{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T20:12:52Z","timestamp":1780949572656,"version":"3.54.1"},"reference-count":43,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"German Aerospace Center (Deutsches Zentrum f\u00fcr Luft-und Raumfahrt e. V.)","award":["01EC1906C"],"award-info":[{"award-number":["01EC1906C"]}]},{"name":"Open Access Publication Fund of Charit\u00e9\u2013Universit\u00e4tsmedizin Berlin","award":["01EC1906C"],"award-info":[{"award-number":["01EC1906C"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JFMK"],"abstract":"<jats:p>Background\/Objectives: Chronic low back pain (CLBP) is prevalent among older adults and leads to significant functional limitations and reduced quality of life. Segmental stabilization exercises (SSEs) are commonly used to treat CLBP, but the selective activation of deep abdominal muscles during these exercises can be challenging for patients. To support muscle activation, physiotherapists use biofeedback methods such as palpation and ultrasound imaging. This randomized controlled pilot study aimed to compare the effectiveness of these two biofeedback techniques in older adults with CLBP. Methods: A total of 24 participants aged 65 years or older with CLBP were randomly assigned to one of two groups: one group performed self-palpation biofeedback, while the other group used real-time ultrasound imaging to visualize abdominal muscle activation. Muscle activation and thickness were continuously tracked using a semi-automated algorithm. The preferential activation ratio (PAR) was calculated to measure muscle activation, and statistical comparisons between groups were made using ANOVA. Results: Both groups achieved positive PAR values during all repetitions of the abdominal-draw-in maneuver (ADIM) and abdominal bracing (AB). Statistical analysis revealed no significant differences between the groups in terms of PAR during ADIM (F(2, 42) = 0.548, p = 0.58, partial \u03b72 = 0.025) or AB (F(2, 36) = 0.812, p = 0.45, partial \u03b72 = 0.043). Both groups reported high levels of exercise enjoyment and low task load. Conclusions: In conclusion, both palpation and ultrasound biofeedback appear to be effective for guiding older adults with CLBP during SSE. Larger studies are needed to confirm these results and examine the long-term effectiveness of these biofeedback methods.<\/jats:p>","DOI":"10.3390\/jfmk10010014","type":"journal-article","created":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T11:24:19Z","timestamp":1735730659000},"page":"14","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Learning Transversus Abdominis Activation in Older Adults with Chronic Low Back Pain Using an Ultrasound-Based Wearable: A Randomized Controlled Pilot Study"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0020-2617","authenticated-orcid":false,"given":"Luis","family":"Perotti","sequence":"first","affiliation":[{"name":"Department of Geriatrics and Medical Gerontology, Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, 13347 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1584-687X","authenticated-orcid":false,"given":"Oskar","family":"Stamm","sequence":"additional","affiliation":[{"name":"Department of Geriatrics and Medical Gerontology, Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, 13347 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah","family":"Strohm","sequence":"additional","affiliation":[{"name":"Fraunhofer Institute for Digital Medicine MEVIS, 28359 Bremen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00fcrgen","family":"Jenne","sequence":"additional","affiliation":[{"name":"Fraunhofer Institute for Digital Medicine MEVIS, 28359 Bremen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0690-9384","authenticated-orcid":false,"given":"Marc","family":"Fournelle","sequence":"additional","affiliation":[{"name":"Department of Ultrasound, Fraunhofer Institute for Biomedical Engineering, 66280 Sulzbach, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nils","family":"Lahmann","sequence":"additional","affiliation":[{"name":"Department of Geriatrics and Medical Gerontology, Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, 13347 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ursula","family":"M\u00fcller-Werdan","sequence":"additional","affiliation":[{"name":"Department of Geriatrics and Medical Gerontology, Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, 13347 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1586\/14737167.6.3.359","article-title":"Chronic Low Back Pain: Epidemiology, Economic Burden and Patient-Reported Outcomes in the USA","volume":"6","author":"Parthan","year":"2006","journal-title":"Expert Rev. Pharmacoecon. Outcomes Res."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1586\/14737167.6.5.591","article-title":"Economic Burden of Chronic Pain","volume":"6","author":"Phillips","year":"2006","journal-title":"Expert Rev. Pharmacoecon. Outcomes Res."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"361","DOI":"10.2147\/CEOR.S134130","article-title":"The Economic and Humanistic Costs of Chronic Lower Back Pain in Japan","volume":"9","author":"Montgomery","year":"2017","journal-title":"Clin. Outcomes Res."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e789","DOI":"10.6061\/clinics\/2019\/e789","article-title":"Prevalence of Low Back Pain in the Elderly Population: A Systematic Review","volume":"74","author":"Sakaguchi","year":"2019","journal-title":"Clinics"},{"key":"ref_5","first-page":"1","article-title":"Pr\u00e4valenz von R\u00fccken- und Nackenschmerzen in Deutschland. Ergebnisse der Krankheitslast-Studie BURDEN 2020","volume":"S3","author":"Krause","year":"2021","journal-title":"J. Health Monit."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1007\/s40122-018-0105-x","article-title":"Physical Therapy Approaches in the Treatment of Low Back Pain","volume":"7","author":"Shipton","year":"2018","journal-title":"Pain Ther."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1016\/S0003-9993(98)90059-4","article-title":"Combined Exercise and Motivation Program: Effect on the Compliance and Level of Disability of Patients with Chronic Low Back Pain: A Randomized Controlled Trial","volume":"79","author":"Friedrich","year":"1998","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1191\/0269215506cr977oa","article-title":"Segmental Stabilizing Exercises and Low Back Pain. What Is the Evidence? A Systematic Review of Randomized Controlled Trials","volume":"20","author":"Rackwitz","year":"2006","journal-title":"Clin. Rehabil."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.1590\/S1807-59322010001000015","article-title":"Segmental Stabilization and Muscular Strengthening in Chronic Low Back Pain\u2014A Comparative Study","volume":"65","author":"Burke","year":"2010","journal-title":"Clinics"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Nascimento, R.K.B.D., Costa, S.C.F., Sales, T.S., and Silva, R.M.V.D. (2020). Effects of Segmental Stabilization in Patients with Low Back Pain: Systematic Review. Mtprehabjournal, 1\u20136.","DOI":"10.17784\/mtprehabjournal.2018.16.563"},{"key":"ref_11","unstructured":"Richardson, C. (1998). Therapeutic Exercise for Spinal Segmental Stabilization: In Lower Back Pain, Churchill Livingstone."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Puntumetakul, R., Saiklang, P., Tapanya, W., Chatprem, T., Kanpittaya, J., Arayawichanon, P., and Boucaut, R. (2021). The Effects of Core Stabilization Exercise with the Abdominal Drawing-in Maneuver Technique versus General Strengthening Exercise on Lumbar Segmental Motion in Patients with Clinical Lumbar Instability: A Randomized Controlled Trial with 12-Month Follow-Up. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18157811"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1054\/math.1995.0243","article-title":"Muscle Control-Pain Control. What Exercises Would You Prescribe?","volume":"1","author":"Richardson","year":"1995","journal-title":"Man. Ther."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/j.math.2009.10.006","article-title":"Experiences of Individuals with Chronic Low Back Pain during and after Their Participation in a Spinal Stabilisation Exercise Programme\u2014A Pilot Qualitative Study","volume":"15","author":"Sokunbi","year":"2010","journal-title":"Man. Ther."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/j.msksp.2018.09.002","article-title":"Low Back Pain Patients\u2019 Perspectives on Long-Term Adherence to Home-Based Exercise Programmes in Physiotherapy","volume":"38","author":"Saner","year":"2018","journal-title":"Musculoskelet. Sci. Pract."},{"key":"ref_16","first-page":"359","article-title":"Practicability of Segmental Stabilizing Exercises in the Context of a Group Program for the Secondary Prevention of Low Back Pain. An Explorative Pilot Study","volume":"43","author":"Rackwitz","year":"2007","journal-title":"Eur. Medicophysica"},{"key":"ref_17","unstructured":"Blumenstein, B. (2002). Brain and Body in Sport and Exercise: Biofeedback Applications in Performance Enhancement, Wiley."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.physio.2008.10.003","article-title":"Reliability of a Test Measuring Transversus Abdominis Muscle Recruitment with a Pressure Biofeedback Unit","volume":"95","author":"Rackwitz","year":"2009","journal-title":"Physiotherapy"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/S1356-689X(98)80002-7","article-title":"Use of Real-Time Ultrasound Imaging for Feedback in Rehabilitation","volume":"3","author":"Hides","year":"1998","journal-title":"Man. Ther."},{"key":"ref_20","first-page":"4","article-title":"Real-time ultrasound feedback and abdominal hollowing exercises for people with low back pain","volume":"35","author":"Sga","year":"2007","journal-title":"N. Z. J. Physiother."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"627","DOI":"10.2519\/jospt.2007.2555","article-title":"Ultrasound Imaging as a Feedback Tool in the Rehabilitation of Trunk Muscle Dysfunction for People with Low Back Pain","volume":"37","author":"Henry","year":"2007","journal-title":"J. Orthop. Sports Phys. Ther."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1123\/JSR.2013-0057","article-title":"Changes in Muscle Thickness After Exercise and Biofeedback in People With Low Back Pain","volume":"23","author":"Partner","year":"2014","journal-title":"J. Sport Rehabil."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1016\/j.pmrj.2015.09.015","article-title":"Reliability of Ultrasound Imaging Measures of Transverse Abdominis and Lumbar Multifidus in Various Positions","volume":"8","author":"Mangum","year":"2016","journal-title":"PMR"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Valent\u00edn-Mazarracin, I., Nogaledo-Mart\u00edn, M., L\u00f3pez-de-Uralde-Villanueva, I., Fern\u00e1ndez-de-las-Pe\u00f1as, C., Stokes, M., Arias-Bur\u00eda, J.L., D\u00edaz-Arribas, M.J., and Plaza-Manzano, G. (2021). Reproducibility and Concurrent Validity of Manual Palpation with Rehabilitative Ultrasound Imaging for Assessing Deep Abdominal Muscle Activity: Analysis with Preferential Ratios. Diagnostics, 11.","DOI":"10.3390\/diagnostics11020298"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"100","DOI":"10.4103\/0976-500X.72352","article-title":"CONSORT 2010 Statement: Updated Guidelines for Reporting Parallel Group Randomised Trials","volume":"1","author":"Schulz","year":"2010","journal-title":"J. Pharmacol. Pharmacother."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Wessel, D., Attig, C., and Franke, T. (2019, January 8). ATI-S\u2014An Ultra-Short Scale for Assessing Affinity for Technology Interaction in User Studies. Proceedings of the Mensch und Computer, Hamburg, Germany.","DOI":"10.1145\/3340764.3340766"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"S17","DOI":"10.1007\/s00586-005-1044-x","article-title":"Pain Assessment","volume":"15","author":"Haefeli","year":"2006","journal-title":"Eur. Spine J."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"3115","DOI":"10.1097\/00007632-200012150-00006","article-title":"The Roland-Morris Disability Questionnaire and the Oswestry Disability Questionnaire","volume":"25","author":"Roland","year":"2000","journal-title":"Spine"},{"key":"ref_29","first-page":"Doc07","article-title":"Validation and Reliability of the German Version of the Chronic Pain Grade Questionnaire in Primary Care Back Pain Patients","volume":"1","author":"Klasen","year":"2004","journal-title":"Psychosoc. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1007\/s11606-009-0981-1","article-title":"Development and Initial Validation of the PEG, a Three-Item Scale Assessing Pain Intensity and Interference","volume":"24","author":"Krebs","year":"2009","journal-title":"J. Gen. Intern. Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1016\/S0166-4115(08)62386-9","article-title":"Development of NASA-TLX (Task Load Index): Results of Empirical and Theoretical Research","volume":"Volume 52","author":"Hancock","year":"1988","journal-title":"Advances in Psychology"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Chen, C., Weyland, S., Fritsch, J., Woll, A., Niessner, C., Burchartz, A., Schmidt, S.C.E., and Jekauc, D. (2021). A Short Version of the Physical Activity Enjoyment Scale: Development and Psychometric Properties. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph182111035"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Holzinger, A. (2008). Construction and Evaluation of a User Experience Questionnaire. HCI and Usability for Education and Work, Springer. Lecture Notes in Computer Science.","DOI":"10.1007\/978-3-540-89350-9"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"2640","DOI":"10.1097\/00007632-199611150-00014","article-title":"Inefficient Muscular Stabilization of the Lumbar Spine Associated with Low Back Pain. A Motor Control Evaluation of Transversus Abdominis","volume":"21","author":"Hodges","year":"1996","journal-title":"Spine"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/j.apmr.2006.10.014","article-title":"Quantification of Lumbar Stability by Using 2 Different Abdominal Activation Strategies","volume":"88","author":"Grenier","year":"2007","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1109\/PROC.1973.9030","article-title":"The Viterbi Algorithm","volume":"61","author":"Forney","year":"1973","journal-title":"Proc. IEEE"},{"key":"ref_37","unstructured":"Bouguet, J.-Y. (1999). Pyramidal Implementation of the Lucas Kanade Feature Tracker Description of the Algorithm, Intel Corporation. Technical Report Microprocessor Research Labs."},{"key":"ref_38","first-page":"122","article-title":"Dr. Dobb\u2019s Journal of Software Tools","volume":"120","author":"Bradski","year":"2000","journal-title":"OpenCV Libr."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Valera-Calero, J.A., Fern\u00e1ndez-de-las-Pe\u00f1as, C., Varol, U., Ortega-Santiago, R., Gallego-Sendarrubias, G.M., and Arias-Bur\u00eda, J.L. (2021). Ultrasound Imaging as a Visual Biofeedback Tool in Rehabilitation: An Updated Systematic Review. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18147554"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Lin, S., Zhu, B., Zheng, Y., Huang, G., Zeng, Q., and Wang, C. (2021). Effect of Real-Time Ultrasound Imaging for Biofeedback on Trunk Muscle Contraction in Healthy Subjects: A Preliminary Study. BMC Musculoskelet. Disord., 22.","DOI":"10.1186\/s12891-021-04006-0"},{"key":"ref_41","first-page":"13","article-title":"The Use of Real-Time Ultrasound Feedback in Teaching Abdominal Hollowing Exercises to Healthy Subjects","volume":"35","author":"Henry","year":"2005","journal-title":"Res. Rep."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Perotti, L., Stamm, O., Mesletzky, L., Vorwerg, S., Fournelle, M., and M\u00fcller-Werdan, U. (2023). Needs and Attitudes of Older Chronic Back Pain Patients towards a Wearable for Ultrasound Biofeedback during Stabilization Exercises: A Qualitative Analysis. Int. J. Environ. Res. Public Health, 20.","DOI":"10.3390\/ijerph20064927"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"819","DOI":"10.12965\/jer.1939064.352","article-title":"Comparison of the Recruitment of Transverse Abdominis through Drawing-in and Bracing in Different Core Stability Training Positions","volume":"15","author":"Moghadam","year":"2019","journal-title":"J. Exerc. Rehabil."}],"container-title":["Journal of Functional Morphology and Kinesiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2411-5142\/10\/1\/14\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T15:23:11Z","timestamp":1759850591000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2411-5142\/10\/1\/14"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,1]]},"references-count":43,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,3]]}},"alternative-id":["jfmk10010014"],"URL":"https:\/\/doi.org\/10.3390\/jfmk10010014","relation":{},"ISSN":["2411-5142"],"issn-type":[{"value":"2411-5142","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,1]]}}}