title: Evaluation of functional and neuromuscular changes after exercise rehabilitation for low back pain using a Swiss ball: a pilot study.
abstract: OBJECTIVE
  The purpose of this pilot study was to use a multidimensional model to evaluate deficits in patients with low back pain (LBP) over the course of a 12-week rehabilitation program using the Swiss ball.
  
  
  METHODS
  A within-subjects, repeated-measures design based at the University exercise training clinic was used. Twenty patients with chronic nonspecific LBP (12 men, 8 women; symptom duration, 4.8 years; 38.8 +/- 12.1 years old; height, 1.76 +/- 0.06 m; weight, 76.15 +/- 7.21 kg) participated in this study. Self-report measures were the Oswestry Disability Index, Visual Analog Scale, Medical Outcomes 12-Item Short Form Health Survey, and Self-Efficacy For Exercise Scale. Physiologic measures were electromyography measurement of feedforward muscle activation, flexion relaxation phenomenon, myoelectric fatigue, endurance capacity measured by the Sorenson test, and a modified sit-up test. Individuals performed 12 weeks of progressive exercise periodized every 4 weeks using a Swiss ball. Outcome measures were assessed at baseline, 4 weeks, 8 weeks, 12 weeks, and at a 3-month follow-up. Repeated-measures analysis for variance for time differences and regression analysis for variance in Oswestry scores were performed.
  
  
  RESULTS
  The Oswestry score for self-reported disability significantly decreased over the intervention (F(4,14) = 19.456, P < .001). Significant improvements in pain and disability maintained to the 3 months of follow-up. There were significant changes in perceptions of physical and mental well-being, erector spinae fatigue, and flexion relaxation measures. Change in flexion relaxation explained 38% of the improvement in Oswestry scores at the 12-week measurement.
  
  
  CONCLUSIONS
  This study showed that the Swiss ball may be successfully used in a rehabilitation context for patients with LBP. This pilot study has used a novel approach to assess improvements during a rehabilitation program, which may be used in the future to explain differences between different treatment modalities.
authors.affiliation: Exercise Rehabilitation Clinic, Department of Sport and Exercise Science, University of Auckland, Auckland, New Zealand. p.marshall@auckland.ac.nz
authors.forename: Paul W M
authors.initials: PW
authors.lastname: Marshall
authors.forename: Bernadette A
authors.initials: BA
authors.lastname: Murphy
mesh_terms: D000328:Adult; D004185:Disability Evaluation; D004576:Electromyography; D005081:Exercise Therapy / Q000295:instrumentation*; D005260:Female; D006801:Humans; D016014:Linear Models; D017116:Low Back Pain / Q000534:rehabilitation*; D008297:Male; D009126:Muscle Relaxation / Q000502:physiology; D010147:Pain Measurement; D026741:Physical Therapy Modalities; D010865:Pilot Projects; D016896:Treatment Outcome