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This randomized control trial study aims to compare the effect of core stability exercises and cognitive tasks with general exercises and cognitive tasks on pain, disability, and postural control strategies of chronic non-specific low back pain patients. The main questions are:
Patients will be aged between 18-50 years. All patients meeting the inclusion criteria will receive 16 training sessions (thrice a week). The primary outcome measure will be pain and disability. Secondary outcome measures will be postural control strategies (including postural control stability and stabilogram diffusion analysis), quality of life, fear of movement, and fear-avoidance beliefs that will be assessed before and after training sessions and at 3-month follow-up; only primary outcomes will be evaluated in each group.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| core stability exercises with cognitive tasks group | Experimental | This research will use core stability exercises to strengthen local muscles (transversus abdominis and multifidus) based on the training program provided by Shamsi et al., which is modified from the exercise program of Koumantakis et al.. Participants will be treated for six weeks, three sessions a week, and 16 sessions. We will also combine stabilization exercises with cognitive tasks. |
|
| general exercises with cognitive tasks group | Active Comparator | This research will use general exercises to strengthen global muscles (abdominal flexor muscles and back extensor muscles) based on the training program provided by Shamsi et al.(110), which is modified by Koumantakis et al.. Participants will be treated for six weeks, three sessions a week, and 16 sessions. We will also combine general exercises with cognitive tasks. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| exercise therapy | Other | Exercise therapy is one of the rehabilitation methods that is defined as a regimen or plan of physical activities designed and prescribed to facilitate the patient's recovery from diseases and any conditions which disturb their movement and activity of daily life or maintain a state of well-being through neuro re-education, gait training, and therapeutic exercises. |
| Measure | Description | Time Frame |
|---|---|---|
| Oswestry Disability Index | Questionnaire evaluating the level of disability. Total score range from 0-100 (higher scores mean more disability) | "Baseline (pre-intervention)", "change from baseline immediately after the intervention at five weeks ", "change from baseline at three months " |
| Measure | Description | Time Frame |
|---|---|---|
| Center of pressure (COP) sway range for anteroposterior (AP range) | AP range is one kind of COP displacement evaluation method characterized as traditional linear measures for evaluating postural control stability. | "Baseline (pre-intervention)", "change from baseline immediately after the intervention at five weeks " |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Zeinab Raoufi | Contact | 00982122222059 | zraoofi93@gmail.com | |
| Reza Salehi | Contact | 00982122222059 | Salehi.re@iums.ac.ir |
| Name | Affiliation | Role |
|---|---|---|
| Zeinab Raoufi, PhD student | Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences | Principal Investigator |
| Reza Salehi, PhD | Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Iran University of Medical Sciences | Recruiting | Tehran | Iran (the Islamic Republic Of) | 1449614535 | Iran |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 33922389 | Background | Frizziero A, Pellizzon G, Vittadini F, Bigliardi D, Costantino C. Efficacy of Core Stability in Non-Specific Chronic Low Back Pain. J Funct Morphol Kinesiol. 2021 Apr 22;6(2):37. doi: 10.3390/jfmk6020037. | |
| 35003902 | Background | Agnus Tom A, Rajkumar E, John R, Joshua George A. Determinants of quality of life in individuals with chronic low back pain: a systematic review. Health Psychol Behav Med. 2022 Jan 5;10(1):124-144. doi: 10.1080/21642850.2021.2022487. eCollection 2022. |
| Label | URL |
|---|---|
| Efficacy of Core Stability in Non-Specific Chronic Low Back Pain | View source |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot | Yes | No | No | Study Protocol | Mar 27, 2023 | Mar 28, 2023 | Prot_000.pdf |
| SAP | No | Yes | No | Statistical Analysis Plan | Mar 27, 2023 | Mar 28, 2023 | SAP_001.pdf |
| ICF | No | No | Yes | Informed Consent Form | Mar 27, 2023 | May 19, 2023 | ICF_003.pdf |
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| ID | Term |
|---|---|
| D017116 | Low Back Pain |
| ID | Term |
|---|---|
| D001416 | Back Pain |
| D010146 | Pain |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
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| ID | Term |
|---|---|
| D005081 | Exercise Therapy |
| ID | Term |
|---|---|
| D012046 | Rehabilitation |
| D000359 | Aftercare |
| D003266 | Continuity of Patient Care |
| D005791 | Patient Care |
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|
| COP sway range for mediolateral (MA range) |
MA range is one kind of COP displacement evaluation method characterized as traditional linear measures for evaluating postural control stability. |
| "Baseline (pre-intervention)", "change from baseline immediately after the intervention at five weeks " |
| COP sway velocity | COP sway velocity is one kind of COP displacement evaluation method characterized as traditional linear measures for evaluating postural control stability. | "Baseline (pre-intervention)", "change from baseline immediately after the intervention at five weeks " |
| Sway area | Sway area is one kind of COP displacement evaluation method characterized as traditional linear measures for evaluating postural control stability. | "Baseline (pre-intervention)", "change from baseline immediately after the intervention at five weeks " |
| Short-term diffusion coefficient of stabilogram diffusion plot | The short-term diffusion coefficient is the slope of the open-loop part of the stabilogram diffusion plot, indicating stochastic activity in open loop control phase in a quiet standing position. | "Baseline (pre-intervention)", "change from baseline immediately after the intervention at five weeks " |
| Long-term diffusion coefficient of stabilogram diffusion plot | The long-term diffusion coefficient is the slope of the close loop part of the stabilogram diffusion plot, indicating stochastic activity in the immediate loop control phase in the quiet standing position. | "Baseline (pre-intervention)", "change from baseline immediately after the intervention at five weeks " |
| Critical point coordinates. | Critical point coordinates are the estimated values of the time intervals and mean square displacements defining the stabilogram-diffusion critical points (the point that open-loop control changed to close loop control) | "Baseline (pre-intervention)", "change from baseline immediately after the intervention at five weeks " |
| 12-item short form health survey | Questionnaire evaluating the quality of life. Total score range from 0-100 (higher scores mean better quality of life) | "Baseline (pre-intervention)", "change from baseline immediately after the intervention at five weeks " |
| Tampa scale for kinesiophobia | Questionnaire evaluating the kinesiophobia because of feeling re-injury. Total score range from 17-68 (higher scores mean more kinesiophobia) | "Baseline (pre-intervention)", "change from baseline immediately after the intervention at five weeks " |
| Fear-avoidance beliefs questionnaire | Questionnaire evaluating fear of pain and consequent avoidance of physical activity because of their fear. Total score range from 0-66 (higher scores mean more fear of pain) | "Baseline (pre-intervention)", "change from baseline immediately after the intervention at five weeks " |
| Visual analog scale | Questionnaire evaluating pain intensity. Total score range from 0-10 (higher scores mean more pain) | "Baseline (pre-intervention)", "change from baseline immediately after the intervention at five weeks ", "change from baseline at three months " |
| Study Director |
| 16550447 | Background | van Tulder M, Becker A, Bekkering T, Breen A, del Real MT, Hutchinson A, Koes B, Laerum E, Malmivaara A; COST B13 Working Group on Guidelines for the Management of Acute Low Back Pain in Primary Care. Chapter 3. European guidelines for the management of acute nonspecific low back pain in primary care. Eur Spine J. 2006 Mar;15 Suppl 2(Suppl 2):S169-91. doi: 10.1007/s00586-006-1071-2. No abstract available. |
| 18439264 | Background | Lamoth CJ, Stins JF, Pont M, Kerckhoff F, Beek PJ. Effects of attention on the control of locomotion in individuals with chronic low back pain. J Neuroeng Rehabil. 2008 Apr 25;5:13. doi: 10.1186/1743-0003-5-13. |
| 24532389 | Background | Kanekar N, Aruin AS. Aging and balance control in response to external perturbations: role of anticipatory and compensatory postural mechanisms. Age (Dordr). 2014 Jun;36(3):9621. doi: 10.1007/s11357-014-9621-8. Epub 2014 Feb 16. |
| 8961451 | Background | Hodges PW, Richardson CA. Inefficient muscular stabilization of the lumbar spine associated with low back pain. A motor control evaluation of transversus abdominis. Spine (Phila Pa 1976). 1996 Nov 15;21(22):2640-50. doi: 10.1097/00007632-199611150-00014. |
| 31726292 | Background | Bussey MD, Aldabe D, Shemmell J, Jowett T. Anticipatory postural control differs between low back pain and pelvic girdle pain patients in the absence of visual feedback. Hum Mov Sci. 2020 Feb;69:102529. doi: 10.1016/j.humov.2019.102529. Epub 2019 Nov 11. |
| 11713638 | Background | Hodges PW. Changes in motor planning of feedforward postural responses of the trunk muscles in low back pain. Exp Brain Res. 2001 Nov;141(2):261-6. doi: 10.1007/s002210100873. |
| 8552278 | Background | Mitchell SL, Collins JJ, De Luca CJ, Burrows A, Lipsitz LA. Open-loop and closed-loop postural control mechanisms in Parkinson's disease: increased mediolateral activity during quiet standing. Neurosci Lett. 1995 Sep 8;197(2):133-6. doi: 10.1016/0304-3940(95)11924-l. |
| 8224055 | Background | Collins JJ, De Luca CJ. Open-loop and closed-loop control of posture: a random-walk analysis of center-of-pressure trajectories. Exp Brain Res. 1993;95(2):308-18. doi: 10.1007/BF00229788. |
| 7589299 | Background | Collins JJ, De Luca CJ, Burrows A, Lipsitz LA. Age-related changes in open-loop and closed-loop postural control mechanisms. Exp Brain Res. 1995;104(3):480-92. doi: 10.1007/BF00231982. |
| 27712027 | Background | Wong JJ, Cote P, Sutton DA, Randhawa K, Yu H, Varatharajan S, Goldgrub R, Nordin M, Gross DP, Shearer HM, Carroll LJ, Stern PJ, Ameis A, Southerst D, Mior S, Stupar M, Varatharajan T, Taylor-Vaisey A. Clinical practice guidelines for the noninvasive management of low back pain: A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Eur J Pain. 2017 Feb;21(2):201-216. doi: 10.1002/ejp.931. Epub 2016 Oct 6. |
| 31666220 | Background | Owen PJ, Miller CT, Mundell NL, Verswijveren SJJM, Tagliaferri SD, Brisby H, Bowe SJ, Belavy DL. Which specific modes of exercise training are most effective for treating low back pain? Network meta-analysis. Br J Sports Med. 2020 Nov;54(21):1279-1287. doi: 10.1136/bjsports-2019-100886. Epub 2019 Oct 30. |
| 15733046 | Background | Koumantakis GA, Watson PJ, Oldham JA. Trunk muscle stabilization training plus general exercise versus general exercise only: randomized controlled trial of patients with recurrent low back pain. Phys Ther. 2005 Mar;85(3):209-25. |
| 34847915 | Background | Hlaing SS, Puntumetakul R, Khine EE, Boucaut R. Effects of core stabilization exercise and strengthening exercise on proprioception, balance, muscle thickness and pain related outcomes in patients with subacute nonspecific low back pain: a randomized controlled trial. BMC Musculoskelet Disord. 2021 Nov 30;22(1):998. doi: 10.1186/s12891-021-04858-6. |
| 27849389 | Background | Coulombe BJ, Games KE, Neil ER, Eberman LE. Core Stability Exercise Versus General Exercise for Chronic Low Back Pain. J Athl Train. 2017 Jan;52(1):71-72. doi: 10.4085/1062-6050-51.11.16. Epub 2016 Nov 16. |
| 27128390 | Background | Saragiotto BT, Maher CG, Yamato TP, Costa LOP, Costa LCM, Ostelo RWJG, Macedo LG. Motor Control Exercise for Nonspecific Low Back Pain: A Cochrane Review. Spine (Phila Pa 1976). 2016 Aug 15;41(16):1284-1295. doi: 10.1097/BRS.0000000000001645. |
| 33992272 | Background | Ganesh GS, Kaur P, Meena S. Systematic reviews evaluating the effectiveness of motor control exercises in patients with non-specific low back pain do not consider its principles - A review. J Bodyw Mov Ther. 2021 Apr;26:374-393. doi: 10.1016/j.jbmt.2020.08.010. Epub 2020 Sep 6. |
| 20434467 | Background | Remy F, Wenderoth N, Lipkens K, Swinnen SP. Dual-task interference during initial learning of a new motor task results from competition for the same brain areas. Neuropsychologia. 2010 Jul;48(9):2517-27. doi: 10.1016/j.neuropsychologia.2010.04.026. Epub 2010 Apr 29. |
| 31066022 | Background | Burcal CJ, Needle AR, Custer L, Rosen AB. The Effects of Cognitive Loading on Motor Behavior in Injured Individuals: A Systematic Review. Sports Med. 2019 Aug;49(8):1233-1253. doi: 10.1007/s40279-019-01116-7. |
| 29332033 | Background | Hemmati L, Piroozi S, Rojhani-Shirazi Z. Effect of dual tasking on anticipatory and compensatory postural adjustments in response to external perturbations in individuals with nonspecific chronic low back pain: Electromyographic analysis. J Back Musculoskelet Rehabil. 2018;31(3):489-497. doi: 10.3233/BMR-170992. |
| 23284879 | Background | Wang XQ, Zheng JJ, Yu ZW, Bi X, Lou SJ, Liu J, Cai B, Hua YH, Wu M, Wei ML, Shen HM, Chen Y, Pan YJ, Xu GH, Chen PJ. A meta-analysis of core stability exercise versus general exercise for chronic low back pain. PLoS One. 2012;7(12):e52082. doi: 10.1371/journal.pone.0052082. Epub 2012 Dec 17. |
| 12127181 | Background | Woollacott M, Shumway-Cook A. Attention and the control of posture and gait: a review of an emerging area of research. Gait Posture. 2002 Aug;16(1):1-14. doi: 10.1016/s0966-6362(01)00156-4. |
| 24636612 | Background | Sherafat S, Salavati M, Takamjani IE, Akhbari B, Rad SM, Mazaheri M, Negahben H, Lali P. Effect of dual-tasking on dynamic postural control in individuals with and without nonspecific low back pain. J Manipulative Physiol Ther. 2014 Mar-Apr;37(3):170-9. doi: 10.1016/j.jmpt.2014.02.003. Epub 2014 Mar 15. |
| 29067082 | Background | Akhtar MW, Karimi H, Gilani SA. Effectiveness of core stabilization exercises and routine exercise therapy in management of pain in chronic non-specific low back pain: A randomized controlled clinical trial. Pak J Med Sci. 2017 Jul-Aug;33(4):1002-1006. doi: 10.12669/pjms.334.12664. |
| 26864057 | Background | Shamsi MB, Rezaei M, Zamanlou M, Sadeghi M, Pourahmadi MR. Does core stability exercise improve lumbopelvic stability (through endurance tests) more than general exercise in chronic low back pain? A quasi-randomized controlled trial. Physiother Theory Pract. 2016;32(3):171-8. doi: 10.3109/09593985.2015.1117550. Epub 2016 Feb 11. |
| 29706690 | Background | Ghorbanpour A, Azghani MR, Taghipour M, Salahzadeh Z, Ghaderi F, Oskouei AE. Effects of McGill stabilization exercises and conventional physiotherapy on pain, functional disability and active back range of motion in patients with chronic non-specific low back pain. J Phys Ther Sci. 2018 Apr;30(4):481-485. doi: 10.1589/jpts.30.481. Epub 2018 Apr 13. |
| 7615030 | Background | Collins JJ, De Luca CJ. The effects of visual input on open-loop and closed-loop postural control mechanisms. Exp Brain Res. 1995;103(1):151-63. doi: 10.1007/BF00241972. |
| 22341985 | Background | Cano-de-la-Cuerda R, Molero-Sanchez A, Carratala-Tejada M, Alguacil-Diego IM, Molina-Rueda F, Miangolarra-Page JC, Torricelli D. Theories and control models and motor learning: clinical applications in neuro-rehabilitation. Neurologia. 2015 Jan-Feb;30(1):32-41. doi: 10.1016/j.nrl.2011.12.010. Epub 2012 Feb 18. English, Spanish. |
| 25317504 | Background | Shamsi MB, Sarrafzadeh J, Jamshidi A. Comparing core stability and traditional trunk exercise on chronic low back pain patients using three functional lumbopelvic stability tests. Physiother Theory Pract. 2015 Feb;31(2):89-98. doi: 10.3109/09593985.2014.959144. Epub 2014 Oct 15. |
| 16778675 | Background | Mousavi SJ, Parnianpour M, Mehdian H, Montazeri A, Mobini B. The Oswestry Disability Index, the Roland-Morris Disability Questionnaire, and the Quebec Back Pain Disability Scale: translation and validation studies of the Iranian versions. Spine (Phila Pa 1976). 2006 Jun 15;31(14):E454-9. doi: 10.1097/01.brs.0000222141.61424.f7. |
| 24254494 | Background | Rostami M, Noorian N, Mansournia MA, Sharafi E, Babaki AE, Kordi R. Validation of the Persian version of the fear avoidance belief questionnaire in patients with low back pain. J Back Musculoskelet Rehabil. 2014;27(2):213-21. doi: 10.3233/BMR-130439. |
| 10488681 | Background | Vlaeyen JWS, Seelen HAM, Peters M, de Jong P, Aretz E, Beisiegel E, Weber WEJ. Fear of movement/(re)injury and muscular reactivity in chronic low back pain patients: an experimental investigation. Pain. 1999 Sep;82(3):297-304. doi: 10.1016/S0304-3959(99)00054-8. |
| 25925506 | Background | Abedi M, Manshadi FD, Khalkhali M, Mousavi SJ, Baghban AA, Montazeri A, Parnianpour M. Translation and validation of the Persian version of the STarT Back Screening Tool in patients with nonspecific low back pain. Man Ther. 2015 Dec;20(6):850-4. doi: 10.1016/j.math.2015.04.006. Epub 2015 Apr 15. |
| 41633131 | Derived | Raoufi Z, Tabatabaei A, Dadgoo M, Takamjani EE, Salehi R, Sanjari MA. The additional effects of dual-task training with core stability exercises versus general exercises on disability and pain in people with nonspecific chronic low back pain: A randomized controlled trial. Musculoskelet Sci Pract. 2026 Apr;82:103501. doi: 10.1016/j.msksp.2026.103501. Epub 2026 Jan 16. |
| Determinants of quality of life in individuals with chronic low back pain: a systematic review | View source |
| Chapter 3. European guidelines for the management of acute nonspecific low back pain in primary care | View source |
| Effects of attention on the control of locomotion in individuals with chronic low back pain | View source |
| Compensatory but not anticipatory adjustments are altered in older adults during lateral postural perturbations | View source |
| Aging and balance control in response to external perturbations: role of anticipatory and compensatory postural mechanisms | View source |
| Inefficient muscular stabilization of the lumbar spine associated with low back pain. A motor control evaluation of transversus abdominis | View source |
| Anticipatory postural control differs between low back pain and pelvic girdle pain patients in the absence of visual feedback | View source |
| Changes in motor planning of feedforward postural responses of the trunk muscles in low back pain | View source |
| Open-loop and closed-loop postural control mechanisms in Parkinson's disease: increased mediolateral activity during quiet standing | View source |
| Open-loop and closed-loop control of posture: a random-walk analysis of center-of-pressure trajectories | View source |
| Age-related changes in open-loop and closed-loop postural control mechanisms | View source |
| Clinical practice guidelines for the noninvasive management of low back pain: A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration | View source |
| Which specific modes of exercise training are most effective for treating low back pain? Network meta-analysis | View source |
| Trunk muscle stabilization training plus general exercise versus general exercise only: randomized controlled trial of patients with recurrent low back pain | View source |
| Effects of core stabilization exercise and strengthening exercise on proprioception, balance, muscle thickness and pain related outcomes in patients with subacute nonspecific low back pain: a randomized controlled trial | View source |
| Core Stability Exercise Versus General Exercise for Chronic Low Back Pain | View source |
| Motor Control Exercise for Nonspecific Low Back Pain: A Cochrane Review | View source |
| Systematic reviews evaluating the effectiveness of motor control exercises in patients with non-specific low back pain do not consider its principles - A review | View source |
| Dual-task interference during initial learning of a new motor task results from competition for the same brain areas | View source |
| The Effects of Cognitive Loading on Motor Behavior in Injured Individuals: A Systematic Review | View source |
| Effect of dual tasking on anticipatory and compensatory postural adjustments in response to external perturbations in individuals with nonspecific chronic low back pain: Electromyographic analysis | View source |
| A meta-analysis of core stability exercise versus general exercise for chronic low back pain | View source |
| Attention and the control of posture and gait: a review of an emerging area of research | View source |
| Effect of dual-tasking on dynamic postural control in individuals with and without nonspecific low back pain | View source |
| Effectiveness of core stabilization exercises and routine exercise therapy in management of pain in chronic non-specific low back pain: A randomized controlled clinical trial | View source |
| Does core stability exercise improve lumbopelvic stability (through endurance tests) more than general exercise in chronic low back pain? A quasi-randomized controlled trial | View source |
| Effects of McGill stabilization exercises and conventional physiotherapy on pain, functional disability and active back range of motion in patients with chronic non-specific low back pain | View source |
| The effects of visual input on open-loop and closed-loop postural control mechanisms | View source |
| Theories and control models and motor learning: clinical applications in neuro-rehabilitation | View source |
| Comparing core stability and traditional trunk exercise on chronic low back pain patients using three functional lumbopelvic stability tests | View source |
| The Oswestry Disability Index, the Roland-Morris Disability Questionnaire, and the Quebec Back Pain Disability Scale: translation and validation studies of the Iranian versions | View source |
| Validation of the Persian version of the fear avoidance belief questionnaire in patients with low back pain | View source |
| Fear of movement/(re)injury and muscular reactivity in chronic low back pain patients: an experimental investigation | View source |
| Translation and validation of the Persian version of the STarT Back Screening Tool in patients with nonspecific low back pain | View source |
| D013568 |
| Pathological Conditions, Signs and Symptoms |
| D013812 |
| Therapeutics |
| D026741 | Physical Therapy Modalities |