Additive Effects of Active Versus Sham Neuromuscular Electrical Stimulation Added to Core-Pelvic Stability Training in Women with Lumbar Hyperlordosis and Anterior Pelvic Tilt: A Randomized Controlled Trial

To investigate whether adding active neuromuscular electrical stimulation to core-pelvic stability training produces greater improvement in lumbar lordosis angle compared to exercise alone or exercise plus sham NMES.

A three-arm parallel-group will randomize controlled trial with assessor blinding and a pretest-posttest design. Participants will be allocated in a 1:1:1 ratio to one of three groups (Exercise, Exercise + Sham NMES, Exercise + Active NMES). The randomization sequence will generate using permuted blocks of six by an independent biostatistician, and group allocation will be concealed using sequentially numbered opaque sealed envelopes (SNOSE). Outcome assessors and the statistician will be blinded to group allocation.

The study will conducted in Isfahan, Iran. All intervention sessions (exercise and electrical stimulation) will delivered in-person under direct supervision. Baseline and post-intervention assessments will be also will perform at the same center by a trained examiner who will be blinded to group allocation.

Women aged 25–40 years Lumbar lordosis >45° (measured by flexible ruler) Anterior pelvic tilt >12° (measured by digital inclinometer) History of spinal surgery or fracture Acute or chronic low back pain requiring treatment within the past year Neurological or vestibular disorders affecting balance Pregnancy or delivery within the previous 12 months Musculoskeletal deformities (congenital or acquired) Participation in structured core stability training within the previous 6 months Contraindications to NMES (e.g., pacemaker, epilepsy, skin conditions at electrode sites) Inability to attend scheduled sessions

3gruops: Exercise Sham NMES Active NMES

Lumbar Lordosis Angle

Randomization was performed using permuted blocks of six with a 1:1:1 allocation ratio. The random sequence was generated by an independent biostatistician, and group allocation was concealed using sequentially numbered opaque sealed envelopes (SNOSE).

Outcome assessors and statisticians were blinded to group allocation. Participants and trainers could not be blinded due to the exercise-based nature of the intervention, but participants were instructed not to disclose their group assignment during testing sessions.

De-identified individual participant data (IPD): Includes demographic data (age, height, weight, BMI), primary outcome data (lumbar lordosis angle at two time points), secondary outcome data (anterior pelvic tilt angle and plank endurance time at two time points), and group allocation data. All data will be shared after removing identifiable information (names, surnames, contact numbers, and addresses).

Access Start: 6 months after publication of the study results in a peer-reviewed scientific journal. Access End: Up to 5 years after publication of results (in accordance with ICMJE standards). Estimated Publication Date: Within 12 months after study completion (study completion: 8 weeks after last participant enrollment).

Researchers affiliated with academic and scientific institutions who submit a written request and obtain approval from their institutional ethics committee. Also, researchers intending to conduct secondary analyses or meta-analyses for scientific and non-commercial purposes. Additional conditions: Priority will be given to researchers who have an approved research proposal from their institutional ethics committee and sign a non-disclosure agreement committing to use the data solely for scientific purposes.

Data and documents may be used exclusively for scientific and research purposes. Permitted uses include: Secondary analyses for research purposes Meta-analyses and systematic reviews Validation of the original study results Education and research methodology training Conditions of use: Proper citation of the original article is mandatory Commercial or for-profit use is prohibited Any new publication of results must be coordinated with the responsible authors Data must not be transferred to third parties

Name: Dr. Saeid Rostami (Corresponding Author and General Public Contact Person) Email: srostami.20@gmail.com Phone: 00989131088601 Postal Address: Department of Sport Sciences, Faculty of Human Sciences, Ragheb Isfahani Higher Education Institute, Isfahan, Iran. Postal Code: 81551-39998 Initial Contact Method: Submit a written request via email, including the study title, IRCT registration code, and proposed research plan for data analysis.

Request Process Steps: Submit a written request via email to the corresponding author (including: study title, IRCT code, requester's full details, institutional affiliation, and purpose of data use) Initial review by the research team (maximum 2 weeks) If approved: Send the non-disclosure agreement and data use agreement form for signature Receive signed form and final approval from the requester's institutional ethics committee Send data/documents via email or secure download link (maximum 4 weeks after final approval) Total Process Time: Approximately 4 to 6 weeks from receipt of a complete request