Background: Exercise therapy is strongly recommended as a treatment for chronic nonspecific low back pain (CNSLBP). However, therapist-guided exercise therapy requires significant medical resources. Ordinary digital telerehabilitation affects efficacy due to a lack of guidance and dynamic support. Artificial intelligence (AI)–assisted interactive health promotion systems may solve these problems. Objective: We aimed to explore whether AI-assisted multimodal exercise telerehabilitation is superior to conventional telerehabilitation in the treatment of people with CNSLBP. Methods: This study was a prospective, double-arm, open-label, randomized clinical controlled trial. People with CNSLBP were randomly allocated to either the AI or video group, receiving AI-assisted multimodal exercise therapy or conventional video guidance, respectively, via a WeChat application add-in. The multimodal exercise consisted of deep core muscle, flexibility, Mackenzie, and breathing exercises. The exercises were performed for 30‐45 minutes per session, 3 times a week, for 4 weeks. Participants underwent face-to-face assessment at baseline and week 4, and web-based assessment at weeks 2 and 8. The primary outcome was the change in Numerical Rating Scale (NRS) relative to baseline at week 4. Secondary outcomes included changes in the Roland-Morris Disability Questionnaire (RMDQ), Oswestry Disability Index (ODI), Pain Castastrophizing Scale (PCS), Timed Up-and-Go (TUG) test, and thickness of the transverse abdominus (TrA) and multifidus (MF) muscles relative to baseline at week 4. Generalized estimating equation and covariance were used to examine the efficacy of the interventions. Results: A total of 38 participants (19 participants per group) were recruited. Eighteen participants in the AI group and 16 participants in the video group completed and were included in the final analysis. There was a significant difference in NRS at week 4 between the AI group and video group (most severe NRS: −3.00 vs −1.50; adjusted mean difference −1.08, 95% CI −1.68 to −0.49; P<.001; mean NRS: −2.61 vs −1.62; adjusted mean difference −0.67, 95% CI −1.19 to −0.15; P=.01). The difference in most severe NRS persisted until week 8 (−3.06 vs −1.69; adjusted mean difference −0.95, 95% CI −1.73 to −0.18; P=.02). Compared with the video group at week 4, the AI group showed significant improvement in secondary outcomes, including RMDQ, PCS, and core muscle thickness of left TrA, right TrA, left MF, and right MF. Conclusions: We showed that 4 weeks of telerehabilitation based on AI-assisted multimodal exercise has better therapeutic effects compared to conventional exercise telerehabilitation in people with CNSLBP. This study provides guidance for developing effective real-time home-based exercise therapies for people with CNSLBP, which may help reduce economic and human resource costs associated with treatment.

Pre-frailty is a transitional stage between health and frailty. Previous studies have demonstrated that individuals with pre-frailty experience declines in cognitive and gait performances compared with healthy individuals. However, the basic neural mechanism underlying this needs to be clarified. In this cross-sectional study, twenty-one healthy older adults and fifteen with pre-frailty underwent three conditions, including a single cognitive task (SC), single walking task (SW), and dual-task (DT), while cortical hemodynamic reactions were measured using functional near-infrared spectroscopy (fNIRS). The prefrail group (PG) showed a significantly lower activation of the left dorsolateral prefrontal cortex (L-DLPFC) than the healthy group (HG) when performing SC (p < 0.05). The PG showed a significantly lower Timed Up and Go test and step speed than the HG during SW (p < 0.05). The coefficient of variation (CV) of the step length of the PG was significantly higher than that of the HG when performing DT (p < 0.05). No significant correlation in cerebral cortex activation and gait parameters in the HG when performing SW and DT was noted (p > 0.05). Participants of the PG with a higher oxygenated area in the left anterior prefrontal cortex (L-APFC) had a lower step frequency during SW (r = −0.533, p = 0.041), and so did the following indicators of the PG during DT: L-APFC and step speed (r = −0.557, p = 0.031); right anterior prefrontal cortex and step speed (r = −0.610, p = 0.016); left motor cortex and step speed (r = −0.674, p = 0.006); step frequency (r = −0.656, p = 0.008); and step length (r = −0.535, p = 0.040). The negative correlations between the cerebral cortex and gait parameters of the PG indicated a neural compensatory effect of pre-frailty. Therefore, older adults with pre-frailty promote prefrontal activation to compensate for the impaired sensorimotor systems.

Although previous studies have shown that galvanic vestibular stimulation (GVS) and proprioceptive stimulation (PS) can improve balance function in patients with post-stroke balance disorders, the exact central mechanisms remain unclear. This study used functional near-infrared spectroscopy (fNIRS) to investigate differences and changes in cortical activation during PS, GVS, and their combination in healthy individuals and patients with post-stroke balance disorders. Sixteen patients with post-stroke balance disorders and twenty healthy controls were enrolled as the patient and healthy groups, respectively. Participants stood on the vibrating platform and underwent three tasks: only GVS (Task 1), only PS (Task 2), and GVS and PS (Task 3). Cortical activation of Somatosensory cortex (S1), Motor cortex (MC), Dorsolateral prefrontal cortex (DLPFC), and Broca's area (Broca) was collected using fNIRS. Task 1 did not activate any region of interest (ROI) in either group. Task 2 activated right S1, bilateral MC, DLPFC, and Broca in the healthy group. In the patient group, Task 2 activated right S1 and left MC. In contrast, Task 3 elicited activation of all ROIs in both groups. Cortical activation between the two groups during the three tasks did not show any significant differences. Compared to GVS or PS alone, combining GVS with PS better improved cortical hemodynamic conditions in patients with post-stroke balance disorders. These findings highlight the clinical potential of GVS and PS in the rehabilitation of patients with post-stroke balance disorders, warranting further exploration.

Introduction: Previous research demonstrates that individuals with chronic nonspecific low back pain (CNSLBP) exhibit changes of gait patterns. However, the neural mechanisms responsible for these adverse events remain unelucidated. In this study, we used functional near-infrared spectroscopy (fNIRS) to investigate cortical activities during cognitive and walking tasks to provide evidence of the central mechanisms responsible for changes of gait patterns in individuals with CNSLBP. Methods: In this cross-sectional study, we evaluated 18 individuals with CNSLBP (the CNSLBP group) and 18 healthy controls (the HC group) under three specific conditions: Task 1 (a single walking task), Task 2 (a single cognitive task) and Task 3 (a cognitive-walking dual task). Cortical activities were measured using fNIRS, including the bilateral premotor cortex and supplementary motor area (PMC/SMA), primary motor cortex (M1), somatosensory association cortex (SAC), and primary somatosensory cortex (S1). Gait parameters, including step duration, step length, stride length, velocity, cadence, swing power, and cycle, were measured using a three-dimensional gait analysis system. Results: In Task 1, the CNSLBP group exhibited a significantly lower velocity ( p = 0.029) and higher activation in the left SAC ( p = 0.001) and right S1 ( p = 0.018) than that of the HC group. In Task 2, the CNSLBP group exhibited higher activation in the left SAC ( p = 0.028), right SAC ( p = 0.033), and left S1 ( p = 0.032). In Task 3, the CNSLBP group exhibited significantly lower step length ( p = 0.031), stride length ( p = 0.041), velocity ( p = 0.016), and swing power ( p = 0.047). Correlation analysis in Task 1 revealed stronger associations between parameters in the CNSLBP group. Conclusion: Our findings suggest that individuals with CNSLBP exhibit distinct patterns of cortical activities and gait performance. The SAC and S1 were involved in walking, and central sensitization was observed in individuals with CNSLBP in daily cognitive and walking tasks. These findings could contribute to the recovery and rehabilitation of CNSLBP.

Chronic non-specific low back pain (CNSLBP) imposes a substantial economic burden. Acupuncture, a key modality in Chinese medicine, is widely used for CNSLBP. However, the therapeutic efficacy of acupuncture may be underestimated due to inadequate induction and evaluation of deqi sensation, a critical component in traditional acupuncture theory. This trial will evaluated the efficacy of 4-week standardized deqi acupuncture in individuals with CNSLBP, with primary and secondary outcomes including Visual Analog Scale (VAS), Roland-Morris Disability Questionnaire (RMDQ), 12-Item Short Form Health Survey (SF-12), Pain Catastrophizing Scale (PCS), and shear wave elastography (SWE) measurements of erector spinae (ES) and multifidus (MF). This study is a prospective, two-arm, participant-, assessor-, and statistician-blinded randomized controlled trial. Overall, 100 participants with CNSLBP will be randomly assigned to receive either standardized deqi acupuncture or sham acupuncture over a 4-week intervention period. Follow-up assessments will be conducted at week 8. The primary outcome is the change in VAS scores from baseline. Secondary outcomes include changes in RMDQ, SF-12, PCS, and SWE measurements of ES and MF muscles. All analyses will be conducted based on the intention-to-treat principle. Repeated-measures linear mixed models and ANCOVA will be employed for statistical analysis. This study is expected to provide robust evidence on the efficacy and safety of standardized Chinese medicine deqi acupuncture for CNSLBP. The findings may offer valuable guidance for clinical practice and inform future research in acupuncture-based pain management. International Traditional Medicine Clinical Trial Registry: ITMCTR2025000766. Registered on April 17, 2025.