Journal of Modern Medical

Introduction
Low back pain (LBP) is one of the most common musculoskeletal disorders among older adults and the leading cause of functional decline and disability across the world [1, 2]. Studies have reported a linear relationship between age and prevalence of LBP [3]. Chronic LBP is associated with muscular and sensory changes [4] that can significantly affect physical functioning [5], reduce the quality of life (QoL), impair balance [6], and increase the risk of falling and hospitalization [4] in older people. Falling in older adults is a considerable public health issue. The most serious consequences of falling include fractures, increased dependence, and hospitalization, which are associated with increased morbidity and mortality [7]. Physical activity using virtual reality training (VRT) is a useful intervention for improving the physical function of the elderly [8], especially those with chronic LBP. Therefore, this study aims to determine the effect of eight weeks of VRT on the QoL and risk of falling in older men with non-specific LBP.

Methods
In this quasi-experimental study, 30 elderly men with non-specific LBP in Hamedan, Iran participated in two groups of VRT and control. The inclusion criteria were age 60-80 years, experiencing LBP in the past six months, no history of spinal surgery, no neurological disorders such as Alzheimer’s disease, multiple sclerosis, and Parkinson’s disease, and no musculoskeletal disorders such as severe rheumatoid arthritis. Those with a history of cardiorespiratory conditions, visual impairment, VRT, absence from the training sessions, and unwillingness to continue participation were excluded from the study.
Baseline assessments included fall risk assessment using the Biodex balance system (BBS), and QoL evaluation using the 36-Item short form health survey (SF-36) which has eight dimensions: Physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional, and mental health. The total score ranges from 0 to 100, where the highest score indicates better health status [9]. After completing the baseline assessments, the VRT group received the intervention program for eight weeks (three sessions per week, each for 30-45 minutes). The control group did not receive any treatments during this period. After 8 weeks, the post-test assessments were performed using the tools used at baseline. One-way analysis of covariance (ANCOVA) was performed to compare the effects of the VRT program on dependent variables. The significance level was set at 0.05.

Results
The demographic characteristics of the participants are presented in Table 1.


The results of ANCOVA to compare the effects of VRT on the risk of falling and QoL are given in Table 2.



Conclusion
This purpose of this study was to determine the effect of eight weeks of VRT on QoL and risk of falling in older men with chronic LBP. The results showed that after performing the VRT, the QoL increased and the risk of falling significantly decreased compared to the control group.
The results indicate the beneficial effects of VRT as an available and interesting intervention method for reducing the risk of falling (by improving balance) and QoL in the elderly with chronic LBP; therefore, this intervention is recommended for this group. It is recommended that future studies compare the effectiveness of VRT with that of sports protocols designed for the elderly. The lack of study on the durability of the effects of VRT is one of the limitations of the present study; therefore, it is recommended that future studies follow up the effects of VRT. Our results can be helpful for the therapists, physiotherapists, and those in contact with the elderly.

Ethical Considerations
Compliance with ethical guidelines
This project was approved by the local Ethics Committee of Bu-Ali Sina University (Code IR.BASU.REC.1399.035) and listed in the Iranian Registry of Clinical Trials (IRCT) (Code. IRCT20200204046368N7).

Funding
This article was done with the financial support of the Research and Technology Vice-Chancellor of Bu-Ali Sina University.

Authors' contributions
Conceptualization, funding acquisition and Supervision: Ali Yalfani; Methodology: Ali Yalfani, Meysam Sahab Gholifar and Azadeh Asgarpoor Kaji; Investigation: Ali Yalfani, Meysam Sahab Gholifar, Zahra Raeisi; Writing the original draft, review & editing: Ali Yalfani and Zahra Raeisi; Resources: All author.

Conflicts of interest
The authors declared no conflicts of interests.


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