Purpose:
The study compared the influence of Clinic-Based McKenzie Therapy (CBMT) and a Virtual Reality Game (VRG) version on pain intensity, back extensor muscles endurance, activity limitation, participation restriction, fear avoidance belief, kinesiophobia, and general health status of patients with chronic non-specific low-back pain.

Methods:
This quasi-experimental study involved 46 patients (CBMT: n = 24; VRG: n = 22) with ‘directional preference’ for extension, randomized into CBMT or VRG group. Treatment was applied thrice weekly for 8 weeks. Outcomes were assessed at the end of the 4^th and 8^th week. Data analysis employed descriptive and inferential statistics of independent t-test, Mann-Whitney U test, repeated measure ANOVA, Friedman’s ANOVA, and ANCOVA. The significance level was set as α = 0.05.

Results:
There were no significant differences in the treatment outcomes (mean change) across the groups (p > 0.05), except for kinesiophobia, where VRG led to a significantly higher decline in mean rank at week 4 (28.3 vs. 19.1; p = 0.018) and 8 (28.7 vs. 18.7; p = 0.009), and vitality (a general health status item) at week 4 (27.6 vs. 19.8; p = 0.042) and 8 (28.1 vs. 19.3; p = 0.042). ANCOVA showed that significant baseline parameters were not significant predictors of vitality (F = 1.986; p = 0.070) or kinesiophobia (F = 0.866; p = 0.563) outcomes.

Conclusions:
The VRG mode of McKenzie therapy is comparable with the clinic-based approach in most outcomes. VRG has a superior effect on kinesiophobia, but may take a higher toll on vitality/energy.