Validation of a novel spinal posture monitor: comparison with digital videofluoroscopy

The Intra-Rater Reliability of Ultrasonography for the Measurement of Lumbar Multifidus and Erector Spinae Thickness in Different Positions in People with and without Active Extension-Related Non-Specific Low Back Pain

Background

The paraspinal muscles, including multifidus (MF) and erector spinae (ES) play key roles in the stability and movement of the lumbar spine. This study aimed to determine the intra-rater reliability of the ES and MF muscle thickness measures of the rehabilitative ultrasound imaging (RUSI) in people with active extension pattern (AEP) non-specific chronic low back pain and controls.

Methods

Fifteen females with AEP and 19 controls participated in this test-retest intra-rater reliability study, including two different testing sessions performed in four to seven days apart. The primary (raw) and derived (normalized) measures of the L4 MF and ES muscles`thickness were examined in three different positions (prone, sitting, and standing) on both days. A two-way mixed average of intra-class correlation coefficient (ICC3, K) with confidence interval (CI = 95%) was used to determine the relative reliability. The standard error of measurement (SEM) and minimal detectable change (MDC) values at a CI of 95% were computed to examine the absolute reliability.

Results

The ICC values for the primary thickness of the L4 ES and MF muscles were from 0.85 to 0.91, except for MF muscle thickness in standing (ICC = 0.67) and sitting (ICC = 0.66) positions . The ICC values for derived data were lower in both groups. The SEM and MDC values were small enough to confirm the absolute reliability of the primary data.

Conclusion

This study supports the use of RUSI for examining the primary measures of the L4 MF and ES muscles in asymptomatic and AEP participants, but it should be used cautiously for assessing the derived measures.

Myofascial Treatment for Microcirculation in Patients with Postural Neck and Shoulder Pain

Vascular impairment is a crucial factor associated with chronic muscle pain, but relevant research from the microcirculatory aspect is lacking. Here, we investigated the differences in neck muscle microcirculation detected through laser-doppler flowmetry (LDF) and cervical biomechanics by a videofluoroscopic image in asymptomatic participants and patients with postural neck and shoulder pain. To understand the mechanism behind the effect of myofascial treatment, transverse friction massage (TFM) was applied and the immediate effects of muscular intervention on microcirculation were monitored. In total, 16 asymptomatic participants and 22 patients (mean age = 26.3 ± 2.4 and 25.4 ± 3.2 years, respectively) were recruited. Their neck muscle microcirculation and spinal image sequence were assessed. The differences in the baseline blood flow between the asymptomatic and patient groups were nonsignificant. However, the standard deviations in the measurements of the upper trapezius muscle in the patients were significantly larger (p < 0.05). Regarding the TFM-induced responses of skin microcirculation, the blood flow ratio was significantly higher in the patients than in the asymptomatic participants (p < 0.05). In conclusion, postintervention hyperemia determined through noninvasive LDF may be an indicator for the understanding of the mechanism underlying massage therapies and the design of interventions for postural pain.

Do stool types have an influence on cervicothoracic muscle activity and cervicothoracic posture among dentists/dental students?

It has been shown that the type of stool influences lumbar posture and muscle activity during dental work. Studies investigating the effect on cervicothoracic muscle activity and posture are scarce though. The present study investigated the effect of different stool types on cervicothoracic muscle activity and posture during a dental procedure. Twenty five participants completed a simulated periodontal screening whilst sitting on the Ghopec, Salli MultiAdjuster saddle and A-dec dental stool. Muscle activity of M. Splenius Capitis, M. Sternocleidomastoideus, M. Trapezius Pars Descendens and M. Trapezius Pars Ascendens was measured using surface electromyography. Cervicothoracic posture was evaluated by means of a strain gauge (BodyGuard™) fixed between C5 and T2. No differences in muscle activity and posture were found between the three stools. Although the type of stool influences lumbar posture and muscle activity, it seems these differences are not continued at the cervicothoracic region.

Effect of cycling exercise on lumbopelvic control performance in elite female cyclists

OBJECTIVES

The purpose of the present study is to assess the effects of an intense cycling training session on the stability of the lumbopelvic-hip complex through two dynamic exercise tests - the single-leg-deadlift (SLD) and a variation of the bird-modified dog (BD), via the OCTOcore application.

METHODS

Thirty-one elite female road cyclists were self-evaluated with their own smartphones, before and immediately after finishing their training sessions. Right, left and composite were measured for each exercise test.

RESULTS

There was a significant time effect on performance for both the SLB and BD tests (p<0.05; η2=0.137), and the SLD and BD tests were increased with respect to the pre-test at 15% and 17%, respectively.

CONCLUSION

An intense cycling training session produced significant alterations in lumbopelvic behavior in the elite female cyclists. The OCTOcore application demonstrated that it was a sensitive tool in detecting these changes and it could easily be used by the cyclists themselves.

In vivo assessment of cervical movement in surgeons-results from open and laparoscopic procedures

BACKGROUND

Musculoskeletal pain is commonly described in surgeons. Research suggests that 21-60% of at-risk physicians may experience significant work-related pain in their back, shoulders, neck or upper extremity and the consequences of this may impact negatively on patient care. Laparoscopic surgery in particular has become increasingly associated with musculoskeletal pain, especially in the cervical spine. Due to a number of constraints, however, it is difficult to evaluate musculoskeletal movement (particularly cervical spine motion) in the operating room environment.

STUDY DESIGN

Three consultant general surgeons were fitted with an ambulatory strain gauge in an attempt to accurately measure and compare cervical motility during open and laparoscopic surgeries. Intraoperative figures pertaining to neck flexion, extension and rotation during forty surgical procedures were collected. The completed data consisted of twenty open and twenty laparoscopic procedures, and the results were compared.

RESULTS

There was a statistically significant reduction (21.38%) in measured neck movement in laparoscopic surgery when compared with open surgery p = 0.004 (Table 2). A standard deviation of 18.97 was computed for open surgery indicating a larger variability in results deviation from the mean when compared with a value of 8.92 for laparoscopic surgery. Mean rotational neck movement was also reduced during laparoscopic procedures (23.5%) when compared with open procedures (87.9%).

CONCLUSION

Based on our results, we believe that laparoscopic surgery requires more prolonged periods of static neck posture when compared with open surgery. This difference may assist in understanding the contributing factors for musculoskeletal (in particular cervical) pain encountered in minimally invasive surgeons. Further investigation of static posture in the operating surgeon is warranted.

Reducing lumbar spine flexion using real-time biofeedback during patient handling tasks

BACKGROUND

Patient handling activities require caregivers to adopt postures that increase the risk of back injury. Training programs relying primarily on didactic methods have been shown to be ineffective at reducing this risk. The use of real-time biofeedback has potential as an alternative training method.

OBJECTIVE

To investigate the effect of real-time biofeedback on time spent by caregivers in end-range lumbar spine flexion.

METHODS

Novice participants were divided into intervention (n = 10) and control (n = 10) groups and were asked to perform a set of simulated care activities eight times on two consecutive days. Individuals in the intervention group watched a training video on safer movement strategies and received real-time auditory feedback from a wearable device (PostureCoach) in four training trials whenever their lumbar spine flexion exceeded a threshold (70% of maximum flexion). Changes in end-range lumbar spine flexion were compared between groups and across trials.

RESULTS

Participants in the intervention group saw reductions in end-range lumbar spine flexion during the simulated patient handling tasks at the end of the training compared to their baseline trials while there was no change for the control group.

CONCLUSIONS

The training program including PostureCoach has the potential to help caregivers learn to use safer postures that reduce the risk of back injury.

A Validation Study of a Polymer Optical Fiber Sensor for Monitoring Lumbar Spine Movement

This study aims to investigate the validity and reliability of a novel plastic optical fiber (POF) sensor, which was developed to measure the angles of flexion, extension and lateral bend at the lumbar region. The angles of flexion, extension and lateral bend for a standing position were measured simultaneously using both the novel POF sensor of this investigation and the commercial Biometrics goniometer instrument. Each movement had two steps of bending which were 10° and 20° based on inclinometer readings. The POF sensor had good intra-rater reliability (Intraclass correlation coefficient, ICC = 0.61 to 0.83). Bland–Altman plots were used to study the agreement using these two sensors. There were proportional differences and bias between the POF sensor and Biometrics goniometer, as the zero points did not lie in the percentage difference region in the Bland–Altman plots. The proportional difference between these two likely reflects the different sizes and thus, measurement regions of the two sensors. There was also strong correlation between the two sensors (r > 0.77). Hence, the POF sensor could be of potential utility in measuring lumbar range of motion (ROM) in a manner which is minimally invasive, and where discrete sections of the spine are under specific investigation.

The role of wearables in spinal posture analysis: a systematic review

Background

Wearables consist of numerous technologies that are worn on the body and measure parameters such as step count, distance travelled, heart rate and sleep quantity. Recently, various wearable systems have been designed capable of detecting spinal posture and providing live biofeedback when poor posture is sustained. It is hypothesised that long-term use of these wearables may improve spinal posture.

Research questions

To (1) examine the capabilities of current devices assessing spine posture, (2) to identify studies implementing such devices in the clinical setting and (3) comment on the clinical practicality of integration of such devices into routine care where appropriate.

Methods

A comprehensive systematic review was conducted in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Guidelines (PRISMA) across the following databases: PubMed; MEDLINE; EMBASE; Cochrane; and Scopus. Articles related to wearables systems able to measure spinal posture were selected amongst all published studies dated from 1980 onwards. Extracted data was collected as per a predetermined checklist including device types, study objectives, findings and limitations.

Results

A total of 37 articles were extensively reviewed and analysed in the final review. The proposed wearables most commonly used Inertial Measurement Units (IMUs) as the underlying technology. Wearables measuring spinal posture have been proposed to be used in the following settings: post-operative rehabilitation; treatment of musculoskeletal disorders; diagnosis of pathological spinal posture; monitoring of progression of Parkinson’s Disease; detection of falls; workplace occupational health and safety; comparison of interventions.

Conclusions

This is the first and only study to specifically review wearable devices that monitor spinal posture. Our findings suggest that currently available devices are capable of assessing spinal posture with good accuracy in the clinical setting. However, further validation regarding the long-term use of these technologies and improvements regarding practicality is required for commercialisation.

Clinically acceptable agreement between the ViMove wireless motion sensor system and the Vicon motion capture system when measuring lumbar region inclination motion in the sagittal and coronal planes

Background

Wireless, wearable, inertial motion sensor technology introduces new possibilities for monitoring spinal motion and pain in people during their daily activities of work, rest and play. There are many types of these wireless devices currently available but the precision in measurement and the magnitude of measurement error from such devices is often unknown. This study investigated the concurrent validity of one inertial motion sensor system (ViMove) for its ability to measure lumbar inclination motion, compared with the Vicon motion capture system.

Methods

To mimic the variability of movement patterns in a clinical population, a sample of 34 people were included – 18 with low back pain and 16 without low back pain. ViMove sensors were attached to each participant’s skin at spinal levels T12 and S2, and Vicon surface markers were attached to the ViMove sensors. Three repetitions of end-range flexion inclination, extension inclination and lateral flexion inclination to both sides while standing were measured by both systems concurrently with short rest periods in between. Measurement agreement through the whole movement range was analysed using a multilevel mixed-effects regression model to calculate the root mean squared errors and the limits of agreement were calculated using the Bland Altman method.

Results

We calculated root mean squared errors (standard deviation) of 1.82° (±1.00°) in flexion inclination, 0.71° (±0.34°) in extension inclination, 0.77° (±0.24°) in right lateral flexion inclination and 0.98° (±0.69°) in left lateral flexion inclination. 95% limits of agreement ranged between -3.86° and 4.69° in flexion inclination, -2.15° and 1.91° in extension inclination, -2.37° and 2.05° in right lateral flexion inclination and -3.11° and 2.96° in left lateral flexion inclination.

Conclusions

We found a clinically acceptable level of agreement between these two methods for measuring standing lumbar inclination motion in these two cardinal movement planes. Further research should investigate the ViMove system’s ability to measure lumbar motion in more complex 3D functional movements and to measure changes of movement patterns related to treatment effects.

Influence of different stool types on muscle activity and lumbar posture among dentists during a simulated dental screening task

Whereas in the past dental stools typically facilitated a 90° hip angle, a number of currently available alternative designs allow for a more extended hip posture. The present study investigated the influence of different stool types on muscle activity and lumbar posture. Twenty five participants completed a simulated dental procedure on a standard stool, a saddle and the Ghopec. The latter stool comprises a seat pan consisting of a horizontal rear part for the pelvis and an inclinable sloping down front part for the upper legs, with a vertically and horizontally adjustable back rest. Lumbar posture was most close to neutral on the Ghopec, whereas sitting on a standard/saddle stool resulted in more flexed/extended postures respectively. Sitting with a 90° angle (standard stool) resulted in higher activation of back muscles while sitting with a 125° angle (saddle and Ghopec) activated abdominal muscles more, although less in the presence of a backrest (Ghopec). To maintain neutral posture during dental screening, the Ghopec is considered the most suitable design for the tasks undertaken.

Cognitive Functional Therapy for Disabling Nonspecific Chronic Low Back Pain: Multiple Case-Cohort Study

BACKGROUND

Multiple dimensions across the biopsychosocial spectrum are relevant in the management of nonspecific chronic low back pain (NSCLBP). Cognitive functional therapy is a behaviorally targeted intervention that combines normalization of movement and abolition of pain behaviors with cognitive reconceptualization of the NSCLBP problem while targeting psychosocial and lifestyle barriers to recovery.

OBJECTIVE

The purpose of this study was to examine the effectiveness of cognitive functional therapy for people with disabling NSCLBP who were awaiting an appointment with a specialist medical consultant.

DESIGN

A multiple case-cohort study (n=26) consisting of 3 phases (A1-B-A2) was conducted.

METHODS

Measurement phase A1 was a baseline phase during which measurements of pain and functional disability were collected on 3 occasions over 3 months for all participants. During phase B, participants entered a cognitive functional therapy intervention program involving approximately 8 treatments over an average of 12 weeks. Finally, phase A2 was a 12-month, no-treatment follow-up period. Outcomes were analyzed using repeated-measures analysis of variance or Friedman test (with post hoc Bonferroni correction) across 7 time intervals, depending on normality of data distribution.

RESULTS

Statistically significant reductions in both functional disability and pain were observed immediately postintervention and were maintained over the 12-month follow-up period. These reductions reached clinical significance for both disability and pain. Secondary psychosocial outcomes, including depression, anxiety, back beliefs, fear of physical activity, catastrophizing, and self-efficacy, were significantly improved after the intervention.

LIMITATIONS

The study was not a randomized controlled trial. Although primary outcome data were self-reported, the assessor was not blinded.

CONCLUSIONS

These promising results suggest that cognitive functional therapy should be compared with other conservative interventions for the management of disabling NSCLBP in secondary care settings in large randomized clinical trials.

Investigating the effect of real-time spinal postural biofeedback on seated discomfort in people with non-specific chronic low back pain

A total of 24 participants with non-specific chronic low back pain (NSCLBP) sat for 2 h while their seated posture and low back discomfort (LBD) were analysed. A total of 16 pain developers (PDs), whose LBD increased by at least two points on the numeric rating scale, repeated the procedure 1 week later, while receiving postural biofeedback. PDs were older (p = 0.018), more disabled (p = 0.021) and demonstrated greater postural variability (p < 0.001). The ramping up of LBD was reduced (p = 0.002) on retesting, when sitting posture was less end-range (p < 0.001), and less variable (p = 0.032). Seated LBD appears to be related with modifiable characteristics such as sitting behaviour. Among people with sitting-related NSCLBP, the ramping up of LBD was reduced by modifying their sitting behaviour according to their individual clinical presentation. The magnitude of change, while statistically significant, was small and no follow-up of participants was completed. Further research should examine integrating biofeedback into comprehensive biopsychosocial management strategies for NSCLBP.

PRACTITIONER SUMMARY

The effect of real-time postural biofeedback on LBD was examined among people with LBP. Postural biofeedback matched to the individual clinical presentation significantly reduced LBD within a single session. Further research should examine the long-term effectiveness of postural biofeedback as an intervention for LBP.

Lumbar repositioning error in sitting: healthy controls versus people with sitting-related non-specific chronic low back pain (flexion pattern)

Studies examining repositioning error (RE) in non-specific chronic low back pain (NSCLBP) demonstrate contradictory results, with most studies not correlating RE deficits with measures of pain, disability or fear. This study examined if RE deficits exist among a subgroup of patients with NSCLBP whose symptoms are provoked by flexion, and how such deficits relate to measures of pain, disability, fear-avoidance and kinesiophobia. 15 patients with NSCLBP were matched (age, gender, and body mass index) with 15 painfree participants. Lumbo-pelvic RE, pain, functional disability, fear-avoidance and kinesiophobia were evaluated. Participants were asked to reproduce a target position (neutral lumbo-pelvic posture) after 5 s of slump sitting. RE in each group was compared by evaluating constant error (CE), absolute error (AE) and variable error (VE). Both AE (p = 0.002) and CE (p = 0.006) were significantly larger in the NSCLBP group, unlike VE (p = 0.165) which did not differ between the groups. There were significant, moderate correlations in the NSCLBP group between AE and functional disability (r = 0.601, p = 0.018), and between CE and fear-avoidance (r = -0.577, p = 0.0024), but all other correlations were weak (r < 0.337, rs < 0.377) or non-significant (p > 0.05). The results demonstrate increased lumbo-pelvic RE in a subgroup of NSCLBP patients, with the selected subgroup undershooting the target position. Overall, RE was only weakly to moderately correlated with measures of pain, disability or fear. The deficits observed are consistent with findings of altered motor control in patients with NSCLBP. The mechanisms underlying these RE deficits, and the most effective method of addressing these deficits, require further study.