Differences in dynamic balance control based on pain catastrophizing level in individuals with nonspecific chronic low back pain

Is dynamic balance impaired in people with non-specific low back pain when compared to healthy people? A systematic review

INTRODUCTION

Low back pain (LBP) represents a frequent health issue in most of the countries; in recent years, there was a growing interest concerning the role of balance and postural stability in individuals with non-specific LBP (NS-LBP). The aim of this systematic review is to provide a synthesis of the evidence on the association between NS-LBP and an impaired dynamic balance.

EVIDENCE ACQUISITION

The reporting of this study followed the 2020 PRISMA statement. Analytical observational studies, investigating the dynamic balance performance via functional or motor-tasks tests in LBP in comparison to healthy people, were searched in PubMed, Embase and Scopus up to December 2023. Their characteristics were reported in a standardized form, and their methodological quality was evaluated using the Joanna Briggs Institute Critical Appraisal Checklist for cross-sectional studies.

EVIDENCE SYNTHESIS

A qualitative synthesis of the study findings and a discussion of the results are provided. 19 cross-sectional studies were included in this review, with an overall sample size of 894. A meta-analysis was not possible due to high levels of heterogeneity across the studies. None of the included studies were deemed to be of a good methodological quality. Overall, most studies reported differences between NS-LBP and healthy people in terms of dynamic balance, showing worst performances in NS-LBP, both at motor-task tests and at the posturography.

CONCLUSIONS

Impaired dynamic balance seems to be correlated to NS-LBP. However, due to the presence of methodological issues in the included studies, further confirmations are needed. Clinicians should take into consideration the importance of a balance assessment in NS-LBP, by implementing proper functional tests. High-quality observational research is recommended, to assess dynamic balance with standardized and uniform modalities, in relation to specific stages of the condition.

Individuals with a ventral hernia who report moderate to high fear have worse functional performance than those with low fear

PURPOSE

Ventral hernia repairs (VHR) are performed to restore the integrity of the abdominal wall. Fear of movement, or kinesiophobia, may develop in patients with ventral hernia due to pain and functional impairments, however it has not yet been objectively measured in this patient population. The purpose of this study was to test the hypothesis that in patients with ventral hernia awaiting surgical repair, higher levels of kinesiophobia would be associated with poorer mobility, abdominal core function, and quality of life.

METHODS

Seventy-seven participants scheduled for ventral hernia repair were enrolled as part of an ongoing randomized controlled trial (NCT05142618). The Tampa Scale of Kinesiophobia (TSK-11) is an 11-item questionnaire that asks about fear of movement and physical activity restriction. Participants were split into groups based on their TSK-11 score (minimal, low, moderate to high). Primary outcome measures included the five-time sit-to-stand (5xSTS), Quiet Unstable Sitting Test (QUeST), and the Hernia-Related Quality-of-Life (HerQLeS) survey. A one-way ANOVA with a Bonferroni correction compared QUeST, 5xSTS, and HerQLes results between groups.

RESULTS

Groups were significantly different on 5xSTS (minimal: 11.4 ± 2.6 s, low: 13.8 ± 3.1 s, moderate to high: 17.8 ± 9.8 s; p = 0.001) and HerQLes (minimal: 58.0 ± 27.8, low: 49.4 ± 22.0, moderate to high: 30.6 ± 25.3; p = 0.003) but not QUeST (minimal: - 2.8 ± 2.5, low: - 6.8 ± 10.0, moderate to high: - 5.5 ± 5.0; p = 0.16).

CONCLUSION

Individuals with moderate to high kinesiophobia have worse pre-operative performance-based (5xSTS) and self-reported (HerQLes) function and quality of life than those with minimal and low kinesiophobia. Future research should examine the influence of kinesiophobia on post-operative outcomes as it may be a potent target for rehabilitation.