Authors (including presenting author) :
LEE WY, POON MWY
Affiliation :
Physiotherapy Department, Hong Kong Buddhist Hospital
Introduction :
Chronic back pain is a prevalent condition that significantly affects patients' quality of life. The STarT Back Screening Tool stratifies patients into low, medium, or high risk for poor outcomes, guiding treatment pathways. Individuals in the low and medium risk groups often undergo standard physiotherapy treatments, which typically be beneficial from exercises. The transverse abdominal muscle (TrA) is crucial for lumbar spine stability, and research indicates that chronic back pain sufferers frequently exhibit reduced TrA activation and thickness, suggesting that TrA weakness may contribute to their condition. Core stabilization exercises targeting TrA could be beneficial, especially when combined with real-time ultrasonography (US) for immediate feedback on muscle activation.
Objectives :
This pilot study aimed to evaluate the effectiveness of a targeted physiotherapy exercise program incorporating real-time US feedback to enhance TrA muscle activation in patients with chronic back pain.
Methodology :
Patients with chronic back pain (onset > 3 months) were recruited from October to December 2024 in Hong Kong Buddhist Hospital and stratified using the STarT Back Screening Tool. Those in the low or medium risk groups participated in a six-week targeted physiotherapy program. The intervention focused on core stabilization exercises emphasizing TrA activation incorporating real-time US. Outcome measures included pain intensity (Numeric Pain Rating Scale, NPRS), TrA thickness (measured by US), core muscle strength (Prone Plank Test), functional disability (Roland Morris Disability Questionnaire), pain self-efficacy (Pain Self-Efficacy Questionnaire, PSEQ), and subjective improvement (Numeric Global Rating of Change Scale, NGRCS).
Result & Outcome :
Ten patients (mean age 58.3 ± 11.1 years; 6 males, 4 females) completed the training, with significant improvement shown including reduction in pain intensity by from 5 to 2 in NPRS(p<0.001), improved TrA thickness change from 0.11cm to 0.34cm (p<0.001), improved TrA activation ratio from 1.41 to 2.22 (p<0.001), enhanced core endurance from 6.2s to 30.3s in Prone Plank Test (p<0.001), and increased pain self-efficacy from 44 to 52 in PSEQ (p=0.001). The disability level was improved from 5 to 2 in RMDQ (p=0.082). The NGRCS increased from 0 to +6. The study indicates that a targeted physiotherapy program with real-time US feedback significantly improves outcomes in chronic back pain patients, warranting further research with larger samples. In view of the significant positive outcome by targeted physiotherapy exercises program, this showed an inspiration to further develop self-empowerment program by other means through tele-training or explore more advanced technology for feedback during exercises.
