Technology-supported exercise therapy for patients with chronic non-specific low back pain: a feasibility study

Abstract

Introduction Various technological systems supporting exercise therapy for low back pain (LBP) have been developed in recent years. One of the problems with the current technology-supported exercise therapy programs for LBP is that they mostly adopt an analytical approach.Purpose/Aim(1) To develop a functional exercise therapy program supported by sensor-based postural feedback, and (2) to evaluate this program in a pilot study.Materials and methodsTen patients with chronic non-specific low back pain and an underlying motor control impairment were recruited. The subjects participated in a rehabilitation program consisting out of 36 sessions (18 weeks). Subjects mainly performed a partially supervised exercise program that included 30 minutes of general conditioning and 90 minutes of functional motor control exercises. The motor control exercises were tailored to the patient’s specific needs and used concepts of segmentation and simplification. During these exercises, postural feedback from motion sensors (ValedoMotion, version 1.2) placed at the L1 and S1 level was provided to the patients. In addition, serious games that had to be controlled by pelvic tilts were used to improve thoracolumbar dissociation. The technological support was also available for home exercises. Primary outcomes were pain (numeric pain rating scale), disability (Roland Morris questionnaire and patient specific functioning scale), self-efficacy (pain self-efficacy questionnaire), kinesiophobia (Tampa scale for kinesiophobia) and treatment satisfaction. Secondary outcomes were quality of life (short form-36), motivation (intrinsic motivation inventory) and credibility and expectancy of the treatment (credibility and expectancy questionnaire).ResultsExcept for treatment satisfaction, there was a significant improvement on all of the primary outcomes. The differences in median scores between baseline and post-intervention were clinically relevant for pain and disability: pain improved 3 points on the numeric pain rating scale (p< 0.05), disability was reduced by 5.5 points on the Roland Morris questionnaire (p< 0.01) and by 3 points on the patient specific functioning scale (p< 0.01). For the secondary outcomes, there was a significant improvement on two subscales of the IMI (p< 0.01) and on the physical component of the short form-36 (p< 0.001). No significant differences were found for the CEQ.ConclusionsIt is feasible to use sensor-based postural feedback in combination with functional exercises, and this approach leads to clinically important improvements in pain and disability. An adequately powered randomized controlled trial should be conducted to confirm the results from this pilot study. To assess the additional value of the postural feedback, this program should be compared to an exercise program without technological support.