The goal of this clinical trial is to evaluate the feasibility, safety, and initial effectiveness of a new augmented reality (AR) system in adults over 18 years old suffering from chronic low back pain and kinesiophobia (fear of movement).

The main questions it aims to answer are:

Is the AR system safe to use and well-tolerated by participants without causing significant motion sickness or discomfort?

Can the visual "illusion" provided by the AR technology help patients increase their range of motion and reduce their fear of bending forward?

Participants will:

• Perform 10 to 12 repetitions of spinal bending exercises while wearing an AR headset that shows a video of them moving further than they actually are.
• Complete questionnaires regarding their pain levels, physical disability, and fear of movement.
• Report any symptoms of "cybersickness" (like dizziness or nausea) experienced during the use of the technology.
• Participate in a brief interview to discuss their experience, how they felt using the device, and provide suggestions for improvement.

Background and Scientific Rationale Chronic low back pain (CLBP) is frequently associated with kinesiophobia, an irrational and debilitating fear of physical movement rooted in the anticipation of pain. This fear often leads to avoidance behaviors, which further limit functional recovery and perpetuate disability. While traditional physical therapy is the standard of care, it often struggles to bypass these psychological barriers. This study explores the use of "AnReal," a novel rehabilitation system that integrates augmented reality (AR) and computer vision to facilitate movement through sensory recalibration.

The AnReal Technology The intervention utilizes an Android-based mobile application paired with a low-cost virtual reality headset. The system employs computer vision algorithms to track the patient's spinal flexion in real-time. The core technical innovation is a visual feedback loop: as the patient performs a forward bending motion, the AR interface generates a visual illusion-via a synchronized video-showing the patient's body continuing the movement beyond their actual physical limit.

Study Procedures

Healthy participants and low back pain patients undergo a session consisting of 10 to 12 repetitions of spinal forward bending guided by the AnReal system. During each repetition, the technology tracks the peak angle of flexion and provides real-time visual cues to encourage progress. Following the physical task, a mixed-methods approach is used to evaluate the experience:

• Quantitative Assessment: Evaluation of cybersickness symptoms and user experience scores.
• Qualitative Assessment: Semi-structured interviews to capture perceptions of safety, movement harmony, and the convincing nature of the visual illusion.

This pilot trial focuses on establishing the feasibility and safety of this task-specific AR tool as a potential complement to traditional physical therapy

Inclusion Criteria:

• Participants must be over 18 years old.
• For the pilot phase: Healthy volunteers with no chronic pathologies or musculoskeletal conditions
• For the clinical phase: Diagnosis of non-specific chronic low back pain (CLBP) lasting longer than three months.
• For the clinical phase: Presence of less than 40 degrees of spinal forward bending movement.

Exclusion Criteria:

• History of spine surgery.
• Diagnosis of vestibular disorders.
• Diagnosis of Meniere's syndrome

The study population consists of two distinct groups recruited for a proof-of-concept and a feasibility trial. The first group includes healthy adult volunteers used for the initial technical validation of the system. The primary clinical group consists of adult patients suffering from non-specific chronic low back pain and kinesiophobia, specifically characterized by a significant limitation in spinal range of motion. All participants were evaluated in a controlled research environment to assess the safety and performance of the AR technology

The small sample size of this pilot study and the qualitative nature of part of the data make it difficult to share de-identified data while fully ensuring participant privacy.