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Physical exercise is a common treatment for people with low back pain (LBP). Wearable sensors that provide feedback on body movements and posture during exercise may enhance postural balance and motor control in people with LBP.BACKGROUNDPhysical exercise is a common treatment for people with low back pain (LBP). Wearable sensors that provide feedback on body movements and posture during exercise may enhance postural balance and motor control in people with LBP.This study aims to investigate whether physical exercising with postural feedback (EPF) improves postural balance, motor control, and patient-reported outcomes in people with LBP.OBJECTIVEThis study aims to investigate whether physical exercising with postural feedback (EPF) improves postural balance, motor control, and patient-reported outcomes in people with LBP.The study was an assessor-blinded 2×2 factorial trial. We planned to recruit 80 participants with nonspecific LBP who did not receive treatment for LBP. In addition, we aimed to recruit 40 patients with chronic, nonspecific LBP who were receiving exercise therapy (ET) at the University Hospital Zurich. Both ET patients and participants without treatment were randomized to receive either an additional EPF intervention or no additional intervention. This resulted in four different combinations of interventions: ET+EPF, ET, EPF, and no intervention. The participants underwent outcome assessments at inclusion (T1); 3 weeks later, at randomization (T2); after an intervention period of 3 weeks with a predefined exercise schedule for participants receiving EPF (T3); and after an additional 6 weeks, during which participants assigned to the EPF groups could exercise as much as they wished (T4). Patients receiving ET completed their regularly prescribed therapies during the study period. Balance was assessed during quiet standing on a force platform, and motor control was assessed during a lifting task and a waiter's bow task. Physical activity was recorded using an activity tracker and the participants' mobile phones during the study. The predefined EPF schedule consisted of nine sessions of 20 minutes of exercise with a tablet and inertial measurement unit sensors at home. Participants performed a series of trunk and hip movements and received feedback on their movements in a gamified environment displayed on the tablet.METHODSThe study was an assessor-blinded 2×2 factorial trial. We planned to recruit 80 participants with nonspecific LBP who did not receive treatment for LBP. In addition, we aimed to recruit 40 patients with chronic, nonspecific LBP who were receiving exercise therapy (ET) at the University Hospital Zurich. Both ET patients and participants without treatment were randomized to receive either an additional EPF intervention or no additional intervention. This resulted in four different combinations of interventions: ET+EPF, ET, EPF, and no intervention. The participants underwent outcome assessments at inclusion (T1); 3 weeks later, at randomization (T2); after an intervention period of 3 weeks with a predefined exercise schedule for participants receiving EPF (T3); and after an additional 6 weeks, during which participants assigned to the EPF groups could exercise as much as they wished (T4). Patients receiving ET completed their regularly prescribed therapies during the study period. Balance was assessed during quiet standing on a force platform, and motor control was assessed during a lifting task and a waiter's bow task. Physical activity was recorded using an activity tracker and the participants' mobile phones during the study. The predefined EPF schedule consisted of nine sessions of 20 minutes of exercise with a tablet and inertial measurement unit sensors at home. Participants performed a series of trunk and hip movements and received feedback on their movements in a gamified environment displayed on the tablet.The first participant was recruited in May 2019. Data collection was completed in October 2020, with 3 patients and 32 eligible people without therapy who passed the eligibility check.RESULTSThe first participant was recruited in May 2019. Data collection was completed in October 2020, with 3 patients and 32 eligible people without therapy who passed the eligibility check.Although it will not be possible to investigate differences in patients and people without other therapies, we expect this pilot study to provide insights into the potential of EPF to improve balance in people with LBP and adherence to such interventions.CONCLUSIONSAlthough it will not be possible to investigate differences in patients and people without other therapies, we expect this pilot study to provide insights into the potential of EPF to improve balance in people with LBP and adherence to such interventions.DERR1-10.2196/26982.INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)DERR1-10.2196/26982.

BackgroundOne-size-fits-all interventions reduce chronic low back pain (CLBP) a small amount. An individualised intervention called cognitive functional therapy (CFT) was superior for CLBP compared with manual therapy and exercise in one randomised controlled trial (RCT). However, systematic reviews show group interventions are as effective as one-to-one interventions for musculoskeletal pain. This RCT investigated whether a physiotherapist-delivered individualised intervention (CFT) was more effective than physiotherapist-delivered group-based exercise and education for individuals with CLBP.Methods206 adults with CLBP were randomised to either CFT (n=106) or group-based exercise and education (n=100). The length of the CFT intervention varied according to the clinical progression of participants (mean=5 treatments). The group intervention consisted of up to 6 classes (mean=4 classes) over 6–8 weeks. Primary outcomes were disability and pain intensity in the past week at 6 months and 12months postrandomisation. Analysis was by intention-to-treat using linear mixed models.ResultsCFT reduced disability more than the group intervention at 6 months (mean difference, 8.65; 95% CI 3.66 to 13.64; p=0.001), and at 12 months (mean difference, 7.02; 95% CI 2.24 to 11.80; p=0.004). There were no between-group differences observed in pain intensity at 6 months (mean difference, 0.76; 95% CI -0.02 to 1.54; p=0.056) or 12 months (mean difference, 0.65; 95% CI -0.20 to 1.50; p=0.134).ConclusionCFT reduced disability, but not pain, at 6 and 12 months compared with the group-based exercise and education intervention. Future research should examine whether the greater reduction in disability achieved by CFT renders worthwhile differences for health systems and patients.Trial registration number ClinicalTrials.gov registry (NCT02145728).

Purpose To evaluate the effect of a multidisciplinary rehabilitation programme on disability, kinesiophobia, catastrophizing, pain, quality of life and gait disturbances in patients with chronic low back pain (CLBP). Methods This was a parallel-group, randomised, superiority-controlled pilot study in which 20 patients were randomly assigned to a programme consisting of motor training (spinal stabilising exercises plus usual-care) and cognitive–behavioural therapy (experimental group, 10 subjects) or usual-care alone (control group, 10 subjects). Before treatment, 8 weeks later (post-treatment), and 3 months after the end of treatment, the Oswestry Disability Index, the Tampa Scale for Kinesiophobia, the Pain Catastrophizing Scale, a pain numerical rating scale, and the Short-Form Health Survey were assessed. Spatio-temporal gait parameters were also measured by means of an electronic walking mat. A linear mixed model for repeated measures was used for each outcome measure. Results The programme had significant group ( p  = 0.027), time ( p  < 0.001), and time-by-group interaction ( p  < 0.001) effects on disability, with the experimental group showing an improvement after training of about 61 % (25 % in the control group). The analyses of kinesiophobia, catastrophizing, and the quality of life also revealed significant time, group, and time-by-group interaction effects in favour of the experimental group, and there was a significant effect of time on pain. Both groups showed a general improvement in gait parameters, with the experimental group increasing cadence significantly more. Conclusion The multidisciplinary rehabilitation programme including cognitive–behavioural therapy was superior to the exercise programme in reducing disability, kinesiophobia, catastrophizing, and enhancing the quality of life and gait cadence of patients with CLBP.

The importance of incorporating lumbo-pelvic stability core and controlling motor exercises in patients with chronic low back pain (CLBP) reinforces the use of strategies to improve biopsychosocial beliefs by reducing biomedical postulations. However, clinical practice guidelines recommend multimodal approaches incorporating exercise and manual therapy (MT), and instead reject the application of kinesiotape (KT) in isolation. Therefore, the objectives of this study were to analyze the effects of 12 weeks of exercises combined with MT or KT on perceived low back pain using the visual analog scale (VAS) and muscle electric activity measured with electromyography (EMG) of the rectus abdominis and multifidus in CLBP (mild disability) and to explore the relationship between the rectus abdominis and multifidus ratios and pain perception after intervention. A blinded, 12-week randomized controlled trial (RCT) was carried out, involving three parallel groups of patients with CLBP. The study was registered at Clinicaltrial.gov and assigned the identification number NCT05544890 (19/09/22). The trial underwent an intention-to-treat analysis. The primary outcome revealed a multimodal treatment program supplemented by additional therapies such as MT and KT, resulting in significant reductions in perceived low back pain. The subjective assessment of individuals with CLBP indicated no discernible distinction between exclusive core stability exercises and control-motor training when combined with MT or KT. Notably, our findings demonstrated positive alterations in both the mean and peak EMG values of the right rectus abdominis in the exercise group, suggesting a beneficial impact on muscle activation. This study focused on assessing the activation levels of the trunk musculature, specifically the rectus abdominis (RA) and multifidus (MF), in individuals with CLBP exhibiting mild disability according to the Oswestry Disability Index. Importantly, improvements in the VAS values were observed independently of changes in muscle electrical activity.

Structured exercise programs delivered via telemedicine have the potential to benefit patients with chronic low back pain (CLBP). However, evidence-practice gaps exist, such as low exercise adherence and lack of attention to the mental health of CLBP, so further research is needed to investigate the impact of telemedicine-supported structured exercise program on patients with CLBP. To compare the clinical outcomes of patients with CLBP following a telemedicine intervention versus usual care therapy. An open label, randomized controlled trial (RCT) was conducted over eight weekly sessions. Participants with CLBP were randomly assigned to either the Experimental Group (EG) or the Control Group (CG) in a 1:1 ratio, using a randomized numeric table. The EG received an intervention consisting of patient education, health coaching, and structured exercise program delivered through mobile health (mHealth) apps. The CG received usual care therapy, including patient education and paper handouts describing home exercises. The outcome measures included disability, pain intensity, mental health status, quality of life, walking ability, and exercise adherence. These were evaluated using the Roland Morris Disability Questionnaire (RMDQ), the Numerical Rating Scale (NRS), Depression-Anxiety-Stress Scale (DASS21), 12-item Short Form Health Survey (SF-12), Time Up and Go (TUG), and Exercise Adherence Rating Scale (EARS), respectively. Linear mixed-effects model analysis was conducted at baseline, after 4 weeks (during treatment), and after 8 weeks (post-treatment), adhering to the principles of intention-to-treat (ITT) analysis. The study included a total of 78 participants, with 39 randomly assigned to each group. Changes were significantly different between groups at 8 weeks in disability (estimated value: -3.96, 95% CI: -5.45 to -2.47, P < 0.001), pain (estimated value: -1.69, 95% CI: -2.14 to -1.24, P < 0.001) and the physical health dimensions of quality of life (estimated value: 4.5, 95% CI: 1.29 to 7.71, P = 0.006). However, there were only within-group differences at 8 weeks in mental health status (estimated value: -3.81, 95% CI: -4.99 to -2.63, P < 0.001), mental health dimensions of quality of life (estimated value: 5.01, 95% CI: 2.9 to 7.13, P < 0.001), walking ability (estimated value: -0.92, 95% CI: -1.17 to -0.68, P < 0.001), and exercise adherence (Z: 1.91, P = 0.06) over time. This study suggests that a telemedicine-based structured exercise program is more effective than usual care therapy in improving disability, pain, and physical health dimensions of quality of life in patients with CLBP. Furthermore, the telemedicine program is equally effective as usual care therapy in enhancing mental health status, mental health dimensions of quality of life, walking ability, and exercise adherence. These findings indicate that implementing such a program could reduce the burden on patients with CLBP. This trial was registered at China Clinical Trial Registration Center with the identifier ChiCTR2300071560.

To assess the cost-effectiveness of acupuncture for pelvic girdle and low back pain (PGLBP) during pregnancy. Pragmatic-open-label randomised controlled trial. Five maternity hospitals. Pregnant women with PGLBP. 1:1 randomization to standard care or standard care plus acupuncture (5 sessions by an acupuncturist midwife). Efficacy: proportion of days with self-assessed pain by numerical rating scale (NRS) ≤ 4/10. Cost effectiveness (societal viewpoint, time horizon: pregnancy): incremental cost per days with NRS ≤ 4/10. Indirect non-healthcare costs included daily compensations for sick leave and productivity loss caused by absenteeism or presenteeism. 96 women were allocated to acupuncture and 103 to standard care (total 199). The proportion of days with NRS ≤ 4/10 was greater in the acupuncture group than in the standard care group (61% vs 48%, p = 0.007). The mean Oswestry disability score was lower in the acupuncture group than with standard care alone (33 versus 38, Δ = 5, 95% CI: 0.8 to 9, p = 0.02). Average total costs were higher in the control group (€2947) than in the acupuncture group (€2635, Δ = -€312, 95% CI: -966 to +325), resulting from the higher indirect costs of absenteeism and presenteeism. Acupuncture was a dominant strategy when both healthcare and non-healthcare costs were included. Costs for the health system (employer and out-of-pocket costs excluded) were slightly higher for acupuncture (€1512 versus €1452, Δ = €60, 95% CI: -272 to +470). Acupuncture was a dominant strategy when accounting for employer costs. A 100% probability of cost-effectiveness was obtained for a willingness to pay of €100 per days with pain NRS ≤ 4.

Exercise therapy is strongly recommended as a treatment for chronic nonspecific low back pain (CNSLBP). However, therapist-guided exercise therapy requires significant medical resources. Ordinary digital telerehabilitation affects efficacy due to a lack of guidance and dynamic support. Artificial intelligence (AI)-assisted interactive health promotion systems may solve these problems. We aimed to explore whether AI-assisted multimodal exercise telerehabilitation is superior to conventional telerehabilitation in the treatment of people with CNSLBP. This study was a prospective, double-arm, open-label, randomized clinical controlled trial. People with CNSLBP were randomly allocated to either the AI or video group, receiving AI-assisted multimodal exercise therapy or conventional video guidance, respectively, via a WeChat application add-in. The multimodal exercise consisted of deep core muscle, flexibility, Mackenzie, and breathing exercises. The exercises were performed for 30-45 minutes per session, 3 times a week, for 4 weeks. Participants underwent face-to-face assessment at baseline and week 4, and web-based assessment at weeks 2 and 8. The primary outcome was the change in Numerical Rating Scale (NRS) relative to baseline at week 4. Secondary outcomes included changes in the Roland-Morris Disability Questionnaire (RMDQ), Oswestry Disability Index (ODI), Pain Castastrophizing Scale (PCS), Timed Up-and-Go (TUG) test, and thickness of the transverse abdominus (TrA) and multifidus (MF) muscles relative to baseline at week 4. Generalized estimating equation and covariance were used to examine the efficacy of the interventions. A total of 38 participants (19 participants per group) were recruited. Eighteen participants in the AI group and 16 participants in the video group completed and were included in the final analysis. There was a significant difference in NRS at week 4 between the AI group and video group (most severe NRS: -3.00 vs -1.50; adjusted mean difference -1.08, 95% CI -1.68 to -0.49; P<.001; mean NRS: -2.61 vs -1.62; adjusted mean difference -0.67, 95% CI -1.19 to -0.15; P=.01). The difference in most severe NRS persisted until week 8 (-3.06 vs -1.69; adjusted mean difference -0.95, 95% CI -1.73 to -0.18; P=.02). Compared with the video group at week 4, the AI group showed significant improvement in secondary outcomes, including RMDQ, PCS, and core muscle thickness of left TrA, right TrA, left MF, and right MF. We showed that 4 weeks of telerehabilitation based on AI-assisted multimodal exercise has better therapeutic effects compared to conventional exercise telerehabilitation in people with CNSLBP. This study provides guidance for developing effective real-time home-based exercise therapies for people with CNSLBP, which may help reduce economic and human resource costs associated with treatment.

Background Patients with chronic low back pain (CLBP) usually demonstrate poor postural control due to impaired core muscle function. Dynamic neuromuscular stabilization (DNS) is based on developmental kinesiology principles, utilizing infant motor patterns to treat motor disorders. DNS has been shown to improve postural control in cerebral palsy patients by activating core muscle. However, whether the DNS approach is superior for enhancing core muscle contractility and postural control in CLBP patients still remains unclear. Objectives This study aimed to compare the effects of DNS training and conventional core exercises on core muscle contractility and standing postural control in CLBP patients. Methods Sixty CLBP patients were randomly assigned to a DNS group or a control group. Participants in the DNS group received DNS training, while those in the control group completed conventional core exercises. Both groups completed 12 sessions over 4 weeks (3 sessions/week, 50 min/session). Pre- and post-intervention evaluations included diagnostic musculoskeletal ultrasound to assess the change rate of core muscles (transversus abdominis (TrA), lumbar multifidus, and diaphragm), a balance assessment system to evaluate postural control performance (center of pressure displacement (COP)), and clinical questionnaires (Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and Roland-Morris Disability Questionnaire (RDQ)) for pain intensity and disability. Results After 4 weeks, comparisons between both groups revealed significant statistical differences in the interaction effects of time*group. These differences were observed in the change rates of the left and right TrA (F 1,58 =4.820 and 3.964, p  = 0.032 and 0.041), diaphragm change rate (F 1,58 =11.945, p  = 0.001), as well as COP velocity (F 1,58 =5.283, p  = 0.025), variability (F 1,58 =13.189, p  = 0.001) in the anterior-posterior (AP) direction, COP path length (F 1,58 =6.395, p  = 0.014), and COP area (F 1,58 =5.038, p  = 0.029) in the eye-closed condition. DNS participants showed significantly greater muscle change rates and reduced COP ( p  < 0.05). The scores of VAS (F 1,58 =173.929, p  = 0.001), ODI (F 1,58 =60.871, p  = 0.001), and RDQ (F 1,58 =60.015, p  = 0.001) decreased significantly over time, although no group differences were found between both groups ( p  > 0.05). Conclusions DNS is superior to conventional core exercises in enhancing core muscle contractility and standing postural control in CLBP patients, showing potential to reduce pain and improve disability. Its mechanism may involve the enhancement of proprioceptive feedback, particularly when visual feedback is blocked. Trial registration This study was registered in the Chinese Clinical Trial Registry (ChiCTR) with the registration number ChiCTR2300074595 on 10 August 2023.