Effects of spinal stabilization exercise with real-time ultrasound imaging biofeedback in individuals with chronic nonspecific low back pain: A pilot study

The use of real-time ultrasound imaging (RUSI) as biofeedback to en-hance the performance of spinal stabilization exercise and recovery from low back pain has been a recent trend in musculoskeletal rehabili-tation. The aim of this pilot study was to evaluate whether it would be feasible to conduct a randomized controlled trial investigating the ef-fects of spinal stabilization exercise with RUSI biofeedback in individu-als with chronic nonspecific low back pain. This was a single-group pretest-posttest quasi-experimental study. Ten consecutive patients with chronic nonspecific low back pain met the study criteria. They re-ceived spinal stabilization exercise with the RUSI biofeedback focusing on lumbar multifidus muscle activation. The intervention was provided twice weekly for 6 weeks. Outcome measures were lumbar multifidus muscle cross-sectional area, pain, disability and quality of life assessed at baseline and after intervention. A paired t-test was applied and effect size (Cohen d) was computed. The recruitment and retention rates were 75% and 83% respectively. No adverse events were reported during the study. Compared with the baseline, the participants demonstrated sta-tistically significant improvement in lumbar multifidus muscle cross- sectional area (P<0.05, d=1.03), pain (P<0.001, d=2.56) and disability (P<0.05, d=1.43) with large effect size after the intervention. However, no statistically significant differences were observed for physical and mental health (P>0.05) after the intervention. It was concluded that spi-nal stabilization exercise with RUSI biofeedback is effective in improv-ing lumbar multifidus muscle cross-sectional area, pain and disability in individuals with chronic nonspecific low back pain. The results demon-strated the feasibility of conducting a future, larger-scale powered ran-domized controlled trial to confirm these preliminary findings.