Comparison of Abdominal Expansion and Abdominal Drawing-In Training With Manual and Verbal Cueing in Chronic Non-Specific Low Back Pain

A Randomized Controlled Trial Comparing Abdominal Expansion and Abdominal Drawing-In Training With Manual and Verbal Cueing in Individuals With Chronic Non-Specific Low Back Pain

This study aims to investigate the interactive effects of two core stability training strategies-abdominal drawing-in manoeuvre (ADIM) and Dynamic Neuromusculoskeletal Stabilization abdominal expansion (DNS-AE)-and two instructional approaches (verbal cueing and manual facilitation) on training outcomes in individuals with chronic non-specific low back pain.

A 2×2 factorial randomized controlled trial design will be employed. Ninety-six participants with chronic non-specific low back pain will be randomly allocated, using block randomization, to one of four intervention groups in equal proportions. All groups will receive a 4-week intervention program, with training conducted twice per week.

Outcome measures will be assessed at four time points: before the intervention (baseline), immediately after the first training session, at the completion of the 4-week intervention, and at a 3-month follow-up, to evaluate short-term and mid-term effects as well as the sustainability of training outcomes.

Study Overview

• Status: Not yet recruiting
• Conditions: Chronic Low Back Pain (Non-specific, Uncomplicated)
• Intervention / Treatment: Behavioral: Abdominal Drawing-In Manoeuvre Training; Behavioral: Dynamic Neuromusculoskeletal Stabilization Abdominal Expansion Training

• Study Type: Interventional
• Enrollment (Estimated): 96
• Phase: Not Applicable

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Adults aged 18 years or older.
• Clinically diagnosed with chronic non-specific low back pain, with symptoms persisting for more than 12 weeks.
• Able to understand the study procedures and comply with the full intervention and assessment protocol.

Exclusion Criteria:

• History of surgery involving the lower back or lower extremities.
• Presence of neurological symptoms, such as numbness or tingling sensations.
• Signs or symptoms of nerve root compression.
• History of any surgical procedure within the past 3 months.
• Diagnosis of cancer.
• Presence of major medical or psychiatric disorders.
• Presence of systemic inflammatory disease.
• Pregnancy.
• Structural scoliosis of the spine.
• Inability to ambulate or stand independently, or other conditions deemed unsuitable for participation.
• Participation in any movement control-based exercise training within the past year.
• Accumulated experience of more than 4 weeks of abdominal drawing-in manoeuvre (ADIM) training or Dynamic Neuromusculoskeletal Stabilization abdominal expansion (DNS-AE) training within the past year.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: ADIM With Verbal Cueing; Participants receive abdominal drawing-in manoeuvre training with verbal cueing, delivered twice weekly for 4 weeks.	Behavioral: Abdominal Drawing-In Manoeuvre Training; Abdominal drawing-in manoeuvre (ADIM) training is a core stability exercise strategy emphasizing selective activation and coordination of the deep abdominal musculature to enhance local trunk stability. Participants receive individualized, one-on-one training delivered by licensed physical therapists, conducted twice weekly for 4 weeks. Training is performed across functional positions and task-specific movements, with instruction provided using either verbal cueing or manual facilitation according to group allocation.
Experimental: ADIM With Manual Cueing; Participants receive abdominal drawing-in manoeuvre training with manual facilitation, delivered twice weekly for 4 weeks.	Behavioral: Abdominal Drawing-In Manoeuvre Training; Abdominal drawing-in manoeuvre (ADIM) training is a core stability exercise strategy emphasizing selective activation and coordination of the deep abdominal musculature to enhance local trunk stability. Participants receive individualized, one-on-one training delivered by licensed physical therapists, conducted twice weekly for 4 weeks. Training is performed across functional positions and task-specific movements, with instruction provided using either verbal cueing or manual facilitation according to group allocation.
Experimental: DNS-AE With Verbal Cueing; Participants receive Dynamic Neuromusculoskeletal Stabilization abdominal expansion training with verbal cueing, delivered twice weekly for 4 weeks.	Behavioral: Dynamic Neuromusculoskeletal Stabilization Abdominal Expansion Training; Dynamic Neuromusculoskeletal Stabilization abdominal expansion (DNS-AE) training focuses on coordinated breathing and abdominal expansion to facilitate intra-abdominal pressure regulation and integrated postural control. Participants receive individualized, one-on-one training delivered by licensed physical therapists, conducted twice weekly for 4 weeks. Training is performed across functional positions and task-specific movements, with instruction provided using either verbal cueing or manual facilitation according to group allocation.
Experimental: DNS-AE With Manual Cueing; Participants receive Dynamic Neuromusculoskeletal Stabilization abdominal expansion training with manual facilitation, delivered twice weekly for 4 weeks.	Behavioral: Dynamic Neuromusculoskeletal Stabilization Abdominal Expansion Training; Dynamic Neuromusculoskeletal Stabilization abdominal expansion (DNS-AE) training focuses on coordinated breathing and abdominal expansion to facilitate intra-abdominal pressure regulation and integrated postural control. Participants receive individualized, one-on-one training delivered by licensed physical therapists, conducted twice weekly for 4 weeks. Training is performed across functional positions and task-specific movements, with instruction provided using either verbal cueing or manual facilitation according to group allocation.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pain intensity	Pain intensity assessed using the Visual Analogue Scale (VAS), ranging from 0 to 10, where 0 indicates no pain and 10 indicates the worst pain imaginable, with higher scores indicating greater pain intensity.	At baseline, after the first week of intervention, and at the end of the 4-week intervention.
Movement control performance	Movement control performance assessed using the Nine-Item Movement Control Test Battery, which evaluates movement quality during standardized functional movement tasks. Each item is scored according to predefined error-based criteria, and item scores are summed to produce a total score ranging from 0 to 93, with higher scores indicating poorer movement control performance.	At baseline, after the first week of intervention, and at the end of the 4-week intervention.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pressure pain threshold	Pressure pain threshold (PPT) assessed using a pressure algometer.	At baseline and at the end of the 4-week intervention.
Learning acquisition during training	Learning acquisition assessed by the instructor after each training session using a numeric rating scale from 0 to 10.	After each training session during the 4-week intervention.
Disability related to low back pain	Disability assessed using the Oswestry Disability Index (ODI), with total scores ranging from 0 %to 100%, where higher scores indicate greater disability.	At baseline, at the end of the 4-week intervention, and at 3-month follow-up.
Patient-specific functional ability	Functional ability assessed using the Patient-Specific Functional Scale (PSFS), with scores ranging from 0 to 10, where 0 indicates inability to perform the activity and 10 indicates the ability to perform the activity at the pre-injury or normal level, with higher scores indicating better functional ability.	At baseline, at the end of the 4-week intervention, and at 3-month follow-up.
Perceived movement difficulty assessed using the Perceived Difficulty Index (PDI).	Perceived difficulty during movement performance assessed using the Perceived Difficulty Index (PDI). Participants rate the level of difficulty experienced during the movement tasks on a numeric rating scale ranging from 0 to 10, where 0 indicates no perceived difficulty and 10 indicates extreme difficulty, with higher scores indicating greater perceived difficulty.	At baseline, after the first week of intervention, and at the end of the 4-week intervention.
Central sensitization symptoms	Symptoms related to central sensitization assessed using the Central Sensitization Inventory (CSI), with total scores ranging from 0 to 100, where higher scores indicate greater symptom severity related to central sensitization.	At baseline and at the end of the 4-week intervention.
Fear-avoidance beliefs	Fear-avoidance beliefs assessed using the Fear-Avoidance Beliefs Questionnaire (FABQ), with total scores ranging from 0 to 96, where higher scores indicate greater fear-avoidance beliefs.	At baseline and at the end of the 4-week intervention.
Pain catastrophizing	Pain catastrophizing assessed using the Pain Catastrophizing Scale (PCS), with total scores ranging from 0 to 52, where higher scores indicate greater pain catastrophizing.	At baseline and at the end of the 4-week intervention.
Global perceived change	Overall perceived change assessed using the Global Rating of Change (GROC) scale, ranging from -7 to +7, where negative scores indicate perceived worsening, 0 indicates no change, and positive scores indicate perceived improvement, with higher scores indicating greater perceived improvement.	At the end of the 4-week intervention and at 3-month follow-up.

Collaborators and Investigators

• Sponsor: National Yang Ming Chiao Tung University

Study record dates

Study Major Dates

• Study Start (Estimated): April 1, 2026
• Primary Completion (Estimated): June 30, 2026
• Study Completion (Estimated): September 30, 2026

Study Registration Dates

• First Submitted: December 23, 2025
• First Submitted That Met QC Criteria: December 23, 2025
• First Posted (Actual): January 6, 2026

Study Record Updates

• Last Update Posted (Actual): January 23, 2026
• Last Update Submitted That Met QC Criteria: January 22, 2026
• Last Verified: January 1, 2026

More Information

Terms related to this study

• Other Study ID Numbers: NYCU114229AE-S3

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No