1
|
Alshehri MA, Alzahrani H, van den Hoorn W, Klyne DM, Vette AH, Hendershot BD, Roberts BWR, Larivière C, Barbado D, Vera-Garcia FJ, van Dieen JH, Cholewicki J, Nussbaum MA, Madigan ML, Reeves NP, Silfies SP, Brown SHM, Hodges PW. Trunk postural control during unstable sitting among individuals with and without low back pain: A systematic review with an individual participant data meta-analysis. PLoS One 2024; 19:e0296968. [PMID: 38265999 PMCID: PMC10807788 DOI: 10.1371/journal.pone.0296968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 12/26/2023] [Indexed: 01/26/2024] Open
Abstract
INTRODUCTION Sitting on an unstable surface is a common paradigm to investigate trunk postural control among individuals with low back pain (LBP), by minimizing the influence lower extremities on balance control. Outcomes of many small studies are inconsistent (e.g., some find differences between groups while others do not), potentially due to confounding factors such as age, sex, body mass index [BMI], or clinical presentations. We conducted a systematic review with an individual participant data (IPD) meta-analysis to investigate whether trunk postural control differs between those with and without LBP, and whether the difference between groups is impacted by vision and potential confounding factors. METHODS We completed this review according to PRISMA-IPD guidelines. The literature was screened (up to 7th September 2023) from five electronic databases: MEDLINE, CINAHL, Embase, Scopus, and Web of Science Core Collection. Outcome measures were extracted that describe unstable seat movements, specifically centre of pressure or seat angle. Our main analyses included: 1) a two-stage IPD meta-analysis to assess the difference between groups and their interaction with age, sex, BMI, and vision on trunk postural control; 2) and a two-stage IPD meta-regression to determine the effects of LBP clinical features (pain intensity, disability, pain catastrophizing, and fear-avoidance beliefs) on trunk postural control. RESULTS Forty studies (1,821 participants) were included for the descriptive analysis and 24 studies (1,050 participants) were included for the IPD analysis. IPD meta-analyses revealed three main findings: (a) trunk postural control was worse (higher root mean square displacement [RMSdispl], range, and long-term diffusion; lower mean power frequency) among individuals with than without LBP; (b) trunk postural control deteriorated more (higher RMSdispl, short- and long-term diffusion) among individuals with than without LBP when vision was removed; and (c) older age and higher BMI had greater adverse impacts on trunk postural control (higher short-term diffusion; longer time and distance coordinates of the critical point) among individuals with than without LBP. IPD meta-regressions indicated no associations between the limited LBP clinical features that could be considered and trunk postural control. CONCLUSION Trunk postural control appears to be inferior among individuals with LBP, which was indicated by increased seat movements and some evidence of trunk stiffening. These findings are likely explained by delayed or less accurate corrective responses. SYSTEMATIC REVIEW REGISTRATION This review has been registered in PROSPERO (registration number: CRD42021124658).
Collapse
Affiliation(s)
- Mansour Abdullah Alshehri
- NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury & Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Physiotherapy Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Mecca, Saudi Arabia
| | - Hosam Alzahrani
- Department of Physical Therapy, College of Applied Medical Sciences, Taif University, Taif, Saudi Arabia
| | - Wolbert van den Hoorn
- NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury & Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - David M. Klyne
- NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury & Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Albert H. Vette
- Department of Mechanical Engineering, Donadeo Innovation Centre for Engineering, University of Alberta, Edmonton, Canada
- Glenrose Rehabilitation Hospital, Alberta Health Services, Edmonton, Canada
| | - Brad D. Hendershot
- Extremity Trauma and Amputation Center of Excellence, Defense Health Agency, Falls Church, Virginia, United States of America
| | - Brad W. R. Roberts
- Department of Mechanical Engineering, Donadeo Innovation Centre for Engineering, University of Alberta, Edmonton, Canada
| | - Christian Larivière
- Institut de recherche Robert-Sauvé en santé et en sécurité du travail (IRSST), Montreal, Quebec, Canada
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal Rehabilitation Institute, Montreal, Quebec, Canada
| | - David Barbado
- Sport Research Centre, Department of Sport Sciences, Miguel Hernández University of Elche, Alicante, Spain
- Institute for Health and Biomedical Research (ISABIAL Foundation), Miguel Hernández University of Elche, Alicante, Spain
| | - Francisco J. Vera-Garcia
- Sport Research Centre, Department of Sport Sciences, Miguel Hernández University of Elche, Alicante, Spain
- Institute for Health and Biomedical Research (ISABIAL Foundation), Miguel Hernández University of Elche, Alicante, Spain
| | - Jaap H. van Dieen
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Jacek Cholewicki
- Center for Neuromusculoskeletal Clinical Research, Michigan State University, Lansing, Michigan, United States of America
- Department of Osteopathic Manipulative Medicine, Michigan State University, East Lansing, Michigan, United States of America
| | - Maury A. Nussbaum
- Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences, Virginia Tech, Blacksburg, Virginia, United States of America
- Department of Industrial and Systems Engineering, Virginia Tech, Blacksburg, Virginia, United States of America
| | - Michael L. Madigan
- Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences, Virginia Tech, Blacksburg, Virginia, United States of America
- Department of Industrial and Systems Engineering, Virginia Tech, Blacksburg, Virginia, United States of America
| | | | - Sheri P. Silfies
- Department of Exercise Science, University of South Carolina, Columbia, South Carolina, United States of America
| | - Stephen H. M. Brown
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Paul W. Hodges
- NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury & Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| |
Collapse
|
2
|
Van Wesemael S, Bogaerts K, De Baets L, Goossens N, Vlemincx E, Amerijckx C, Sohail S, Matheve T, Janssens L. The association between pain-related psychological variables and postural control in low back pain: A systematic review and meta-analysis. Gait Posture 2024; 107:253-268. [PMID: 37925241 DOI: 10.1016/j.gaitpost.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 09/13/2023] [Accepted: 10/17/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND Alterations in postural control have been found in individuals with low back pain (LBP), particularly during challenging postural tasks. Moreover, higher levels of negative pain-related psychological variables are associated with increased trunk muscle activity, reduced spinal movement, and worse maximal physical performance in individuals with LBP. RESEARCH QUESTION Are pain-related psychological variables associated with postural control during static bipedal standing tasks in individuals with LBP? METHODS A systematic review and meta-analysis were conducted. Pubmed, Web of Science, and PsycINFO were searched until March 2023. Studies were included if they evaluated postural control during static bipedal standing in individuals with LBP by measuring center of pressure (CoP) variables, and reported at least one pain-related psychological variable. Correlation coefficients between pain-related psychological variables and CoP variables were extracted. Study quality was assessed with the "Quality In Prognosis Studies" tool (QUIPS). Random-effect models were used to calculate pooled correlation coefficients for different postural tasks. Sub-analyses were performed for positional or dynamic CoP variables. Certainty of evidence was assessed with an adjusted "Grading of Recommendations, Assessment, Development, and Evaluations" tool (GRADE). The protocol was registered on PROSPERO (CRD42021241739). RESULTS Sixteen studies (n = 723 participants) were included. Pain-related fear (16 studies) and pain catastrophizing (three studies) were the only reported pain-related psychological variables. Both pain-related fear (-0.04 < pooled r < 0.14) and pain catastrophizing (0.28 < pooled r < 0.29) were weakly associated with CoP variables during different postural tasks. For all associations, the certainty of evidence was very low. SIGNIFICANCE Pain-related fear and pain catastrophizing are only weakly associated with postural control during static bipedal standing in individuals with LBP, regardless of postural task difficulty. Certainty of evidence is very low thus it is conceivable that future studies accounting for current study limitations might reveal different findings.
Collapse
Affiliation(s)
- Sofie Van Wesemael
- UHasselt, REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Agoralaan Gebouw A, 3590 Diepenbeek, Belgium.
| | - Katleen Bogaerts
- UHasselt, REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Agoralaan Gebouw A, 3590 Diepenbeek, Belgium; KU Leuven, Health Psychology, Faculty of Psychology and Educational Sciences, Tiensestraat 102, 3000 Leuven, Belgium
| | - Liesbet De Baets
- Vrije Universiteit Brussel, Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Pleinlaan 2, 1050 Brussels, Belgium
| | - Nina Goossens
- UHasselt, REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Agoralaan Gebouw A, 3590 Diepenbeek, Belgium
| | - Elke Vlemincx
- KU Leuven, Health Psychology, Faculty of Psychology and Educational Sciences, Tiensestraat 102, 3000 Leuven, Belgium; Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam Movement Sciences Research Institute, Department of Health Sciences, De Boelelaan 1105, 1081 HV Amsterdam, the Netherlands
| | - Charlotte Amerijckx
- UHasselt, REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Agoralaan Gebouw A, 3590 Diepenbeek, Belgium
| | - Suniya Sohail
- UHasselt, REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Agoralaan Gebouw A, 3590 Diepenbeek, Belgium; Foundation University Islamabad, Department of Rehabilitation Sciences, Defence Avenue, Phase-I, DHA, 44000 Islamabad, Pakistan
| | - Thomas Matheve
- UHasselt, REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Agoralaan Gebouw A, 3590 Diepenbeek, Belgium; Ghent University, Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - Lotte Janssens
- UHasselt, REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Agoralaan Gebouw A, 3590 Diepenbeek, Belgium
| |
Collapse
|
3
|
Nzamba J, Van Damme S, Favre J, Christe G. The relationships between spinal amplitude of movement, pain and disability in low back pain: A systematic review and meta-analysis. Eur J Pain 2024; 28:37-53. [PMID: 37475698 DOI: 10.1002/ejp.2162] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 07/05/2023] [Accepted: 07/08/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND AND OBJECTIVES The role of spinal movement alterations in low back pain (LBP) remains unclear. This systematic review and meta-analyses examined the relationships between spinal amplitude of movement, disability and pain intensity in patients with LBP. DATABASES AND DATA TREATMENT We searched PubMed, CINAHL, Embase, Pedro and Web of Science for relevant articles until 14th March 2023. Risk of bias was assessed with the Quality in Prognostic Studies Tool. We analysed the relationships between amplitude of movement, disability and pain intensity with standard correlational meta-analyses and meta-analytic structural equation modelling (MASEM) in cross-sectional and longitudinal data. RESULTS A total of 106 studies (9001 participants) were included. In cross-sectional data, larger amplitude of movement was associated with lower disability (pooled coefficient: -0.25, 95% confidence interval: [-0.29 to -0.21]; 69/5899 studies/participants) and pain intensity (-0.13, [-0.17 to -0.09]; 74/5806). An increase in amplitude of movement was associated with a decrease in disability (-0.23, [-0.31 to -0.15]; 33/2437) and pain intensity (-0.25, [-0.33 to -0.17]; 38/2172) in longitudinal data. MASEM revealed similar results and, in addition, showed that amplitude of movement had a very small influence on the pain intensity-disability relationship. CONCLUSIONS These results showed a significant but small association between amplitude of movement and disability or pain intensity. Moreover, they demonstrated a direct association between an increase in amplitude of movement and a decrease in pain intensity or disability, supporting interventions aiming to reduce protective spinal movements in patients with LBP. SIGNIFICANCE The large meta-analyses performed in this work revealed an association between reductions in spinal amplitude of movement and increased levels of disability and pain intensity in people with LBP. Moreover, it highlighted that LBP recovery is associated with a reduction in protective motor behaviour (increased amplitude of movement), supporting the inclusion of spinal movement in the biopsychosocial understanding and management of LBP.
Collapse
Affiliation(s)
- J Nzamba
- Division of Physiotherapy, School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - S Van Damme
- Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - J Favre
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - G Christe
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Department of Physiotherapy, HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| |
Collapse
|
4
|
Sahebalam M, ShahAli S, Komlakh K, Shanbehzadeh S. The association between disability and physical performance, pain intensity, and pain-related anxiety in patients after lumbar decompression surgery: a cross-sectional study. J Orthop Surg Res 2023; 18:961. [PMID: 38093340 PMCID: PMC10717370 DOI: 10.1186/s13018-023-04462-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 12/10/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Most patients with lumbar spinal stenosis improve significantly within 6 months of lumbar decompression surgery, however, unfavorable long-term disability may persist in some patients. It was unclear which potential influencing factors were more likely to be associated with disability. This study aimed to assess the association between disability and physical performance, pain, and pain-related anxiety in patients after lumbar decompression surgery. METHODS Patients who underwent decompression for lumbar spinal stenosis were included. Participants completed the visual analog scale, Oswestry Disability Index, and Pain Anxiety Symptoms Scale-20 to collect pain intensity, disability, and pain-related anxiety information. For physical performance assessment, participants performed timed up and go (TUG), functional reach test (FRT), 6-min walking test, and modified Sorensen test, 6-12 months after lumbar decompression surgery. The associations were examined with bivariate and multivariable linear regression analyses. RESULTS A total of 80 patients were included. A significant association between disability and pain-related anxiety, the FRT, and the modified Sorensen test scores was confirmed in multivariable analyses. Both bivariate (r = - 0.75) and multivariable (β = 0.60, 95% CI, 0.24, 0.54; P = 0.00) analyses confirmed that pain-related anxiety was the strongest indicator of disability. The association between disability and pain intensity, TUG, and 6-min walking test scores was not confirmed. CONCLUSION Pain-related anxiety should be considered in the rehabilitation programs after lumbar decompression surgery. The evaluation of all aspects of physical performance following lumbar decompression surgery is also recommended.
Collapse
Affiliation(s)
- Mohamad Sahebalam
- Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Shabnam ShahAli
- Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Khalil Komlakh
- Imam Hossein Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sanaz Shanbehzadeh
- Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
5
|
Alsubaie AM, Mazaheri M, Martinez-Valdes E, Falla D. Is movement variability altered in people with chronic non-specific low back pain? A systematic review. PLoS One 2023; 18:e0287029. [PMID: 37315096 DOI: 10.1371/journal.pone.0287029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 05/28/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Variability in spine kinematics is a common motor adaptation to pain, which has been measured in various ways. However, it remains unclear whether low back pain (LBP) is typically characterised by increased, decreased or unchanged kinematic variability. Therefore, the aim of this review was to synthesise the evidence on whether the amount and structure of spine kinematic variability is altered in people with chronic non-specific LBP (CNSLBP). METHODS Electronic databases, grey literature, and key journals were searched from inception up to August 2022, following a published and registered protocol. Eligible studies must investigated kinematic variability in CNSLBP people (adults ≥18 years) while preforming repetitive functional tasks. Two reviewers conducted screening, data extraction, and quality assessment independently. Data synthesis was conducted per task type and individual results were presented quantitatively to provide a narrative synthesis. The overall strength of evidence was rated using the Grading of Recommendations, Assessment, Development and Evaluation guidelines. FINDINGS Fourteen observational studies were included in this review. To facilitate the interpretation of the results, the included studies were grouped into four categories according to the task preformed (i.e., repeated flexion and extension, lifting, gait, and sit to stand to sit task). The overall quality of evidence was rated as a very low, primarily due to the inclusion criteria that limited the review to observational studies. In addition, the use of heterogeneous metrics for analysis and varying effect sizes contributed to the downgrade of evidence to a very low level. INTERPRETATION Individuals with chronic non-specific LBP exhibited altered motor adaptability, as evidenced by differences in kinematic movement variability during the performance of various repetitive functional tasks. However, the direction of the changes in movement variability was not consistent across studies.
Collapse
Affiliation(s)
- Amal M Alsubaie
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Masood Mazaheri
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Eduardo Martinez-Valdes
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| |
Collapse
|