The effectiveness of technology-supported exercise therapy for low back pain: A systematic review

Abstract

AIM The aim of this systematic review is (1) to provide an overview of the available Technology Supported Exercise Therapy (TSET) programs for low back pain, and (2) to assess the effectiveness of TSET compared to other forms of rehabilitation, placebo interventions or no treatment. METHODS Electronic databases (Pubmed, Embase, Cochrane Central Register of Controlled Trials, PEDro, IEEE and ACM) were searched until January 2014. Randomized controlled trials comparing TSET to other forms of rehabilitation, placebo interventions or no treatment were included. Further inclusion criteria were: (1) patients with low back pain of musculoskeletal origin, (2) adult population, (3) technologies with an electrical component, (4) simultaneous use of technology with the exercise therapy, and (5) assessment of at least one of the following outcomes: pain, functional status or muscle function. Two reviewers independently selected studies based on these eligibility criteria. A descriptive analysis was performed. RESULTS A total of 28 randomized controlled trials met the inclusion criteria. The following TSE interventions were reported: EMG Biofeedback (n = 11), Real-time ultrasound feedback (n = 8), Internet based rehabilitation (n = 3), Whole body vibration (n = 2), Motion biofeedback (n = 1), Respiratory feedback (n=1), Nintendo Wii (n = 1) and Repetitive peripheral magnetic neurostimulation (n = 1). In most studies, TSET was compared to another intervention, no treatment or a waiting list. Technology was used as the single variable difference between interventions in only nine studies. TSET can improve pain and functional status for patients with low back pain. However, TSET is not more effective compared to other interventions: Training of the deep lumbar stabilizing muscles (Transversus abdominis and deep part of Multifidus) with Real-time ultrasound feedback did not improve pain and functional status more than other exercise therapies. EMG-biofeedback exercises did not yield better results than cognitive behavioral therapy or relaxation exercises. Studies comparing Internet based rehabilitation, Respiratory feedback or Whole body vibration to other exercise therapy programs, did not show significant differences between interventions. With regard to Transversus Abdominis function, it remains unclear whether the use of Real-time ultrasound feedback leads to better results than other exercise interventions. However, great methodological differences in outcome measures for improved Transversus Abdominis function are reported. One study showed that motor control training of Multifidus with EMG-biofeedback significantly increased Multifidus activation during slow trunk movements, compared to extension exercises. CONCLUSION TSET can improve pain and functional status for patients with low back pain. However, to date there is no evidence that TSET is more effective than other interventions. It remains unclear whether TSET yields better results compared to non-TSET in improving Transversus Abdominis function. Few studies apply technology as the single variable difference between interventions, which makes it difficult to assess the independent effects of the technology. Furthermore, the current technologies are mostly used during analytical exercises, and are not introduced into functional rehabilitation. Future research should try to address these two shortcomings of present studies.