Chronic Low Back Pain
Conditions
Keywords
Chronic Low Back Pain, Sensorimotor Training, Visual Feedback, Two-Point Discrimination, Lumbopelvic Motor Control
Brief summary
Chronic nonspecific low back pain is a common musculoskeletal condition that can negatively affect physical function and quality of life. This randomized controlled trial aims to investigate the effectiveness of visual feedback-assisted sensorimotor training on pain, functional disability, sensory discrimination, and lumbopelvic motor control in patients with chronic nonspecific low back pain. A total of 70 participants aged 18-65 years will be randomly assigned to two groups: visual feedback-assisted sensorimotor training or conventional exercise therapy. Both groups will receive 12 treatment sessions over four weeks, with three sessions per week. Participants will be evaluated at baseline, immediately after the four-week intervention, and one month after treatment completion. The primary outcomes will be pain intensity and functional disability. Secondary outcomes will include two-point discrimination, lumbopelvic motor control, fear of movement, pain catastrophizing, quality of life, and disability. The study aims to determine whether visual feedback-assisted sensorimotor training provides greater improvements than conventional exercise therapy.
Detailed description
Chronic nonspecific low back pain is associated with alterations in sensory processing, body perception, and motor control. Sensorimotor training approaches targeting tactile discrimination and lumbopelvic movement control may contribute to improvements in pain and functional outcomes. This study is a single-center, prospective, two-arm, parallel-group randomized controlled trial conducted in the Department of Physical Medicine and Rehabilitation at Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital, Istanbul, Türkiye. Seventy adults aged 18-65 years with chronic nonspecific low back pain lasting at least three months will be enrolled and randomly allocated to one of two intervention groups. The experimental group will receive visual feedback-assisted sensorimotor training consisting of two-point discrimination training, graphesthesia exercises, and lumbopelvic motor control exercises , supported by visual feedback. The control group will receive a conventional exercise program consisting of warm-up, stretching, and strengthening exercises. Both groups will complete 12 supervised treatment sessions over four weeks, with three 30-minute sessions per week. Assessments will be performed at baseline, immediately after the four-week intervention, and one month after treatment completion. The primary outcomes will be pain intensity, measured using the Numeric Rating Scale (NRS), and functional disability, measured using the Roland-Morris Disability Questionnaire (RMDQ). Secondary outcomes will include two-point discrimination, lumbopelvic motor control, kinesiophobia, pain catastrophizing, quality of life, and disability, assessed using the corresponding clinical tests and questionnaires.
Interventions
BEHAVIORALVisual Feedback-Assisted Sensorimotor Training
Participants will receive visual feedback-assisted sensorimotor training, including two-point discrimination, graphesthesia, and lumbopelvic motor control exercises. Two-point discrimination training will be individualized according to sensory thresholds, with a 10% reduction in distance when 90% accuracy is achieved. Graphesthesia training will involve identifying figures traced on the lumbar region. Motor control exercises will include posterior pelvic tilt, hip hinge, single-leg stance, sitting knee extension, and prone knee flexion-rotation. Mirror-based visual feedback will be provided during motor control exercises. Training will be conducted three times per week for four weeks, totaling 12 sessions of approximately 30 minutes each.
BEHAVIORALConventional Exercise Training
Participants will receive a conventional exercise program consisting of a 5-minute warm-up, 5 minutes of stretching, 15 minutes of strengthening exercises, and a 5-minute cool-down period including diaphragmatic breathing and relaxation exercises.Stretching will target the hamstrings, hip flexors, and lumbar paraspinal muscles and will include knee-to-chest exercises. Strengthening exercises will include curl-ups, straight leg raises, glute bridges, side-lying hip abduction, and bird-dog exercises.The program will be administered three times per week for four weeks, totaling 12 sessions of 30 minutes each.
Sponsors
Sehit Prof. Dr. Ilhan Varank Sancaktepe Training and Research Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
This study is a single-center, prospective, two-arm, parallel-group randomized controlled trial. Participants with chronic nonspecific low back pain will be randomly allocated to either visual feedback-assisted sensorimotor training or conventional exercise training.
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Adults aged 18 to 65 years. * Diagnosis of chronic nonspecific low back pain lasting at least 3 months. * Presence of low back pain symptoms on a daily basis. * Willingness to participate in the study and provision of written informed consent.
Exclusion criteria
* Specific causes of low back pain, including lumbar disc herniation with neurological deficits, spinal stenosis, spondylolisthesis of grade II or higher, secondary vertebral lesions, neoplasms, or vascular disorders. * Lumbar radiculopathy. * History of lumbar spine surgery. * Spinal deformity or vertebral fracture. * Fibromyalgia, rheumatological diseases, or diabetes mellitus. * Pregnancy. * Participation in motor imagery training or lumbopelvic exercise programs within the previous 12 months.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Pain Intensity (Numeric Rating Scale) | Baseline, Week 4 (post-intervention), and Week 8 (1-month follow-up) | Pain intensity will be assessed using the Numeric Rating Scale (NRS), ranging from 0 (no pain) to 10 (worst imaginable pain). Higher scores indicate greater pain intensity. Changes in NRS scores from baseline to post-intervention and follow-up will be evaluated. |
| Change in Functional Disability (Roland-Morris Disability Questionnaire) | Baseline, Week 4 (post-intervention), and Week 8 (1-month follow-up) | Functional disability related to low back pain will be assessed using the Roland-Morris Disability Questionnaire (RMDQ). The total score ranges from 0 to 24, with higher scores indicating greater disability. Changes in RMDQ scores from baseline to post-intervention and follow-up will be evaluated. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in Lumbar Two-Point Discrimination Threshold | Baseline, Week 4 (post-intervention), and Week 8 (1-month follow-up) | Lumbar tactile spatial acuity will be assessed using a two-point discrimination test with a caliper. The minimum distance at which participants can reliably distinguish two simultaneous touch points will be recorded in millimeters (mm). Lower thresholds indicate better tactile discrimination. Changes from baseline to post-intervention and follow-up will be evaluated. |
| Change in Lumbopelvic Motor Control (Luomajoki Movement Control Tests) | Baseline, Week 4 (post-intervention), and Week 8 (1-month follow-up) | Lumbopelvic motor control will be assessed using the Luomajoki Movement Control Tests. The test battery consists of six movement control tests evaluating the ability to maintain appropriate lumbar spine control during functional movements. Each test is scored as 0 (correct performance) or 1 (incorrect performance), resulting in a total score ranging from 0 to 6. Higher scores indicate greater movement control impairment. Changes in total scores from baseline to post-intervention and follow-up will be evaluated. |
| Change in Kinesiophobia (Tampa Scale of Kinesiophobia) | Baseline, Week 4 (post-intervention), and Week 8 (1-month follow-up) | Kinesiophobia will be assessed using the 17-item Tampa Scale of Kinesiophobia (TSK-17). Each item is rated on a 4-point Likert scale. The total score ranges from 17 to 68, with higher scores indicating greater fear of movement and reinjury. Changes in total TSK scores from baseline to post-intervention and follow-up will be evaluated. |
| Change in Pain Catastrophizing (Pain Catastrophizing Scale) | Baseline, Week 4 (post-intervention), and Week 8 (1-month follow-up) | Pain catastrophizing will be assessed using the Pain Catastrophizing Scale (PCS), a 13-item self-report questionnaire evaluating rumination, magnification, and helplessness related to pain. Each item is scored from 0 to 4, resulting in a total score ranging from 0 to 52. Higher scores indicate greater pain catastrophizing. Changes in total PCS scores from baseline to post-intervention and follow-up will be evaluated. |
| Change in Physical Health-Related Quality of Life (SF-12 Physical Component Summary) | Baseline, Week 4 (post-intervention), and Week 8 (1-month follow-up) | Health-related quality of life will be assessed using the 12-Item Short Form Health Survey (SF-12). The questionnaire provides two summary scores: the Physical Component Summary (PCS) and the Mental Component Summary (MCS). Higher scores indicate better physical and mental health, respectively. Changes from baseline will be evaluated at post-intervention and follow-up. |
| Change in Disability (WHODAS 2.0 - 12-item) | Baseline, Week 4 (post-intervention), and Week 8 (1-month follow-up) | Disability will be assessed using the 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). Each item is scored from 0 (no difficulty) to 4 (extreme difficulty or inability to perform), yielding a total score ranging from 0 to 48 using simple summation. Higher scores indicate greater disability. Changes from baseline will be assessed. |
| Change in Mental Health-Related Quality of Life (SF-12 Mental Component Summary) | Baseline, Week 4 (post-intervention), and Week 8 (1-month follow-up) | Mental health-related quality of life will be assessed using the Mental Component Summary (MCS) score of the 12-Item Short Form Health Survey (SF-12). Higher scores indicate better mental health-related quality of life. Changes in MCS scores from baseline to post-intervention and follow-up will be evaluated. |
Countries
Turkey (Türkiye)
Contacts
CONTACTrumeysa özdemir, MD
PRINCIPAL_INVESTIGATORVildan B Safer, MD
University of Health Sciences, Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital
Outcome results
None listed