Perturbation Training for Nonspecific Low Back Pain: A Randomized Controlled Trial
Bibliographic record
Abstract
Context Trunk-stabilization exercises, especially when performed under unstable conditions, may be beneficial for low back pain (LBP) and related symptoms. However, more evidence is needed to determine whether adding a perturbation component to the training program contributes to greater improvement. Objective To determine the effects of perturbation training on trunk-muscle endurance, disability, pain, functional mobility, quality of life, fear-avoidance beliefs, and satisfaction in patients with nonspecific LBP. Design Randomized controlled clinical trial. Setting Physiotherapy laboratory. Patients or Other Participants A total of 44 patients with nonspecific LBP (30 women, 14 men; age = 33.06 ± 9.55 years) who had pain for at least 3 months (pain duration = 3.02 ± 3.25 years) was randomly assigned to either the exercise group (EG) or the perturbation group (PG). Interventions The EG received a 2-phase trunk-based exercise program, and the PG received a 4-phase training program with perturbations added to the exercises performed by the EG. All interventions were performed 2 days per week for 8 weeks. Main Outcome Measure(s) Trunk endurance (McGill endurance tests) and LBP-related disability (Oswestry Disability Index) were the primary outcome measures. Pain intensity (visual analog scale), functional mobility (timed up-and-go test), quality of life (Short Form 12), fear-avoidance attitudes (Fear-Avoidance Beliefs Questionnaire), and patient satisfaction (Global Rating of Change) were the secondary outcome measures. Results Both groups showed improvement in all variables ( P < .05). However, the PG was superior to the EG in improving trunk-muscle endurance (flexor: F 1,41 = 12.24, P = .001; extensor: F 1,41 = 17.67, P < .001; right lateral flexor: F 1,41 = 12.93, P = .001; left lateral flexor: F 1,41 = 15.02, P < .001) and the Oswestry Disability Index ( P = .005). Between-groups effect sizes were large (partial η 2 range, 0.18–0.30). The timed up-and-go test ( F 1,41 = 4.96, P = .03) and Fear-Avoidance Beliefs Questionnaire total score improved more in the PG ( F 1,41 = 5.06, P = .03), with a medium effect size (partial η 2 = 0.11), and satisfaction was also higher in the PG ( = 4.46, P = .03). Conclusions An 8-week trunk-based exercise program, when combined with perturbation training, led to greater improvements in trunk-muscle endurance, function, total fear-avoidance belief scores, and satisfaction.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.004 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.006 | 0.003 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.009 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".