Learning Transversus Abdominis Activation in Older Adults with Chronic Low Back Pain Using an Ultrasound-Based Wearable: A Randomized Controlled Pilot Study

<b>Background/Objectives</b>: Chronic low back pain (CLBP) is prevalent among older adults and leads to significant functional limitations and reduced quality of life. Segmental stabilization exercises (SSEs) are commonly used to treat CLBP, but the selective activation of deep abdominal...

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Main Authors: Luis Perotti, Oskar Stamm, Hannah Strohm, Jürgen Jenne, Marc Fournelle, Nils Lahmann, Ursula Müller-Werdan
Format: Article
Language:English
Published: MDPI AG 2025-01-01
Series:Journal of Functional Morphology and Kinesiology
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Online Access:https://www.mdpi.com/2411-5142/10/1/14
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author Luis Perotti
Oskar Stamm
Hannah Strohm
Jürgen Jenne
Marc Fournelle
Nils Lahmann
Ursula Müller-Werdan
author_facet Luis Perotti
Oskar Stamm
Hannah Strohm
Jürgen Jenne
Marc Fournelle
Nils Lahmann
Ursula Müller-Werdan
author_sort Luis Perotti
collection DOAJ
description <b>Background/Objectives</b>: Chronic low back pain (CLBP) is prevalent among older adults and leads to significant functional limitations and reduced quality of life. Segmental stabilization exercises (SSEs) are commonly used to treat CLBP, but the selective activation of deep abdominal muscles during these exercises can be challenging for patients. To support muscle activation, physiotherapists use biofeedback methods such as palpation and ultrasound imaging. This randomized controlled pilot study aimed to compare the effectiveness of these two biofeedback techniques in older adults with CLBP. <b>Methods</b>: A total of 24 participants aged 65 years or older with CLBP were randomly assigned to one of two groups: one group performed self-palpation biofeedback, while the other group used real-time ultrasound imaging to visualize abdominal muscle activation. Muscle activation and thickness were continuously tracked using a semi-automated algorithm. The preferential activation ratio (PAR) was calculated to measure muscle activation, and statistical comparisons between groups were made using ANOVA. <b>Results</b>: Both groups achieved positive PAR values during all repetitions of the abdominal-draw-in maneuver (ADIM) and abdominal bracing (AB). Statistical analysis revealed no significant differences between the groups in terms of PAR during ADIM (<i>F</i>(2, 42) = 0.548, <i>p</i> = 0.58, partial <i>η</i><sup>2</sup> = 0.025) or AB (<i>F</i>(2, 36) = 0.812, <i>p</i> = 0.45, partial <i>η</i><sup>2</sup> = 0.043). Both groups reported high levels of exercise enjoyment and low task load. <b>Conclusions</b>: In conclusion, both palpation and ultrasound biofeedback appear to be effective for guiding older adults with CLBP during SSE. Larger studies are needed to confirm these results and examine the long-term effectiveness of these biofeedback methods.
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spelling doaj-art-3e99e9c329bb4d9682f78d86367da1292025-08-20T02:11:05ZengMDPI AGJournal of Functional Morphology and Kinesiology2411-51422025-01-011011410.3390/jfmk10010014Learning Transversus Abdominis Activation in Older Adults with Chronic Low Back Pain Using an Ultrasound-Based Wearable: A Randomized Controlled Pilot StudyLuis Perotti0Oskar Stamm1Hannah Strohm2Jürgen Jenne3Marc Fournelle4Nils Lahmann5Ursula Müller-Werdan6Department of Geriatrics and Medical Gerontology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 13347 Berlin, GermanyDepartment of Geriatrics and Medical Gerontology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 13347 Berlin, GermanyFraunhofer Institute for Digital Medicine MEVIS, 28359 Bremen, GermanyFraunhofer Institute for Digital Medicine MEVIS, 28359 Bremen, GermanyDepartment of Ultrasound, Fraunhofer Institute for Biomedical Engineering, 66280 Sulzbach, GermanyDepartment of Geriatrics and Medical Gerontology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 13347 Berlin, GermanyDepartment of Geriatrics and Medical Gerontology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 13347 Berlin, Germany<b>Background/Objectives</b>: Chronic low back pain (CLBP) is prevalent among older adults and leads to significant functional limitations and reduced quality of life. Segmental stabilization exercises (SSEs) are commonly used to treat CLBP, but the selective activation of deep abdominal muscles during these exercises can be challenging for patients. To support muscle activation, physiotherapists use biofeedback methods such as palpation and ultrasound imaging. This randomized controlled pilot study aimed to compare the effectiveness of these two biofeedback techniques in older adults with CLBP. <b>Methods</b>: A total of 24 participants aged 65 years or older with CLBP were randomly assigned to one of two groups: one group performed self-palpation biofeedback, while the other group used real-time ultrasound imaging to visualize abdominal muscle activation. Muscle activation and thickness were continuously tracked using a semi-automated algorithm. The preferential activation ratio (PAR) was calculated to measure muscle activation, and statistical comparisons between groups were made using ANOVA. <b>Results</b>: Both groups achieved positive PAR values during all repetitions of the abdominal-draw-in maneuver (ADIM) and abdominal bracing (AB). Statistical analysis revealed no significant differences between the groups in terms of PAR during ADIM (<i>F</i>(2, 42) = 0.548, <i>p</i> = 0.58, partial <i>η</i><sup>2</sup> = 0.025) or AB (<i>F</i>(2, 36) = 0.812, <i>p</i> = 0.45, partial <i>η</i><sup>2</sup> = 0.043). Both groups reported high levels of exercise enjoyment and low task load. <b>Conclusions</b>: In conclusion, both palpation and ultrasound biofeedback appear to be effective for guiding older adults with CLBP during SSE. Larger studies are needed to confirm these results and examine the long-term effectiveness of these biofeedback methods.https://www.mdpi.com/2411-5142/10/1/14chronic low back painbiofeedbacksegmental stabilizationultrasound imagingpreferential activation ratioreal-time
spellingShingle Luis Perotti
Oskar Stamm
Hannah Strohm
Jürgen Jenne
Marc Fournelle
Nils Lahmann
Ursula Müller-Werdan
Learning Transversus Abdominis Activation in Older Adults with Chronic Low Back Pain Using an Ultrasound-Based Wearable: A Randomized Controlled Pilot Study
Journal of Functional Morphology and Kinesiology
chronic low back pain
biofeedback
segmental stabilization
ultrasound imaging
preferential activation ratio
real-time
title Learning Transversus Abdominis Activation in Older Adults with Chronic Low Back Pain Using an Ultrasound-Based Wearable: A Randomized Controlled Pilot Study
title_full Learning Transversus Abdominis Activation in Older Adults with Chronic Low Back Pain Using an Ultrasound-Based Wearable: A Randomized Controlled Pilot Study
title_fullStr Learning Transversus Abdominis Activation in Older Adults with Chronic Low Back Pain Using an Ultrasound-Based Wearable: A Randomized Controlled Pilot Study
title_full_unstemmed Learning Transversus Abdominis Activation in Older Adults with Chronic Low Back Pain Using an Ultrasound-Based Wearable: A Randomized Controlled Pilot Study
title_short Learning Transversus Abdominis Activation in Older Adults with Chronic Low Back Pain Using an Ultrasound-Based Wearable: A Randomized Controlled Pilot Study
title_sort learning transversus abdominis activation in older adults with chronic low back pain using an ultrasound based wearable a randomized controlled pilot study
topic chronic low back pain
biofeedback
segmental stabilization
ultrasound imaging
preferential activation ratio
real-time
url https://www.mdpi.com/2411-5142/10/1/14
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