Accepted for/Published in: JMIR Serious Games
Date Submitted: Jun 30, 2021
Open Peer Review Period: Jun 30, 2021 - Aug 25, 2021
Date Accepted: Apr 14, 2022
(closed for review but you can still tweet)
Feedback on Trunk Movements from an Electronic Game to Improve Postural Balance in People With Nonspecific Low Back Pain: A Pilot Randomized Controlled Trial
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 sensorībased 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 a Box Lift and a Waiter Bow task, as well as participant reported outcomes. Adherence to the exercising intervention was also examined.
Methods:
A randomized controlled trial was conducted with participants in the intervention group receiving unsupervised home exercises with visual feedback using the VALEDO Home, an exergame based on 2 inertial measurement units (IMU). The control group received no intervention. Outcomes were recorded by blinded staff during 4 visits (T1-T4) at the 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 IMU. The assessments included pain intensity, disability, quality of life, and fear of movement questionnaires.
Results:
Thirty-two participants with nonspecific low back pain completed the first assessment T1 and 27 participants were randomized at T2 (14 control, 13 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=.07). None of the outcomes showed significant change in accordance with our hypotheses. The intervention group completed a median of 61% exercises (55/90; range 2%; -99%) of 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 challenge the robustness of these conclusions. Clinical Trial: ClinicalTrials.gov NCT04364243
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