Effects of Core Stability Exercises and Cognitive Tasks on Chronic Non-specific Back Pain

Effects of Core Stability Exercises and Cognitive Tasks Compared to General Exercises and Cognitive Tasks on Chronic Non-specific Back Pain

This randomized control trial study aims to compare the effect of core stability exercises and cognitive tasks with general exercises and cognitive tasks on pain, disability, and postural control strategies of chronic non-specific low back pain patients. The main questions are: Are core stability exercises and cognitive tasks more effective than general exercises and cognitive tasks in reducing the pain of chronic non-specific low back pain patients? Are core stability exercises and cognitive tasks more effective than general exercises and cognitive tasks in reducing the disability of chronic non-specific low back pain patients? Are core stability exercises and cognitive tasks more effective than general exercises and cognitive tasks in improving postural stability parameters of chronic non-specific low back pain patients? Are core stability exercises and cognitive tasks more effective than general exercises and cognitive tasks in improving stabilogram diffusion analysis parameters of chronic non-specific low back pain patients? This study is designed to apply two exercise protocols on two groups of 17 people with non-specific back pain. Group A will receive core stability exercises along with cognitive tasks, and group B will receive general exercises along with cognitive tasks.

Patients will be aged between 18-50 years. All patients meeting the inclusion criteria will receive 16 training sessions (thrice a week). The primary outcome measure will be pain and disability. Secondary outcome measures will be postural control strategies (including postural control stability and stabilogram diffusion analysis), quality of life, fear of movement, and fear-avoidance beliefs that will be assessed before and after training sessions and at 3-month follow-up; only primary outcomes will be evaluated in each group.

This research will use core stability exercises to strengthen local muscles (transversus abdominis and multifidus) based on the training program provided by Shamsi et al., which is modified from the exercise program of Koumantakis et al.. Participants will be treated for six weeks, three sessions a week, and 16 sessions. We will also combine stabilization exercises with cognitive tasks.

This research will use general exercises to strengthen global muscles (abdominal flexor muscles and back extensor muscles) based on the training program provided by Shamsi et al.(110), which is modified by Koumantakis et al.. Participants will be treated for six weeks, three sessions a week, and 16 sessions. We will also combine general exercises with cognitive tasks.

Exercise therapy is one of the rehabilitation methods that is defined as a regimen or plan of physical activities designed and prescribed to facilitate the patient's recovery from diseases and any conditions which disturb their movement and activity of daily life or maintain a state of well-being through neuro re-education, gait training, and therapeutic exercises.

"Baseline (pre-intervention)", "change from baseline immediately after the intervention at five weeks ", "change from baseline at three months "

Questionnaire evaluating the level of disability. Total score range from 0-100 (higher scores mean more disability)

"Baseline (pre-intervention)", "change from baseline immediately after the intervention at five weeks ", "change from baseline at three months "

AP range is one kind of COP displacement evaluation method characterized as traditional linear measures for evaluating postural control stability.

"Baseline (pre-intervention)", "change from baseline immediately after the intervention at five weeks "

MA range is one kind of COP displacement evaluation method characterized as traditional linear measures for evaluating postural control stability.

"Baseline (pre-intervention)", "change from baseline immediately after the intervention at five weeks "

COP sway velocity is one kind of COP displacement evaluation method characterized as traditional linear measures for evaluating postural control stability.

"Baseline (pre-intervention)", "change from baseline immediately after the intervention at five weeks "

Sway area is one kind of COP displacement evaluation method characterized as traditional linear measures for evaluating postural control stability.

"Baseline (pre-intervention)", "change from baseline immediately after the intervention at five weeks "

The short-term diffusion coefficient is the slope of the open-loop part of the stabilogram diffusion plot, indicating stochastic activity in open loop control phase in a quiet standing position.

"Baseline (pre-intervention)", "change from baseline immediately after the intervention at five weeks "

The long-term diffusion coefficient is the slope of the close loop part of the stabilogram diffusion plot, indicating stochastic activity in the immediate loop control phase in the quiet standing position.

"Baseline (pre-intervention)", "change from baseline immediately after the intervention at five weeks "

Critical point coordinates are the estimated values of the time intervals and mean square displacements defining the stabilogram-diffusion critical points (the point that open-loop control changed to close loop control)

"Baseline (pre-intervention)", "change from baseline immediately after the intervention at five weeks "

Questionnaire evaluating the quality of life. Total score range from 0-100 (higher scores mean better quality of life)

"Baseline (pre-intervention)", "change from baseline immediately after the intervention at five weeks "

Questionnaire evaluating the kinesiophobia because of feeling re-injury. Total score range from 17-68 (higher scores mean more kinesiophobia)

"Baseline (pre-intervention)", "change from baseline immediately after the intervention at five weeks "

Questionnaire evaluating fear of pain and consequent avoidance of physical activity because of their fear. Total score range from 0-66 (higher scores mean more fear of pain)

"Baseline (pre-intervention)", "change from baseline immediately after the intervention at five weeks "

Inclusion Criteria: Orthopedist-confirmed diagnosis of chronic nonspecific low back pain that has lasted at least three months since its onset. Pain score of 3 or more on a visual analog scale. Pain during quiet standing. Cognitive level above 24 based on mini-mental state examination (MMSE). Exclusion Criteria: Radicular pain and any neurological signs. Uncorrected vision impairment. Hearing problems. Vestibular dysfunctions. Cognitive deficit. Previous spinal surgery. Severe deformity or injury to the lower extremities.

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Compensatory but not anticipatory adjustments are altered in older adults during lateral postural perturbations

Aging and balance control in response to external perturbations: role of anticipatory and compensatory postural mechanisms

Inefficient muscular stabilization of the lumbar spine associated with low back pain. A motor control evaluation of transversus abdominis

Anticipatory postural control differs between low back pain and pelvic girdle pain patients in the absence of visual feedback

Open-loop and closed-loop postural control mechanisms in Parkinson's disease: increased mediolateral activity during quiet standing

Open-loop and closed-loop control of posture: a random-walk analysis of center-of-pressure trajectories

Clinical practice guidelines for the noninvasive management of low back pain: A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration

Which specific modes of exercise training are most effective for treating low back pain? Network meta-analysis

Trunk muscle stabilization training plus general exercise versus general exercise only: randomized controlled trial of patients with recurrent low back pain

Effects of core stabilization exercise and strengthening exercise on proprioception, balance, muscle thickness and pain related outcomes in patients with subacute nonspecific low back pain: a randomized controlled trial

Systematic reviews evaluating the effectiveness of motor control exercises in patients with non-specific low back pain do not consider its principles - A review

Dual-task interference during initial learning of a new motor task results from competition for the same brain areas

Effect of dual tasking on anticipatory and compensatory postural adjustments in response to external perturbations in individuals with nonspecific chronic low back pain: Electromyographic analysis

Effect of dual-tasking on dynamic postural control in individuals with and without nonspecific low back pain

Effectiveness of core stabilization exercises and routine exercise therapy in management of pain in chronic non-specific low back pain: A randomized controlled clinical trial

Effects of McGill stabilization exercises and conventional physiotherapy on pain, functional disability and active back range of motion in patients with chronic non-specific low back pain

The Oswestry Disability Index, the Roland-Morris Disability Questionnaire, and the Quebec Back Pain Disability Scale: translation and validation studies of the Iranian versions

Validation of the Persian version of the fear avoidance belief questionnaire in patients with low back pain

Fear of movement/(re)injury and muscular reactivity in chronic low back pain patients: an experimental investigation

Translation and validation of the Persian version of the STarT Back Screening Tool in patients with nonspecific low back pain