Biofeedback Sensor vs. Physiotherapist Feedback During Core Stabilization Training in Patients with Chronic Nonspecific Low Back Pain

Abstract

Core stabilization training utilizes principles of motor learning to retrain control of the trunk muscles and lead to improvements in chronic non-specific low back pain (CNLBP). To compare the effects of biofeedback sensor and conventional physiotherapist (PT) feedback during core stabilization and activity training in patients with CNLBP. Thirty-eight patients with CNLBP were randomly assigned to Biofeedback (n = 19) or PT feedback (n = 19) groups. Patients continued 12 sessions of combined core stabilization and activity training. An auditory and tactile biofeedback was given using a validated tilt sensor integrated with an application in the Biofeedback group. An experienced PT provided verbal and tactile feedback to maintain the neutral position in the PT Feedback group. The outcomes were; disability (Revised Oswestry Disability Index-RODI), muscle activity (m.transversus abdominis and m.multifidus), pain (Visual Analog Scale-VAS), proprioception error of the trunk, patient beliefs (Fear Avoidance Beliefs Questionnaire-FABQ) and presence of depressive symptoms (Beck Depression Index-BDI), and quality of life (Short Form (SF)-36). The main effect of time were statistically significant on VAS, RODI, m.transversus abdominis and m.multifidus muscle activities, flexion, and extension proprioception error of the trunk, FABQ, BDI, and SF-36 scores in Biofeedback and PT feedback groups (p < 0.05 for all). The time X group interaction was significant on flexion and extension proprioception error of the trunk PT feedback group (consecutively; p = 0.004, p = 0.022). Biofeedback sensor or PT feedback during core stabilization training equally improves pain, disability, muscle activity, depressive symptoms, patient beliefs, and quality of life in patients with CNLBP.