{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T21:20:11Z","timestamp":1787865611211,"version":"build-2784847793"},"reference-count":66,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T00:00:00Z","timestamp":1787788800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004320","name":"Shiraz University of Medical Sciences","doi-asserted-by":"publisher","award":["27512"],"award-info":[{"award-number":["27512"]}],"id":[{"id":"10.13039\/501100004320","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Chronic non-specific low back pain is a multifactorial condition encompassing both physical and psychosocial components, frequently characterized by maladaptive pain-related cognitions and fear-avoidance behaviours. Pain neuroscience education seeks to reconceptualize these cognitions and mitigate pain-related fear. This study evaluated the additional benefits of integrating pain neuroscience education with Flexi-Bar-based stabilization exercises on pain intensity, functional disability, and geometry of the abdominal and lumbar Multifidus muscles in individuals with chronic non-specific low back pain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Forty-eight participants diagnosed with chronic non-specific low back pain were randomly allocated to one of two groups: (1) Pain neuroscience education followed by Flexi-Bar stabilization exercises or (2) Flexi-Bar stabilization exercises alone. Both groups underwent supervised Flexi-Bar stabilization training sessions three times a week for six weeks. The primary outcome was functional disability assessed by the Roland\u2013Morris Questionnaire at baseline, immediately post-intervention, and at the 4-week follow-up. Secondary outcomes included pain intensity, kinesiophobia, pain catastrophizing, and fear-avoidance beliefs, all measured at the same three time points, as well as ultrasound-based geometry of abdominal and lumbar multifidus muscles, which was assessed at baseline and post-intervention in supine, seated, and standing positions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Result<\/jats:title>\n                    <jats:p>Repeated-measures ANOVA revealed significant Time\u2009\u00d7\u2009Group interaction effects, main effects of time, and main effects of Group for both functional disability and pain intensity (p\u2009&lt;\u20090.05). Ultrasound analysis demonstrated significant post-intervention increases in Transverse Abdominis and lumbar Multifidus muscle thickness across all tested positions (p\u2009&lt;\u20090.05), with the pain neuroscience education plus exercise group exhibiting significantly greater increases compared to the exercise-only group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      The combined PNE plus stabilization exercises yielded superior improvements in pain, disability, and muscle geometry compared with stabilization alone. However, the absence of a PNE-only group precludes isolating the educational component\u2019s unique contribution.\n                      <jats:bold>Iranian Registry of Clinical Trials; prospectively registered<\/jats:bold>\n                      (Trial number\n                      <jats:bold>:<\/jats:bold>\n                      IRCT20230505058095N1).\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0355692","type":"journal-article","created":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T20:35:39Z","timestamp":1787862939000},"page":"e0355692","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["The effect of integrating pain neuroscience education with stabilization exercises using a flexi-bar on functional disability, pain, and geometry of abdominal and multifidus muscles in patients with chronic non-specific low back pain"],"prefix":"10.1371","volume":"21","author":[{"given":"Zahra","family":"Dehghani","sequence":"first","affiliation":[{"name":"Student Research Committee, Shiraz University of Medical Sciences","place":["Shiraz, Iran"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1999-1778","authenticated-orcid":true,"given":"Sara","family":"Abolahrari-Shirazi","sequence":"additional","affiliation":[{"name":"School of rehabilitation Sciences, Shiraz University of Medical Sciences","place":["Shiraz, Iran"],"department":["Physical Therapy Department"]},{"name":"Orthopedic & Rehabilitation Research Center, Shiraz University of Medical Science","place":["Shiraz, Iran"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farahnaz","family":"Emami","sequence":"additional","affiliation":[{"name":"Orthopedic & Rehabilitation Research Center, Shiraz University of Medical Science","place":["Shiraz, Iran"]},{"name":"School of Rehabilitation Sciences, Shiraz University of Medical Science","place":["Shiraz, Iran"],"department":["Physical Therapy Department"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4852-8202","authenticated-orcid":true,"given":"Ghazal","family":"Roshdi","sequence":"additional","affiliation":[{"name":"Student Research Committee, Shiraz University of Medical Sciences","place":["Shiraz, Iran"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salman","family":"Nazary-Moghadam","sequence":"additional","affiliation":[{"name":"School of Paramedical and Rehabilitation Sciences, Mashhad University of Medical Sciences","place":["Mashhad, Iran"],"department":["Department of Physiotherapy"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,8,27]]},"reference":[{"issue":"6","key":"pone.0355692.ref001","article-title":"Comparative effect of trunk balance exercise over conventional back care 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