Effects of motor training and biofeedback on movement, brain activity and balance in women with chronic low back pain

Arm 1: Functional motor training (MCT) Participants performed a structured functional motor training program for 8 weeks (2 sessions per week) under the supervision of a physiotherapist. Each session lasted approximately 45 minutes and was delivered in small groups. Sessions were conducted twice weekly with at least 48 hours between sessions. Exercise intensity was maintained at a moderate level and was individually adjusted according to participant tolerance and progression. The program consisted of three components: (1) motor control and stabilization exercises focusing on the lumbopelvic region, (2) strengthening exercises (e.g. squats, deadlifts, hip bridge, dead bug, Pallof press), and (3) stretching exercises aimed at improving flexibility and reducing muscle tension. Adherence to the intervention was monitored using attendance records completed by the supervising physiotherapist at each session. Arm 2: Functional motor training with biofeedback (MCT-BF) Participants performed the same functional motor training program as in Arm 1, with additional biofeedback-based training. Each session lasted approximately 60 minutes, including 15 minutes of biofeedback training performed on ALFA and SIGMA stabilometric platforms. Sessions were delivered in small groups under the supervision of a physiotherapist and were conducted twice weekly with at least 48 hours between sessions. The biofeedback component consisted of static and dynamic balance exercises and proprioceptive tasks performed on stabilometric platforms. Participants received real-time visual feedback displayed on a monitor regarding body sway and centre of pressure displacement. Interactive game-based tasks requiring weight shifting, balance control, and postural adjustments were also performed. The purpose of the biofeedback training was to improve postural control, proprioception, and neuromuscular coordination. Exercise intensity was maintained at a moderate level and was individually adjusted according to participant tolerance and progression. Adherence to the intervention was monitored using attendance records completed by the supervising physiotherapist at each session. Arm 3: Control group (CG) Participants in the control group did not receive any intervention during the study period and were instructed to continue their usual daily activities. Outcome assessments were performed at the same time points as in the intervention groups.