Anderson-Worth SG, Henry SM, Bunn J; University of Vermont, Burlington, Vermont, USA. Worth@gmavt.net.

PURPOSES: Real time ultrasound (RTUS) may be a useful teaching tool for physical therapy patients with low back pain (LBP) learning the abdominal hollowing exercise (AHE), the first exercise in a lumbar stabilization exercise progression. The RTUS provides visualization of the 3 anterolateral abdominal muscles whilst the patient attempts to preferentially activate the transversus abdominis. This study examined whether or not supplementing typical clinical instruction with visual feedback from RTUS facilitates performance and learning of the AHE for patients with recurrent episodic LBP. SUBJECTS: Nineteen patients (35 years ± 12 years; 9 females; 1.72 m ± 0.12 m; 76.4 kg ± 12.3 kg) with recurrent episodic LBP of longer than 6 months were randomly divided into two feedback groups. McGill Pain Questionnaire (8.3 ± 4.4 word score), Oswestry Disability Index (18.9 ± 8.3), and Visual Analogue scores (3.5 ± 2.4) were obtained on the initial test session. METHODS: In the hook-lying position, Group 1 (control) received typical clinical instruction (verbal and palpatory feedback) whilst attempting the AHE, whereas Group 2 additionally received visual feedback from RTUS. A retention test was performed on each subject within 5 days of the initial testing session. Exercise performance during both sessions was assessed by the primary investigator using visual feedback from RTUS, and palpation/visual observation of the abdomen. The criterion for successful learning of the AHE was defined as three consecutive correct AHEs out of ten attempts within each 20-minute session. ANALYSIS: A Kaplan-Meier test examined the difference between the survival times (# trials to criterion) in the two feedback groups for each of the testing sessions separately. RESULTS: RTUS decreased the number of trials to criterion for patients in Group 2 (supplemented with RTUS) as they attempted the AHE compared to Group 1 (no RTUS) (p = 0.0002). 100% of Group 2 reached criterion during the initial testing whereas only 40% of Group 1 reached criterion. For retention testing, a trend is shown toward a decreased number of trials to criterion for Group 2 compared to Group 1 (p = 0.0502). 100% of Group 2 and 60% of Group 1 reached criterion. CONCLUSION: RTUS can enhance the learning of the AHE in patients with recurrent episodic LBP, making it a useful clinical teaching tool for physical therapists. Quicker mastery of the AHE allows physical therapy treatment time to be used for progressing patients through their specific performance impairments and functional goals using the AHE. FUNDING SOURCE: The Physical Therapy Fund, UVM.

No material gain.

Copyright 2004 by the American Physical Therapy Association

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