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

This randomized controlled trial aims to: (1) examine the effects of virtual walking intervention on chronic pain (primary outcome), and on depression, stress, anxiety, and quality of life (secondary outcomes) compared with the passive observing video control group in individuals with SMI (primarily spinal cord injury and post-polio); (2) explore the neurological mechanism of virtual walking intervention using the resting-state and task-based electroencephalography (EEG); (3) understand their perceived effects, strengths, and limitations for the virtual walking intervention using semi-structured focus group interviews.

Inclusion Criteria: * People with SMI (the operational definition of SMI is inability to walk 4 meters in less than 10 seconds, or self-, proxy-, or medical record reported inability to walk across a small room, or dependence on a walking aid during walking for more than 6 months (Pahor et al., 2014)); * At least 6 months post-injury and in stable status; * Persistent chronic pain (more than 3 months) with a reported Numerical Pain Rating Scale ≥ 4 (Villiger et al., 2017); * Had no changes in their pain medication regimen in the past month; * Able to communicate in Cantonese and to provide informed consent. Exclusion Criteria: * Have severe cognitive impairment (a score \< 6 on the Abbreviated Mental Test (Chu et al., 1995)); * Had a history of moderate to severe brain injury; * Have neurological disorders which affect brain function (i.e., stroke, Alzheimer's, Parkinson's, epilepsy) that may confound EEG measures; * Have a severe psychiatric disorder (schizophrenia or major depression); * Have an upper limb condition influencing the use of VR (e.g., arthritis or upper limb amputation).