Acupuncture Combined with Core Stability Exercise for Pain, Function, and Postural Control Impairments in Chronic Low Back Pain: A Randomized Controlled Trial Protocol

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Background: Chronic low back pain (cLBP) is a major cause of disability, productivity loss, and healthcare burden. Its recurrence has been associated with impaired postural control, particularly altered anticipatory postural adjustments (APAs). Core stability exercise (CSE) may improve compensatory postural adjustments (CPAs), but its effects on APAs are limited. Acupuncture is effective for cLBP; however, whether it modulates APA-related feedforward control remains unclear. Objective: This exploratory randomised controlled trial aims to evaluate the feasibility and preliminary effectiveness of acupuncture combined with CSE and Self-Compassion Training (SCT) for improving pain, function, pain-related psychological factors, and postural control in patients with cLBP. Patients and Methods: This assessor-blinded, parallel-group trial will enrol 60 patients with cLBP, randomised 1:1 to a study group (SG) or control group (CG). The CG will receive CSE plus SCT, whereas the SG will receive Yaosan acupuncture in addition to CSE and SCT for 4 weeks. Primary outcomes include APA activation timing, APA activation amplitude, CPA activation amplitude, and centre-of-pressure sway area and path length, assessed at baseline and post-intervention. Secondary outcomes include pain intensity, disability/function, pain catastrophizing, fear-avoidance beliefs, and pain self-efficacy, assessed using the VAS, RMDQ, PCS, FABQ, and PSEQ at baseline, post-intervention, and 3-month follow-up. Safety outcomes include acupuncture-related adverse events, blood pressure, pulse, and post-exercise muscle soreness. Analyses will be performed using SPSS 25.0, with mixed-effects models as the primary analytical approach for repeated continuous outcomes. Conclusion: This trial will provide preliminary evidence on whether adjunctive acupuncture improves pain, function, psychological outcomes, and postural control and modulates APA-related feedforward mechanisms in cLBP. Trial Registration: ITMCTR2026000520.

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