Effects of a Core Stabilization Exercise Program with the Abdominal Drawing-In Maneuver Technique in Chronic Non-Specific Low Back Pain with Lumbar Instability Using Telerehabilitation: A Randomized Controlled Trial
Abstract
Objective: Despite the increasing use of telerehabilitation, few studies have examined its effectiveness for core stabilization exercises in chronic non-specific low back pain (CNSLBP) with lumbar instability (LI). This study compared telerehabilitation-based versus clinic-based delivery of core stabilization exercise with abdominal drawing-in maneuver (CSE with ADIM) on pain, functional disability, lumbar joint repositioning error (LJRE), quality of life, and satisfaction in individuals with CNSLBP and LI.
Material and Methods: A single-blind randomized controlled trial that included 30 participants with CNSLBP and LI, randomized to telerehabilitation-based (n=15) or clinic-based (n=15) groups. Both groups completed 7 weeks of CSE with ADIM; the telerehabilitation-based group received training via video calls, while the clinic-based group received in-person training. Pain, functional disability, quality of life, and LJRE were measured at baseline and post-intervention; satisfaction was assessed at completion.
Results: Both groups demonstrated significant within-group reductions in pain (numerical rating scale [NRS]) and functional disability scores (Oswestry Disability Index [ODI] and Roland-Morris Disability Questionnaire [RMDQ]; p-value<0.05), with no significant between-group differences. Telerehabilitation-based delivery improved in most SF-36 domains except the social function domain, whereas clinic-based training improved in only the physical function domain. LJRE had no significant changes within and between groups. Training adherence was high (96%) with high satisfaction (telerehabilitation-based: 4.94±0.08; clinic-based: 4.87±0.20). No adverse events occurred.
Conclusion: Telerehabilitation-delivered CSE-ADIM is an effective alternative to clinic-based care for reducing pain and improving functional disability and quality of life in CNSLBP with LI.
Keywords
Full Text:
PDF (Early Version)References
Olafsson G, Jonsson E, Fritzell P, Hägg O, Borgström F. A health economic lifetime treatment pathway model for low back pain in Sweden. J Med Econ 2017;20:1281-9. doi: 10.1080/13696998.2017.1372252.
Koes BW, van Tulder MW, Thomas S. Diagnosis and treatment of low back pain. BMJ 2006;332:1430-4. doi: 10.1136/bmj.332.7555.1430.
Hides JA, Jull GA, Richardson CA. Long-term effects of specific stabilizing exercises for first-episode low back pain. Spine (Phila Pa 1976) 2001;26:E243-8. doi: 10.1097/00007632-200106010-00004.
Ibarz E, Más Y, Mateo J, Lobo-Escolar A, Herrera A, Gracia L. Instability of the lumbar spine due to disc degeneration: a finite element simulation. Adv Biosci Biotechnol 2013;4:548-56. doi: 10.4236/abb.2013.45072.
Leungbootnak A, Puntumetakul R, Kanpittaya J, Chatprem T, Boucaut R. Validity of a screening tool for patients with a sub-threshold level of lumbar instability: a cross-sectional study. Int J Environ Res Public Health 2021;18:12151. doi: 10.3390/ijerph182212151.
Chatprem T, Puntumetakul R, Boucaut R, Wanpen S, Chatchawan U. A screening tool for patients with lumbar instability: a criteria-related validity of Thai version. Spine (Phila Pa 1976) 2020;45:e1431-8. doi: 10.1097/BRS.0000000000003617.
Batıbay S, Külcü DG, Kaleoğlu Ö, Mesci N. Effect of Pilates mat exercise and home exercise programs on pain, functional level, and core muscle thickness in women with chronic low back pain. J Orthop Sci 2021;26:979-85. doi: 10.1016/j.jos.2020.10.026.
Puntumetakul R, Chalermsan R, Hlaing SS, Tapanya W, Saiklang P, Boucaut R. The effect of core stabilization exercise on lumbar joint position sense in patients with subacute non-specific low back pain: a randomized controlled trial. J Phys Ther Sci 2018;30:1390-5. doi: 10.1589/jpts.30.1390.
Chalermsan R, Puntumetakul R, Dornpunha W, Kamolrat T, Chatchawan U, Pitak R, et al. Effects of core stabilization exercise in subacute non-specific low back pain: pilot study. J Nurs Sci Health 2016;39:48-60.
Shem K, Irgens I, Alexander M. Getting started: mechanisms of telerehabilitation. In: Telerehabilitation. Elsevier; 2022. p.5-20. doi: 10.1016/B978-0-323-86112-8.00001-4.
Mbada CE, Olaoye MI, Dada OO, Ayanniyi O, Johnson OE, Odole AC, et al. Comparative efficacy of clinic-based and telerehabilitation application of McKenzie therapy in chronic low-back pain. Int J Telerehabil 2019;11:41-58. doi: 10.5195/ijt.2019.6270.
Özden F, Sarı Z, Karaman ÖN, Aydoğmuş H. The effect of video exercise-based telerehabilitation on clinical outcomes, expectation, satisfaction, and motivation in patients with chronic low back pain. Ir J Med Sci 2022;191:1229-39. doi: 10.1007/s11845-021-02768-0.
Wu MC, Fisher MR, DeMets DL. Sample sizes for long-term medical trials with time-dependent dropout and event rates. Control Clin Trials 1980;1:111-23. doi: 10.1016/0197-2456(80)90036-9.
Kumar SP. Efficacy of segmental stabilization exercise for lumbar segmental instability in patients with mechanical low back pain: a randomized placebo controlled crossover study. N Am J Med Sci 2011;3:456-61. doi: 10.4297/najms.2011.3456.
Puntumetakul R, Areeudomwong P, Emasithi A, Yamauchi J. Effect of 10-week core stabilization exercise training and detraining on pain-related outcomes in patients with clinical lumbar instability. Patient Prefer Adherence 2013;7:1189-99. doi: 10.2147/PPA.S51658.
Macedo LG, Latimer J, Maher CG, Hodges PW, Nicholas M, Tonkin L, et al. Motor control or graded activity exercises for chronic low back pain? A randomised controlled trial. BMC Musculoskelet Disord 2008;9:65. doi: 10.1186/1471-2474-9-65.
Ostelo RW, de Vet HC. Clinically important outcomes in low back pain. Best Pract Res Clin Rheumatol 2005;19:593-607. doi: 10.1016/j.berh.2005.03.003.
Sae-jung S, Hunzavong T, Jirarattanapochai K. Reliability of Thai version of Oswestry Questionnaire for the evaluation of low back pain patients. Srinagarind Med J 2002;17:247-53.
Jirarattanaphochai K, Jung S, Sumananont C, Saengnipanthkul S. Reliability of the Roland-Morris Disability Questionnaire (Thai version) for the evaluation of low back pain patients. J Med Assoc Thai 2005;88:407-11.
Jirarattanaphochai K, Jung S, Sumananont C, Saengnipanthkul S. Reliability of the medical outcomes study short-form survey version 2.0 (Thai version) for the evaluation of low back pain patients. J Med Assoc Thai 2005;88:1355.
Hlaing SS, Puntumetakul R, Khine EE, Boucaut R. Effects of core stabilization exercise and strengthening exercise on proprioception, balance, muscle thickness and pain related outcomes in patients with subacute nonspecific low back pain: a randomized controlled trial. BMC Musculoskelet Disord 2021;22:998. doi: 10.1186/s12891-021-04858-6.
Richardson JT. Eta squared and partial eta squared as measures of effect size in educational research. Educ Res Rev 2011;6:135-47. doi: 10.1016/j.edurev.2010.12.001.
Akhtar MW, Karimi H, Gilani SA. Effectiveness of core stabilization exercises and routine exercise therapy in management of pain in chronic non-specific low back pain: a randomized controlled clinical trial. Pak J Med Sci 2017;33:1002-6. doi: 10.12669/pjms.334.12664.
Kwon SH, Oh SJ, Kim DH. The effects of lumbar stabilization exercise on transversus abdominis muscle activation capacity and function in low back pain patients. Isokinet Exerc Sci 2020;28:147–52. doi: 10.3233/IES-192191.
Noormohammadpour P, Kordi M, Mansournia MA, Akbari-Fakhrabadi M, Kordi R. The role of a multi-step core stability exercise program in the treatment of nurses with chronic low back pain: a single-blinded randomized controlled trial. Asian Spine J 2018;12:490-9. doi: 10.31616/asj.2018.12.3.490.
Suh JH, Kim H, Jung GP, Ko JY, Ryu JS. The effect of lumbar stabilization and walking exercises on chronic low back pain: a randomized controlled trial. Medicine (Baltimore) 2019;98:e16173. doi: 10.1097/MD.0000000000016173.
Porwal S, Rizvi MR, Sharma A, Ahmad F, Alshahrani MS, Raizah A, et al. Enhancing functional ability in chronic nonspecific lower back pain: the impact of EMG-guided trunk stabilization exercises. Healthcare (Basel) 2023;11:2009. doi: 10.3390/healthcare11142009.
Ota M, Kaneoka K, Hangai M, Koizumi K, Muramatsu T. Effectiveness of lumbar stabilization exercises for reducing chronic low back pain and improving quality of life. J Phys Ther Sci 2011;23:679-81. doi: 10.1589/jpts.23.679.
Saiklang P, Chatprem T, Saiklang P, Puntumetakul R, Yeowell G. The effect of abdominal drawing-in manoeuvres and abdominal bracing techniques via telerehabilitation on lumbar repositioning error in seated sedentary participants with chronic low back pain and lumbar instability: a randomised controlled trial. Hum Mov 2025;26:101-14. doi: 10.5114/hm.2024.132512.
Amin J, Ahmad B, Amin S, Siddiqui AA, Alam MK. Rehabilitation professional and patient satisfaction with telerehabilitation of musculoskeletal disorders: a systematic review. Biomed Res Int 2022;2022:7366063. doi: 10.1155/2022/7366063.
Refbacks
- There are currently no refbacks.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.