic pain in person with paraplegia.

2.     To identify the effectiveness of circuit-based interval training on endurance and neuropathic pain in person with paraplegia.

3.     To compare the effect of virtual reality-based aerobic exercises and circuit-based interval training on endurance and neuropathic pain in person with paraplegia.

HYPOTHESIS:

NULL HYPOTHESIS-

H_N1: There is no difference between the effect of virtual reality based aerobic exercise and circuit-based interval training on endurance in person with paraplegia.

H_N2: There is no difference between the effect of virtual reality based aerobic exercise and circuit-based interval training on endurance in person with paraplegia

ALTERNATE HYPOTHESIS-

H_A1: There is a significant difference between the effect of virtual reality based aerobic exercise and circuit-based interval training on endurance in person with paraplegia

H_A2: There is a significant difference between the effect of virtual reality based aerobic exercise and circuit-based interval training on endurance in person with paraplegia..

MATERIALS AND METHODS

STUDY DESIGN: Experimental study design

SAMPLE SIZE: 30 (15 in each group)

(Outcome measure used is Wheelchair Propulsion Test)

Thorat, K. D. (2022). Effectiveness of virtual rehabilitation on functional outcome for wheelchair navigation in patients with spinal cord injury – A pilot study. International Journal of Science and Healthcare Research, 7(2), 322–330. https://doi.org/10.52403/ijshr.20220444

ENROLMENT PERIOD: 6-7 months after RRC and IEC clearance

TOTAL STUDY DURATION: 4 weeks intervention duration.

STUDY PROCEDURES: Patients will be screened based on inclusion and exclusion criteria. They will be enrolled into 2 groups with the help of random allocation software. (Experimental Group 1) will receive virtual reality-based aerobic exercise and conventional physiotherapy for 3 times a week for 4 weeks. (Control Group 2) will receive Circuit-based interval training along with conventional physiotherapy for the same duration.

ASSESSMENT TOOLS: Pre- and post-intervention tests will be carried out using-

·       6 minute push test

·       Wheelchair Propulsion Test

·       International Spinal Cord Injury Pain Basic Data Set

STATISTICAL ANALYSIS PLAN (SAP):

·       DESCRIPTIVE STATISTICS: Descriptive statistics will be used to calculate mean and standard deviation for quantitative variables (such as age, 6 minute push test, Wheelchair Propulsion Test and International Spinal Cord Injury Pain Basic Data Set) and number and percentages for categorical variables (such as gender)

·       ASSUMPTIONS AND DATA PREPARATION: Normality of data will be checked by Shapiro Wilk Test.

·       INFERENTIAL  STATISTICS TO TEST THE HYPOTHESES: If data is found to be normally distributed then to find the mean difference in endurance and neuropathic pain between group ( Virtual Reality group and Circuit based interval  training group) will be examined by using T test (independent ) and dependent t test used within groups

·       If the data is found to be skewed then

·       Mann-Whitney U test will be used to check the average difference between endurance and neuropathic pain between the groups.

·       Wilcoxin signed rank test will be used to assess the change in score in 6 minute push test, Wheelchair Propulsion Test and International Spinal Cord Injury Pain Basic Data Set within the group

·       Statistical software analysis of subjects will be performed by using software SPSS 21 for Windows version.

·       Data will be managed and processed in excel before importing into SPSS

·       INTERPRETATION OF RESULTS statistical significance will be assessed using alpha level of 5 %