A meta-analysis of core stability exercise versus general exercise for chronic low back pain

Targeted multifidus muscle activation reduces fibrosis of multifidus muscle following intervertebral disc injury

PURPOSE

Aerobic exercise produces beneficial outcomes in patients with low back pain and partially attenuates the fibrotic changes to the multifidus in a model of intervertebral disc (IVD) degeneration. More targeted exercise might be required to fully attenuate these fibrotic alterations. This study aimed to investigate whether activation of the multifidus induced by neurostimulation could reduce fibrosis of the multifidus in a model of IVD degeneration in sheep.

METHODS

IVD degeneration was induced in 18 merino sheep via a partial thickness unilateral annulus fibrosus lesion to the L1/2 and L3/4 IVDs. All sheep received an implantable neurostimulation device that provides stimulation of the L2 medial branch of the dorsal ramus. Three months after surgery, the animals were assigned to Injury or Activated groups. Activated animals received neurostimulation and the Injury group received no stimulation. Six months after surgery, the multifidus was harvested at L2 and L4. Van Gieson's, Sirius Red and immunofluorescence staining for Collagen-I and -III and quantitative PCR was used to examine fibrosis. Muscle harvested from a previous study without IVD injury was used as a control.

RESULTS

Neurostimulation of the multifidus attenuated IVD degeneration dependent increases in the connective tissue, including Collagen-I but not Collagen-III, compared to the Injury group at L4. No measures of the multifidus muscle at L2, which received no stimulation, differed between the Injury and Activated groups.

CONCLUSIONS

These data reveal that targeted activation of the multifidus muscle attenuates IVD degeneration dependent fibrotic alterations to the multifidus.

"Finding a new normal: the lived experience of persons' journey towards coping with persistent low back pain"

INTRODUCTION

Persistent low back pain (PLBP) is the biggest global cause of disability. Persons with PLBP experience biographic disruption and existential crisis. Guidelines recommend a biopsychosocial approach to management, with the emphasis on coping strategies.

PURPOSE

However, there is a paucity of research exploring the lived experience of persons who self-identify as coping with PLBP.

METHOD

The study used an interpretive phenomenological approach, analyzing transcripts from 1:1 interviews with six persons who self-identify as coping with PLBP. Poetic language was used to elicit empathic, embodied relational understanding and convey a richer understanding of the phenomenon that authentic quotations might not able to reveal.

FINDINGS AND CONCLUSION

Participants' descriptions conveyed the sense of a journey, starting with the loss of a sense of self as they engaged in the pain battle, followed by a transition toward a new 'normal,' in which time, acceptance and trust in their own intuition were meaningful components. Although anxiety and fear were a continued presence, but they became more manageable. Society's role in the coping process was significantly meaningful and is something which requires reflections from therapists' and more widely.

Management of low back pain and lumbosacral radicular syndrome: the Guideline of the Royal Dutch Society for Physical Therapy (KNGF)

BACKGROUND

Significant progress and new insights have been gained since the Dutch Physical Therapy guideline on low back pain (LBP) in 2013 and the Cesar en Mensendieck guideline in 2009, necessitating an update of these guidelines.

AIM

To update and develop an evidence-based guideline for the comprehensive management of LBP and lumbosacral radicular syndrome (LRS) without serious specific conditions (red flags) for Dutch physical therapists and Cesar and Mensendieck Therapists.

DESIGN

Clinical practice guideline.

SETTING

Inpatient and outpatient.

POPULATION

Adults with LBP and/or LRS.

METHODS

Clinically relevant questions were identified based on perceived barriers in current practice of physical therapy. All clinical questions were answered using published guidelines, systematic reviews, narrative reviews or systematic reviews performed by the project group. Recommendations were formulated based on evidence and additional considerations, as described in the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Evidence-to-Decision framework. Patients participated in every phase.

RESULTS

The guideline describes a comprehensive assessment based on the International Classification of Functioning, Disability and Health (ICF) Core Set for LBP and LRS, including the identification of alarm symptoms and red flags. Patients are assigned to three treatment profiles (low, moderate and high risk of persistent symptoms) based on prognostic factors for persistent LBP. The guideline recommends offering simple and less intensive support to people who are likely to recover quickly (low-risk profile) and more complex and intensive support to people with a moderate or high risk of persistent complaints. Criteria for initiating and discontinuing physical therapy, and referral to a general practitioner are specified. Recommendations are formulated for information and advice, measurement instruments, active and passive interventions and behavior-oriented treatment.

CONCLUSIONS

An evidence based physical therapy guideline for the management of patients with LBP and LRS without red flags for physical therapists and Cesar and Mensendieck therapists was developed. Cornerstones of physical therapy assessment and treatment are risk stratification, shared decision-making, information and advice, and exercises.

CLINICAL REHABILITATION IMPACT

This guideline provides guidance for clinicians and patients to optimize treatment outcomes in patients with LBP and LRS and offers transparency for other healthcare providers and stakeholders.

The Effectiveness and Optimal Dose of Resistance Training in Patients With Subacute and Persistent Low Back-Related Leg Pain: A Systematic Review

A subgroup of patients with low back pain (LBP) suffers from low back-related leg pain (LBLP), which can be classified as radicular pain, or somatic referred pain without nerve root involvement. LBLP is considered an obstacle to recovery and a strong negative prognostic factor for medium- and long-term disability. In this review, we aimed to investigate the effectiveness and optimal dose of resistance training (RT) in patients with subacute or persistent LBLP to provide clinical recommendations for practice. This systematic review was conducted by adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the recommendations of the Cochrane Collaboration. We conducted a literature search on PubMed, PEDro, Cochrane Library, Scopus, and Web of Science databases. Only randomized controlled trials (RCTs) involving patients ≥18 years of age were included. The risk of bias in the included studies was assessed using "the Cochrane Collaboration's tool for assessing risk of bias" (RoB) and the inter-rater agreement for full-text selection was evaluated using Cohen's Kappa (K). The search elicited a total of 4.537 records, and two RCTs involving a total of 196 participants were identified through a selection process based on title, abstract, and full-text assessment. Both studies had a low to moderate risk of bias. The inter-examiner concordance index for the selection of full text was excellent (K=1). RT seems to be an effective and safe intervention for patients with LBLP, but its long-term effectiveness, superiority over other types of exercise-based therapies, and optimal dosage still constitute a gray area in the literature.

Isometric vs Isotonic Core Stabilization Exercises to Improve Pain and Disability in Patients with Non-specific Chronic Low Back Pain: A Randomized Controlled Trial

Background

Non-specific chronic low back pain (NSCLBP) is a prevalent condition that affects 90% of individuals experiencing low back pain. Core stabilization exercises (CSE) stand out as the most commonly employed therapeutic approach for managing NSCLBP. Nevertheless, there remains uncertainty regarding the superior effectiveness between isometric (ISOM) and isotonic (ISOT) types of CSE in the treatment of NSCLBP.

Objectives

The primary objective of this study was to compare the efficacy of ISOM and ISOT exercises concerning pain and disability in patients with NSCLBP. Additionally, the study aimed to assess the effectiveness of both ISOM and ISOT in comparison to no intervention concerning these variables in these patients.

Methods

This study was a randomized controlled trial that involved 41 men and women experiencing NSCLBP. Participants were randomly allocated to three groups: ISOM CSE (n = 13), ISOT CSE (n = 14), and a waitlist control (n = 14). The exercise training was administered for 40 - 60 minutes three times a week over a period of up to 8 weeks. Pain (assessed using the Visual Analog Scale or VAS) and disability (evaluated through the Oswestry Disability Index or ODI) variables were measured before and after the interventions.

Results

Based on the results, there was no significant difference between the 2 exercise groups (ISOM and ISOT) regarding pain and disability. However, the ISOM group demonstrated numerically better results than the ISOT group. Both the ISOM and ISOT groups exhibited a significant decrease in pain levels, with the VAS score decreasing from 5.5 to 2.7 for ISOM and from 5.8 to 3.7 for ISOT, as compared to the control group (P < 0.001 and P = 0.001, respectively). Additionally, the average disability showed a significant improvement in both the ISOM (ODI score from 17 to 11) and ISOT (ODI score from 15.4 to 11) groups compared to the control group (P < 0.001).

Conclusions

Both ISOM and ISOT methods are effective in alleviating pain and disability in patients with NSCLBP. However, there is no significant difference in the benefits between them. Numerically, ISOM exercises were found to be superior. Further studies are needed to obtain a more accurate answer regarding their superiority.

Core stabilisation exercises reduce chronic low back pain in Air Force fighter pilots: a randomised controlled trial

BACKGROUND

There is evidence that core stabilisation, strength and endurance training contribute to reduce low back pain in the general population. However, we are not aware of the effect of these exercises on fighter aviation pilots. Therefore, the present study aims to investigate the effects of an exercise protocol on chronic low back pain in Brazilian Air Force fighter pilots. Changes in neck pain, lumbar disability, range of motion, strength and resistance were also investigated.

METHODS

Fourteen participants with chronic low back pain were randomised into two groups: stabilisation exercise group (SEG-n=7), exercise protocol twice a week for 12 weeks) and the regular exercise group (REG-n=7), which performed their own usual exercise routine. The evaluations were carried out before and after the training period. The primary outcome was the intensity of low back pain and the secondary outcomes were cervical pain, functional disability, range of motion, maximum isometric strength and trunk muscle resistance.

RESULTS

The SEG had a significant reduction in low back pain compared with the REG (difference of 2.3 points, p=0.04) and a lower rate of cervical pain (difference of 2.5 points, p=0.01) at the end of the protocol. Maintenance of trunk muscle strength was also observed in the SEG over the period, while the REG presented a decrease in flexural strength to the right side (difference between groups: -3.7%, p=0.04). There were no differences in the rates of disability, range of motion or resistance to fatigue between groups.

CONCLUSIONS

The stabilisation exercise programme focused on the core muscles was successful in decreasing the fighter pilots' chronic lumbar pain. Pilots are normally active; however, our results indicate that specific trunk training programmes should be offered considering the work needs of these subjects.

CLINICAL TRIALS

'Exercise protocol for pilots with back pain' (registered: 09 October 2018)-NCT03713814 (https://clinicaltrials.gov/ct2/show/NCT03713814).

Effects of spinal stabilization exercises focusing on the pelvic floor in women with overactive bladder

INTRODUCTION AND HYPOTHESIS

The objective was to investigate the effects of spinal stabilization exercises (SSEs) focusing on the pelvic floor with regard to urinary symptoms, pelvic floor muscle strength (PFMS), core stability, quality of life (QoL), and perception of subjective improvement (PSI) in women with overactive bladder (OAB).

METHODS

Patients were randomly divided into SSE (n=23) and control (n=24) groups. The SSE group received SSEs focusing on the pelvic floor for 3 days a week for 8 weeks and recommendation. The control group received only recommendation. Before (BT) and after treatment (AT), urinary symptoms were evaluated with Overactive Bladder Questionnaire-Version 8 (OAB-V8) and bladder diary. PFMS, core stability, and QoL were assessed using the Modified Oxford Scale (MOS), Sharman test, and King's Health Questionnaire (KHQ) respectively. AT, PSI with a Likert-type scale, and compliance with recommendations using a visual analog scale were assessed.

RESULTS

The OAB-V8 and the KHQ scores, the number of voids per day and voids per night decreased and the MOS and the Sharman scores increased in the SSE group (p<0.05). In the control group, the OAB-V8 and incontinence effect, social limitations, emotional state, and sleep sub-dimension scores related to KHQ decreased (p<0.05). The OAB-V8, role and physical limitations, emotional state, and sleep sub-dimension scores decreased more, and the MOS, the Sharman, the PSI, and the compliance with recommendations scores increased more in the SSE group than in the control group (p<0.05).

CONCLUSIONS

The SSEs focusing on the pelvic floor improved urinary symptoms, PFMS, core stability, QoL, and PSI. This exercise approach may be beneficial in the management of OAB.

Effects of sling exercises on pain, function, and corticomuscular functional connectivity in individuals with chronic low back pain- preliminary study

BACKGROUND

Individuals with chronic low back pain (CLBP) exhibit altered brain function and trunk muscle activation.

AIM

This study examined the effects of sling exercises on pain, function, and corticomuscular coherence (CMC) in healthy adults and individuals with CLBP.

METHODS

Eight individuals with CLBP and 15 healthy adults received sling exercise training for 6 weeks. Before and after training, participants performed two motor tasks: rapid arm lifts and repeated trunk flexion-extension tasks, and electromyography of the trunk muscles and electroencephalography of the sensorimotor cortex were recorded. Chi-squared test and Mann-Whitney U tests were used for between group comparison, and Wilcoxon signed-rank tests were used for pre- and post-training comparison. Spearman's Rank Correlation Coefficient (Rs) was used to identify for the relationship between motor performance and Corticomuscular coherence.

RESULTS

Sling exercises significantly improved pain (median from 3 to 1, p = .01) and Oswestry Disability Index scores (median from 2.5 to 2, p = .03) in the CLBP group. During rapid arm lifts, individuals with CLBP showed lower beta CMC of the transverse abdominis and internal oblique (Tra/IO) (0.8 vs. 0.49, p = .01) and lumbar erector spinae (0.70 vs. 0.38, p = .04) than the control group at baseline. During trunk flexion-extension, the CLBP group showed higher gamma CMC of the left Tra/IO than the control group at baseline (0.28 vs. 0.16 , p = .001). After training, all CMC became statistically non-significant between groups. The training induced improvement in anticipatory activation of the Tra/IO was positively correlated with the beta CMC (rs = 0.7851, p = .02).

CONCLUSION

A 6-week sling exercises diminished pain and disability in patients with CLBP and improved the anticipatory activation and CMC in some trunk muscles. These improvements were associated with training induced changes in corticomuscular connectivity in individuals with CLBP.

Exercise intervention for patients with chronic low back pain: a systematic review and network meta-analysis

Purpose

Chronic low back pain (CLBP) is an aging and public health issue that is a leading cause of disability worldwide and has a significant economic impact on a global scale. Treatments for CLBP are varied, and there is currently no study with high-quality evidence to show which treatment works best. Exercise therapy has the characteristics of minor harm, low cost, and convenient implementation. It has become a mainstream treatment method in clinics for chronic low back pain. However, there is insufficient evidence on which specific exercise regimen is more effective for chronic non-specific low back pain. This network meta-analysis aimed to evaluate the effects of different exercise therapies on chronic low back pain and provide a reference for exercise regimens in CLBP patients.

Methods

We searched PubMed, EMBASE, Cochrane Library, and Web of Science from inception to 10 May 2022. Inclusion and exclusion criteria were used for selection. We collected information from studies to compare the effects of 20 exercise interventions on patients with chronic low back pain.

Results

This study included 75 randomized controlled trials (RCTs) with 5,254 participants. Network meta-analysis results showed that tai chi [standardized mean difference (SMD), -2.11; 95% CI, -3.62 to -0.61], yoga (SMD, -1.76; 95% CI -2.72 to -0.81), Pilates exercise (SMD, -1.52; 95% CI, -2.68, to -0.36), and sling exercise (SMD, -1.19; 95% CI, -2.07 to -0.30) showed a better pain improvement than conventional rehabilitation. Tai chi (SMD, -2.42; 95% CI, -3.81 to -1.03) and yoga (SMD, -2.07; 95% CI, -2.80 to -1.34) showed a better pain improvement than no intervention provided. Yoga (SMD, -1.72; 95% CI, -2.91 to -0.53) and core or stabilization exercises (SMD, -1.04; 95% CI, -1.80 to -0.28) showed a better physical function improvement than conventional rehabilitation. Yoga (SMD, -1.81; 95% CI, -2.78 to -0.83) and core or stabilization exercises (SMD, -1.13; 95% CI, -1.66 to -0.59) showed a better physical function improvement than no intervention provided.

Conclusion

Compared with conventional rehabilitation and no intervention provided, tai chi, toga, Pilates exercise, sling exercise, motor control exercise, and core or stabilization exercises significantly improved CLBP in patients. Compared with conventional rehabilitation and no intervention provided, yoga and core or stabilization exercises were statistically significant in improving physical function in patients with CLBP. Due to the limitations of the quality and quantity of the included studies, it is difficult to make a definitive recommendation before more large-scale and high-quality RCTs are conducted.

Effects of Motor Control Exercises in Patients With Chronic Nonspecific Low Back Pain: A Systematic Review and Meta-Analysis

OBJECTIVE

The primary objective of this systematic review is to assess whether motor control exercises consisting of the methodology described by Richardson and Hodges improve the pain and disability of patients with nonspecific low back pain.

DESIGN

Systematic review and a meta-analysis.

SETTING

A literature review was conducted using PubMed, PEDro, Scielo, CINAHL, Web of Science, Dialnet, Scopus, and MEDLINE from inception to November 2021.

PATIENTS

Patients with chronic nonspecific low back pain.

INTERVENTIONS

Randomized controlled trials assessing motor control exercises versus inactive control, placebo or minimal intervention, and other exercises.

MAIN OUTCOME MEASURES

Pain intensity, disability, and physical activity were considered as primary outcomes.

RESULTS

Eighteen studies with 1356 patients were finally included in the systematic review, of which only 13 randomized clinical trials could be meta-analyzed. Statistically significant results were found in favor of the motor control group for the comparison with other exercises in disability at postintervention term (Mean Difference, 95% Confidence Interval [CI], -3.13 [-5.87 to -0.38], P = 0.03); for the comparison with inactive control, placebo, or minimal intervention in pain at postintervention term (MD, 95% CI, -18.10 [-30.79 to -5.41], P = 0.008); and for comparison with general exercises (MD, 95% CI, -12.70 [-20.80 to -4.60], P = 0.002).

CONCLUSIONS

Moderate-quality evidence regarding the effectiveness of motor control exercises to reduce pain intensity and disability exists, but the reduction should be interpreted with caution.

Effects of a Therapeutic Exercise Protocol for Patients with Chronic Non-Specific Back Pain in Primary Health Care: A Single-Group Retrospective Cohort Study

BACKGROUND

Back pain is highly prevalent; in Spain, it produces a very high economic cost and the scientific evidence supporting treatments shows low to moderate evidence for exercise. Therefore, the aim of this study was to assess the effectiveness of a therapeutic group exercise protocol in reducing pain intensity and disability in patients with back pain in primary health care setting.

METHODS

A total sample of 149 patients who suffered from chronic non-specific back pain was selected. Patients received a therapeutic exercise protocol, including auto-mobilization exercises for the neck and lumbar regions, as well as core stabilization exercises. Pain intensity and disability were evaluated before and after the therapeutic exercise protocol.

RESULTS

Statistically significant differences (p < 0.05) were shown in pain intensity and disability for patients with non-specific neck and low-back pain, with an effect size from moderate to large.

CONCLUSIONS

A therapeutic exercise protocol may provide beneficial effects upon disability and pain intensity in patients with chronic non-specific back pain, including neck and low-back pain conditions In addition, It could be considered for inclusion as a back-pain-approach program in primary healthcare.

Effectiveness of an exercise intervention based on preactivation of the abdominal transverse muscle in patients with chronic nonspecific low back pain in primary care: a randomized control trial

BACKGROUND

Low back pain is one of the most common disabling pathologies in humanity worldwide. Physical exercises have been used in recent decades to reduce the pain, improve the functionality of the lumbar spine and avoid relapses. The purpose of the study is to analyze the effect of a program based on re-education exercises involving preactivation of the abdominal transverse muscle compared to conventional treatment in adults with chronic nonspecific low back pain.

METHODS

A two-arm, single-blind randomized control trial with 35 primary care patients with chronic nonspecific low back pain. Both groups received a 4-week intervention. Data were collected at baseline and at the end of the intervention. Sixteen patients participated in the intervention group, and 19 patients in the control group.

RESULTS

For the experimental group, the outcomes of disability and activation of the abdominal transverse muscle decreased significantly (MD -2.9; CI 95% -5.6 to -0.35; η2 = 0.14; p = 0.028) and (MD 2.3; CI 95% 0.91 to 3.67; η2 = 0.25; p = 0.002) respectively, with a large effect size, compared to the control group. There were no differences between the groups in pain intensity, thickness, and resistance of the transverse abdominal muscle.

CONCLUSION

A 4-week specific program based on re-education exercises of the preactivation of the abdominal transverse muscle is more effective than conventional treatment for reducing disability and increasing the activation of the abdominal transverse muscle measured by VAS scale and PBU.

TRIAL REGISTRATION

Clinicaltrials.gov identifier: NCT03097497. Date of registration: 31/03/2017.

Validity and reliability of the Turkish version of breathlessness beliefs questionnaire

BACKGROUND

Dyspnea is often the main symptom that limits exercise; however, the vicious cycle of dyspnea limiting exercise participation is also an important contributor to the reduced exercise capacity.

OBJECTIVE

The aim of our study was to investigate the reliability and validity of Turkish Breathlessness Beliefs Questionnaire (BBQ) in patients with Chronic Obstructive Pulmonary Diseases (COPD).

METHODS

Seventy-seven COPD patients were included in the study. Sociodemographic and physical characteristics were recorded. Turkish version of BBQ, Saint George Respiratory Questionnaire (SGRQ) and Hospital Anxiety and Depression Scale (HADS) were applied. Second evaluation of BBQ was conducted via telephone calls with no drop-outs. Reliability of the questionnaire was explored by calculating the internal consistency and test-retest analysis. Construct validity was assessed calculating correlation coefficients of BBQ with HADS and SGRQ scores. Known group validity was also explored.

RESULTS

Cronbach alpha coefficients for total score of BBQ were 0.78, indicating that the questionnaire has 'good' internal consistency. Initial and test-retest BBQ total scores were 41.42 ± 6.47 and 41.18 ± 6.24, respectively. Intra-class correlation coefficients (ICC_2,1) values of BBQ and its sub-scales varied between 0.973 and 0.983, indicating strong test-retest reliability. Correlation coefficient between BBQ total and SGRQ-Activity (0.619) was highest among the variables of interest, followed by BBQ total and SGRQ total (0.611). There was a significant correlation between BBQ total and HADS (0.390). One-way analysis of variance revealed that BBQ total and BBQ-Activity Avoidance scores were significantly differ in disease stages.

CONCLUSION

Turkish version of BBQ was found to be a valid and reliable tool for measuring dysfunctional beliefs related to the dyspnea in patients with COPD.

Effects of Resistance Training on Pain Control and Physical Function in Older Adults With Low Back Pain: A Systematic Review With Meta-analysis

BACKGROUND AND PURPOSE

Low back pain (LBP) has a high prevalence in older adults and is associated with elevated health care costs. This systematic review and meta-analysis examines the effects of progressive resistance training (PRT) interventions on physical function (PF) and pain control in community-dwelling older adults with chronic LBP.

METHODS

A meta-analysis applying the quality effect method was performed by calculating the effect sizes (ESs) using the Cohen d with a 95% CI. A subgroup analysis was performed according to the participant and intervention characteristics. The statistical significance of differences between subgroups was calculated using a Z-test. Study bias was estimated using the version 2 of the Cochrane risk of bias tool for randomized trials (RoB 2.0) and quality of evidence (Qi) index. Small study effect/publication bias was estimated using the Doi plot and Luis Furuya-Kanamori (LFK) index. The systematic search was conducted in major databases for clinical trials published between January 1, 1990, and January 9, 2021. The inclusion criteria were articles that (1) were peer-reviewed; (2) had participants' mean age of more than 60 years; (3) studied PRT interventions; (4) had participants with LBP; (5) measured LBP or PF outcomes; (6) measured PF in terms of functionality; (7) were randomized controlled trials; (8) and non-randomized controlled trials. The exclusion criteria were (1) articles not written in English, (2) nonexperimental studies, and (3) repeated publications.

RESULTS AND DISCUSSION

Twenty-one studies were included (n = 1661). Clear improvements were found in PF (ES = 0.32 [95% CI, 0.05-0.58]; I2 = 75.1%; P < .001), but results on LBP decrease were inconclusive (ES = 0.24 [95% CI, -0.05 to 1.10]; I2 = 75.7%; P < .001). The overall evidence of this aggregated data meta-analysis of clinical trials is level C+. Main limitations are the use of aggregated data and the large heterogeneity between studies.

CONCLUSIONS

The Qi of this meta-analysis is level I (C+). We concluded that PRT interventions are useful for PF improvement in older adults with generalized LBP, LBP not arising from lumbar spinal stenosis, and having body mass index less than 27. In older adults with LBP not arising from lumbar spine stenosis, PRT interventions also decrease LBP. Interventions should have a frequency of at least 3 sessions per week. In addition, at a lower level of evidence IV (C+), we recommend that interventions with a duration of more than 12 weeks should be considered, whenever possible.

Effect of Trunk-Focused Exercises on Pain, Disability, Quality of Life, and Trunk Physical Fitness in Low Back Pain and How Potential Effect Modifiers Modulate Their Effects: A Systematic Review With Meta-analyses

OBJECTIVE: To analyze the effect of trunkfocused exercise programs (TEPs) and moderator factors on chronic nonspecific low back pain (LBP). DESIGN: Systematic review with meta-analyses. LITERATURE SEARCH: We searched the PubMed, Scopus, Embase, SPORTDiscus, and CENTRAL databases from their inception to June 2022. STUDY SELECTION CRITERIA: We included randomized controlled trials comparing TEPs to control or general exercises. DATA SYNTHESIS: We used random-effects models to calculate the standardized mean difference (SMD) plus confidence interval (CI) and heterogeneity (I²) for pain, disability, quality of life, and trunk performance. The impact of moderator factors was analyzed through meta-regression. RESULTS: Forty randomized controlled trials (n = 2391) were included. TEPs showed positive effects for all outcomes versus control (SMD 0.90-2.46; 95% CI, -0.04 to 4.96; I2 61%-98%). There were small effects in favor of TEPs versus general exercises for pain (SMD = 0.20; 95% CI, 0.03-0.37; I² = 13.4%) and disability (SMD = 0.20; 95% CI, 0.02-0.38; I² = 0%). Trunk and/or hip range-of-motion improvements were associated with greater reductions in pain (P<.01; β = 0.56; 95% CI, 0.25-0.87) and disability (P<.01; β = 0.66; 95% CI, 0.27-1.05). Low body mass was associated with higher pain reduction (P = .03; β = -0.17; 95% CI, -0.32 to -0.02). CONCLUSIONS: Trunk-focused exercise programs had positive effects on pain, disability, quality of life, and trunk performance compared to control groups, and on pain and disability compared to general exercises. Increasing trunk and/or hip range of motion was associated with greater pain and disability reduction, and lower body mass with higher pain reduction. J Orthop Sports Phys Ther 2023;53(2):64-93. Epub: 16 January 2023. doi:10.2519/jospt.2023.11091.

Effect of Progressive Postural Control Exercise Versus Core Stability Exercise in Young Adults with Chronic Low Back Pain: A Randomized Controlled Trial

INTRODUCTION

This study aimed to investigate the effects of progressive postural control exercise (PPCE) vs core stability exercise (CSE) in patients with chronic low back pain (CLBP).

METHODS

A total of 34 young-adult participants with CLBP were randomly assigned to two groups (the PPCE group and the CSE group). They received instructions for two different exercise training regimens persisting over 8 weeks. Before, after, and at 6 months after the intervention, the participants were evaluated on the basis of pain intensity (VAS), degree of dysfunction (ODI and RMDQ), contractility of transversus abdominis (TrA) and lumbar multifidus (MF), as well as the ability to control static posture.

RESULTS

There was no significant difference between the results of the PPCE group and the CSE group. At the 6-month follow-up after the 8-week treatment, the scores of VAS, ODI, and RMDQ in the two groups decreased significantly compared to before (p < 0.05). The percentage change in thickness of bilateral TrA and left MF (p < 0.05) was elevated and the sway area of center of pressure during static stance tasks with eyes opened (p < 0.05) was decreased in both groups.

CONCLUSION

In the short term, PPCE provides positive effects similar to those of core stability exercise in patients with CLBP. The effective mechanism of PPCE might be the consequence of neuromuscular plasticity and adaptation adjustments. PPCE enriches the choices of treatment for CLBP.

CLINICAL TRIAL REGISTRATION

The trial was registered at www.chictr.org.cn , identifier ChiCTR2100043113.

Effectiveness of Spinal Stabilization Exercises on Movement Performance in Adults with Chronic Low Back Pain

Introduction

Low back pain (LBP) is a musculoskeletal disorder that affects more than 80% of people in the United States at least once in their lifetime. LBP is one of the most common complaints prompting individuals to seek medical care. The purpose of this study was to determine the effects of spinal stabilization exercises (SSEs) on movement performance, pain intensity, and disability level in adults with chronic low back pain (CLBP).

Methods

Forty participants, 20 in each group, with CLBP were recruited and randomly allocated into one of two interventions: SSEs and general exercises (GEs). All participants received their assigned intervention under supervision one to two times per week for the first four weeks and then were asked to continue their program at home for another four weeks. Outcome measures were collected at baseline, two weeks, four weeks, and eight weeks, including the Functional Movement ScreenTM (FMSTM), Numeric Pain Rating Scale (NPRS), and Modified Oswestry Low Back Pain Disability Questionnaire (OSW) scores.

Results

There was a significant interaction for the FMSTM scores (p = 0.016), but not for the NPRS and OSW scores. Post hoc analysis showed significant between-group differences between baseline and four weeks (p = 0.005) and between baseline and eight weeks (p = 0.026) favor SSEs over GEs. Further, the results demonstrated that all participants, regardless of group, had significant improvements in movement performance, pain intensity, and disability level over time.

Conclusion

The results of the study favor SSEs over GEs in improving movement performance for individuals with CLBP, specifically after four weeks of the supervised SSE program.

Comparison of maximum joint angles during pole vaulting between male pole vaulters with and without lumbar disc degeneration or lumbar spondylolysis

BACKGROUND

Pole vaulting involves trunk flexion, extension, and rotation, which may place the lumbar spine under stress. Repeated pole vaulting may cause lumbar disc degeneration (DD) and lumbar spondylolysis (LS); however, this phenomenon is yet to be established.

OBJECTIVE

This study aimed to determine the difference in the maximum joint angles of the shoulder, hip, and trunk during pole vaulting between male pole vaulters with and without lumbar DD or LS.

METHODS

This retrospective study included 17 male pole vaulters. Four high-speed cameras were used to record the pole vaulters at 240 Hz. Radiography and magnetic resonance imaging were used to examine the lumbar spine in all athletes. Differences in the data between two sets of groups were analyzed using the unpaired t-test or the Mann-Whitney U test.

RESULTS

There was a significant difference in the maximum joint angle of hip flexion between pole vaulters with and without lumbar DD (p= 0.03).

CONCLUSION

Pole vaulters with lumbar DD may use lumbar flexion instead of hip flexion during the rock-back movement. Moreover, LS may occur due to repeated failed vaulting. Therefore, trunk stability and functional movements should be prioritized to prevent organic changes in the lower back.

What Modifies the Effect of an Exercise Treatment for Chronic Low Back Pain? A Meta-epidemiologic Regression Analysis of Risk of Bias and Comparative Effectiveness

OBJECTIVE: To investigate how risk of bias and intervention type modify effect sizes of exercise interventions that are intended to reduce chronic low back pain intensity. DESIGN: Systematic review with meta-epidemiologic regression analysis. LITERATURE SEARCH: PubMed, CENTRAL, Embase, and CINAHL (until January 31, 2021). STUDY SELECTION CRITERIA: Systematic reviews with meta-analyses of randomized controlled exercise trials. DATA SYNTHESIS: The dependent variable was pain, calculated as standardized mean difference (SMD). Potential effect modifiers were risk of bias, exercise modes, study, and meta-analyses characteristics. Multilevel meta-regressions and inverse variance-weighted meta-regressions with random intercepts were modelled. RESULTS: Data from 26 systematic reviews (k = 349 effect sizes, n = 18,879 participants) were analysed. The overall mean effect was SMD: -0.35 (k = 349, [95% CI -0.02 to -0.7]). There was a clinically relevant effect overestimation in studies with a high risk of bias due to missing outcomes (each k = 197, Beta coefficient = -1.9 [95% CI -2.9 to -.9]) and low sample size (B = 0.01 [.001 to .01], [ie, one participant more leads to an SMD decrease of 0.01]). There was a clinically relevant underestimation of the effect when studies were at high risk of bias in allocation concealment (B = 1.3 [.5 to 2.1]) and outcome measurement (B = 1.3 [.44 to 2.0]). Motor control and stabilization training (B = -1.3 [-2.3 to -.37]) had the largest effects; stretching (B = 1.3 [-.03 to .5]) had the smallest effect. CONCLUSIONS: The effects of exercise trials at high risk of bias may be overestimated or underestimated. After accounting for risk of bias, motor control and stabilization exercises may represent the most effective exercise therapies for chronic low back pain. J Orthop Sports Phys Ther 2022;52(12):792-802. Epub: 12 August 2022. doi:10.2519/jospt.2022.11149.

Dose-response relationship and effect modifier of stabilisation exercises in non-specific low back pain: a project-wide individual patient data re-analysis on 1,483 intervention participants

ABSTRACT

To derive a dose-response relationship under consideration of further effect modifiers in exercises on low back pain.In this planned MiSpEx-Network re-analysis, 1,483 intervention participants with low back pain (mean age 40.9 years (SD 14 years)) performed stabilisation exercises (3 weeks supervised, 9 weeks self-administered). Patients reported pain intensity, disability and disability days at baseline, 3 weeks, 12 weeks and 6 months post-randomisation. Exercise characteristics and effect modifiers were prospectively monitored. Beyond the comparison to the aggregated control group, linear mixed models were calculated to determine a dose-response-relationship.The interventions led to small but significantly larger symptom reductions than the control at each measurement. Longer durations of the intervention led to larger symptom reductions. Higher exercise frequencies were associated with a decrease in pain intensity: to train once more per week led to a mean decrease of 0.93 points in pain intensity [95% CI= -1.54 to -0.32]. Disability days were also impacted (estimate=-0.07 [-0.14 to 0.00]), disability was not (-0.09 [-0.67 to 0.48]). Adding perturbation was superior to adding stretching or a behavioural module. The relationships were robust when additional effect modifiers were considered and against the control group' effects. The odds ratio for a clinically important effect with higher exercise frequencies decreased at 3 weeks (OR=0.71 [0.618 to 0.813] for >2.5*week -1 ) and increased at 12 weeks (1.13 [1.006 to 1.270], >1.5*week -1 ).Using longer intervention durations, adding a perturbation component to the stabilisation trainings and utilising higher frequencies (up to a certain point) may lead to an even more beneficial response in patients with low back pain. Developing strategies to maintain a training frequency of at least two times per week may be relevant in stabilisation exercises to treat low back pain.

Postoperative Physical Therapy Program Focused on Low Back Pain Can Improve Treatment Satisfaction after Minimally Invasive Lumbar Decompression

Patient satisfaction is crucial in pay-for-performance initiatives. To achieve further improvement in satisfaction, modifiable factors should be identified according to the surgery type. Using a prospective cohort, we compared the overall treatment satisfaction after microendoscopic lumbar decompression between patients treated postoperatively with a conventional physical therapy (PT) program (control; n = 100) and those treated with a PT program focused on low back pain (LBP) improvement (test; n = 100). Both programs included 40 min outpatient sessions, once per week for 3 months postoperatively. Adequate compliance was achieved in 92 and 84 patients in the control and test cohorts, respectively. There were no significant differences in background factors; however, the patient-reported pain score at 3 months postoperatively was significantly better, and treatment satisfaction was significantly higher in the test than in the control cohort (−0.02 ± 0.02 vs. −0.03 ± 0.03, p = 0.029; 70.2% vs. 55.4%, p = 0.045, respectively). In the multivariate logistic regression analysis, patients treated with the LBP program tended to be more satisfied than those treated with the conventional program, independent of age, sex, and diagnosis (adjusted odds ratio = 2.34, p = 0.012). Postoperative management with the LBP program could reduce pain more effectively and aid spine surgeons in achieving higher overall satisfaction after minimally invasive lumbar decompression, without additional pharmacological therapy.

Neuroendocrine effects of a single bout of functional and core stabilization training in women with chronic nonspecific low back pain: A crossover study

Exercise-induced hypoalgesia (EIH) is characterized as the pain reduction after an exercise session and it seems to be related to the release of plasma β-endorphin. In this sense, the core stabilization training (CT) has been suggested for patients with chronic nonspecific low back pain (CNSLBP), but it is unclear whether it induces EIH. Patients with CNSLBP have neuromotor dysfunctions that can affect the performance of functional tasks, thus, performing functional training (FT) could improve motor control and promote EIH, since functional training uses multi-joint exercises that aim to improve the functionality of actions performed in daily life. EIH is usually assessed using quantitative sensory tests (QST) such as conditioned pain modulation, pressure pain threshold, and temporal summation. Thus, the sum of parameters from quantitative sensory tests and plasma β-endorphin would make it possible to understand what the neuroendocrine effects of FT and CT session are. Our study compared the acute effect of CT and FT on the EIH and plasma β-endorphin release, and correlated plasma β-endorphin with quantitative sensory testing in patients with CNSLBP. Eighteen women performed two training sessions (CT and FT) with an interval of 48 h between sessions. EIH was assessed by QST and plasma β-endorphin levels. Results showed that only FT significantly increased plasma β-endorphin (FT p < 0.01; CT p = 0.45), which correlated with pain pressure threshold (PPT) and conditioned pain modulation (CPM). However, QST values were not different in women with CNSLBP after CT or FT protocols. Plasma β-endorphin correlated with PPT and CPM, however, the same did not occur with a temporal summation.

Summarizing the effects of different exercise types in chronic low back pain - a systematic review of systematic reviews

Background

In chronic LBP (CLBP), guideline-endorsed treatment is to stay active, return to normal activity, and to exercise. Several reviews on various exercise types used in CLBP have been published. We aimed to identify systematic reviews of common exercise types used in CLBP, to appraise their quality, and to summarize and compare their effect on pain and disability.

Methods

We searched the databases OVID MEDLINE, EMBASE, COCHRANE LIBRARY, and WEB OF SCIENCE (Core collection) for systematic reviews and meta-analyses on adults between 18 and 70 years of age suffering from chronic or recurrent LBP for a period of at least 12 weeks, which investigated the effects of exercises on pain and disability. All searches were conducted without language restriction. The search was performed up until 2022–01-26. The included reviews were grouped into nine exercise types: aerobic training, aquatic exercises, motor control exercises (MCE), resistance training, Pilates, sling exercises, traditional Chinese exercises (TCE), walking, and yoga. The study quality was assessed with AMSTAR-2. For each exercise type, a narrative analysis was performed, and the level of evidence for the effects of exercise was assessed through GRADE.

Results

Our database search resulted in 3,475 systematic reviews. Out of the 253 full texts that were screened, we included 45 systematic reviews and meta-analyses. The quality of the included reviews ranged from high to critically low. Due to large heterogeneity, no meta-analyses were performed. We found low-to-moderate evidence of mainly short-term and small beneficial effects on pain and disability for MCE, Pilates, resistance training, TCE, and yoga compared to no or minimal intervention.

Conclusions

Our findings show that the effect of various exercise types used in CLBP on pain and disability varies with no major difference between exercise types. Many of the included systematic reviews were of low-to-moderate quality and based on randomized controlled trials with high risk of bias. The conflicting results seen, undermine the certainty of the results leading to very-low-to-moderate quality of evidence for our results. Future systematic reviews should be of higher quality to minimize waste of resources.

Trial registration

PROSPERO: Reg no 190409 Registration date 01AUG 2020.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-022-05722-x.

Metformin use and the risk of total knee replacement among diabetic patients: a propensity-score-matched retrospective cohort study

Metformin has been shown to modulate meta-inflammation, an important pathogenesis in knee osteoarthritis (OA). The study aimed to test the association between regular metformin use with total knee replacement (TKR) in patients with diabetes. This is a retrospective study with electronic records retrieved in Hong Kong public primary care. Patients with diabetes aged ≥ 45 who visited during 2007 to 2010, were followed up for a four-year period from 2011 to 2014 to determine the incidence of TKR. Propensity score matching based on age, sex, co-medications and chronic conditions was conducted to adjust for confounding. Cox regression was implemented to examine the association between metformin use and TKR. In total, 196,930 patients were eligible and 93,330 regular metformin users (defined as ≥ 4 prescriptions over the previous year) and non-users were matched. Among 46,665 regular users, 184 TKRs were conducted, 17.1% fewer than that among non-users. Cox regression showed that regular metformin users had a 19%-lower hazard of TKR [hazard ratio (HR) = 0.81, 95% confidence interval: 0.67 to 0.98, P = 0.033], with a dose–response relationship. Findings suggest a potential protective effect of metformin on knee OA progression and later TKR incidence among diabetic patients.

A randomized controlled trial concerning the implementation of the postural Mézières treatment in elite athletes with low back pain

OBJECTIVE

This study aimed to evaluate the impact of adding the Mézières Method (MM) to the standard rehabilitation protocol for the elite athletes with low back pain (LBP) in reducing lumbar pain than only using the traditional rehabilitation protocol treatment. The disciplines considered in this study were soccer, rhythmic gymnastics, and basketball.

DESIGN

Randomized controlled trial.

SETTING

Training Camp.

PARTICIPANTS

One hundred thirty-nine elite athletes with low back pain of whom 69 were assigned to the experimental group.

INTERVENTION

The intervention consists of treatment with three lying postures in a 40-minutes long session twice a week. The session goal was to focus on breathing exercises, spine mobility, and stretching of the back muscles, with particular attention to the diaphragmatic, paravertebral, and latissimus dorsi muscles.

OUTCOME MEASURES

Assessments as Visual Analogue Scale (VAS), Sit and Reach flexibility test, Roland-Morris Questionnaire, and health status questionnaire (SF12) were used.

RESULTS

The evaluation of all outcomes in 4 measurement periods of the study (baseline, 4, 12, and 24 weeks) showed a significant difference between groups. Also, at the 6-month of the intervention, a significant difference in the means (SD) was observed in pain (VAS), back flexibility (Sit & Reach) and back disability (QRM) outcomes in favor of the experimental group with a medium-large effect size comparing with the control group.

CONCLUSION

The MM approach can also be applied in established conventional protocols to alleviate pain and functionality. The obtained results include improving the quality of life of the athletes and their physical and emotional states.

Clinical trial registration number ID: NCT03849053.

Effectiveness of whole-body vibration exercise and core stabilization exercise in chronic non-specific low back pain: A randomized-controlled study

Objectives

The aim of this study was to investigate the effectiveness of whole-body vibration exercise (WBVE) and core stabilization exercise (CSE) on pain, muscle strength, and functional recovery in patients with chronic non-specific low back pain (NLBP).

Patients and methods

Between June 2016 and July 2017, a total of 74 patients with NLBP (12 males, 62 females; mean age: 44.7±8.9 years; range, 24 to 64 years) were included in this prospective, randomized-controlled study. The patients were randomly assigned to WBVE group (WBVEG, n=25), CSE group (CSEG, (n=25), and home exercise group as the control group (CG, (n=24). All groups performed 24 sessions of exercise for a total of eight weeks. Clinical outcome was measured using the Visual Analog Scale (VAS), Roland-Morris Disability Questionnaire (RMDQ), computerized isokinetic muscle strengths (IMS) and progressive isoinertial lifting evaluation (PILE) test.

Results

The VAS and RMDQ scores in WBVEG and CSEG statistically significantly decreased (p<0.05). The difference between the pre-treatment and at three-month VAS scores during intense activity were significantly different in both WBVEG and CSEG than the CG (p<0.05). The IMS values, except for the isokinetic flexion total work (IKFTW), increased significantly in all three groups (p<0.05). The IKFTW values increased significantly in the WBVEG and CSEG (p<0.05). A statistically significant increase in the functional work performance with PILE was observed in all three groups (p<0.05). The differences between the pre-treatment and three-month PILE test (ground to back and back to shoulder) were significantly different in both WBVEG and CSEG than the CG (p<0.05).

Conclusion

In the treatment of chronic NLBP, WBVE and CSE appear to be effective in pain and functionality. Although there was a significant improvement in muscle strength and functional work performance in all three groups, greater improvements were observed in the WBVEG and CSEG than the CG.

Effects of core stability training on older women with low back pain: a randomized controlled trial

Background

Studies have demonstrated that elderly people with low back pain (LBP) may have poor postural control compared to healthy older adults. Poor postural control is associated with poor balance performance and a high risk of serious falls. A variety of training strategies are proposed for LBP therapy, particularly core stabilization training. But this treatment for older people with LBP remains unclear.

Methods

31 participants were randomly placed in a core stability training group (TG, n = 15) and a control group (CG, n = 16). The participants in the training group were required to complete 4 sets of core stability training and conventional physiotherapy 4 times per week for 4 weeks, whereas the participants in the control group only completed physiotherapy 4 times per week for 4 weeks. Ultrasound imaging was used to measure transverse abdominal muscle (TrA) thickness before and after the intervention. A 10-cm visual analog scale (VAS), the Oswestry Disability Index (ODI), and mobility functions were applied before and after the intervention. Data are reported as the median and range and were compared using two-way repeated-measures ANOVA,t-tests and chi-squared tests. P < 0.05 was considered significant in all statistical tests.

Results

After intervention, there was a statistically significant difference in scores in the intervention group, especially for VAS, ODI, timed up-and-go,10-m walking and the four-square step test. TrA thickness was increased after core stability training, which was not observed in the control group.

Conclusion

Core stability training is an effective intervention for older women with LBP.

Supplementary Information

The online version contains supplementary material available at 10.1186/s11556-022-00289-x.

Effect of Six-Week Resistance and Sensorimotor Training on Trunk Strength and Stability in Elite Adolescent Athletes: A Randomized Controlled Pilot Trial

Intervention in the form of core-specific stability exercises is evident to improve trunk stability. The purpose was to assess the effect of an additional 6 weeks sensorimotor or resistance training on maximum isokinetic trunk strength and response to sudden dynamic trunk loading (STL) in highly trained adolescent athletes. The study was conducted as a single-blind, 3-armed randomized controlled trial. Twenty-four adolescent athletes (14f/10 m, 16 ± 1 yrs.;178 ± 10 cm; 67 ± 11 kg; training sessions/week 15 ± 5; training h/week 22 ± 8) were randomized into resistance training (RT; n = 7), sensorimotor training (SMT; n = 10), and control group (CG; n = 7). Athletes were instructed to perform standardized, center-based training for 6 weeks, two times per week, with a duration of 1 h each session. SMT consisted of four different core-specific sensorimotor exercises using instable surfaces. RT consisted of four trunk strength exercises using strength training machines, as well as an isokinetic dynamometer. All participants in the CG received an unspecific heart frequency controlled, ergometer-based endurance training (50 min at max. heart frequency of 130HF). For each athlete, each training session was documented in an individual training diary (e.g., level of SMT exercise; 1RM for strength exercise, pain). At baseline (M1) and after 6 weeks of intervention (M2), participants’ maximum strength in trunk rotation (ROM:63°) and flexion/extension (ROM:55°) was tested on an isokinetic dynamometer (concentric/eccentric 30°/s). STL was assessed in eccentric (30°/s) mode with additional dynamometer-induced perturbation as a marker of core stability. Peak torque [Nm] was calculated as the main outcome. The primary outcome measurements (trunk rotation/extension peak torque: con, ecc, STL) were statistically analyzed by means of the two-factor repeated measures analysis of variance (α = 0.05). Out of 12 possible sessions, athletes participated between 8 and 9 sessions (SMT: 9 ± 3; RT: 8 ± 3; CG: 8 ± 4). Regarding main outcomes of trunk performance, experimental groups showed no significant pre–post difference for maximum trunk strength testing as well as for perturbation compensation (p &gt; 0.05). It is concluded, that future interventions should exceed 6 weeks duration with at least 2 sessions per week to induce enhanced trunk strength or compensatory response to sudden, high-intensity trunk loading in already highly trained adolescent athletes, regardless of training regime.

Pain Neuroscience Education and Motor Control Exercises versus Core Stability Exercises on Pain, Disability, and Balance in Women with Chronic Low Back Pain

Background: Several interventions have been used to relieve chronic low back pain (CLBP). This study aimed to compare the effects of pain neuroscience education (PNE) followed by motor control exercises (MCEs) with core stability training (CST) on pain, disability, and balance in women with CLBP. Methods: Thirty-seven women with CLBP were randomly divided into two groups of PNE/MCE (n = 18, 55.2 ± 2.6 years) or CST (n = 19, 54.6 ± 2.4 years). Eight weeks of PNE/MCE or CST were prescribed for each group, independently. Pain intensity (VAS scale), disability (Roland Morris Disability Questionnaire), unipodal static balance, and dynamic balance (time up and go test) were measured at the beginning and 8 weeks after the intervention. Two-way mixed ANOVA was used to analyze the results with alpha of 5%. Results: After 8 weeks, there was a significant difference in VAS scale between groups (p = 0.024), with both PNE/MCE and CST showing 58% and 42% reductions, respectively. There were no differences for all other variables between groups. Regarding pre- to post-comparisons, both groups showed improvements in all dependent variables (p < 0.001). Conclusion: The treatment with PNE/MCE was more effective in improving pain disability and unipodal static and dynamic balance than treatment with CST. Even so, both treatments were shown to be valid and safe in improving all dependent variables analyzed in women with CLBP.

Efficacy of a multidimensional versus usual care physiotherapy on pain and electroencephalography (EEG) spectrum in chronic nonspecific low back pain: study protocol for a randomized controlled trial

BACKGROUND

Non-specific chronic low back pain (NSCLBP) is a major public health and global socioeconomic burden associated with a complex interplay of biopsychosocial factors. Despite scientific signs of progress, treatment of NSCLBP often tends to stick to a biomechanical model, without targeting psychological and social factors. To enhance the clinical efficacy of usual physiotherapy for NSCLBP, the development of clinical strategies is to be pursued. This study aims to assess the effectiveness of multidimensional physiotherapy based on a biopsychosocial approach compared to usual care physiotherapy, on clinical findings and electroencephalography spectrum in non-specific chronic low back pain.

METHODS

This study is a triple-blind, two-arm (1:1) randomized controlled trial with a 4 months follow-up. Seventy NSCLBP patients will be randomly allocated to either the experimental (multidimensional physiotherapy) or the active control group (usual physiotherapy); each group will receive 6 weeks of physiotherapy. The main outcome is pain and secondary outcomes are brain function, quality of life, disability, lumbar flexion range of motion, and psychosocial correlates. Assessment will be performed at baseline, post-treatment, and at 1 and 4 months follow-up.

DISCUSSION

Findings may provide evidence on the effectiveness of multidimensional physiotherapy on clinical findings and brain characteristics and might provide evidence towards showing the role of brain and biopsychosocial factors on chronic pain.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04270422 , Registered on 17 February 2020, IRCT Identifier: IRCT20140810018754N11.

Low Back Pain: A Comprehensive Review on the Diagnosis, Treatment Options, and the Role of Other Contributing Factors

BACKGROUND: In recent years, low back pain (LBP) is a growing major health issue around the world and mostly addressed in primary healthcare settings. This may be due to changing work environment including the nature of long sitting work hours, especially in the booming information and technology (IT) and Business Process Outsourcing (BPO) industry. LBP is normally considered as a combination of various types of pain and its related conditions, which eventually lead to disabilities. AIM: In this article, the aim is to discuss the current and future perspectives of LBP mainly on diagnosis and therapeutic front of LBP. METHODS: A search was performed using electronic databases, which include PubMed Central and Google Scholar, using the related key words “back pain and low back pain.” All related peer reviewed published articles were included regardless of the language, region, or the publication date. RESULTS: Although the management of LBP both in terms of diagnosis as well as in the therapeutic options has witnessed considerable progress but challenges are still exist not only within countries but also in the regions and continents among various medical professionals. However, in the past few years, a huge array of coordinated but randomized multi-center clinical studies were performed and various detailed insight investigations have been done, and substantial clinical guidelines have become available. Hence, a new view on evidence-based management approach for LBP has significantly improved recently and discussed here. CONCLUSION: Based on the available evidence and literature, this comprehensive review discusses the present and future perspectives of LBP mainly on diagnosis and therapeutic front for LBP. In addition, current intervention and prevention plans have failed to lessen the considerable burden of LBP and hence several areas which require more details, which deserves additional discussion to augment us through an understanding of this very important topic on improvements of multi tasked outcomes to benefit the affected patients.

Effects of an Artificial Intelligence-Assisted Health Program on Workers With Neck/Shoulder Pain/Stiffness and Low Back Pain: Randomized Controlled Trial

Background

Musculoskeletal symptoms such as neck and shoulder pain/stiffness and low back pain are common health problems in the working population. They are the leading causes of presenteeism (employees being physically present at work but unable to be fully engaged). Recently, digital interventions have begun to be used to manage health but their effectiveness has not yet been fully verified, and adherence to such programs is always a problem.

Objective

This study aimed to evaluate the improvements in musculoskeletal symptoms in workers with neck/shoulder stiffness/pain and low back pain after the use of an exercise-based artificial intelligence (AI)–assisted interactive health promotion system that operates through a mobile messaging app (the AI-assisted health program). We expected that this program would support participants’ adherence to exercises.

Methods

We conducted a two-armed, randomized, controlled, and unblinded trial in workers with either neck/shoulder stiffness/pain or low back pain or both. We recruited participants with these symptoms through email notifications. The intervention group received the AI-assisted health program, in which the chatbot sent messages to users with the exercise instructions at a fixed time every day through the smartphone’s chatting app (LINE) for 12 weeks. The program was fully automated. The control group continued with their usual care routines. We assessed the subjective severity of the neck and shoulder pain/stiffness and low back pain of the participants by using a scoring scale of 1 to 5 for both the intervention group and the control group at baseline and after 12 weeks of intervention by using a web-based form. We used a logistic regression model to calculate the odds ratios (ORs) of the intervention group to achieve to reduce pain scores with those of the control group, and the ORs of the subjective assessment of the improvement of the symptoms compared to the intervention and control groups, which were performed using Stata software (version 16, StataCorp LLC).

Results

We analyzed 48 participants in the intervention group and 46 participants in the control group. The adherence rate was 92% (44/48) during the intervention. The participants in the intervention group showed significant improvements in the severity of the neck/shoulder pain/stiffness and low back pain compared to those in the control group (OR 6.36, 95% CI 2.57-15.73; P<.001). Based on the subjective assessment of the improvement of the pain/stiffness at 12 weeks, 36 (75%) out of 48 participants in the intervention group and 3 (7%) out of 46 participants in the control group showed improvements (improved, slightly improved) (OR 43.00, 95% CI 11.25-164.28; P<.001).

Conclusions

This study shows that the short exercises provided by the AI-assisted health program improved both neck/shoulder pain/stiffness and low back pain in 12 weeks. Further studies are needed to identify the elements contributing to the successful outcome of the AI-assisted health program.

Trial Registration

University hospital Medical Information Network-Clinical Trials Registry (UMIN-CTR) 000033894; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000038307.

Goal attainment scaling for patients with low back pain in rehabilitation: A systematic review

BACKGROUND AND AIMS

Goal attainment scaling (GAS) has been widely applied to chronic conditions; however, only recently has it been used for patients with low back pain (LBP). The objectives of this systematic review were to (a) examine the characteristics and rigor of published studies of GAS in the rehabilitation of patients with LBP, (b) describe how GAS has been applied in patients with LBP, and (c) evaluate the responsiveness and validity of GAS as an outcome measure in patients with LBP.

METHODS

A systematic search of the CINAHL, PubMed, and MEDLINE databases was performed (1968 and 1 September 2020) in addition to hand searching. Studies including GAS procedures in patients with LBP during rehabilitation were included in the review. Two authors independently selected studies for inclusion and determined levels of evidence using the Oxford Levels of Evidence and rated each study for quality using the Newcastle-Ottawa scale and reporting transparency using the STROBE statement checklist.

RESULTS

Six Level IV and one Level III/IV study were included in this review (search produced 248 studies for review). These studies assessed GAS feasibility, validity, sensitivity, and association with other outcome measures in patients with LBP. Findings suggest that patients with LBP are able to identify and set individualized goals during GAS, while GAS may be more sensitive to change and may measure different aspects of the patient experience as compared with fixed-item patient-reported measures. Additionally, GAS may have a therapeutic effect while improving patient outcomes and may be associated with patient satisfaction.

CONCLUSION

Based on this review, GAS shows promise as a feasible patient-centered measure that may be more responsive to change than traditional outcome measures. However, GAS has been inadequately developed and validated for use during rehabilitation in patients with LBP.

The Effects of Whole-Body Vibration Exercise on Anticipatory Delay of Core Muscles in Patients with Nonspecific Low Back Pain

Objective

The objective of this study is to determine the effect of whole-body vibration (WBV) exercise on the anticipatory delay of core muscles in nonspecific low back pain (NSLBP) patients.

Methods

Forty participants with NSLBP were randomly divided into the WBV group and the control group. The sEMG signals of deltoid, erector spines (ES), multifidus (MF), rectus abdominis (RA), and transversus abdominus/internal oblique muscles (TrA/IO) were recorded before and after the intervention in the weight-shifting task. The relative activation time of each muscle was calculated.

Results

In the WBV group, the relative activation time of bilateral MF and bilateral TrA/IO was significantly reduced on shoulder flexion (right MF: P=0.014; left MF: P=0.011; right TrA/IO: P=0.008; left TrA/IO: P=0.026). As for shoulder abduction, except for the left TrA/IO and the left RA, the relative activation time of other muscles was significantly reduced (right ES: P=0.001; left ES: P < 0.001; right MF: P=0.001; left MF: P=0.009; right TrA/IO: P < 0.001; right RA: P=0.001). In the control group, there was no significant difference in the relative activation time of each muscle before and after the intervention (P > 0.05).

Conclusions

WBV exercise can effectively alleviate the anticipatory delay of core muscles in NSLBP patients, but the long-term effects still need further study. This trial is registered with ChiCTR-TRC-13003708.

Simulation in physiotherapy students for clinical decisions during interaction with people with low back pain: randomised controlled trial

BACKGROUND

Low back pain (LBP) is a condition with a high global prevalence, which is getting health professionals' attention, including physiotherapists as they must have the skills to provide treatment that increases the patient's quality of life. Clinical simulations could be a pedagogic strategy that facilitates adequate training for students to acquire skills to improve their professional reasoning in this clinical situation.

OBJECTIVE

This study sought to determine the effects of clinical simulations with simulated patients (SP) on the physiotherapy students' clinical decision-making within a role-playing (RP) scenario while caring of LBP patients.

METHODS

This experimental study included 42 participants from two Colombian universities, randomized into two groups (SP, n = 21; RP, n = 21). The clinical skill of performing the Objective Structured Clinical Examination (OSCE-LBP) was evaluated while students cared for patients with LBP; after that, a pedagogical method was conducted that included clinical simulation and, finally, the OSCE-LBP was applied again to compare both groups.

RESULTS

Changes occurred in the OSCE-LBP among both groups of students: the scores increased (0.66 and 0.59 in RP and SP, respectively), and neither of the two was superior (p value 0.01; 95%CI - 0.21 to 0.23).

CONCLUSION

Both types of simulation favor decision-making in professional reasoning in physiotherapy students during interactions with individuals with LBP. Trial registration https://clinicaltrials.gov/ct2/show/NCT04428892 Identifying number: NCT04428892. It was retrospectively registered.

Spine Injury Prevention

Spinal injury and back pain are a common problem facing patients seeking medical care including athletes, which can lead to significant disability, medical costs, and impaired performance for these patients. Rehabilitation including core muscle stabilization, Kinesio taping, and flexibility have been shown to help with treatment and prevention. Critical factors such as equipment, technique, and rule changes can also be an important part of spine injury prevention.

The effects of core stability training in nurses with nonspecific low back pain

To investigate the effect of core stability training on nonspecific low back pain (NSLBP) in nurses.The data were collected retrospectively by reviewing the patient's medical records and pain questionnaires in our rehabilitation center. A total of 40 nurses with NSLBP were included and divided into observation group and control group. Each group were given routine health education for NSLBP. Core stability training was performed in observation group for 4 weeks. Surface electromyography (sEMG) evaluation of erector spine and multifidus muscle, pain Numeric Rating Scale (NRS) and Japanese Orthopaedic Association (JOA) scores were evaluated and analyzed before and 4 weeks after intervention.There was no significant difference of NRS score and JOA score between two groups before intervention (P > .05, respectively). The NRS and JOA scores were significantly improved in both two groups after 4 weeks of intervention (P < .05, respectively). Moreover, the improvement of NRS and JOA scores in the observation group were better than those of the control group (P < .05, respectively). No significant difference of average electromyography (AEMG) or median frequency (MF) were noted between the healthy side and the affected side in both groups before or after intervention (P > .05, respectively). After 4 weeks of intervention, the AEMG of the healthy and the affected side of the two groups showed an improved trend without significant difference (P > .05, respectively). The MF of affected side was significantly higher 4 weeks after intervention than those before treatment in the observation and control group (P < .05, respectively).Core stability training can alleviate pain, improve the fatigue resistance of the core muscles and the balance of the functions of bilateral multifidus muscles in nurses with NSLBP.

Psychological effects of traditional Chinese mind-body exercises for low back pain: A protocol for meta-analysis

INTRODUCTION

Several studies reported that traditional Chinese mind-body exercises showed beneficial effects on improving anxiety and depression of patients with low back pain (LBP) in recent years. However, the effects of traditional Chinese mind-body exercises on improving psychological disorders of patients with LBP remain controversial. Most previous reviews only focused on the effects of traditional Chinese mind-body exercises for LBP on pain and dysfunction. Therefore, the present systematic review and meta-analysis will be conducted to evaluate the evidence on psychological effects of traditional Chinese mind-body exercises for LBP.

METHODS AND ANALYSIS

The electronic databases (PubMed, Embase, MEDLINE, Cochrane Central Register of Controlled Trials, Web of Science, China Knowledge Resource Integrated Database, and Wanfang Data) will be searched. The search will include all documents from their inception to February 2021. The Physiotherapy Evidence Database scale will be used for quality assessment of eligible studies. Risk of bias of eligible studies will also be assessed by Cochrane tool. The meta-analysis will be conducted using the Review Manager Version 5.3 software. The Higgins I2 statistic will be performed to examine for heterogeneity. The subgroup analysis will be conducted based on different types of traditional Chinese mind-body exercises, different intervention time, and different outcomes. Quality of evidence will be assessed using the Grades of Recommendation, Assessment, Development and Evaluation.

ETHICS AND DISSEMINATION

No ethical statement will be required for the performance of this review and meta-analysis. The results of this review will be published in an international peer-reviewed journal.

INPLASY REGISTRATION NUMBER

INPLASY202130075.

Acute Responses of Core Muscle Activity during Bridge Exercises on the Floor vs. the Suspension System

This study aimed to compare the neuromuscular activation of selected core musculature in supine and prone bridge exercises under stable versus suspended conditions. Forty-three healthy male participants were recruited to measure the electromyographic activities of the rectus abdominis (RA), lumbar multifidus (LM), thoracic erector spinae (TES), rectus femoris (RF), gluteus maximus (GM), and biceps femoris (BF) during supine and prone bridge exercises under six conditions: control, both arms and feet on the floor (Prone_con and Supine_con); arms on the floor and feet on the suspension system (Prone-Feet_suspension and Supine-Feet_suspension); and arms on the suspension system and feet on the floor (Prone-Arm_suspension and Supine-Arm_suspension). Prone-Arm_suspension yielded significantly higher activities in the RA, RF, TES, and LM than Prone-Feet_suspension (p < 0.01) and Prone_con (p < 0.001). Moreover, Supine-Feet_suspension elicited significantly higher activities in the RA, RF, TES, LM, and BF than Supine-Arm_suspension (p < 0.01) and Supine_con (p < 0.001). Furthermore, Supine-Feet_suspension elicited significantly higher activities in the RF, TES, and BF than Supine_con (p < 0.01). Therefore, if the RA and/or RF were the target training muscles, then Prone-Arm_suspension was recommended. However, if the TES, LM, and/or BF were the target training muscles, then Supine-Feet_suspension was recommended.

American Society of Hematology 2020 guidelines for sickle cell disease: management of acute and chronic pain

BACKGROUND

The management of acute and chronic pain for individuals living with sickle cell disease (SCD) is a clinical challenge. This reflects the paucity of clinical SCD pain research and limited understanding of the complex biological differences between acute and chronic pain. These issues collectively create barriers to effective, targeted interventions. Optimal pain management requires interdisciplinary care.

OBJECTIVE

These evidence-based guidelines developed by the American Society of Hematology (ASH) are intended to support patients, clinicians, and other health care professionals in pain management decisions for children and adults with SCD.

METHODS

ASH formed a multidisciplinary panel, including 2 patient representatives, that was thoroughly vetted to minimize bias from conflicts of interest. The Mayo Evidence-Based Practice Research Program supported the guideline development process, including updating or performing systematic reviews. Clinical questions and outcomes were prioritized according to importance for clinicians and patients. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used, including GRADE evidence-to-decision frameworks, to assess evidence and make recommendations, which were subject to public comment.

RESULTS

The panel reached consensus on 18 recommendations specific to acute and chronic pain. The recommendations reflect a broad pain management approach, encompassing pharmacological and nonpharmacological interventions and analgesic delivery.

CONCLUSIONS

Because of low-certainty evidence and closely balanced benefits and harms, most recommendations are conditional. Patient preferences should drive clinical decisions. Policymaking, including that by payers, will require substantial debate and input from stakeholders. Randomized controlled trials and comparative-effectiveness studies are needed for chronic opioid therapy, nonopioid therapies, and nonpharmacological interventions.

Effectiveness of motor control exercise on non-specific chronic low back pain, disability and core muscle morphological characteristics: A meta-analysis of randomized controlled trials

INTRODUCTION

Chronic low back pain (CLBP) has been recognized as the leading cause of disability. Up to 90% of patients with CLBP are classified as having non-specific CLBP (NSCLBP). Motor control exercise (MCE) is one of the most popular and widespread treatment options, and has many advantages in alleviating pain and disability. This meta-analysis is aimed to investigate the effectiveness of MCE on NSCLBP, disability, and core muscles reported in randomized controlled trials (RCTs).

METHODS

PubMed, Web of Science, and EMBASE were searched from inception to August 2020. Articles were eligible if they were RCTs that evaluated MCE against sham or other treatments in isolation and measured outcomes including pain intensity and disability or core muscles morphologic characteristics.

RESULTS

Two authors independently extracted the data. Eighteen studies of 897 studies with a total of 1333 individuals with NSCLBP were retained for the meta-analysis. Compared with other conservative treatments, MCE was better in reducing pain and disability posttreatment and was better in reducing pain at the 6-month follow-up period. However, it had comparable effects on pain reduction at 12-month and 24-month follow-up period, and on disability at the 6-month, 12-month and 24-month follow-up period. MCE resulted in comparable effects to other treatments in improving the core muscle thickness posttreatment. However, other important outcomes, such as the function, strength and endurance of core muscles, which could hamper a comprehensive understanding of the effects of MCE on NSCLBP.

LIMITATIONS

Publication bias was not assessed in several comparisons due to the scarcity of data in published literature. This might downgrade the strength of the evidence. The protocol of this meta-analysis was reviewed by an expert committee, but was not registered in a public trial registry.

CONCLUSIONS

Low to very low quality of evidence supported that MCE resulted in a greater reduction of pain and disability posttreatment, and a greater reduction of pain at the 6-month follow-up than other treatments for NSCBLP. The findings in this review further support that MCE may be more effective than other treatments at short-term followups, and at least has equivalent long-term effects to other forms of treatments in NSCLBP.

Can a Single Trial of a Thoracolumbar Myofascial Release Technique Reduce Pain and Disability in Chronic Low Back Pain? A Randomized Balanced Crossover Study

Although manual therapy for pain relief has been used as an adjunct in treatments for chronic low back pain (CLBP), there is still the belief that a single session of myofascial release would be effective. This study was a crossover clinical trial aimed to investigate whether a single session of a specific myofascial release technique reduces pain and disability in subjects with CLBP. 41 participants over 18 years old were randomly enrolled into 3 situations in a balanced and crossover manner: experimental, placebo, and control. The subjects underwent a single session of myofascial release on thoracolumbar fascia and the results were compared with the control and placebo groups. The outcomes, pain and functionality, were evaluated using the numerical pain rating scale (NPRS), pressure pain threshold (PPT), and Oswestry Disability Index (ODI). There were no effects between-tests, within-tests, nor for interaction of all the outcomes, i.e., NPRS (η ² = 0.32, F = 0.48, p = 0.61), PPT (η² = 0.73, F = 2.80, p = 0.06), ODI (η² = 0.02, F = 0.02, p = 0.97). A single trial of a thoracolumbar myofascial release technique was not enough to reduce pain intensity and disability in subjects with CLBP.

Efficacy of Core Stability in Non-Specific Chronic Low Back Pain

(1) Background: Management of chronic low back pain (cLBP) is often multidisciplinary, involving a combination of treatments, including therapeutic exercises. Core stability exercises aim to improve pain and disability in cLBP increasing spinal stability, neuromuscular control, and preventing shear force that causes injury to the lumbar spine. The purpose of this study was to review the available evidence about the effectiveness in reducing pain and improving disability of core stability exercises for non-specific cLBP. (2) Methods: We perform a systematic research on common Medline databases: PubMed, Pedro, and Cochrane Library. Search results were limited to articles written in English and published between January 2005 and November 2020.The search provided a total of 420 articles. Forty-nine articles met the inclusion criteria and 371 articles were excluded. (3) Results: Core stability provides great therapeutic effects in patients with non-specific chronic low back pain reducing pain intensity, functional disability, and improving quality of life, core muscle activation, and thickness. Evidences suggest that core stability is more effective than rest or no/minimal intervention and combination with other types of exercise for cLBP have shown grater efficacy. (4) Conclusion: Core stability could be proposed in a comprehensive approach in cLBP, the combination with other modalities of therapeutic exercise should be promoted. Patient compliance is crucial to determine the efficacy of the intervention.

[Therapeutic exercise as treatment for spinal chronic pain: systematic review of randomized clinical trials]

OBJECTIVE

The objective of the present review was to analyze and compare the effectiveness of different types of therapeutic exercise in people with chronic spinal pain.

METHODS

Data search was conducted using the electronic database MEDLINE. Randomized clinical trials, conducted in patients between 18 and 65 years old with chronic pain in the spine region, were included.

RESULTS

Two independent reviewers performed the analysis of methodological quality using the PEDro scale, with 13 studies finally selected. The different types of therapeutic exercise had significant effects on pain reduction, decrease of disability and improvement of the quality of life of the patients.

CONCLUSIONS

The results show that there is no modality of therapeutic exercise superior to others. The combination of different therapeutic exercise modalities could be a complete tool for the management of chronic pain in the spine.

Effectiveness of specific stabilization exercise compared with traditional trunk exercise in women with non-specific low back pain: a pilot randomized controlled trial

Background

Non-specific low back pain (LBP) is the leading cause of disability worldwide. The primary physiotherapeutic treatment for LBP is physical exercise, but evidence suggesting a specific exercise as most appropriate for any given case is limited.

Objective

To determine if specific stabilization exercise (SSE) is more effective than traditional trunk exercise (TTE) in reducing levels of pain, disability and inflammation in women with non-specific low back pain (LBP).

Design

A pilot randomized controlled trial was conducted in Rovira i Virgili University, Catalonia.

Methods

Thirty-nine females experiencing non-specific LBP were included in two groups: the TTE program and SSE program, both were conducted by a physiotherapist during twenty sessions. The primary outcome was pain intensity (10-cm Visual Analogue Scale). Secondary outcomes were disability (Roland Morris Disability Questionnaire), and inflammation (IL-6 and TNF-α plasma levels). Measurements were taken at baseline, at half intervention, at post-intervention, and a month later.

Results

Mean group differences in change from baseline to post-intervention for TTE were: -4.5 points (CI 3.3 to 5.6) for pain, -5.1 points (CI 3.0 to 7.3) for disability, 0.19 pg/mL (95% CI [-1.6-1.2]) for IL-6 levels, and 46.2 pg/mL (CI 13.0 to 85.3) for TNF-α levels. For SSE, differences were: -4.3 points (CI 3.1 to 5.6) for pain, -6.1 points (CI 3.7 to 8.6) for disability, 1.1 pg/mL (CI 0.0 to 2.1) for IL-6 levels , and 12.8 pg/mL (95% CI [-42.3-16.7]) for TNF-α levels. There were an insignificant effect size and no statistically significant overall mean differences between both groups.

Conclusion

This study suggests that both interventions (traditional trunk and specific stabilization exercises) are effective in reducing pain and disability in non-specific LBP patients, but the two programs produce different degrees of inflammation change.

Clinical trial registration number

NCT02103036.

The effect of static and dynamic core exercises on dynamic balance, spinal stability, and hip mobility in female office workers

Objectives

This study aims to compare the effect of static and dynamic core exercises in terms of dynamic balance, spinal stability, and hip mobility in female office workers.

Patients and methods

Between May 2018 and June 2018, a total of 34 women (mean age 36.4±6.5 years; range, 28 to 54 years) who worked for a bank and exercised in the fitness center of the work place were recruited. The women were divided into two groups including 17 women in each as static and dynamic core groups and administered sessions of 20 to 30 min twice a week for six weeks. Both groups were tested for dynamic balance (Y-balance test), spinal stability (functional reach test), and hip mobility (active flexion and extension) before and after six weeks of exercise.

Results

A statistically significant improvement was found in both groups between the pre- and post-test results in terms of spinal stability, hip mobility, and dynamic balance (p<0.05). The only exception was the right and left leg anterior balance in the static core group. Dynamic core exercises seemed to be more effective than static core exercises in improving the right and left leg anterior balance. There were no statistically significant differences between the groups in terms of spinal stability, hip mobility, and dynamic balance according to the mean absolute change (p>0.05).

Conclusion

Our study results indicate that both types of exercises are effective in improving dynamic balance, spinal stability, and hip mobility in female office workers. Therefore, the expected benefits from core exercises are to enhance dynamic balance, spinal stability, and hip mobility. Female workers can perform both types of exercises safely and effectively.

Dose-response-relationship of stabilisation exercises in patients with chronic non-specific low back pain: a systematic review with meta-regression

Stabilization exercise (SE) is evident for the management of chronic non-specific low back pain (LBP). The optimal dose-response-relationship for the utmost treatment success is, thus, still unknown. The purpose is to systematically review the dose-response-relationship of stabilisation exercises on pain and disability in patients with chronic non-specific LBP. A systematic review with meta-regression was conducted (Pubmed, Web of Knowledge, Cochrane). Eligibility criteria were RCTs on patients with chronic non-specific LBP, written in English/German and adopting a longitudinal core-specific/stabilising/motor control exercise intervention with at least one outcome for pain intensity and/or disability. Meta-regressions (dependent variable = effect sizes (Cohens d) of the interventions (for pain and for disability), independent variable = training characteristics (duration, frequency, time per session)), and controlled for (low) study quality (PEDro) and (low) sample sizes (n) were conducted to reveal the optimal dose required for therapy success. From the 3,415 studies initially selected, 50 studies (n = 2,786 LBP patients) were included. N = 1,239 patients received SE. Training duration was 7.0 ± 3.3 weeks, training frequency was 3.1 ± 1.8 sessions per week with a mean training time of 44.6 ± 18.0 min per session. The meta-regressions' mean effect size was d = 1.80 (pain) and d = 1.70 (disability). Total R² was 0.445 and 0.17. Moderate quality evidence (R² = 0.231) revealed that a training duration of 20 to 30 min elicited the largest effect (both in pain and disability, logarithmic association). Low quality evidence (R² = 0.125) revealed that training 3 to 5 times per week led to the largest effect of SE in patients with chronic non-specific LBP (inverted U-shaped association). In patients with non-specific chronic LBP, stabilization exercise with a training frequency of 3 to 5 times per week (Grade C) and a training time of 20 to 30 min per session (Grade A) elicited the largest effect on pain and disability.

Comparison between bracing and hollowing trunk exercise with a focus on the change in T2 values obtained by magnetic resonance imaging

The purpose of this study was to compare the muscle activity of Bracing and Hollowing trunk exercises by means of T2 values using MRI. Subjects were 19 healthy adult males, of whom 10 (with mean height ± SD: 172.3 ± 4.7 cm, mean weight ± SD: 64.3 ± 5.4 kg, mean age ± SD 21.5 ± 1.9 years) performed hollowing and 9 (with mean height ± SD: 171.3 ± 2.1 cm, mean weight ± SD: 68.5 ± 11.7 kg, mean age ± SD: 23.0 ± 2.6 years) performed bracing. They were assessed using MRI. The imaging was completed using Osirix software, which measured T2 values from the transversus abdominis (TrA), internal oblique (IO), external oblique (EO), and multifidus (MF) muscles. Subsequently, T2 values recorded before the exercise were compared with those recorded after the exercise to evaluate the extent of change effected by exercise on the muscles. MRI T2 values indicated that the TrA and IO regions were activated to a significantly greater degree after bracing. No significant changes occurred in any muscle before and after hollowing. It was determined that the activity of the deeper trunk muscles was higher in bracing than in hollowing on comparing the T2 values obtained in the MRI.

Motor Control Stabilisation Exercise for Patients with Non-Specific Low Back Pain: A Prospective Meta-Analysis with Multilevel Meta-Regressions on Intervention Effects

Low-to-moderate quality meta-analytic evidence shows that motor control stabilisation exercise (MCE) is an effective treatment of non-specific low back pain. A possible approach to overcome the weaknesses of traditional meta-analyses would be that of a prospective meta-analyses. The aim of the present analysis was to generate high-quality evidence to support the view that motor control stabilisation exercises (MCE) lead to a reduction in pain intensity and disability in non-specific low back pain patients when compared to a control group. In this prospective meta-analysis and sensitivity multilevel meta-regression within the MiSpEx-Network, 18 randomized controlled study arms were included. Participants with non-specific low back pain were allocated to an intervention (individualized MCE, 12 weeks) or a control group (no additive exercise intervention). From each study site/arm, outcomes at baseline, 3 weeks, 12 weeks, and 6 months were pooled. The outcomes were current pain (NRS or VAS, 11 points scale), characteristic pain intensity, and subjective disability. A random effects meta-analysis model for continuous outcomes to display standardized mean differences between intervention and control was performed, followed by sensitivity multilevel meta-regressions. Overall, 2391 patients were randomized; 1976 (3 weeks, short-term), 1740 (12 weeks, intermediate), and 1560 (6 months, sustainability) participants were included in the meta-analyses. In the short-term, intermediate and sustainability, moderate-to-high quality evidence indicated that MCE has a larger effect on current pain (SMD = −0.15, −0.15, −0.19), pain intensity (SMD = −0.19, −0.26, −0.26) and disability (SMD = −0.15, −0.27, −0.25) compared with no exercise intervention. Low-quality evidence suggested that those patients with comparably intermediate current pain and older patients may profit the most from MCE. Motor control stabilisation exercise is an effective treatment for non-specific low back pain. Sub-clinical intermediate pain and middle-aged patients may profit the most from this intervention.