Feedback on Trunk Movements From an Electronic Game to Improve Postural Balance in People With Nonspecific Low Back Pain: Pilot Randomized Controlled Trial

Anita Meinke, Rick Peters, Ruud H Knols, Jaap Swanenburg, Walter Karlen, Anita Meinke, Rick Peters, Ruud H Knols, Jaap Swanenburg, Walter Karlen

Abstract

Background: Postural balance is compromised in people with low back pain, possibly by changes in motor control of the trunk. Augmenting exercising interventions with sensor-based feedback on trunk posture and movements might improve postural balance in people with low back pain.

Objective: We hypothesized that exercising with feedback on trunk movements reduces sway in anterior-posterior direction during quiet standing in people with low back pain. Secondary outcomes were lumbar spine and hip movement assessed during box lift and waiter bow tasks, as well as participant-reported outcomes. Adherence to the exercising intervention was also examined.

Methods: A randomized controlled trial was conducted with the intervention group receiving unsupervised home exercises with visual feedback using the Valedo Home, an exergame based on 2 inertial measurement units. The control group received no intervention. Outcomes were recorded by blinded staff during 4 visits (T1-T4) at University Hospital Zurich. The intervention group performed 9 sessions of 20 minutes in the 3 weeks between T2 and T3 and were instructed to exercise at their own convenience between T3 and T4. Postural balance was assessed on a force platform. Lumbar spine and hip angles were obtained from 3 inertial measurement units. The assessments included pain intensity, disability, quality of life, and fear of movement questionnaires.

Results: A total of 32 participants with nonspecific low back pain completed the first assessment T1, and 27 (84%) participants were randomized at T2 (n=14, 52% control and n=13, 48% intervention). Intention-to-treat analysis revealed no significant difference in change in anterior-posterior sway direction during the intervention period with a specified schedule (T2-T3) between the groups (W=99; P=.36; r=0.07). None of the outcomes showed significant change in accordance with our hypotheses. The intervention group completed a median of 61% (55/90; range 2%-99%) of the exercises in the predefined training program. Adherence was higher in the first intervention period with a specified schedule.

Conclusions: The intervention had no significant effect on postural balance or other outcomes, but the wide range of adherence and a limited sample size challenged the robustness of these conclusions. Future work should increase focus on improving adherence to digital interventions.

Trial registration: ClinicalTrials.gov NCT04364243; https://ichgcp.net/clinical-trials-registry/NCT04364243.

International registered report identifier (irrid): RR2-10.2196/26982.

Keywords: exergame; inertial measurement unit; kinesiophobia; low back pain; motor control; postural balance; postural feedback; randomized controlled trial.

Conflict of interest statement

Conflicts of Interest: None declared.

©Anita Meinke, Rick Peters, Ruud H Knols, Jaap Swanenburg, Walter Karlen. Originally published in JMIR Serious Games (https://games.jmir.org), 10.06.2022.

Figures

Figure 1
Figure 1
Overview of the study schedule showing assessment visits T1 to T4 and the interventions.
Figure 2
Figure 2
Setup of the movement tasks, inertial measurement unit positions (orange markers), and task material adaptation for A: box lift task and B: waiter bow task. The specifications have been adopted from Matheve et al [46].
Figure 3
Figure 3
Participant flow through the study. Numbers of analyzed participants are reported in the text. LBP: low back pain.
Figure 4
Figure 4
Lumbar spine and hip movement in degrees during the box lift and waiter bow task at T2 and T3. Data as included in the intention-to-treat analysis (control: n=14 and intervention n=13). Red triangles and solid lines show data of participants in the intervention group. Blue points and dashed lines show data of participants in the control group. Circled values represent imputed data.
Figure 5
Figure 5
Scores of participant-reported outcomes for the assessment visits T2 and T3. Data as included in the intention-to-treat analysis (control: n=14 and intervention: n=13) are displayed. To represent all data in the graph despite exact overlap, small random values were added for the graphical representation of the data. Red triangles and solid lines show data of participants in the intervention group. Blue points and dashed lines show data of participants in the control group. Circled values represent imputed data. NRS: numeric rating scale; RMDQ: Roland Morris disability questionnaire; TSK-11: Tampa Scale for Kinesiophobia, 11-item version; WHOQOL-Bref Physical: Physical domain World Health Organization Quality of Life Questionnaire-short version.
Figure 6
Figure 6
Exercises that have been completed during the study per participant per day. Darker color indicates a larger number of exercises performed. All exercises, including exercises that have not been intended as a part of the schedule are displayed. Black bars show assessment visit T3 and black boxes show dropouts at or before T3.

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