The effect of treadmill walk with abdominal bracing versus usual care on functional limitation and fear-avoidance behaviours in the management of non-specific low back pain—a randomized control study

Abstract

Background The use of a combined abdominal bracing technique concurrently with treadmill walking exercise seems not to have been widely investigated, The use of either abdominal bracing and treadmill walk as a single individual method of treatment has proven to be of immense benefit in athletic training and amelioration of pain and functional limitation among different age groups suffering from chronic low back pain. Thus, the need to investigate whether the combination of abdominal bracing and treadmill walking would produce greater benefits than when the exercises are carried out in isolation in the management of chronic low back pain patients. Study design The study was a randomized control. Participants Thirty-three participants who met the inclusion criteria with age from 18 to 65 participated in the study. Aim This study aimed to compare the effects of treadmill walk with and without abdominal bracing versus usual care on pain, functional limitation and fear-avoidance behaviours among patients with non-specific chronic low back pain. Methods Thirty-three non-specific chronic low back pain (NSCLBP) patients were randomized into three groups treadmill walk without abdominal bracing (TWW), treadmill walk with abdominal bracing (TWAB) and usual care (UC). Interventions were carried out for 6 weeks. Outcome measure Pre and post-intervention scores of pain intensity, functional limitation, and fear-avoidance belief were assessed with box numerical pain rating scales, Oswestry disability index and Fear-Avoidance Belief Questionnaire, respectively. Results Pre-intervention scores of pain intensity functional disability and fear-avoidance belief did not show significant differences among the groups (P >0.05). Within-group analysis with paired t-test showed that pain intensity and functional limitation were significantly reduced after 6 weeks of intervention among the 3 groups. Fear-avoidance belief recorded statistical reduction among the 2 treadmill procedures (TWAB and TWW) groups (P<0.05) but not in the usual care groups (P>0.05). Participants in the TWW group showed greater improvement than those in TWAB in terms of reduction in pain intensity (24.17±16.49), functional limitation (7.00±5.97, P = 0.001) and fear- avoidance (30.83±17.90, P = 0.003) Conclusion Treadmill walk with and without abdominal bracing as well as usual care could be effective in reducing pain. However, treadmill walk without abdominal bracing was more effective in improving back function in terms of reduction in pain intensity, functional limitation (as reported by the Oswestry scale) and reducing fear-avoidance behaviour (as reported by fear-avoidance belief scores). Trial registration PACTR, PACTR201910691645076. Registered on 22 October 2019.