Impact of a game-based intervention on chronic low back pain considering the interference of kinesiophobia in middle-aged and older adults

Introduction: Chronic low back pain (CLBP) is a prevalent condition among middle-aged and older adults, causing physical, psychological, and social impairments. Innovative interventions, such as gamified exercise programs, may improve adherence and engagement while reducing pain. Objective: This pre- and post-experimental study analysed the effect of an analog game (gamification of physical exercise) on CLBP and explored how kinesiophobia influences engagement and pain outcomes in middle-aged and older adults. Methods: Twenty-five participants (66.8 ± 13.5 years; 76% female) completed four sessions of the Tree Game, a structured floor-based analog game combining physical, cognitive, and social challenges. Pain intensity was measured with the Numeric Pain Rating Scale (NPRS) at baseline (T0), post-intervention (T1), and after a no-intervention period (T2). Engagement and focus were assessed through post-session open-ended reflections. Baseline kinesiophobia was measured using the Tampa Scale for Kinesiophobia (TSK-13). Results: Pain intensity decreased significantly from T0 to T1 (6.9 ± 2.9 vs. 3.4 ± 2.9, p < 0.001) and remained lower at T2 (4.6 ± 2.5, p < 0.001). Engagement shifted from task execution to cognitive concentration and competitiveness/social interaction across sessions, indicating progressive immersion. No significant interaction was found between baseline kinesiophobia and pain outcomes. Conclusions: The Tree Game effectively reduced pain intensity while promoting cognitive and social engagement. Emphasizing game mechanics and immersive elements may enhance participant involvement, supporting gamified physical interventions as a multifaceted strategy for managing CLBP in older adults.