AUGMENTED REALITY & FELDENKRAIS® METHOD VS. TRADITIONAL CORE STABILIZATION & MOTOR CONTROL EXERCISES: COMPARATIVE EFFECTS ON PERSONS WITH CHRONIC LBP

Background: Chronic back problems continue to be a leading cause for disability in all of medicine and are the number one symptom disorder for patients who seek trials of other types of alternative and integrative therapies. The Feldenkrais Method^®  of somatic education is one approach that is newly amenable to physiotherapy practice. Its premise seeks to clarify new functional interrelationships towards an improved neuroplasticity-based change in the cognitive construct of one’s own background body schema; with shared understanding that improved body perception and augmented sensory discrimination via constructed imagery and movement are more closely associated with recovery from chronic pain - especially LBP - as compared to usual muscular training.

Purpose: As a test of comparative efficacy, An RCT study design was implemented to compare a novel Feldenkrais Method^® based body schema / sensory augmentation /movement approach to a more universally common standard of outpatient PT practice, i.e. Traditional Motor Control Exercises with Core Stabilization, and in measuring their respective effect outcomes on persons with chronic non-specific low back pain (CNSLBP).

Methods: A single-blinded Randomized Controlled Trial (RCT) compared a novel 8-week Augmented Mixed Reality / Feldenkrais^® Movement (AXR/FM) intervention against standard & conventional protocols for Core Stabilization Training / Motor Control (CS/MC). The (AXR/FM) treatment component consisted of full-scale anatomical models, kinematic avatars, skeletal density imagery, corresponding temporal bone-vestibular system informants, and haptic self-touch as cuing techniques for accentuating selected Feldenkrais^® movements - and with aim to help re-conceptualize participant’s prior notions and beliefs regarding body schema and low back pain (LBP). N=30 participants medically diagnosed with Chronic LBP were assigned to either the experimental group (AXR /FM @ N=15) or the control group (CS/MC @ N=15). Known confounding biopsychosocial variables were controlled via stratified-random assignment on the Fear-Avoidance Beliefs Questionnaire (FABQ). Treatment Outcome measures included the Visual Analog Scale for pain (VAS-PAIN), the Roland Morris Disability Questionnaire (RMDQ), the Patient-Specific Functional Scale (PSFS), and Timed Position Endurance Testing – including Flexion / Extension Ratios at baseline, 2-weeks, 4-weeks and 8-weeks. Statistical Analysis was conducted using Wilcoxon Rank Sum and paired, two-tailed t-test.

Results: The AXR/FM group demonstrated greater improvement in all treatment outcome measures as compared to the matched CS/MC control group. However, only the PSFS demonstrated statistical significance for greatest improvement at p < 0.05 upon more stringent non-parametric testing.

Conclusion(s): This study demonstrated that a novel Augmented Mixed Reality / Feldenkrais^® Movement (AXR/FM) approach appears more efficacious than the more common practice of Motor Control Exercises and Core Stabilization in reducing symptoms, disability, and in objectively improving performance outcomes in persons with Chronic Non Specific Low Back Pain (CNSLBP).

Implications: Core Stabilization, and other isolationist or fitness-based models have come under scrutiny in recent years. Early investigation now reveals that Body Schema based somatic education and sensory augmentation interventions, like the AXR / Feldenkrais^® protocol, can appear more efficacious, and deserve further investigation. Future multi-site RCT studies with larger sample sizes are therefore recommended.  

Funding, acknowledgements: N/A

Keywords: Chronic Low Back Pain, Augmented Reality, The Feldenkrais Method®, Core Stabilization, Motor Control Exercises

Topic: Musculoskeletal: spine

Did this work require ethics approval? Yes

Institution: Saybrook University

Committee: SIRB

Ethics number: SIRB_Sobie_2016