741: “I reckon I could pedal for hours”: Experiences of Mediated Reality for Knee Osteoarthritis

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic primary musculoskeletal pain, Non-pharmacological treatments, Physiotherapy (e.g. exercise, rehab)

Background and Aims: Exercise is effective for managing knee osteoarthritis (OA) pain. However, while exercise reduces pain in the long-term, it is often painful in the short-term, presenting a barrier to engagement. Mediated reality (MeR) shows promising effects in knee OA, with bodily illusions that alter the viewed morphology of the knee reducing pain by ~40% (1). MeR technology may allow people with knee OA to exercise with less pain, improving engagement. Despite its potential, clinical translation of an MeR intervention has yet to be explored. This qualitative study aimed to investigate participant experiences of a novel MeR, exercise, and pain-science education intervention.

Methods: Thirty people with painful knee OA (44% female, 68±6 years) completed 8 sessions (each 60-minutes) over 4-weeks with an allied health professional, where they received pain-science education (PSE) via standardised videos, self-paced cycling, and MeR bodily illusions (knee joint stretch illusion delivered at rest, and a strong-leg illusion [superimposing muscled legs over their own] provided during cycling). Semi-structured phone interviews were completed post-intervention to capture participants’ experience with MeR. Interviews were transcribed verbatim, and content analysis was undertaken. One author (SD) first derived inductive codes, which were deductively grouped by two authors (SD, EM). Counts of grouped data are reported.

Results: Overall, participants reported enjoying the intervention (n=28), with many inspired to continue exercising (n=13), feeling hopeful for their OA future (n=8), and no longer believing they would need a knee replacement (n=4). Participants reported that the PSE videos helped them learn something new (n=4) and positively changed their beliefs about exercise/knee OA (n=5). Many participants reported that the MeR improved their knee OA pain/stiffness (n=11) and/or exercise capabilities (n=14). Participants identified several areas for improvement including: improving exercise equipment comfort (n=12); refining PSE videos (n=11); increasing MeR immersion (n=9); spreading awareness about MeR and exercise (n=9); and enhancing accessibility (n=7).

Conclusions: Participants reported positive experiences of the intervention and found each component provided complementary and unique benefits (i.e., education changed beliefs around exercise, MeR reducing knee OA pain/stiffness making exercise easier). Such feedback suggests that pairing PSE and MeR can enhance cycling engagement in those with painful knee OA, and that this intervention is credible and acceptable within this population. Participants suggested minor improvements to intervention equipment and content, which should be considered prior to further evaluation of the intervention. Together, feedback supports progression to a larger randomised controlled trial to fully evaluate intervention effectiveness.

References: Stanton, T. R., Gilpin, H. R., Edwards, L., Moseley, G. L., & Newport, R. (2018). Illusory resizing of the painful knee is analgesic in symptomatic knee osteoarthritis. PeerJ, 6, e5206.

Presenting Author: Stephanie Dumuid
Submitting Author: Stephanie Dumuid

Senior Author: Tasha R Stanton

IASP 2026 Global Year theme of Neuropathic Pain: No

• Erin MacIntyre: PhD - Persistent Pain Research Group, Hopwood Centre for Neurobiology, Lifelong Health Theme, South Australian Medical Research Institute (SAHMRI), Adelaide, Australia
• Roger Newport: PhD - School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
• Oliver Davis: Bachelor - IIMPACT in Health, Adelaide University, Adelaide, Australia
• Zina Trost: PhD - Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, USA
• Ami Lisbee: Bachelor - Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, USA
• Luana Colloca: PhD - Department of Pain Translational Symptoms Science, School of Nursing, University of Maryland, Baltimore, MD, United States
• Mathew Avedano: Bachelor - Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, USA
• Tasha R Stanton: PhD - Persistent Pain Research Group, Hopwood Centre for Neurobiology, Lifelong Health Theme, South Australian Medical Research Institute (SAHMRI), Adelaide, Australia