Effects of dynamic neuromuscular stabilization with and without immersive virtual reality on pain, postural, and functional outcomes in women with lumbar hyperlordosis and chronic non-specific low back pain: a randomised controlled trial
Journal of Orthopaedic Surgery and Research · 9 Oct 2026
† Impact is the editorial-priority score. All scores are out of 100. Clinical is a stored clinical-importance score from the earlier method; it has not been recalculated.
Why it matters
Core motor-control exercise programmes are a mainstay for chronic non-specific low back pain, and this trial tests whether a consumer VR headset adds measurable value on top of them.
The evidence
This single-centre randomised trial assigned 45 women aged 30 to 50 with an exaggerated lumbar curve (hyperlordosis) and chronic non-specific low back pain to six weeks of dynamic neuromuscular stabilization (DNS) exercises, DNS plus immersive virtual reality (VR) dodgeball, or no treatment. Both exercise groups improved pain, balance, lumbar position sense, range of motion and lordosis angle compared with untreated controls. Adding VR gave a slightly larger pain reduction than DNS alone (mean difference -0.74 cm on a 10 cm VAS, 95% CI -1.49 to 0.00, p = 0.050), which was not statistically significant. It did give modestly better lordosis angle (about 2.6 degrees) and some balance indices.
A coherent primary effect estimate is unavailable. Clinical relevance does not estimate treatment benefit.
Why this rigour score?
RCTDesign starting point: 59.5
Raised the score
- Adequately powered+6
- Concealed allocation+5.1
Lowered the score
- Per-protocol analysis only−6
- 10% loss to follow-up−1.2
Score capped at 55. The conclusion asserts a benefit the primary outcome did not show.
Methods at a glance
Recorded assessment- Outcome assessors blindedNot reported
- Allocation concealedMet
- Random sequence generatedMet
- Intention-to-treat analysisNot met
- Adequate statistical powerMet
- Prospective registrationMet
Not reported does not mean not done. Checks have different weights; this is not a count of boxes ticked.
See the full score breakdown
- Study design starting point
- 59.5
- Concealed allocation
- +5.1
- Random sequence generation
- +2.5
- Compared against an accepted alternative
- +1.7
- Per-protocol analysis only
- −6
- 10% loss to follow-up
- −1.2
- Adequately powered
- +6
- Prospectively registered
- +5.1
- Methodological cap
- −17.7
- Final rigour score rounded
- 55 / 100
Study design sets the starting point and a ceiling of 96. Recorded methods then adjust the score. Points are shown to one decimal place; the final score uses unrounded values.
Checklist from the stored appraisal. “Not met” describes the recorded criterion; it does not always produce a deduction. This overview supports reading the full study.
For journal club
1.For a woman with chronic non-specific low back pain and hyperlordosis, how would you counsel her about choosing a supervised stabilization programme with or without a VR component, given the small added pain benefit?
2.Should a few degrees of change in lumbar lordosis angle influence treatment decisions or follow-up in chronic low back pain, when pain and function are what patients care about?
Original publication title
Effects of dynamic neuromuscular stabilization with and without immersive virtual reality on pain, postural, and functional outcomes in women with lumbar hyperlordosis and chronic non-specific low back pain: a randomized controlled trial