Taxiarchopoulos N1, Billis E1, Giannioti M1, Moutzouri M2
1TEI of Western Greece, Department of Physiotherapy, Patras, Greece, 2Filoktitis Rehabilitation Centre, Physiotherapy Unit, Patras, Greece
Background: Chronic low back pain (LBP) is commonly associated with dysfunction of spinal muscle stability, resulting in motor and functional deficits. Although research evidence is still limited, it is believed that ultrasound (US) imaging is useful for measuring such deficits and for patient rehabilitation (muscle re-training), since muscle imaging provides some form of patient biofeedback. In particular, US-guided imaging of activation/contraction of the deep abdominal or spinal muscles, such as transverse abdominis (TrA), pelvic floor or multifidus, which cannot be evaluated visually or by palpation, is considered useful for assisting muscle re-education and motor control.
Purpose: To evaluate the use of real-time ultrasound as a feedback device for transverse abdominis (TrA) activation, determining if it improves pain, motor control and function in patients with chronic LBP.
Methods: This single-blind randomized controlled trial explored the effectiveness of a progressive and comprehensive movement control exercise program based on TrA and pelvic floor muscle activation with and without US-guided visual feedback. Subjects were recruited from a large Greek city, following an open call from social media. They had to be adults suffering from chronic (over 3 months) LBP with/or without associated reported leg symptoms and good cognitive-communicative ability. Subjects were randomly assigned into 2 groups; intervention (US-guided) group and control (non-US guided) group. The same exercise program was applied to both groups. All patients received 12-16 one-to-one (physiotherapist to patient) 30-minute treatments over a period of 6-8 weeks. Participants were tested at baseline and post-intervention. The outcome measures used included numeric pain rating scale (NPRS), Roland-Morris Disability Questionnaire, Hospital Anxiety and Depression Scale (HADS), TrA activation (pressure biofeedback device) and seven established motor control tests; waiter's bow, pelvic tilt, forward and backward rocking (quadruped position), active knee flexion (prone), controlled knee extension (sitting), hip external rotation (hook lying). Time-group interactions for each dependent variable were examined with a two-way mixed ANOVA model, whereas independent samples and paired samples t tests were utilized for across and within group differences, respectively.
Results: 23 chronic LBP patients were recruited and randomly assigned to the US-guided group (n=12, 8 women, aged 47,6±2,55 years) and the control (non-US guided) group (n=11, 9 women, aged 46,9±4,29 years). Intra- and inter-tester reliability for motor control tests were satisfactory. For each group, all variables (NDI, NPRS, HADS, pressure stabilizer scores, motor control tests) yielded statistically significant differences (p>0,05) post-intervention, indicating significant improvements in both groups. However, there were no significant group x time interactions for any of the outcomes measured, thus, not indicating any superiority of the US-guided group.
Conclusion(s): These outcomes confirmed the benefits of motor control exercises in reducing pain, improving function, psychosocial levels, motor control and TrA activation in chronic LBP patients. However, the addition of the US as a visual feedback device did not yield any additional benefits.
Implications: This study provides insight into
a) the effectiveness of a progressive motor control exercise program for improving chronic LBP pain, physchosocial status and motor control function and
b) our understanding on the mechanisms behind LBP motor control impairments.
Keywords: Real-time ultrasound imaging, low back pain, motor control exercises
Funding acknowledgements: None
Purpose: To evaluate the use of real-time ultrasound as a feedback device for transverse abdominis (TrA) activation, determining if it improves pain, motor control and function in patients with chronic LBP.
Methods: This single-blind randomized controlled trial explored the effectiveness of a progressive and comprehensive movement control exercise program based on TrA and pelvic floor muscle activation with and without US-guided visual feedback. Subjects were recruited from a large Greek city, following an open call from social media. They had to be adults suffering from chronic (over 3 months) LBP with/or without associated reported leg symptoms and good cognitive-communicative ability. Subjects were randomly assigned into 2 groups; intervention (US-guided) group and control (non-US guided) group. The same exercise program was applied to both groups. All patients received 12-16 one-to-one (physiotherapist to patient) 30-minute treatments over a period of 6-8 weeks. Participants were tested at baseline and post-intervention. The outcome measures used included numeric pain rating scale (NPRS), Roland-Morris Disability Questionnaire, Hospital Anxiety and Depression Scale (HADS), TrA activation (pressure biofeedback device) and seven established motor control tests; waiter's bow, pelvic tilt, forward and backward rocking (quadruped position), active knee flexion (prone), controlled knee extension (sitting), hip external rotation (hook lying). Time-group interactions for each dependent variable were examined with a two-way mixed ANOVA model, whereas independent samples and paired samples t tests were utilized for across and within group differences, respectively.
Results: 23 chronic LBP patients were recruited and randomly assigned to the US-guided group (n=12, 8 women, aged 47,6±2,55 years) and the control (non-US guided) group (n=11, 9 women, aged 46,9±4,29 years). Intra- and inter-tester reliability for motor control tests were satisfactory. For each group, all variables (NDI, NPRS, HADS, pressure stabilizer scores, motor control tests) yielded statistically significant differences (p>0,05) post-intervention, indicating significant improvements in both groups. However, there were no significant group x time interactions for any of the outcomes measured, thus, not indicating any superiority of the US-guided group.
Conclusion(s): These outcomes confirmed the benefits of motor control exercises in reducing pain, improving function, psychosocial levels, motor control and TrA activation in chronic LBP patients. However, the addition of the US as a visual feedback device did not yield any additional benefits.
Implications: This study provides insight into
a) the effectiveness of a progressive motor control exercise program for improving chronic LBP pain, physchosocial status and motor control function and
b) our understanding on the mechanisms behind LBP motor control impairments.
Keywords: Real-time ultrasound imaging, low back pain, motor control exercises
Funding acknowledgements: None
Topic: Musculoskeletal: spine
Ethics approval required: Yes
Institution: TEI of Western Greece
Ethics committee: School of Health & Caring Professions
Ethics number: 07/22-11-2017
All authors, affiliations and abstracts have been published as submitted.
