The effectiveness of perturbation training in nonspecific low back pain

The aim of this study was to investigate the effects of perturbation training added to trunk-focused exercise training in individuals with nonspecific low back pain (NSLBP). A total of 48 patients with NSLBP lasting longer than 3 months were randomly assigned to either the Perturbation Group (PG) or the Exercise Group (EG). The EG received a two-phase exercise program over 8 weeks, consisting of four trunk stabilization and strengthening exercises. The PG followed a four-phase program incorporating the same exercises with the addition of a perturbation component. Before and after the interventions, assessments were conducted as follows: trunk muscle endurance was assessed using the McGill endurance tests; disability level was assessed using the Oswestry Disability Index (ODI); pain intensity at rest, during activity, and at night was assessed using the Visual Analog Scale (VAS); functional mobility was assessed with the Timed Up and Go Test (TUG); quality of life was assessed using the Short Form-12 (SF-12); and fear-avoidance beliefs were assessed with the Fear-Avoidance Beliefs Questionnaire (FABQ). Group comparisons were analyzed using pre-post test ANCOVA, with a significance level set at p<0.05. The study was completed with a total of 44 patients. At the end of the interventions, improvements in the primary outcome measures—trunk muscle endurance and ODI scores—were significantly greater in the PG (p<0.05), with large effect sizes (0.18–0.30). Among the secondary outcomes, improvements in TUG and total FABQ scores were also significantly greater in the PG (p<0.05), with moderate effect sizes (0.11). No significant differences were found between groups for VAS, SF-12, FABQ-Physical Activity, or FABQ-Work subscale scores (p>0.05). Our results indicate that perturbation training added to an 8-week trunk-focused exercise program is more effective in improving trunk muscle endurance, disability, functional mobility, and total fear-avoidance beliefs in individuals with NSLBP.