Comparison of Abdominal Expansion and Abdominal Drawing-In Training With Manual and Verbal Cueing in Chronic Non-Specific Low Back Pain

NCT07318454 | Not Yet Recruiting

• 1 other identifier: NYCU114229AE-S3
• Study Type: interventional
• Target: 96
• Locations: 0 countries
• Sites: N/A

Brief Summary

This study aims to investigate the interactive effects of two core stability training strategies-abdominal drawing-in manoeuvre (ADIM) and Dynamic Neuromusculoskeletal Stabilization abdominal expansion (DNS-AE)-and two instructional approaches (verbal cueing and manual facilitation) on training outcomes in individuals with chronic non-specific low back pain. A 2×2 factorial randomized controlled trial design will be employed. Ninety-six participants with chronic non-specific low back pain will be randomly allocated, using block randomization, to one of four intervention groups in equal proportions. All groups will receive a 4-week intervention program, with training conducted twice per week. Outcome measures will be assessed at four time points: before the intervention (baseline), immediately after the first training session, at the completion of the 4-week intervention, and at a 3-month follow-up, to evaluate short-term and mid-term effects as well as the sustainability of training outcomes.

Conditions

Chronic Low Back Pain (Non-specific, Uncomplicated)

Outcome Measures

Primary Outcomes (2)

• Pain intensity

  Pain intensity assessed using the Visual Analogue Scale (VAS), ranging from 0 to 10, where 0 indicates no pain and 10 indicates the worst pain imaginable, with higher scores indicating greater pain intensity.

  At baseline, after the first week of intervention, and at the end of the 4-week intervention.

• Movement control performance

  Movement control performance assessed using the Nine-Item Movement Control Test Battery, which evaluates movement quality during standardized functional movement tasks. Each item is scored according to predefined error-based criteria, and item scores are summed to produce a total score ranging from 0 to 93, with higher scores indicating poorer movement control performance.

  At baseline, after the first week of intervention, and at the end of the 4-week intervention.

Secondary Outcomes (9)

• Disability related to low back pain

  At baseline, at the end of the 4-week intervention, and at 3-month follow-up.

• Patient-specific functional ability

  At baseline, at the end of the 4-week intervention, and at 3-month follow-up.

• Perceived movement difficulty assessed using the Perceived Difficulty Index (PDI).

  At baseline, after the first week of intervention, and at the end of the 4-week intervention.

• Central sensitization symptoms

  At baseline and at the end of the 4-week intervention.

• Fear-avoidance beliefs

  At baseline and at the end of the 4-week intervention.

Study Arms (4)

ADIM With Verbal Cueing

EXPERIMENTAL

Participants receive abdominal drawing-in manoeuvre training with verbal cueing, delivered twice weekly for 4 weeks.

Behavioral: Abdominal Drawing-In Manoeuvre Training

ADIM With Manual Cueing

EXPERIMENTAL

Participants receive abdominal drawing-in manoeuvre training with manual facilitation, delivered twice weekly for 4 weeks.

Behavioral: Abdominal Drawing-In Manoeuvre Training

DNS-AE With Verbal Cueing

EXPERIMENTAL

Participants receive Dynamic Neuromusculoskeletal Stabilization abdominal expansion training with verbal cueing, delivered twice weekly for 4 weeks.

Behavioral: Dynamic Neuromusculoskeletal Stabilization Abdominal Expansion Training

DNS-AE With Manual Cueing

EXPERIMENTAL

Participants receive Dynamic Neuromusculoskeletal Stabilization abdominal expansion training with manual facilitation, delivered twice weekly for 4 weeks.

Behavioral: Dynamic Neuromusculoskeletal Stabilization Abdominal Expansion Training

Interventions

Abdominal Drawing-In Manoeuvre Training BEHAVIORAL

Abdominal drawing-in manoeuvre (ADIM) training is a core stability exercise strategy emphasizing selective activation and coordination of the deep abdominal musculature to enhance local trunk stability. Participants receive individualized, one-on-one training delivered by licensed physical therapists, conducted twice weekly for 4 weeks. Training is performed across functional positions and task-specific movements, with instruction provided using either verbal cueing or manual facilitation according to group allocation.

ADIM With Manual Cueing; ADIM With Verbal Cueing

Dynamic Neuromusculoskeletal Stabilization Abdominal Expansion Training BEHAVIORAL

Dynamic Neuromusculoskeletal Stabilization abdominal expansion (DNS-AE) training focuses on coordinated breathing and abdominal expansion to facilitate intra-abdominal pressure regulation and integrated postural control. Participants receive individualized, one-on-one training delivered by licensed physical therapists, conducted twice weekly for 4 weeks. Training is performed across functional positions and task-specific movements, with instruction provided using either verbal cueing or manual facilitation according to group allocation.

DNS-AE With Manual Cueing; DNS-AE With Verbal Cueing

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Adults aged 18 years or older.
• Clinically diagnosed with chronic non-specific low back pain, with symptoms persisting for more than 12 weeks.
• Able to understand the study procedures and comply with the full intervention and assessment protocol.

You may not qualify if:

• History of surgery involving the lower back or lower extremities.
• Presence of neurological symptoms, such as numbness or tingling sensations.
• Signs or symptoms of nerve root compression.
• History of any surgical procedure within the past 3 months.
• Diagnosis of cancer.
• Presence of major medical or psychiatric disorders.
• Presence of systemic inflammatory disease.
• Pregnancy.
• Structural scoliosis of the spine.
• Inability to ambulate or stand independently, or other conditions deemed unsuitable for participation.
• Participation in any movement control-based exercise training within the past year.
• Accumulated experience of more than 4 weeks of abdominal drawing-in manoeuvre (ADIM) training or Dynamic Neuromusculoskeletal Stabilization abdominal expansion (DNS-AE) training within the past year.

Sponsors & Collaborators

• National Yang Ming Chiao Tung University: lead

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor, Department of Physical Therapy, National Yang Ming Chiao Tung University

Study Record Dates

• First Submitted: December 23, 2025
• First Posted: January 6, 2026
• Study Start: April 1, 2026
• Primary Completion (Estimated): June 30, 2026
• Study Completion (Estimated): September 30, 2026
• Last Updated: January 23, 2026

Record last verified: 2026-01