Exercise Prescription for Patients With Persistent Low Back Pain Who Present With Impaired Lateral Abdominal Muscle Activation: A Delphi Survey.

BACKGROUND AND PURPOSE: Exercise is commonly prescribed for patients with low back pain (LBP) and maladaptive changes in lateral abdominal muscle (LAM) activation. The literature has considered various exercise programs, but the evidence has not consistently identified exercise parameters associated with superior outcomes. The aim of this study was to determine how physiotherapists should prescribe exercise for patients with persistent LBP who present with maladaptive LAM activation.

METHODS

This was a three round Delphi survey. The international expert panel comprised physiotherapy clinicians with postgraduate orthopaedic manipulative physiotherapy training. Round 1 included open ended questions. Responses were collated and coded using content analysis. In Rounds 2 and 3, participants were provided with the collated responses and rated their agreement with or chose their preferred options regarding exercise prescription for patients with maladaptive LAM activation. Items were defined as meeting consensus when ≥ 70% of participants agreed/disagreed or chose the same option.

RESULTS

Twenty-three physiotherapists consented to participate. Seventeen, 20 and 15 participants completed Rounds 1, 2 and 3, respectively. The exercise prescription suggestions consisted of 46 items reaching consensus across the domains of exercise: goals, considerations, agreement on prescribing exercise for the LAM and other muscles, muscle activation during exercise, the exercise prescription and its focus.

DISCUSSION: This study provides clinically informed recommendations for physiotherapists prescribing exercise for patients with persistent LBP and maladaptive LAM activation. Findings align with motor control exercise approaches outlined in the literature. Participants emphasised the consideration of patient preferences and balancing motor control exercise with moderate/vigorous physical activity.