Abstract

The clinical efficacy of the Rehabilitative ultrasound imaging (RUSI)-guided multifidus training for managing chronic low back pain (CLBP) remains unclear. This systematic review and meta-analysis aimed to evaluate the effectiveness of multifidus muscle training using RUSI in patients with CLBP. A comprehensive search of PubMed, PEDro, Scopus, and Embase databases was performed to identify randomized controlled trials (RCTs) published between 1990 and 2024. Studies were selected based on predefined inclusion criteria, and methodological quality was assessed using the PEDro scale and the Cochrane Risk of Bias 2.0 tool. Eight RCTs met the inclusion criteria. The findings consistently demonstrated that RUSI-assisted multifidus training significantly improved pain intensity, functional outcomes, and multifidus muscle thickness and activation compared with control or conventional exercise interventions. RUSI provides effective visual feedback, thereby enhancing motor learning and the precision of muscle recruitment, and potentially improving both clinical and neuromuscular outcomes in individuals with CLBP. The integration of RUSI as a biofeedback tool may enhance rehabilitation by facilitating the targeted activation of deep spinal stabilizers.