Effectiveness of Perturbation Training in Nonspecific Low Back Pain: A Randomized Controlled Trial
Trunk stabilization exercises, especially when performed under unstable conditions, may have a beneficial effect on low back pain (LBP) and related symptoms. However, more evidence is needed to determine whether adding a perturbation component to the training program contributes to greater improvement. To determine the effects of perturbation training on trunk muscle endurance, disability, pain, functional mobility, quality of life, fear-avoidance beliefs, and satisfaction in patients with nonspecific low back pain (NSLBP). Randomized controlled trial Physiotherapy laboratory Forty-two patients with NSLBP (30 female, 12 male; age=33.06 ± 9.55 years) who had pain for at least three months (pain duration=3.02±3.25 years) were randomly assigned to either the exercise group (EG) or the perturbation group (PG). EG received a 2-phase trunk-based exercise program, while PG received a 4-phase training program with perturbations added to the exercises in EG. All interventions were performed 2 days per week for 8 weeks. The McGill endurance tests and the Oswestry Disability Index (ODI) were the primary outcome measures. The Visual Analog Scale (VAS), Timed Up and Go test (TUG), Fear Avoidance Beliefs Questionnaire (FABQ), Short Form-12 (SF-12), and satisfaction were the secondary outcome measures. Both groups showed improvement in all parameters (p<0.05). However, PG was superior to EG in improving trunk muscle endurance (flexor p=0.001, extensor p<0.001, lateral flexor p=0.001 for right/ p<0.001 for left), and ODI (p=0.005). Between-group effect sizes were large (0.18 to 0.30). Additionally, improvements in TUG and FABQ total score were in favor of the PG (p=0.030), with a moderate effect size (0.11), and satisfaction was also higher in the PG (p=0.034). An 8-week trunk-based exercise program, when combined with perturbation training, leads to greater improvements in trunk muscle endurance, function, total fear avoidance belief scores, and satisfactionABSTRACT
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