Ultrasound-guided Biofeedback for Transversus Abdominus Re-education in Non-specific Low Back Pain Patients
Condition: Non-specific Low Back Pain (NSLBP)
MeSH terms: Back Pain; Low Back Pain
Study type: Interventional

Summary: 
      As rehabilitative ultrasound imaging (RUSI) for monitoring and re-educating deep trunk
      muscles is becoming more and more popular in current musculoskeletal rehabilitation and
      research, the purpose of this pilot study was to explore the effects of applying
      ultrasound-guided imaging as a means of feedback for the activation/contraction of the deep
      transervsus abdominis muscle of the trunk during an exercise programme in people with
      non-specific low back pain (NSLBP). The outcome mesures being explored were pain intensity
      (primary outcome) through Numeric Pain Rating Scale (NPRS), functional, muscular and
      psychosocial parameters.
    

Detailed description: 
      Background: It is believed that ultrasound-guided imaging of activation/contraction of the
      deep abdominal muscles (such as transervsus abdominis) is useful for assisting deep muscle
      re-education, which is often dysfunctional in non-specific low back pain (NSLBP). Thus, this
      pilot study aimed to evaluate the use of real-time ultrasound (US) as a feedback device for
      transverse abdominis (TrA) activation/contraction during an exercise program in chronic NSLBP
      patients.

      Methods: Chronic NSLBP patients are recruited and randomly assigned to an US-guided or
      control group. The same motor control-based exercise program is applied to both groups. All
      patients would receive physiotherapy twice per week for 7 weeks. Outcome measures, tested at
      baseline and post-intervention, include Numeric Pain Rating Scale (NPRS), TrA activation
      level (measured through a pressure biofeedback unit-based developed protocol), seven
      established motor control tests, Roland-Morris Disability Questionnaire (RMDQ) and Hospital
      Anxiety and Depression Scale (HADS). Analysis of variance utilizing a two-way mixed ANOVA
      model for dependent measures of two factors (treatment group and time point of measurement)
      of which only one is repeated (time point of measurement) is performed to determine between-
      and within-group differences before and after treatment. Additionally, independent samples'
      t-test and paired samples' t-test are used for differences between and within groups,
      respectively, as well as χ2 tests for differences on the motor control tests and the TrA
      activation level procedure across the groups.
    

Intervention name(s): Real-time rehabilitative ultrasound imaging (RUSI); Tactile feedback (control intervention)
Intervention type(s): Device; Other
Intervention description(s): Τhe ultrasound equipment used was B-K Μedical Mini Focus 1402 equipped with high frequency linear probe (8670, 5-12MHz) using standard musculoskeletal settings and the software: V 1.01.01.137. Ultrasound gel (AQUASONIC® 100, Parker Inc., Orange, NJ) was used as coupling agent. TrA imaging was initially performed with participants in crook lying, with the US head positioned along the lateral abdominal wall with reference points at the lower point of the rib cage (last rib) and the anterior superior iliac spine, on the right side of the person, midway between these two points. The US head was moved until tester (investigator) had the best possible visualization of the lateral abdominal muscles (external oblique, internal oblique and TrA). During the execution of the exercises, the participants could watch the ultrasound screen along with the therapist's guidance, thus receiving information (US-visual feedback) of their TrA activation; Palpatory-guided (manual) feedback for TrA activation
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment