Perturbation Training for Nonspecific Low Back Pain: A Randomized Controlled Trial

Abstract

Context: Trunk-stabilization exercises, especially when performed under unstable conditions, may be beneficial for low back pain (LBP) and related symptoms. However, more evidence is needed to determine whether adding a perturbation component to the training program contributes to greater improvement. Objective: To determine the effects of perturbation training on trunk-muscle endurance, disability, pain, functional mobility, quality of life, fear-avoidance beliefs, and satisfaction in patients with nonspecific LBP. Design: Randomized controlled clinical trial. Setting: Physiotherapy laboratory. Patients or Other Participants: A total of 44 patients with nonspecific LBP (30 women, 14 men; age = 33.06 ± 9.55 years) who had pain for at least 3 months (pain duration = 3.02 ± 3.25 years) was randomly assigned to either the exercise group (EG) or the perturbation group (PG). Interventions: The EG received a 2-phase trunk-based exercise program, and the PG received a 4-phase training program with perturbations added to the exercises performed by the EG. All interventions were performed 2 days per week for 8 weeks. Main Outcome Measures: Trunk endurance (McGill endurance tests) and LBP-related disability (Oswestry Disability Index) were the primary outcome measures. Pain intensity (visual analog scale), functional mobility (timed up-and-go test), quality of life (Short Form 12), fear-avoidance attitudes (Fear-Avoidance Beliefs Questionnaire), and patient satisfaction (Global Rating of Change) were the secondary outcome measures. Results: Both groups showed improvement in all variables (P < .05). However, the PG was superior to the EG in improving trunk-muscle endurance (flexor: F1,41 = 12.24, P = .001; extensor: F1,41 = 17.67, P < .001; right lateral flexor: F1,41 = 12.93, P = .001; left lateral flexor: F1,41 = 15.02, P < .001) and the Oswestry Disability Index (P = .005). Between-groups effect sizes were large (partial η2 range, 0.18-0.30). The timed up-and-go test (F1,41 = 4.96, P = .03) and Fear-Avoidance Beliefs Questionnaire total score improved more in the PG (F1,41 = 5.06, P = .03), with a medium effect size (partial η2 = 0.11), and satisfaction was also higher in the PG ( formula presented = 4.46, P = .03). Conclusions: An 8-week trunk-based exercise program, when combined with perturbation training, led to greater improvements in trunk-muscle endurance, function, total fear-avoidance belief scores, and satisfaction.