Investigation of the therapeutic effects of an innovative lumbar support comprising hot pack and core muscle activation feedback in individuals with low back pain

Abstract

Low back pain is a health problem with a high incidence in people of all countries. It affects work performance and activity in daily living. Lumbar supports are suggested as one of the assistive devices in the management of low back pain. However, there was limited use due to the concerns about the complication of trunk muscle weakness from prolonged usage. Therefore, it was decided to redesign lumbar support with additional built-in features such as superficial heat therapy and biofeedback to exercise the core muscles. The therapeutic effects of innovative lumbar support including hot pack and core stability activation in the management of low back pain are warranty to prove before launching to the larger population. The first study aimed to explore the effectiveness of pain modulation and quality of life of the lumbar support belt in patients with low back pain. The relevant articles using keywords “back pain, lumbar support belt, lumbar belt, back belt” were collected from the databases to identify the effectiveness of lumbar support for pain reduction and quality of life. Five of them were good quality randomized controlled trials. A systematic review showed that using lumbar support with receiving usual care reduced pain and improved quality of life in individuals with low back pain. The prescription of lumbar support, which showed positive results, was wearing lumbar support 6 – 8 hours daily for at least one month. The second study aimed to examine the validity and reliability of the feedback device for TrA muscle contraction. Twenty healthy participants were studied. The feedback sensor was applied at the front of the trunk attached to the lumbar support. Participants performed an abdominal drawing-in maneuver (ADIM) to activate TrA, and the values from the feedback sensor were collected at the same time. Ultrasound imaging of the TrA was also collected simultaneously. The feedback sensor collected values at the different clinical levels of the pressure biofeedback unit at 64, 66, 68, and 70 mmHg. The protocol was repeated with 24 hr. intervals. The intraclass correlation coefficient, coefficient of variation, and standard error of measurements were used to examine reliability. The validity of the values obtained from the relationship between the feedback sensor and TrA thickness was analyzed using Pearson’s correlation coefficients. Results: Test-retest reliability of the feedback sensor was excellent (ICC = 0.946, CV = 2.6%, SEMs = 0.54%). The values of feedback sensor reported a significant moderate correlation with the gold standard ultrasound measurement (r = - 0.514, p < 0.001). The third study aimed to investigate the effectiveness of innovative lumbar support comprising hot pack and core muscle activation feedback on pain, muscle function, quality of life, and disability. Eighty participants with chronic non-specific low back pain were randomly allocated into 4 groups, 20 participants for each group: 1) traditional lumbar support, 2) innovative lumbar support with a hot pack, 3) innovative lumbar support with core muscle exercise, and 4) innovative lumbar support with a hot pack and core muscle exercise. All participants were instructed to use lumbar support daily for 8 weeks. The primary outcomes were pain intensity, pressure pain threshold, thermal pain threshold, tissue blood flow, and transversus abdominis muscle thickness. The secondary outcomes were lumbopelvic stability control, the cross-section area of lumbar multifidus muscle, quality of life, and disability. Blinded outcome measures were taken at baseline, 4-week intervals, after treatment, and at 3-month follow-up. The results showed that there was no loss to follow-up. All groups improved in primary and secondary outcome measures at all periods of assessment (p < 0.05) except the size of core muscles and lumbopelvic stability control, which were improved in only groups 3 and 4. Overall results when compared to group 1, participants in groups 2 and 4 had more significantly reduced in pain intensity, pressure pain threshold, and thermal pain threshold (p < 0.05), participants in groups 3 and 4 had greater core muscle size and core muscle i function (p < 0.05), and participants in group 4 had greater improved in quality life and disability (p < 0.05). This study suggested that the lumbar support seems to be effective as additional intervention along with usual care in the management of non-specific low back pain and using 6 – 8 hours at least a month. The innovative device had potential reliability and validity for clinical usage to indicate transversus abdominis muscle activation. The overall finding highlights that innovative lumbar support comprising a hot pack and core muscle activation feedback is more effective than traditional lumbar support. It could be considered an additional device in rehabilitation in people who suffer chronic nonspecific low back pain.