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Hao Z, Cheng X, Jiang H, Yang J, Li Y, Ambrose Lo WL, Yu Q, Wang C. The associations between lumbar proprioception and postural control during and after calf vibration in people with and without chronic low back pain. Front Bioeng Biotechnol 2024; 12:1329437. [PMID: 38572361 PMCID: PMC10987701 DOI: 10.3389/fbioe.2024.1329437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 01/19/2024] [Indexed: 04/05/2024] Open
Abstract
The relationships of lumbar proprioception with postural control have not been clarified in people with chronic low back pain. This study aimed to compare the associations between lumbar proprioception and postural control in response to calf vibration in individuals with and without chronic low back pain. In this study, we recruited twenty patients with chronic low back pain (CLBP group) and twenty healthy control subjects (HC group) aged between 18 and 50 years. This study was a cross-sectional study and completed from May 2022 to October 2022. The passive joint repositioning sense (PJRS) test for two positions (15° and 35°) were used to assess lumbar proprioception and expressed as the mean of reposition error (RE). Postural control was tested by adding and removing calf vibration while standing on a stable force plate with eyes closed. The sway velocity in the anterior-posterior (AP) direction of center of pressure (COP) data with a window of 15s epoch at baseline, during and after calf vibration was used to evaluate postural control. Mann-Whitney U-tests were used to compare the difference of lumbar proprioception between two groups, and the independent t-tests were used to compare the difference of postural control at baseline and during vibration, and a mixed design ANOVA was used to compare the difference of postural control during post-perturbation. In addition, to explore the association between postural control and lumbar proprioception and pain intensity, Spearman's correlations were used for each group. The major results are: (1) significantly higher PJRS on RE of 15° (CLBP: 95% CI [2.03, 3.70]; HC: 95% CI [1.03, 1.93]) and PJRS on RE of 35° (CLBP: 95% CI [2.59, 4.88]; HC: 95% CI [1.07, 3.00]) were found in the CLBP group; (2) AP velocity was not different between the CLBP group and the HC group at baseline and during calf vibration. However, AP velocity was significantly larger in the CLBP group compared with the HC group at epoch 2-14 after calf vibration, and AP velocity for the CLBP group took a longer time (23 epochs) to return to the baseline after calf vibration compared with the HC group (9 epochs); (3) lumbar proprioception represented by PJRS on RE of 15°correlated negatively with AP velocity during and after vibration for the HC group. Within the CLBP group, no significant relationships between PJRS on RE for two positions (15° and 35°) and AP velocity in any postural phases were found. In conclusion, the CLBP group has poorer lumbar proprioception, slower proprioceptive reweighting and impaired postural control after calf vibration compared to the HC group. Lumbar proprioception offers different information on the control strategy of standing control for individuals with and without CLBP in the situations with proprioceptive disturbance. These results highlight the significance of assessing lumbar proprioception and postural control in CLBP patients.
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Affiliation(s)
- Zengming Hao
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xue Cheng
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Haimei Jiang
- Department of Rehabilitation Medicine, The 10th Affiliated Hospital of Southern Medical University (Dongguan People’s Hospital), Dongguan, China
| | - Jiajia Yang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yan Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wai Leung Ambrose Lo
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Engineering and Technology Research Center for Rehabilitation Medicine and Translation, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qiuhua Yu
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chuhuai Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Soysal Tomruk M, Tomruk M, Kalemci O. Comparisons of postural control, proprioception, muscle strength, pain and disability between individuals with acute, subacute and chronic low back pain. Somatosens Mot Res 2024; 41:26-33. [PMID: 36634047 DOI: 10.1080/08990220.2023.2165057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 01/02/2023] [Indexed: 01/13/2023]
Abstract
PURPOSE/AIM Postural control, proprioception and lower extremity muscle strength are affected in individuals with low back pain (LBP). However, it is yet unknown whether these variables differentiate between acute, subacute and chronic stages of LBP. The aim was to investigate if there were any differences in postural control, proprioception, lower extremity muscle strength, pain intensity and disability between individuals in the different stages of LBP. MATERIALS AND METHODS In this cross-sectional study, 124 individuals with LBP were grouped as acute LBP (ALBP) (n = 38), subacute LBP (SLBP) (n = 30) and chronic LBP (CLBP) (n = 56) groups. Postural control was assessed via computerised technology. Lumbar proprioception, lower extremity muscle strength, pain intensity and disability were assessed using Joint Repositioning Error Test, hand-held dynamometer, Numeric Rating Scale and Oswestry Disability Index (ODI), respectively. Kruskal-Wallis Tests, ANCOVA and post hoc Mann-Whitney U-Test with Bonferroni correction were performed. RESULTS While there were no significant differences in terms of postural control, proprioception and pain intensity (p > 0.05), significant differences were found in terms of lower extremity muscle strength and ODI scores between groups when adjusted for age (p < 0.05). Individuals with CLBP demonstrated poorer lower extremity muscle strength than those with ALBP and SLBP, and higher disability than those with ALBP (p < 0.017). CONCLUSIONS Although postural control, proprioception and pain intensity were similar between individuals with acute, subacute and chronic LBP, muscle strength and disability seem to worsen stepwise as the pain becomes chronic. Muscle strength and disability should be taken into account while evaluating and/or managing individuals with acute and subacute stages of LBP.
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Affiliation(s)
- Melda Soysal Tomruk
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Burdur Mehmet Akif Ersoy University, Burdur, Turkey
| | - Murat Tomruk
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Burdur Mehmet Akif Ersoy University, Burdur, Turkey
| | - Orhan Kalemci
- Faculty of Medicine, Department of Neurosurgery, Dokuz Eylül University, İzmir, Turkey
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Ducas J, Memari S, Houle M, Schwendenmann Y, Abboud J, Yiou É, Descarreaux M. Impact of lumbar delayed-onset muscle soreness on postural stability in standing postures. Gait Posture 2024; 109:201-207. [PMID: 38350184 DOI: 10.1016/j.gaitpost.2024.02.001] [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: 10/20/2023] [Revised: 01/22/2024] [Accepted: 02/01/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND Similar impact on proprioception has been observed in participants with lumbar delayed-onset muscle soreness (DOMS) and chronic low back pain (LBP), raising questions about the relevance of lumbar DOMS as a suitable pain model for LBP when assessing back pain-related postural stability changes. RESEARCH QUESTION Does lumbar DOMS impact postural stability? METHODS Twenty healthy adults participated in this experimental study and underwent a posturographic examination before and 24 to 36 h after a protocol designed to induce lumbar DOMS. Posturographic examination was assessed during quiet standing on both feet with eyes opened (EO), with eyes closed (EC), and on one-leg (OL) standing with eyes opened. Postural stability was assessed through center of pressure (COP) parameters (COP area, velocity, root mean square, mean power frequency) which were compared using repeated measure ANOVA. Moreover, pain, soreness and pressure pain threshold (PPT) on specific muscles were assessed. RESULTS There was a significant main effect of the postural condition on all COP variables investigated. More specifically, each COP variable reached a significantly higher value in the OL stance condition than in both EO and EC bipedal conditions (all with p < 0.001). In addition, the COP velocity and the mean power frequency along the anteroposterior direction both reached a significantly higher value in EC than in EO (p < 0.001). In contrast, there was no significant main effect of the DOMS nor significant DOMS X postural condition interaction on any of the COP variables. There was a significant decrease in the PPT value for both the left and right erector spinae muscles, as well as the left biceps femoris. SIGNIFICANCE Lumbar DOMS had no impact on postural stability, which contrasts findings in participants with clinical LBP. Although DOMS induces similar trunk sensorimotor adaptations to clinical LBP, it does not appear to trigger similar postural stability adaptations.
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Affiliation(s)
- Julien Ducas
- Department of Human Kinetics, Université du Québec à Trois-Rivières, 3351 Bd Des Forges, Trois-Rivières, QC G8Z 4M3, Canada; Groupe de Recherche sur les Affections Neuromusculosquelettiques (GRAN), Université du Québec à Trois-Rivières, 3351 Bd Des Forges, Trois-Rivières, QC G8Z 4M3, Canada
| | - Sahel Memari
- Department of Human Kinetics, Université du Québec à Trois-Rivières, 3351 Bd Des Forges, Trois-Rivières, QC G8Z 4M3, Canada; CIAMS Laboratory, Université Paris-Saclay, Orsay Cedex, France; CIAMS Laboratory, Université d'Orléans, Orléans, France; Research Department, Institut Franco-Européen de Chiropraxie, 94200 Ivry-Sur-Seine, France
| | - Mariève Houle
- Groupe de Recherche sur les Affections Neuromusculosquelettiques (GRAN), Université du Québec à Trois-Rivières, 3351 Bd Des Forges, Trois-Rivières, QC G8Z 4M3, Canada; Department of Anatomy, Université du Québec à Trois-Rivières, 3351 Bd Des Forges, Trois-Rivières, QC G8Z 4M3, Canada
| | - Yves Schwendenmann
- Department of Human Kinetics, Université du Québec à Trois-Rivières, 3351 Bd Des Forges, Trois-Rivières, QC G8Z 4M3, Canada; Groupe de Recherche sur les Affections Neuromusculosquelettiques (GRAN), Université du Québec à Trois-Rivières, 3351 Bd Des Forges, Trois-Rivières, QC G8Z 4M3, Canada
| | - Jacques Abboud
- Department of Human Kinetics, Université du Québec à Trois-Rivières, 3351 Bd Des Forges, Trois-Rivières, QC G8Z 4M3, Canada; Groupe de Recherche sur les Affections Neuromusculosquelettiques (GRAN), Université du Québec à Trois-Rivières, 3351 Bd Des Forges, Trois-Rivières, QC G8Z 4M3, Canada
| | - Éric Yiou
- CIAMS Laboratory, Université Paris-Saclay, Orsay Cedex, France; CIAMS Laboratory, Université d'Orléans, Orléans, France
| | - Martin Descarreaux
- Department of Human Kinetics, Université du Québec à Trois-Rivières, 3351 Bd Des Forges, Trois-Rivières, QC G8Z 4M3, Canada; Groupe de Recherche sur les Affections Neuromusculosquelettiques (GRAN), Université du Québec à Trois-Rivières, 3351 Bd Des Forges, Trois-Rivières, QC G8Z 4M3, Canada.
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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.
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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
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Lee D, Sung PS. Postural adaptations within normalized stability between older adults with and without chronic low back pain. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:4420-4427. [PMID: 37718340 DOI: 10.1007/s00586-023-07939-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 08/26/2023] [Accepted: 08/30/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Adaptations of dynamic balance performance are related to sway excursions in older adults with chronic low back pain (LBP). However, there is a lack of understanding on postural control within different thresholds of radius from the center of pressure (COP). PURPOSE This study was conducted to compare the normalized stability based on the time-in-boundary (TIB) during repeated unilateral limb standing trials between subjects with and without chronic LBP. METHODS There were 26 older adults with LBP and 39 control subjects who completed three trials of repeated unilateral limb standing on a force plat. RESULTS The TIB based on the seven thresholds was analyzed, and the groups demonstrated a significant interaction on thresholds for TIB (F = 8.76, p = 0.01). The TIB was significantly different in the 10 mm (F = 4.01, p = 0.04), 15 mm (F = 5.21, p = 0.03), and 20 mm (F = 4.48, p = 0.04) radius of thresholds only in the second trial. However, there was no group difference on TIB at the first and third trials due to potential compensatory and/or adaptive reactions to avoid fall risks. CONCLUSION The LBP group lacked postural stability within the thresholds less than a 20 mm radius at the second trial of unilateral standing. The significant group interaction with the thresholds indicates an adaptation strategy on sway thresholds. This postural reaction from repeated trials should be considered with sway excursion adjustments and fall prevention in older adults with LB.
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Affiliation(s)
| | - Paul S Sung
- Doctor of Physical Therapy Program, Indiana Wesleyan University, 4201 South Washington Street, Marion, IN, 46953, USA.
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Lee SH, Liang HW. Discriminative Changes in Sitting and Standing Postural Steadiness in Patients With Chronic Low Back Pain. IEEE Trans Neural Syst Rehabil Eng 2023; 31:3752-3759. [PMID: 37676799 DOI: 10.1109/tnsre.2023.3312982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
Postural control is reduced in patients with low back pain (LBP), which is considered an important factor attributing to the chronicity of LBP and a target for treatment. It is proposed that the changes in postural steadiness in sitting reflect the trunk control better than those in standing, but the previous study results are inconsistent. Thus, this study aimed to compare trunk sway parameters during standing and sitting between patients with chronic LPB (CLBP) and controls using a tracker-based posturography to record the trunk displacement trajectories at the lumbar level (TD [Formula: see text]. A total of 64 participants (32 patients with CLBP and 32 pain-free controls) were included in this study. The postural sway was measured under four conditions, sitting or standing on unstable surface, with eyes open or closed. The TDL parameters were compared between the two groups to explore their discriminative ability. The CLBP group had more body sway than the control group, characterized by several TDL parameters in sitting with eyes closed and standing with eyes open. The TDL parameters with the highest area under the curve according to the receiver operating characteristic curve analysis were the root mean square distance and mean frequency in the medial-lateral direction obtained in the sitting with eyes closed. In conclusion, we confirmed the advantage of using sitting posturographic parameters as a sensitive measure to detect impaired trunk control in patients with CLBP. The results would help choose sensitive outcome measures to reflect the postural control of patients with LBP.
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Porwal S, Rizvi MR, Sharma A, Ahmad F, Alshahrani MS, Raizah A, Shaik AR, Seyam MK, Miraj M, Alkhamis BA, Mukherjee D, Ahmad I. Enhancing Functional Ability in Chronic Nonspecific Lower Back Pain: The Impact of EMG-Guided Trunk Stabilization Exercises. Healthcare (Basel) 2023; 11:2153. [PMID: 37570393 PMCID: PMC10418369 DOI: 10.3390/healthcare11152153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 07/16/2023] [Accepted: 07/20/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Nonspecific lower back pain (NSLBP) is described as pain that is not caused by an identifiable, well-known disease, such as infection, tumor, osteoporosis, fracture, structural deformity, inflammatory condition, radicular syndrome, or cauda equina syndrome. AIM The aim of this study was to determine the effect of EMG-guided trunk stabilization exercises on functional disability associated with LBP. MATERIALS AND METHODS A single-blinded pre- and post-test experimental comparative design was used for this study. Fifty individuals with chronic NSLBP were screened for inclusion criteria. Of these, forty were randomly grouped into the EMG group receiving trunk-stability exercises with electromyography biofeedback and non-EMG group receiving trunk-stabilization exercises without EMG biofeedback. Participants performed five trunk-stability exercises 3 days a week for 4 weeks. The intensity of pain, range of motion, functional disability, and balance were measured at baseline and after 4 weeks. RESULTS Both techniques indicated a significant effect on chronic NSLBP; however, trunk-stability exercises combined with EMG biofeedback produced better results in alleviating the intensity of pain, increasing the range of motion, and improving functional disabilities and static balance. CONCLUSION The present study confirms that trunk-stability exercises with EMG biofeedback can be practiced safely, contributes to a greater boost in neuromuscular efficiency in the lumbar flexors and extensors, and is effective in modifying functional disability for patients with NSLBP.
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Affiliation(s)
- Shivani Porwal
- Department of Physiotherapy, School of Allied Health Sciences, Manav Rachna International Institute and Studies (MRIIRS), Faridabad 121001, India; (S.P.); (A.S.)
| | - Moattar Raza Rizvi
- School of Allied Health Sciences, Manav Rachna International Institute and Studies (MRIIRS), Faridabad 121001, India;
| | - Ankita Sharma
- Department of Physiotherapy, School of Allied Health Sciences, Manav Rachna International Institute and Studies (MRIIRS), Faridabad 121001, India; (S.P.); (A.S.)
| | - Fuzail Ahmad
- Respiratory Care Department, College of Applied Sciences, Almaarefa University, Diriya, Riyadh 13713, Saudi Arabia
| | - Mastour Saeed Alshahrani
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61413, Saudi Arabia; (M.S.A.); (B.A.A.); (D.M.)
| | - Abdullah Raizah
- Department of Orthopaedics, College of Medicine, King Khalid University, Abha 61413, Saudi Arabia;
| | - Abdul Rahim Shaik
- Department of Physical Therapy & Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al Majma’ah 15431, Saudi Arabia; (A.R.S.); (M.K.S.); (M.M.)
| | - Mohamed K. Seyam
- Department of Physical Therapy & Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al Majma’ah 15431, Saudi Arabia; (A.R.S.); (M.K.S.); (M.M.)
| | - Mohammad Miraj
- Department of Physical Therapy & Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al Majma’ah 15431, Saudi Arabia; (A.R.S.); (M.K.S.); (M.M.)
| | - Batool Abdulelah Alkhamis
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61413, Saudi Arabia; (M.S.A.); (B.A.A.); (D.M.)
| | - Debjani Mukherjee
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61413, Saudi Arabia; (M.S.A.); (B.A.A.); (D.M.)
| | - Irshad Ahmad
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61413, Saudi Arabia; (M.S.A.); (B.A.A.); (D.M.)
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Park J, Nguyen VQ, Ho RLM, Coombes SA. The effect of chronic low back pain on postural control during quiet standing: A meta-analysis. Sci Rep 2023; 13:7928. [PMID: 37193730 DOI: 10.1038/s41598-023-34692-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 05/05/2023] [Indexed: 05/18/2023] Open
Abstract
Low back pain (LBP) has been associated with altered body sway during quiet standing, but the pattern of results is inconsistent. The purpose of this meta-analysis is to examine the effects of vision (eyes open, eyes closed) and changing the support surface (foam surface, firm surface) on postural sway during quiet standing in individuals with chronic LBP (cLBP). Five electronic databases were searched on March 27th, 2022. Of 2,856, 16 studies (n = 663) were included. Across all conditions, we found a positive and medium effect size (g = 0.77 [0.50, 1.04]) that represented greater body sway in individuals with cLBP. Subgroup analyses revealed medium effects during eyes open conditions (firm surface: g = 0.60 [0.33, 0.87]; foam surface: g = 0.68 [0.38, 0.97]), and large effects during eyes closed conditions (firm surface: g = 0.97 [0.60, 1.35]; foam surface: g = 0.89 [0.28, 1.51]). We quantified effects of self-reported pain and found a moderate effect during eyes closed plus firm surface conditions (Q = 3.28; p = 0.070). We conclude that cLBP is associated with increased postural sway, with largest effect sizes evident when vision is removed and when self-reported pain intensity is higher.
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Affiliation(s)
- Jinhan Park
- Laboratory for Rehabilitation Neuroscience, Department of Applied Physiology and Kinesiology, University of Florida, PO Box 118206, Gainesville, FL, 32611, USA
| | - Vinh Q Nguyen
- Laboratory for Rehabilitation Neuroscience, Department of Applied Physiology and Kinesiology, University of Florida, PO Box 118206, Gainesville, FL, 32611, USA
| | - Rachel L M Ho
- Laboratory for Rehabilitation Neuroscience, Department of Applied Physiology and Kinesiology, University of Florida, PO Box 118206, Gainesville, FL, 32611, USA
| | - Stephen A Coombes
- Laboratory for Rehabilitation Neuroscience, Department of Applied Physiology and Kinesiology, University of Florida, PO Box 118206, Gainesville, FL, 32611, USA.
- Department of Biomedical Engineering, University of Florida, Gainesville, FL, 32611, USA.
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Rüger A, Laudner K, Delank KS, Schwesig R, Steinmetz A. Effects of Different Forms of Sensorimotor Training on Postural Control and Functional Status in Patients with Chronic Low Back Pain. J Pers Med 2023; 13:jpm13040634. [PMID: 37109020 PMCID: PMC10145057 DOI: 10.3390/jpm13040634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 03/28/2023] [Accepted: 04/03/2023] [Indexed: 04/07/2023] Open
Abstract
The aim of this study was to compare three sensorimotor training forms in patients with chronic low back pain to determine their effects on the reduction of pain-related impairment and changes in posturography. Over two weeks, during the multimodal pain therapy (MMPT) period, six sessions of sensorimotor physiotherapy or training in the Galileo® or Posturomed® (n = 25 per group) were performed. A significant reduction in pain-related impairment after the intervention phase was shown across all groups (time effect: p < 0.001; ηp2 = 0.415). There was no change in postural stability (time effect: p = 0.666; ηp2 = 0.003), but there was a significant improvement in the peripheral vestibular system (time effect: p = 0.014; ηp2 = 0.081). An interaction effect was calculated for the forefoot-hindfoot ratio (p = 0.014; ηp2 = 0.111). Only the Posturomed® group showed an improvement in anterior-posterior weight distribution (heel load: 47% vs. 49%). These findings suggest that these forms of sensorimotor training in the context of MMPT are suitable for reducing pain-related impairment. Posturography demonstrated stimulation of a subsystem, but no improvement in postural stability.
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Affiliation(s)
- Alex Rüger
- Department of Orthopedic and Trauma Surgery, Martin-Luther-University Halle-Wittenberg, 06120 Halle, Germany
- Department of Ophthalmology, Martin-Luther-University Halle-Wittenberg, 06120 Halle, Germany
| | - Kevin Laudner
- Department of Health Sciences, University of Colorado, Colorado Springs, CO 80918, USA
| | - Karl-Stefan Delank
- Department of Orthopedic and Trauma Surgery, Martin-Luther-University Halle-Wittenberg, 06120 Halle, Germany
| | - René Schwesig
- Department of Orthopedic and Trauma Surgery, Martin-Luther-University Halle-Wittenberg, 06120 Halle, Germany
| | - Anke Steinmetz
- Department of Trauma, Reconstructive Surgery and Rehabilitation Medicine, University Medicine Greifswald, Physical and Rehabilitation Medicine, 17475 Greifswald, Germany
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Lavín-Pérez AM, León-Llamas JL, Salas Costilla FJ, Collado-Mateo D, López de las Heras R, Gasque Celma P, Villafaina S. Validity of On-Line Supervised Fitness Tests in People with Low Back Pain. Healthcare (Basel) 2023; 11:healthcare11071019. [PMID: 37046945 PMCID: PMC10094436 DOI: 10.3390/healthcare11071019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/28/2023] [Accepted: 03/31/2023] [Indexed: 04/05/2023] Open
Abstract
This study aimed to investigate the concurrent validity between online evaluations (OEs) and face-to-face evaluations (IPEs) of a Senior Fitness Test and two balance tests in people with low back pain (LBP). Forty participants of 58.48 (9.87) years were included. The 30 s chair stand-up, arm curl, 2 min step, chair-sit and reach, back scratch, 8 foot up-and-go, sharpened Romberg, and one-legged stance tests were administrated using both OE and IPE methods. The results indicated no significant differences (p > 0.05) between the two methods except in the 8-foot up-and-go test (p = 0.007). Considering the ICC values and Bland-Altman plots, excellent agreement was found for the chair-sit and reach test, moderate agreement for the arm-curl and 8-foot up-and-go tests, and good agreement for the other tests. Strong correlations (p < 0.001) were observed in all variables except for the arm-curl and 8-foot up-and-go tests, where moderate correlations were found (p < 0.05). These results support the validity of OEs and IPEs in all tests, except for the arm-curl and 8-foot up-and-go tests, where lower ICC values and moderate correlations were found. However, it is important to consider the range of fluctuation of the ICC and the significant values obtained through correlations.
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Affiliation(s)
- Ana Myriam Lavín-Pérez
- Centre for Sport Studies, Rey Juan Carlos University, 28943 Fuenlabrada, Spain
- GO fitLAB, Ingesport, 28003 Madrid, Spain
| | - Juan Luis León-Llamas
- Physical Activity and Quality of Life Research Group (AFYCAV), Facultad de Ciencias del Deporte, Universidad de Extremadura, 10003 Cáceres, Spain
| | | | | | | | - Pablo Gasque Celma
- Sports Medicine Service, Alcobendas City Council, 28100 Alcobendas, Spain
- Department of Physical Education, Sport and Human Motricity, Autónoma Univesity, Ciudad Universitaria de Cantoblanco, 28049 Madrid, Spain
| | - Santos Villafaina
- Physical Activity and Quality of Life Research Group (AFYCAV), Facultad de Ciencias del Deporte, Universidad de Extremadura, 10003 Cáceres, Spain
- Departamento de Desporto e Saúde, Escola de Saúde e Desenvolvimento Humano, Universidade de Évora, 7004-516 Évora, Portugal
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11
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Li Y, Xu Z, Xie H, Fu R, Lo WLA, Cheng X, Yang J, Ge L, Yu Q, Wang C. Changes in cortical activation during upright stance in individuals with chronic low back pain: An fNIRS study. Front Hum Neurosci 2023; 17:1085831. [PMID: 36816497 PMCID: PMC9936824 DOI: 10.3389/fnhum.2023.1085831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/17/2023] [Indexed: 02/05/2023] Open
Abstract
Introduction Postural control deficits are a potential cause of persistent and recurrent pain in patients with chronic low back pain (CLBP). Although some studies have confirmed that the dorsolateral prefrontal cortex (DLPFC) contributes to pain regulation in CLBP, its role in the postural control of patients with CLBP remains unclear. Therefore, this study aimed to investigate the DLPFC activation of patients with CLBP and healthy controls under different upright stance task conditions. Methods Twenty patients with CLBP (26.50 ± 2.48 years) and 20 healthy controls (25.75 ± 3.57 years) performed upright stance tasks under three conditions: Task-1 was static balance with eyes open; Task-2 was static balance with eyes closed; Task-3 involved dynamic balance on an unstable surface with eyes open. A wireless functional near-infrared spectroscopy (fNIRS) system measured cortical activity, including the bilateral DLPFC, pre-motor cortex (PMC) and supplementary motor area (SMA), the primary motor cortex (M1), the primary somatosensory cortex (S1), and a force platform measured balance parameters during upright stance. Results The two-way repeated measures ANOVA results showed significant interaction in bilateral PMC/SMA activation. Moreover, patients with CLBP had significantly increased right DLPFC activation and higher sway 32 area and velocity than healthy controls during upright stance. Discussion Our results imply that PMC/SMA and DLPFC maintain standing balance. The patients with CLBP have higher cortical activity and upright stance control deficits, which may indicate that the patients with CLBP have low neural efficiency and need more motor resources to maintain balance.
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12
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Wochatz M, Schraplau A, Engel T, Zecher MM, Sharon H, Alt Y, Mayer F, Kalron A. Application of eccentric training in various clinical populations: Protocol for a multi-centered pilot and feasibility study in people with low back pain and people with multiple sclerosis. PLoS One 2022; 17:e0270875. [PMID: 36548298 PMCID: PMC9779041 DOI: 10.1371/journal.pone.0270875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 05/25/2022] [Indexed: 12/24/2022] Open
Abstract
Physical activity and exercise are effective approaches in prevention and therapy of multiple diseases. Although the specific characteristics of lengthening contractions have the potential to be beneficial in many clinical conditions, eccentric training is not commonly used in clinical populations with metabolic, orthopaedic, or neurologic conditions. The purpose of this pilot study is to investigate the feasibility, functional benefits, and systemic responses of an eccentric exercise program focused on the trunk and lower extremities in people with low back pain (LBP) and multiple sclerosis (MS). A six-week eccentric training program with three weekly sessions is performed by people with LBP and MS. The program consists of ten exercises addressing strength of the trunk and lower extremities. The study follows a four-group design (N = 12 per group) in two study centers (Israel and Germany): three groups perform the eccentric training program: A) control group (healthy, asymptomatic); B) people with LBP; C) people with MS; group D (people with MS) receives standard care physiotherapy. Baseline measurements are conducted before first training, post-measurement takes place after the last session both comprise blood sampling, self-reported questionnaires, mobility, balance, and strength testing. The feasibility of the eccentric training program will be evaluated using quantitative and qualitative measures related to the study process, compliance and adherence, safety, and overall program assessment. For preliminary assessment of potential intervention effects, surrogate parameters related to mobility, postural control, muscle strength and systemic effects are assessed. The presented study will add knowledge regarding safety, feasibility, and initial effects of eccentric training in people with orthopaedic and neurological conditions. The simple exercises, that are easily modifiable in complexity and intensity, are likely beneficial to other populations. Thus, multiple applications and implementation pathways for the herein presented training program are conceivable. Trial registration: DRKS00020483 (DRKS, German Clinical Trials Register; 24th January 2020 -retrospectively registered; https://www.drks.de/DRKS00020483).
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Affiliation(s)
- Monique Wochatz
- University of Potsdam, University Outpatient Clinic, Sports Medicine and Sports Orthopaedics, Potsdam, Germany
| | - Anne Schraplau
- University of Potsdam, University Outpatient Clinic, Sports Medicine and Sports Orthopaedics, Potsdam, Germany
- Faculty of Health Sciences, Joint Faculty of the University of Potsdam, The Brandenburg Medical School Theodor Fontane and the Brandenburg University of Technology, Cottbus, Senftenberg, Germany
| | - Tilman Engel
- University of Potsdam, University Outpatient Clinic, Sports Medicine and Sports Orthopaedics, Potsdam, Germany
| | - Mahli M. Zecher
- University of Potsdam, University Outpatient Clinic, Sports Medicine and Sports Orthopaedics, Potsdam, Germany
| | - Hadar Sharon
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Yasmin Alt
- Department of Physical Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Frank Mayer
- University of Potsdam, University Outpatient Clinic, Sports Medicine and Sports Orthopaedics, Potsdam, Germany
| | - Alon Kalron
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel
- Department of Physical Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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13
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Hermans SMM, Paulussen EMB, Notermans RAJ, Krijntjes BDM, Schotanus MGM, Most J, van Santbrink H, van Hemert WLW, Curfs I. Motion analysis in patients with postpartum sacroiliac joint dysfunction: A cross-sectional case-control study. Clin Biomech (Bristol, Avon) 2022; 100:105773. [PMID: 36191512 DOI: 10.1016/j.clinbiomech.2022.105773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 09/19/2022] [Accepted: 09/23/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Patients with sacroiliac joint dysfunction are limited in daily life activities such as gait, climbing stairs and rising from a chair. It is well known that individuals with chronic low back pain have impaired balance compared to healthy individuals. This cross-sectional case-control study aims to investigate spatiotemporal parameters, center of pressure and mass, pelvic angles and other joint angles in patients with sacroiliac joint dysfunction in comparison with healthy controls. METHODS Motion analysis existed of three tasks: (1) normal gait, (2) single-leg-stance, and (3) sit-to-stance. Spatiotemporal parameters, center of pressure, pelvic angles and other joint angles were measured using a twelve-camera, three-dimensional motion capture system and ground reaction force platforms. FINDINGS Thirty subjects were recruited for this study; ten patients, ten matched controls and ten healthy student controls. For gait, patients had a lower cadence, longer double support phase, shorter step length and slower walking speed than controls. For single-leg-stance, patients had a smaller hip angle of the risen leg than controls. Also, variability in center of pressure was larger in patients. For sit-to-stance, the total time to perform the task was almost doubled for patients compared to controls. INTERPRETATION This study demonstrates that patients with sacroiliac joint dysfunction have an impaired gait, more balance problems during standing and standing up compared to healthy controls. This novel information assists to further comprehend the pathology and disease burden of sacroiliac joint dysfunction, in addition, it may allow us to evaluate the effect of current therapies.
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Affiliation(s)
- Sem M M Hermans
- Department of Orthopedic Surgery and Traumatology, Zuyderland Medical Center, Heerlen, The Netherlands; Care and Public Health Research Institute (CAPHRI) Maastricht University, Maastricht, The Netherlands.
| | - Evy M B Paulussen
- Department of Orthopedic Surgery and Traumatology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Remi A J Notermans
- Department of Biometrics, Zuyd University of Applied Sciences, Heerlen, The Netherlands
| | - Bas D M Krijntjes
- Department of Biometrics, Zuyd University of Applied Sciences, Heerlen, The Netherlands
| | - Martijn G M Schotanus
- Department of Orthopedic Surgery and Traumatology, Zuyderland Medical Center, Heerlen, The Netherlands; Care and Public Health Research Institute (CAPHRI) Maastricht University, Maastricht, The Netherlands
| | - Jasper Most
- Department of Orthopedic Surgery and Traumatology, Zuyderland Medical Center, Heerlen, The Netherlands; Care and Public Health Research Institute (CAPHRI) Maastricht University, Maastricht, The Netherlands
| | - Henk van Santbrink
- Care and Public Health Research Institute (CAPHRI) Maastricht University, Maastricht, The Netherlands; Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Neurosurgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Wouter L W van Hemert
- Department of Orthopedic Surgery and Traumatology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Inez Curfs
- Department of Orthopedic Surgery and Traumatology, Zuyderland Medical Center, Heerlen, The Netherlands
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14
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Impact of plantar fasciitis on postural control and walking in young middle-aged adults. Foot (Edinb) 2022; 53:101951. [PMID: 36463613 DOI: 10.1016/j.foot.2022.101951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 07/11/2022] [Accepted: 11/02/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE To assess if plantar fasciitis has an impact on postural control and walking pattern from gait analysis across different experimental conditions. METHODS Thirty participants (n = 15 with plantar fasciitis) performed 5 different balance tasks on a force platform, and the center of pressure (COP) was computed for postural control analysis. Participants were also asked to walk at 3 different speeds on a gait analysis system to compute the spatial-temporal parameters. Clinical foot measurements (pain, mobility) were also collected through all participants. RESULTS Clinical foot measurements showed no significant difference between the two groups; except for pain palpation in plantar fasciitis group. Significant differences were observed between the two groups for COP area displacement sway (p < 0.01; d = 0.08) and velocity (p = 0.022; d = 0.04), where the fasciitis group reported poorer postural control than control mainly during more challenging balance tasks (semi-tandem, unipodal). Plantar fasciitis group reported a decrease of gait velocity (p < 0.01; d = 0.12), step length (p < 0.01; d = 0.16) and step width (p < 0.01; d = 0.18) when compared to the healthy group across walking speed tests. CONCLUSIONS Individuals with plantar fasciitis report poor postural control and changes in walking pattern across three speeds performance.
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Ansari S, Sharma S, Kumar S, Sharma S. Effect of stabilization exercises on balance parameters in chronic low back pain: a systematic review. SPORT SCIENCES FOR HEALTH 2022. [DOI: 10.1007/s11332-021-00864-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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16
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de Oliveira FCL, Larivière C, Dallaire M, Mecheri H, Ngomo S, da Silva RA. Immediate Effect of Lumbosacral Orthosis and Abdominal Drawing-In Maneuver on Postural Control in Adults With Nonspecific Chronic Low Back Pain. J Manipulative Physiol Ther 2022; 45:425-435. [PMID: 36400598 DOI: 10.1016/j.jmpt.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 08/26/2022] [Accepted: 09/20/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The purpose of this study was to examine the immediate effects of lumbosacral orthosis and the abdominal drawing-in maneuver on the trunk postural control of adults with chronic low back pain compared with asymptomatic controls during 1-legged and semi-tandem stances. METHODS An experimental and comparative study (cross-sectional design) was conducted in a laboratory setting. Twenty adults with chronic low back pain and 20 asymptomatic controls randomly performed 2 postural balance tasks over a force platform, considering 3 experimental conditions: (1) natural posture (baseline-control), (2) lumbosacral orthosis, and (3) abdominal drawing-in maneuver. Linear variables (mean amplitude, ellipse area, and sway velocity) derived from the center of pressure were computed, and 2-way analysis of variance (group × condition) for repeated measures were conducted. RESULTS No group × condition interactions (.139 ≤ P ≤.938) were detected in any center of pressure parameters. No condition effect was detected, but a group effect (P = .042) was observed for 1 center of pressure parameter. The chronic low back pain group presented with a lower mean anteroposterior center of pressure amplitude than asymptomatic controls (∆ = 0.31 ± 0.66 cm [95% confidence interval, 0.05-0.56], P = .019) during the semi-tandem stance balance task. CONCLUSION Neither lumbosacral orthosis nor the abdominal drawing-in maneuver showed immediate improvement in trunk postural control in any group. Thus, clinicians should not expect immediate benefits or improvements yielded by lumbosacral orthosis or the abdominal drawing-in maneuver when patients with chronic low back pain undergo these interventions.
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Affiliation(s)
- Fábio Carlos Lucas de Oliveira
- Department of Health Sciences, Intersectoral Center in Sustainable Health, BioNR Research Laboratory, University of Quebec at Chicoutimi (UQAC), Saguenay, Quebec, Canada; Research Unit in Sport and Physical Activity (CIDAF), Faculty of Sport Sciences and Physical Education, University of Coimbra, Coimbra, Portugal
| | - Christian Larivière
- Occupational Health and Safety Research Robert-Sauvé Institute (IRSST), Montreal, Québec, Canada
| | - Mathieu Dallaire
- Department of Health Sciences, Intersectoral Center in Sustainable Health, BioNR Research Laboratory, University of Quebec at Chicoutimi (UQAC), Saguenay, Quebec, Canada; Occupational Health and Safety Research Robert-Sauvé Institute (IRSST), Montreal, Québec, Canada
| | - Hakim Mecheri
- Occupational Health and Safety Research Robert-Sauvé Institute (IRSST), Montreal, Québec, Canada
| | - Suzy Ngomo
- Department of Health Sciences, Intersectoral Center in Sustainable Health, BioNR Research Laboratory, University of Quebec at Chicoutimi (UQAC), Saguenay, Quebec, Canada; Physical Therapy Program, University of Quebec at Chicoutimi (UQAC), Saguenay, Quebec, Canada
| | - Rubens A da Silva
- Department of Health Sciences, Intersectoral Center in Sustainable Health, BioNR Research Laboratory, University of Quebec at Chicoutimi (UQAC), Saguenay, Quebec, Canada; Physical Therapy Program, University of Quebec at Chicoutimi (UQAC), Saguenay, Quebec, Canada; Integrated Health and Social Services Center of Saguenay-Lac-Saint-Jean (CIUSSS SLSJ), Specialized Geriatrics Services-Bay Hospital, Saguenay, Quebec, Canada; Doctoral and Master Programs in Human Movement and Rehabilitation, Evangélica University of Goiás, Anapolis, Goiás, Brazil.
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17
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Dal Farra F, Arippa F, Arru M, Cocco M, Porcu E, Tramontano M, Monticone M. Effects of exercise on balance in patients with non-specific low back pain: a systematic review and meta-analysis. Eur J Phys Rehabil Med 2022; 58:423-434. [PMID: 34636528 PMCID: PMC9980551 DOI: 10.23736/s1973-9087.21.07293-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Non-specific low back pain (NS-LBP) is one of the most common musculoskeletal conditions related to medical expenses and disability. Evidence suggests that changes in motion patterns could induce trunk instability and impaired postural control. Therefore, this systematic review investigated the effects of exercise on balance in patients with NS-LBP. EVIDENCE ACQUISITION A systematic review and meta-analysis were conducted. Findings were reported following the 2020 PRISMA statement and the main databases were searched for RCTs. Studies were independently screened through a standardized form and their internal validity assessed by using the Cochrane risk of bias (RoB) tool. Pooled effects were calculated at post-treatment and quality of evidence was assessed through the GRADE framework. EVIDENCE SYNTHESIS Twelve articles were included in the review, eight in the meta-analysis. None of the studies were judged at low RoB. There is very low-quality evidence that exercise is effective in reducing Centre of Pressure (CoP) displacement (-16.99 [-27.29, -6.68]; P=0.001) and in improving single-leg stance test performance (-28.7 [-48.84, -8.67]; P=0.005) and dynamic balance (-4.74 [-8.02, -1.46]; P=0.005). Conversely, no significant results were observed in "ellipse area" and in "limits of stability" indexes. Other results were summarized in a qualitative synthesis. CONCLUSIONS Exercise could be effective in improving both static and dynamic balance in patients with NS-LBP over a short-term period. However, quality of evidence was estimated as very low, hence further double-blinded, high-quality RCTs are needed to address clinical practice and research.
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Affiliation(s)
- Fulvio Dal Farra
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Federico Arippa
- Unit of Neurorehabilitation, Department of Neuroscience and Rehabilitation, ARNAS G. Brotzu, Cagliari, Italy -
| | - Mauro Arru
- Unit of Physical and Rehabilitation Medicine, Department of Clinical Sciences and Translational Medicine, Tor Vergata University, Rome, Italy
| | - Martina Cocco
- Unit of Physical and Rehabilitation Medicine, Department of Clinical Sciences and Translational Medicine, Tor Vergata University, Rome, Italy
| | - Elisa Porcu
- Unit of Physical and Rehabilitation Medicine, Department of Clinical Sciences and Translational Medicine, Tor Vergata University, Rome, Italy
| | - Marco Tramontano
- IRCCS Santa Lucia Foundation, Rome, Italy.,Department of Movement, Human and Health Sciences, Interuniversity Center of Bioengineering of the Human Neuromusculoskeletal System, Foro Italico University of Rome, Rome, Italy
| | - Marco Monticone
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Neurorehabilitation, Department of Neuroscience and Rehabilitation, ARNAS G. Brotzu, Cagliari, Italy
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18
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Freitas JP, Corrêa LA, Bittencourt JV, Armstrong KM, Nogueira LAC. Immediate effects of spinal manipulation on painful sensitivity and postural stability in patients with chronic nonspecific low back pain: study protocol for a controlled randomised clinical trial. Trials 2022; 23:188. [PMID: 35241124 PMCID: PMC8895827 DOI: 10.1186/s13063-022-06111-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 02/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low back pain is one of the main public health concerns. Chronic low back pain (cLBP) reduces functional capacity and affects postural stability. Although health professionals widely use spinal manipulation, its immediate effect on painful sensitivity and postural stability is lacking. This study aims to verify the immediate effects of lumbar spinal manipulation on the pressure pain threshold and postural stability in individuals with cLBP. METHODS A two-arm, placebo-controlled clinical trial with parallel groups and examiner-blinded will be conducted with 80 participants with cLBP from an outpatient physical therapy department, randomly allocated at a 1:1 distribution. The experimental group will receive a lumbar spinal manipulation technique, and the placebo group will receive a simulated lumbar spinal manipulation. Both groups will receive one session of treatment and will be evaluated before and immediately after the intervention. The primary outcomes will be the pressure pain threshold and postural stability. Pain intensity and patient's expectation will be assessed as a secondary outcome. The pressure pain threshold will be assessed using a pressure algometer in 6 different anatomical regions. The evaluation of postural stability will be performed in a baropodometry exam by displacing the centre of pressure. The pain intensity will be measured using the Numeric Pain Rating Scale. A Likert scale will be used for the patient's expectation about the treatment. A two-way analysis of variance will compare the effect of the interventions between groups. DISCUSSION This study will provide insights regarding the immediate effects of spinal manipulation in patients with cLBP against a simulated spinal manipulation using objective outcomes and considering patients' expectations regarding the treatment. TRIAL REGISTRATION Brazilian Registry of Clinical Trials RBR-3ksq2c . Registered on 13 July 2020.
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Affiliation(s)
- João Paulo Freitas
- Rehabilitation Science Postgraduation Program, Augusto Motta University Centre (UNISUAM), Rio de Janeiro, Brazil
- Physiotherapy Department, Midwestern Parana State University (UNICENTRO), Paraná, Brazil
- Physiotherapy Department, Guairacá University Centre (UNIGUAIRACA), Paraná, Brazil
| | - Leticia Amaral Corrêa
- Rehabilitation Science Postgraduation Program, Augusto Motta University Centre (UNISUAM), Rio de Janeiro, Brazil
| | - Juliana Valentim Bittencourt
- Rehabilitation Science Postgraduation Program, Augusto Motta University Centre (UNISUAM), Rio de Janeiro, Brazil
| | | | - Leandro Alberto Calazans Nogueira
- Rehabilitation Science Postgraduation Program, Augusto Motta University Centre (UNISUAM), Rio de Janeiro, Brazil
- Physiotherapy Department, Federal Institute of Rio de Janeiro (IFRJ), Rio de Janeiro, Brazil
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19
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Zanetti MRD, Dourado VZ, Scudeller TT, Vieira ER, Amaral MTPD. Pelvic Floor Muscle Strength and the Postural Balance in Middle-Aged Women: A Pilot Study. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2022. [DOI: 10.1080/02703181.2022.2044968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - Victor Zuniga Dourado
- Department of Human Movement Sciences, Federal University of São Paulo, Santos, Brazil
| | | | - Edgar Ramos Vieira
- Department of Physical Therapy, Florida International University, Miami, Florida, USA
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20
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Gorji SM, Mohammadi Nia Samakosh H, Watt P, Henrique Marchetti P, Oliveira R. Pain Neuroscience Education and Motor Control Exercises versus Core Stability Exercises on Pain, Disability, and Balance in Women with Chronic Low Back Pain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052694. [PMID: 35270384 PMCID: PMC8910692 DOI: 10.3390/ijerph19052694] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/20/2022] [Accepted: 02/23/2022] [Indexed: 12/28/2022]
Abstract
Background: Several interventions have been used to relieve chronic low back pain (CLBP). This study aimed to compare the effects of pain neuroscience education (PNE) followed by motor control exercises (MCEs) with core stability training (CST) on pain, disability, and balance in women with CLBP. Methods: Thirty-seven women with CLBP were randomly divided into two groups of PNE/MCE (n = 18, 55.2 ± 2.6 years) or CST (n = 19, 54.6 ± 2.4 years). Eight weeks of PNE/MCE or CST were prescribed for each group, independently. Pain intensity (VAS scale), disability (Roland Morris Disability Questionnaire), unipodal static balance, and dynamic balance (time up and go test) were measured at the beginning and 8 weeks after the intervention. Two-way mixed ANOVA was used to analyze the results with alpha of 5%. Results: After 8 weeks, there was a significant difference in VAS scale between groups (p = 0.024), with both PNE/MCE and CST showing 58% and 42% reductions, respectively. There were no differences for all other variables between groups. Regarding pre- to post-comparisons, both groups showed improvements in all dependent variables (p < 0.001). Conclusion: The treatment with PNE/MCE was more effective in improving pain disability and unipodal static and dynamic balance than treatment with CST. Even so, both treatments were shown to be valid and safe in improving all dependent variables analyzed in women with CLBP.
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Affiliation(s)
- Sahar Modares Gorji
- Department of Biomechanics and Corrective Exercises and Sports Injuries, University of ARAK, Arak 38156879, Iran
- Correspondence:
| | - Hadi Mohammadi Nia Samakosh
- Department of Biomechanics and Corrective Exercises and Sports Injuries, University of Kharazmi, Tehran 15719-14911, Iran;
| | - Peter Watt
- Environmental Extremes Lab, Sport and Exercise Science and Medicine Research and Enterprise Group, University of Brighton, Eastbourne, East Sussex, Brighton BN2 4AT, UK;
| | | | - Rafael Oliveira
- Sports Science School of Rio Maior–Polytechnic Institute of Santarém, 2140-413 Rio Maior, Portugal;
- Research Center in Sport Sciences, Health Sciences and Human Development, 5001-801 Vila Real, Portugal
- Life Quality Research Centre, 2140-413 Rio Maior, Portugal
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21
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Wang H, Zheng J, Fan Z, Luo Z, Wu Y, Cheng X, Yang J, Zhang S, Yu Q, Lo WLA, Wang C. Impaired static postural control correlates to the contraction ability of trunk muscle in young adults with chronic non-specific low back pain: A cross-sectional study. Gait Posture 2022; 92:44-50. [PMID: 34823100 DOI: 10.1016/j.gaitpost.2021.11.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/28/2021] [Accepted: 11/15/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Patients with chronic non-specific low back pain (CNSLBP) were found with impaired postural control in previous studies. Since the trunk muscle take important efforts on core stability, the study aimed to examine the relationships of postural control during stance tasks and the contractility of trunk muscle in young adults with CNSLBP and without. METHODS Healthy individuals (n = 25) and individuals with CNSLBP (n = 30) were included. The thickness of the bilateral transversus abdominis (TrA) and lumbar multifidus (MF) was measured during rest and maximal voluntary contraction, and the change percentages (TrA%, MF%) were calculated. Regarding postural control, COP path length and sway area during the stance tasks were measured thrice in each group. RESULTS The bilateral TrA% of the CNSLBP group was less than that of the HC group (p < 0.05). The bilateral TrA% of the CNSLBP group was less than that of the HC group (p < 0.05). The bilateral MF% showed no significantly different(p > 0.05) between the two groups. Compared with healthy controls, CNSLBP patients resulted larger path length and sway area of COP during most of static stance tasks. During the EO task in the CNSLBP group, TrA% was found correlate to COP path length (p < 0.05); the right MF% was correlated with COP sway area (p < 0.05). No significant correlations appeared in the healthy controls (p > 0.05). CONCLUSIONS Compared with healthy individuals, impaired postural control during static stance with eyes open in patients with CNSLBP was likely to be related to the poor contraction ability of bilateral transversus abdominis and correlated to the normal contraction ability of right lumbar multifidus.
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Affiliation(s)
- Hongjiang Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
| | - Jiaxuan Zheng
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
| | - Ziyan Fan
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
| | - Zichong Luo
- Department of Electromechanical Engineering, Faculty of Science and Technology, University of Macau, Macau, China
| | - Yi Wu
- School of Arts and Design, Guangdong University of Technology, Guangzhou 510080, China
| | - Xue Cheng
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
| | - Jiajia Yang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
| | - Siyun Zhang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
| | - Qiuhua Yu
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
| | - Wai Leung Ambrose Lo
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
| | - Chuhuai Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China.
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22
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Beaupré P, da Silva RA, Chevrette T. The Impact of Pain on Functionality, Postural Control and Fall Risk in Woman Aged 45 to 64 Years Old. Geriatrics (Basel) 2022; 7:10. [PMID: 35076521 PMCID: PMC8788291 DOI: 10.3390/geriatrics7010010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 12/27/2021] [Accepted: 12/30/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Ageing in women is associated with chronic degenerative pain leading to a functional decrease and therefore increase fall risk. It is therefore essential to detect early functional decreases in the presence of pain related to osteoarthritis. OBJECTIVE This cross-sectional study aimed to assess the impact of pain on functionality, postural control and fall risk in women aged between 45 to 64 years old. METHODS Twenty-one (21) women aged 45 to 64 were evaluated by clinical and functional measures such as a pain questionnaire (Lequesne Index), functional tests (Stair Step Test, 5 times sit-to-stand, 6MWD, Timed-up and Go) and postural performance (under force platform). Women were classified into 2 groups from the Lequesne Pain Index (PI): low pain (score ≤ 9) and strong pain (score ≥ 10) for subsequent comparisons on functionality (physical and postural control performance). RESULTS A significant impact was observed between the pain index (strong PI) and 3 of the 4 functional tests carried out including Stair Step Test (p = 0.001; g = 1.44), walking distance (p = 0.003; g = 1.31) and Timed-up and Go (p = 0.04; g = -0.93). The group with a strong PI score reported further poor postural control under force platform compared to the weak pain group. CONCLUSION Pain and severity based on the PI index negatively modulate physical and postural control performance in women aged 45 to 64 years old.
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Affiliation(s)
- Priscilla Beaupré
- Masters of Biomedical Science Program, Université du Québec à Chicoutimi (UQAC), Saguenay, QC G7H 2B1, Canada; (P.B.); (R.A.d.S.)
| | - Rubens A. da Silva
- Masters of Biomedical Science Program, Université du Québec à Chicoutimi (UQAC), Saguenay, QC G7H 2B1, Canada; (P.B.); (R.A.d.S.)
- Physical Therapy McGill Program in Extension, Université du Québec à Chicoutimi (UQAC), Saguenay, QC G7H 2B1, Canada
- Centre Intersectoriel en Santé Durable, Département des Sciences de la Santé, Université du Québec à Chicoutimi (UQAC), Saguenay, QC G7H 2B1, Canada
- Centre Intégré de Santé et Services Sociaux du Saguenay—Lac-Saint-Jean (CIUSSS SLSJ), Specialized Geriatrics Services–La Baie Hospital, Saguenay, QC G7H 7K9, Canada
- BioNR Research Lab, Département des Sciences de la santé, Université du Québec à Chicoutimi (UQAC), Chicoutimi, QC G7H 2B1, Canada
| | - Tommy Chevrette
- Masters of Biomedical Science Program, Université du Québec à Chicoutimi (UQAC), Saguenay, QC G7H 2B1, Canada; (P.B.); (R.A.d.S.)
- Centre Intersectoriel en Santé Durable, Département des Sciences de la Santé, Université du Québec à Chicoutimi (UQAC), Saguenay, QC G7H 2B1, Canada
- Département des Sciences de la santé, Clinique Universitaire de Kinésiologie, Université du Québec à Chicoutimi (UQAC), Chicoutimi, QC G7H 2B1, Canada
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IS THERE A RELATIONSHIP BETWEEN PAIN, LIMITS OF STABILITY AND SENSORY INTERACTION BALANCE IN PATIENTS WITH LUMBAR DISC HERNIATION? A CROSS-SECTIONAL STUDY. INTERNATIONAL JOURNAL OF HEALTH SERVICES RESEARCH AND POLICY 2021. [DOI: 10.33457/ijhsrp.942729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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24
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Pena Junior PM, de Sá Ferreira A, Telles G, Lemos T, Calazans Nogueira LA. Concurrent validation of the centre of pressure displacement analyzed by baropodometry in patients with chronic non-specific low back pain during functional tasks. J Bodyw Mov Ther 2021; 28:489-495. [PMID: 34776183 DOI: 10.1016/j.jbmt.2021.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 03/24/2021] [Accepted: 06/08/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Low back pain is highly prevalent worldwide and in Brazil. Postural control is a functional limitation in patients with low back pain. Postural control can be investigated through the centre of pressure (CoP) displacement, using a baropodometry. However, there is a lack of validation data about posturography variables obtained from the baropodometer. This study aimed to investigate the concurrent validity of the displacement of CoP measured through baropodometer T-Plate® in patients with chronic non-specific low back pain during three tasks. METHOD A validation study was conducted in 37 participants with chronic non-specific low back pain during three different tasks, including bipedal support, bipedal support holding bags, and bipedal squatting holding bags. The tasks were performed on a baropodometer (index method) placed on a force plate (criterion measure). Measurements included velocity, amplitude of displacement, and sway area. RESULTS Weak to strong correlations were found in the three tasks between the baropodometer and the force plate for most variables. The Bland-Altman analyses revealed no substantive differences between the two methods for the standard deviation of amplitude mediolateral and sway area for the three tasks. There was a systematic bias for the mean velocity and the standard deviation of amplitude anteroposterior displacement in the three tasks. CONCLUSION The baropodometer could be used to measure the displacement of the CoP in patients with chronic non-specific low back pain. Sway area showed an appropriate validity to measure postural stability of the participants using the baropodometer.
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Affiliation(s)
- Pedro Manoel Pena Junior
- Rehabilitation Science Postgraduation Progam - Augusto Motta University Centrr (UNISUAM), Rio de Janeiro, Brazil
| | - Arthur de Sá Ferreira
- Rehabilitation Science Postgraduation Progam - Augusto Motta University Centrr (UNISUAM), Rio de Janeiro, Brazil
| | - Gustavo Telles
- Rehabilitation Science Postgraduation Progam - Augusto Motta University Centrr (UNISUAM), Rio de Janeiro, Brazil
| | - Thiago Lemos
- Rehabilitation Science Postgraduation Progam - Augusto Motta University Centrr (UNISUAM), Rio de Janeiro, Brazil
| | - Leandro Alberto Calazans Nogueira
- Rehabilitation Science Postgraduation Progam - Augusto Motta University Centrr (UNISUAM), Rio de Janeiro, Brazil; Physiotherapy Department - Federal Institute of Rio de Janeiro (IFRJ), Rio de Janeiro, Brazil.
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25
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Mingorance JA, Montoya P, Miranda JGV, Riquelme I. An Observational Study Comparing Fibromyalgia and Chronic Low Back Pain in Somatosensory Sensitivity, Motor Function and Balance. Healthcare (Basel) 2021; 9:1533. [PMID: 34828579 PMCID: PMC8619309 DOI: 10.3390/healthcare9111533] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 11/08/2021] [Accepted: 11/08/2021] [Indexed: 01/07/2023] Open
Abstract
Fibromyalgia (FM) and chronic low back pain (CLBP) have shared pathophysiology and have a considerable impact on patients' daily activities and quality of life. The main objective of this study was to compare pain impact, somatosensory sensitivity, motor functionality, and balance among 60 patients with FM, 60 patients with CLBP, and 60 pain-free controls aged between 30 and 65 years. It is essential to know the possible differences existing in symptomatology of two of the major chronic pain processes that most affect the population, such as FM and CLBP. The fact of establishing possible differences in sensory thresholds, motor function, and proprioceptive measures among patients with FM and CLBP could bring us closer to a greater knowledge of the chronic pain process. Through an observational study, a comparison was made between the three groups (FM, CLBP, and pain-free controls) evaluating functional performance, postural balance, kinematic gait parameters, strength, depression, fatigue, and sensitivity to pain and vibration. Patients with chronic pain showed worse somatosensory sensitivity (p < 0.001) and motor function (p < 0.001) than pain-free controls. Moreover, patients with FM showed greater pain impact (p < 0.001) and bigger somatosensory (p < 0.001) and motor deficiencies (p < 0.001) than patients with CLBP. Further research should explore the possible reasons for the greater deterioration in patients with FM in comparison with other chronic pain conditions. Our results, showing the multiple areas susceptible of deterioration, make it necessary to adopt interdisciplinary interventions focused both on physical and emotional dysfunction.
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Affiliation(s)
- José Antonio Mingorance
- Research Institute of Health Sciences (IUNICS-IdISBa), University of the Balearic Islands, 07122 Palma de Mallorca, Spain;
- Physiotherapy Department, Son Espases Hospital, 07120 Palma de Mallorca, Spain
- Department of Nursing and Physiotherapy, University of the Balearic Islands, 07122 Palma de Mallorca, Spain
| | - Pedro Montoya
- Research Institute of Health Sciences (IUNICS-IdISBa), University of the Balearic Islands, 07122 Palma de Mallorca, Spain;
- Center for Mathematics, Computing and Cognition, Federal University of ABC, São Bernardo do Campo 09606-070, Brazil
| | - José García Vivas Miranda
- Laboratory of Biosystems, Institute of Physics, Federal University of Bahia, Salvador 40170-115, Brazil;
| | - Inmaculada Riquelme
- Research Institute of Health Sciences (IUNICS-IdISBa), University of the Balearic Islands, 07122 Palma de Mallorca, Spain;
- Department of Nursing and Physiotherapy, University of the Balearic Islands, 07122 Palma de Mallorca, Spain
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26
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Bazargan M, Loeza M, Ekwegh T, Adinkrah EK, Kibe LW, Cobb S, Assari S, Bazargan-Hejazi S. Multi-Dimensional Impact of Chronic Low Back Pain among Underserved African American and Latino Older Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7246. [PMID: 34299695 PMCID: PMC8306928 DOI: 10.3390/ijerph18147246] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 06/23/2021] [Accepted: 07/02/2021] [Indexed: 12/25/2022]
Abstract
Chronic low back pain is one of the most common, poorly understood, and potentially disabling chronic pain conditions from which older adults suffer. The existing low back pain research has relied almost exclusively on White/Caucasian participant samples. This study examines the correlates of chronic low back pain among a sample of underserved urban African American and Latino older adults. Controlling for age, gender, race/ethnicity, education, living arrangement, and number of major chronic conditions, associations between low back pain and the following outcome variables are examined: (1) healthcare utilization, (2) health-related quality of life (HR-QoL) and self-rated quality of health; and (3) physical and mental health outcomes. METHODS We recruited nine hundred and five (905) African American and Latino older adults from the South Los Angeles community using convenience and snowball sampling. In addition to standard items that measure demographic variables, our survey included validated instruments to document HR-QoL health status, the Short-Form McGill Pain Questionnaire-2, Geriatric Depression Scale, sleep disorder, and healthcare access. Data analysis includes bivariate and 17 independent multivariate models. RESULTS Almost 55% and 48% of the Latino and African American older adults who participated in our study reported chronic low back pain. Our data revealed that having low back pain was associated with three categories of outcomes including: (1) a higher level of healthcare utilization measured by (i) physician visits, (ii) emergency department visits, (iii) number of Rx used, (iv) a higher level of medication complexity, (v) a lower level of adherence to medication regimens, and (vi) a lower level of satisfaction with medical care; (2) a lower level of HR-QoL and self-assessment of health measured by (i) physical health QoL, (ii) mental health QoL, and (iii) a lower level of self-rated health; and (3) worse physical and mental health outcomes measured by (i) a higher number of depressive symptoms, (ii) a higher level of pain, (iii) falls, (iv) sleep disorders, (v) and being overweight/obese. DISCUSSION Low back pain remains a public health concern and significantly impacts the quality of life, health care utilization, and health outcomes of underserved minority older adults. Multi-faceted and culturally sensitive interventional studies are needed to ensure the timely diagnosis and treatment of low back pain among underserved minority older adults. Many barriers and challenges that affect underserved African American and Latino older adults with low back pain simply cannot be addressed in over-crowded EDs. Our study contributes to and raises the awareness of healthcare providers and health policymakers on the necessity for prevention, early diagnosis, proper medical management, and rehabilitation policies to minimize the burdens associated with chronic low back pain among underserved older African American and Latino patients in an under-resourced community such as South Los Angeles.
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Affiliation(s)
- Mohsen Bazargan
- Department of Family Medicine, Charles R Drew University of Medicine and Science (CDU), Los Angeles, CA 90059, USA; (M.B.); (M.L.); (S.A.)
- Department of Public Health, CDU, Los Angeles, CA 90059, USA;
- Physician Assistant Program, CDU, Los Angeles, CA 90059, USA;
- Department of Family Medicine, UCLA, Los Angeles, CA 90095, USA
| | - Margarita Loeza
- Department of Family Medicine, Charles R Drew University of Medicine and Science (CDU), Los Angeles, CA 90059, USA; (M.B.); (M.L.); (S.A.)
- Department of Family Medicine, UCLA, Los Angeles, CA 90095, USA
| | - Tavonia Ekwegh
- School of Nursing, CDU, Los Angeles, CA 90059, USA; (T.E.); (S.C.)
| | | | - Lucy W. Kibe
- Physician Assistant Program, CDU, Los Angeles, CA 90059, USA;
| | - Sharon Cobb
- School of Nursing, CDU, Los Angeles, CA 90059, USA; (T.E.); (S.C.)
| | - Shervin Assari
- Department of Family Medicine, Charles R Drew University of Medicine and Science (CDU), Los Angeles, CA 90059, USA; (M.B.); (M.L.); (S.A.)
- Department of Public Health, CDU, Los Angeles, CA 90059, USA;
| | - Shahrzad Bazargan-Hejazi
- Department of Psychiatry, UCLA, Los Angeles, CA 90095, USA
- Department of Psychiatry, CDU, Los Angeles, CA 90059, USA
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27
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Papcke C, Batista JDF, Veiga Neto PSD, Vendramini IC, Machado RO, Scheeren EM. Low back pain leads to a protective action of pain on dynamic postural stability. Res Sports Med 2021; 30:628-640. [PMID: 34028310 DOI: 10.1080/15438627.2021.1929229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Low back pain (LBP) is a painful manifestation in the lower part of the spine which causes disabilities changing the sensitivity of sensory neurons resulting in weakness of postural muscles interfering with the balance. It is not already clear if LBP people's muscle changes affect the centre of pressure (CoP) recovery in challenging stance perturbations. The aim of this study was to identify differences in the muscle reactions of people with and without LBP to control CoP in challenging stance perturbations. We applied low (Vel1) and high (Vel2) magnitude stance perturbation by a movable platform and evaluated (a) the magnitude and latency time of trunk and lower limb muscle activation, (b) and the displacement and the latency time of the first CoP peak. The latency of trunk and hip muscle activation on Vel2 was lower for LBP group. The CoP latency and displacement did not change between groups and velocities indicating that the muscles took the same time to overcome the external forces. In conclusion, the maintenance of CoP latency at both velocities was not affected on Vel2, suggesting that such alterations have protective action and preservation of the pain on the LPB group in challenging stance perturbations.
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Affiliation(s)
- Caluê Papcke
- Graduate Program in Health Technology, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | | | | | - Iago Carvalho Vendramini
- Graduate Program in Health Technology, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Rafaela Oliveira Machado
- Graduate Program in Health Technology, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
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Tajali S, Roozbehfar N, Mehravar M, Goharpey S, Gayem K. Effects of back extensor and hip abductor fatigue on dynamic postural stability in patients with nonspecific chronic low back pain: A case-control study. Physiother Theory Pract 2021; 38:1987-1995. [PMID: 33881376 DOI: 10.1080/09593985.2021.1913775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Patients with nonspecific chronic low back pain (NSCLBP) complain of pain and fatigue during functional activities. Poor back muscle endurance has been associated with recurrent pain and long-term disability. However, the relationship between proximal muscle fatigue and postural stability is not well understood. PURPOSE To investigate the effects of lumbar extensor and hip abductor fatigue on postural stability in NSCLBPs. METHODS To induce isolated fatigue, participants (24 LBPs, 24 controls) were asked to perform multiple back extension and hip abduction in the separate sessions until the muscle force reached 60% of pre-fatigued force. The overall (OSI), anteroposterior (APSI), and mediolateral (MLSI) stability indices were measured during single-leg stance using the Biodex dynamic platform. RESULTS The results revealed higher postural instability (APSI and OSI) following fatiguing lumbar extensor and hip abductor muscles (greater effect size for APSI than OSI) in LBPs than controls. Furthermore, significant and inverse relationships were found between the level of physical activity, pain, and post-fatigue postural instability (OSI) in NSCLBPs. CONCLUSION Fatigue of proximal muscles could differentiate postural stability primarily in the sagittal plane between NSCLBPs and controls. Therefore, reducing the fatigability of these muscles by endurance training in addition to balance training may improve physical activity.
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Affiliation(s)
- Shirin Tajali
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.,Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Khuzestan, Iran
| | - Narges Roozbehfar
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Khuzestan, Iran
| | - Mohammad Mehravar
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Khuzestan, Iran
| | | | - Khadije Gayem
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Khuzestan, Iran
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Šarabon N, Vreček N, Hofer C, Löfler S, Kozinc Ž, Kern H. Physical Abilities in Low Back Pain Patients: A Cross-Sectional Study with Exploratory Comparison of Patient Subgroups. Life (Basel) 2021; 11:life11030226. [PMID: 33802214 PMCID: PMC8000067 DOI: 10.3390/life11030226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/06/2021] [Accepted: 03/07/2021] [Indexed: 11/29/2022] Open
Abstract
An abundance of literature has investigated the association between low back pain (LBP) and physical ability or function. It has been shown that LBP patients display reduced range of motion, decreased balance ability, impaired proprioception, and lower strength compared to asymptomatic persons. The aim of this study was to investigate the differences between LBP patients and healthy controls in terms of several physical abilities. Based on the premised that different biomechanical and physiological causes and consequences could be related to different types of LBP, a secondary exploratory attempt of the study was to examine the differences between LBP subgroups based on the pain location (local or referred) or type of pathology (discogenic or degenerative) on the level of impairment of function and ability. Participants performed range of motion tests, trunk maximal voluntary contraction force tests, a sitting balance assessment, the timed up-and-go test, the chair rise test, and the trunk reposition error test. Compared to the control group, symptomatic patients on average showed 45.7% lower trunk extension (p < 0.001, η2 = 0.33) and 27.7 % lower trunk flexion force (p < 0.001, η2 = 0.37) during maximal voluntary contraction. LBP patients exhibited decreased sitting balance ability and lower scores in mobility tests (all p < 0.001). There were no differences between groups in Schober’s test and trunk repositioning error (p > 0.05). No differences were observed among the LBP subgroups. The exploratory analyses are limited by the sample size and uncertain validity of the diagnostic procedures within this study. Further studies with appropriate diagnostic procedures and perhaps a different subgrouping of the LBP patients are needed to elucidate if different types of LBP are related to altered biomechanics, physiology, and function.
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Affiliation(s)
- Nejc Šarabon
- Faculty of Health Sciences, University of Primorska, 6310 Izola, Slovenia; (N.V.); (Ž.K.)
- Laboratory for Motor Control and Motor Behaviour, S2P, Science to Practice Ltd., 1000 Ljubljana, Slovenia
- Human Health Department, InnoRenew CoE, 6310 Izola, Slovenia
- Correspondence:
| | - Nace Vreček
- Faculty of Health Sciences, University of Primorska, 6310 Izola, Slovenia; (N.V.); (Ž.K.)
| | - Christian Hofer
- Ludwig Boltzmann Institute for Rehabilitation Research, 3100 St. Pölten, Austria; (C.H.); (S.L.)
| | - Stefan Löfler
- Ludwig Boltzmann Institute for Rehabilitation Research, 3100 St. Pölten, Austria; (C.H.); (S.L.)
- Institute for Physical Medicine, Physiko und Rheumatherapie, 3100 St. Pölten, Austria;
| | - Žiga Kozinc
- Faculty of Health Sciences, University of Primorska, 6310 Izola, Slovenia; (N.V.); (Ž.K.)
- Andrej Marušič Institute, University of Primorska, 6000 Koper, Slovenia
| | - Helmut Kern
- Institute for Physical Medicine, Physiko und Rheumatherapie, 3100 St. Pölten, Austria;
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Kadri MA, Violette M, Dallaire M, de Oliveira FCL, Lavallière M, Ngomo S, Beaulieu LD, Larivière C, da Silva RA. The immediate effect of two lumbar stabilization methods on postural control parameters and their reliability during two balance tasks. J Man Manip Ther 2021; 29:235-243. [PMID: 33385191 DOI: 10.1080/10669817.2020.1864961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Background: Lumbosacral orthosis (LSO) and/or the isolated contraction of the transversus abdominis muscle by the abdominal drawing-in maneuver (ADIM) can increase lumbar stiffness, consequently influencing postural control. The purpose of this study was to compare the effects of LSO and ADIM on postural control during two balance tasks and determine their reliability.Methods: Twenty participants (50% men) randomly performed three experimental conditions: 1) without lumbar stabilization, 2) with LSO), and 3) with ADIM. Each experimental condition was tested in two postural tasks: semi-tandem and one-legged stance on a force platform for 30 seconds, while the Center of pressure postural (COP) parameters were computed.Results: The two methods of lumbar stabilization were comparable and did not significantly reduce the COP values across time, even though a few individuals presented a change in their COP data above the levels of measurement errors. The reliability of these measurements was generally acceptable and sometimes excellent (≥ 0.90 and ≤10% error measurement).Conclusions: Both LSO and isolated contraction of the transversus abdominis muscle by ADIM do not change postural control in one-legged stance and in semi-tandem tasks. These results have implications for use or not these methods for postural control on a rehabilitation perspective.
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Affiliation(s)
- Mohamed Abdelhafid Kadri
- Département des Sciences de la Santé, Centre intersectoriel en santé durable, Laboratoire de recherche BioNR - Université du Québec à santé (UQAC), Saguenay, Québec, Canada
| | - Marianne Violette
- Programme de physiothérapie de l'Université McGill offert en extension à l'Université du Québec à Chicoutimi (UQAC), Saguenay, Québec, Canada
| | - Mathieu Dallaire
- Programme de physiothérapie de l'Université McGill offert en extension à l'Université du Québec à Chicoutimi (UQAC), Saguenay, Québec, Canada
| | - Fábio Carlos Lucas de Oliveira
- Département des Sciences de la Santé, Centre intersectoriel en santé durable, Laboratoire de recherche BioNR - Université du Québec à santé (UQAC), Saguenay, Québec, Canada
| | - Martin Lavallière
- Département des Sciences de la Santé, Centre intersectoriel en santé durable, Laboratoire de recherche BioNR - Université du Québec à santé (UQAC), Saguenay, Québec, Canada
| | - Suzy Ngomo
- Département des Sciences de la Santé, Centre intersectoriel en santé durable, Laboratoire de recherche BioNR - Université du Québec à santé (UQAC), Saguenay, Québec, Canada.,Programme de physiothérapie de l'Université McGill offert en extension à l'Université du Québec à Chicoutimi (UQAC), Saguenay, Québec, Canada
| | - Louis-David Beaulieu
- Département des Sciences de la Santé, Centre intersectoriel en santé durable, Laboratoire de recherche BioNR - Université du Québec à santé (UQAC), Saguenay, Québec, Canada.,Programme de physiothérapie de l'Université McGill offert en extension à l'Université du Québec à Chicoutimi (UQAC), Saguenay, Québec, Canada
| | - Christian Larivière
- Occupational Health and Safety Research Institute Robert-Sauvé, 505 boul. De Maisonneuve Ouest, Montreal, Quebec, Canada
| | - Rubens A da Silva
- Département des Sciences de la Santé, Centre intersectoriel en santé durable, Laboratoire de recherche BioNR - Université du Québec à santé (UQAC), Saguenay, Québec, Canada.,Programme de physiothérapie de l'Université McGill offert en extension à l'Université du Québec à Chicoutimi (UQAC), Saguenay, Québec, Canada
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Low-Back Pain and Knee Position-Related Differences on Postural Control Measures During a One-Legged Stance in Athletes. J Sport Rehabil 2020; 30:631-637. [PMID: 33238243 DOI: 10.1123/jsr.2020-0095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 06/22/2020] [Accepted: 09/07/2020] [Indexed: 11/18/2022]
Abstract
CONTEXT Chronic low-back pain (CLBP) may be associated with changes in postural balance in athletes as poor postural control during sports practice. OBJECTIVE To compare the postural control of athletes with and without CLBP during 2 one-legged stance tasks and identify the center of pressure (COP) cutoff values to determine the main differences. Designed: A cross-sectional study. SETTING Laboratory of functional evaluation and human motor performance. PARTICIPANTS A total of 56 male athletes, 28 with and 28 without CLBP (mean age = 26 y). INTERVENTION The one-legged stance with knee extension and with the knee at 30° flexion tasks were measured and analyzed on a force platform. The participants completed three 30-second trials (30 s of rest between each trial). MAIN OUTCOME MEASURES The COP parameters: the area of COP, mean COP sway velocity in both the anteroposterior and mediolateral directions, and total COP displacement were computed, and a receiver operating characteristics curve analysis was applied to determine the group differences. RESULTS Athletes with CLBP had poorer postural control (P < .01) in both tasks. The 30° knee flexion reported more postural instability than the knee extension for all COP parameters (a large effect size d = 0.80).The knee extension cutoffs identified were >7.1 cm2 for the COP area, >2.6 cm/s for the COP sway velocity in the anterior-posterior direction, and >3.2 cm/s for the mediolateral direction. Whereas, the 30° knee flexion cutoffs were >10.9 cm2 for the COP area, >2.9 cm/s for the COP sway velocity in the anterior-posterior direction, and >4.1 cm/s for the mediolateral direction. Both measures showed enough sensitivity and specificity (ie, area under the curve = 0.88 in and 0.80, respectively) to discriminate both groups. CONCLUSIONS The athletes with CLBP had poorer postural control than the healthy athletes and obtained specific cutoff scores from the COP values.
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Bataller-Cervero AV, Cimarras-Otal C, Roche-Seruendo LE, Alcázar-Crevillén A, Villalba-Ruete JA, Berzosa C. Static Balance Modification during the Workday in Assembly Chain Workers with and without Current Low Back Pain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207385. [PMID: 33050448 PMCID: PMC7600820 DOI: 10.3390/ijerph17207385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/06/2020] [Accepted: 10/08/2020] [Indexed: 11/16/2022]
Abstract
Background: Low back pain (LBP) is a common recurrent pathology among assembly chain workers. This population tends to spend most of the workday in a static standing posture and handling loads, with balance being essential for correct job performance. LBP is related to poorer postural control, so balance could be affected in this condition. Methods: The purpose of the present study is to analyze the deterioration of static balance generated by work activity in a prolonged standing position. We assess sway with a pressure platform at three moments of the workday (before, during, and after work), comparing the different balance parameters in 22 manufacturing plant workers with (17) and without (5) LBP. Results: In the pre-work capture, an independent t-test showed no significant differences between the pain and non-pain groups’ static balance parameters. Between the pre- and mid-workday captures, a two-way ANOVA with repeated measures showed a significant decrease in the medial-lateral center of pressure displacement with open eyes in workers with LBP. Conclusions: workers with low back pain do not show a greater deterioration in static balance than workers without pain during the workday.
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Affiliation(s)
- Ana Vanessa Bataller-Cervero
- Facultad de Ciencias de la Salud, Universidad San Jorge, 50830 Villanueva de Gállego, Spain; (A.V.B.-C.); (L.E.R.-S.); (C.B.)
| | - Cristina Cimarras-Otal
- Facultad de Ciencias de la Salud, Universidad San Jorge, 50830 Villanueva de Gállego, Spain; (A.V.B.-C.); (L.E.R.-S.); (C.B.)
- Correspondence:
| | - Luis Enrique Roche-Seruendo
- Facultad de Ciencias de la Salud, Universidad San Jorge, 50830 Villanueva de Gállego, Spain; (A.V.B.-C.); (L.E.R.-S.); (C.B.)
| | | | | | - César Berzosa
- Facultad de Ciencias de la Salud, Universidad San Jorge, 50830 Villanueva de Gállego, Spain; (A.V.B.-C.); (L.E.R.-S.); (C.B.)
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Impact of retrowalking on pain, range of motion, muscle fatigability, and balance in collegiate athletes with chronic mechanical low back pain. SPORT SCIENCES FOR HEALTH 2020. [DOI: 10.1007/s11332-020-00682-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Albano S, Gilmor R, Calvelo K, Afraz R, Bacani MG, Siddiqi J. Investigating the Correlation Between Anterior-Posterior and Lateral Asymmetric Muscular Balance With Low Back Pain. Cureus 2020; 12:e9785. [PMID: 32953301 PMCID: PMC7491684 DOI: 10.7759/cureus.9785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Objective The objective of this pilot study was to determine if there is a correlation between the proposed physical testing protocol and low back pain. The proposed physical testing protocol is an attempt to assess muscular asymmetry in the anterior-posterior plane and the lateral plane. Methods A total of 96 volunteers were recruited from Touro University after obtaining IRB approval. Volunteers were initially provided a questionnaire regarding demographics and back pain. After ensuring participants satisfied the inclusion criteria, a physical test protocol was performed. After data compilation, odds ratios as well and linear regression models were generated to assess for correlation with back pain. Results A total of 96 participants were recruited. The odds ratio for asymmetric anterior-posterior balance in relation to back pain is 3.00 with a 95% confidence interval 1.26-7.12. The odds ratio for total ability to tolerate asymmetric loads greater than 50% of ideal body weight is 0.44 with a 95% confidence interval 0.11-1.77. The linear regression coefficient of anterior-posterior balance greater than 25% of ideal body weight in relation to level of pain is 1.96. Conclusions Increased muscular asymmetry in the sagittal plane and lateral plane showed a trend toward increased levels of low back pain; however, there is a weak correlation. This is a correlation and not an association. Future studies to assess the relationship between muscular balance and low back pain are needed to determine if therapy can be targeted to improve muscular sagittal balance, which can improve symmetry and back pain.
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Affiliation(s)
- Stephen Albano
- Neurosurgery, Desert Regional Medical Center, Palm Springs, USA
| | - Ruby Gilmor
- College of Osteopathic Medicine, Touro University of California, Vallejo, USA
| | - Kevin Calvelo
- College of Osteopathic Medicine, Touro University of California, Vallejo, USA
| | - Rehman Afraz
- College of Osteopathic Medicine, Touro University of California, Vallejo, USA
| | - Mary Grace Bacani
- Intensive Care Unit, Desert Regional Medical Center, Palm Springs, USA
| | - Javed Siddiqi
- Neurological Surgery, Desert Regional Medical Center, Palm Springs, USA
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Fontana Carvalho AP, Dufresne SS, Rogerio de Oliveira M, Couto Furlanetto K, Dubois M, Dallaire M, Ngomo S, da Silva RA. Effects of lumbar stabilization and muscular stretching on pain, disabilities, postural control and muscle activation in pregnant woman with low back pain. Eur J Phys Rehabil Med 2020; 56:297-306. [PMID: 32072792 DOI: 10.23736/s1973-9087.20.06086-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Low back pain is common during pregnancy. Lumbar stabilization and stretching exercises are recommended to treat low back pain in the general population. However, few studies have applied the effects of these two interventions in pregnant women with low back pain. AIM To compare the effects of lumbar stabilization and stretching exercises for the treatment of gestational low back pain. DESIGN A pilot randomized clinical trial. SETTING Laboratory of Functional Evaluation and Human Motor Performance and physical therapy clinics. POPULATION Initially, 30 pregnant women with low back pain were recruited, of which 24 met the following inclusion criteria: being between 19-29 weeks of gestation; being in prenatal clinical follow-up; having nonspecific mechanical low back pain started in pregnancy; not participating in specific low back pain treatment in the last 3 months. A total of 20 women completed the study (10 each group). METHODS The main outcome measures were clinical (pain by Visual Analogue Scale (VAS) and McGill Pain Questionnaire and disability by Roland Morris Questionnaire), and secondary outcome measures were: postural balance (force platform); muscle activation level of multifidus, iliocostalis lumborum, rectus abdominis and external abdominal oblique (electromyography). The women were randomized into two groups for 6 weeks of intervention twice a week for a 50-minute treatment: 1) lumbar stabilization exercise protocol and 2) stretching exercise protocol. RESULTS There was a significant reduction (P=0.03) in pain (1.68 in VAS and 4.81 for McGill questionnaire) for both interventions, but no change in disability score. In addition, both interventions were comparable for a significant improvement in postural stability (in mean d=0.77) for the velocity sway parameter, and significantly increased activation (P>0.05) of the external abdominal oblique muscle after intervention. CONCLUSIONS Both modalities (lumbar stabilization and stretching) were efficient for pain reduction, improving balance and increasing one trunk activity muscle after 6 weeks of intervention in pregnant women with low back pain. CLINICAL REHABILITATION IMPACT The present study has implications, especially for clinical decision-making with regard to therapy choice in pregnant women with LBP to reduce pain and improve trunk function as measured through balance performance.
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Affiliation(s)
- Adriana P Fontana Carvalho
- Laboratory of Functional Evaluation and Human Motor Performance (LAFUP), Universidade Pitagoras UNOPAR, Londrina, PR, Brazil.,Doctoral Program in Rehabilitation Sciences, UEL/UNOPAR, Londrina, PR, Brazil
| | - Sébastien S Dufresne
- Department of Health Sciences, BioNR Research Laboratory, Université du Québec à Chicoutimi, Chicoutimi QC, Canada
| | - Márcio Rogerio de Oliveira
- Laboratory of Functional Evaluation and Human Motor Performance (LAFUP), Universidade Pitagoras UNOPAR, Londrina, PR, Brazil
| | - Karina Couto Furlanetto
- Laboratory of Functional Evaluation and Human Motor Performance (LAFUP), Universidade Pitagoras UNOPAR, Londrina, PR, Brazil.,Doctoral Program in Rehabilitation Sciences, UEL/UNOPAR, Londrina, PR, Brazil
| | - Maryane Dubois
- Department of Health Sciences, BioNR Research Laboratory, Université du Québec à Chicoutimi, Chicoutimi QC, Canada
| | - Mathieu Dallaire
- Department of Health Sciences, BioNR Research Laboratory, Université du Québec à Chicoutimi, Chicoutimi QC, Canada
| | - Suzy Ngomo
- Department of Health Sciences, BioNR Research Laboratory, Université du Québec à Chicoutimi, Chicoutimi QC, Canada
| | - Rubens A da Silva
- Laboratory of Functional Evaluation and Human Motor Performance (LAFUP), Universidade Pitagoras UNOPAR, Londrina, PR, Brazil - .,Doctoral Program in Rehabilitation Sciences, UEL/UNOPAR, Londrina, PR, Brazil.,Department of Health Sciences, BioNR Research Laboratory, Université du Québec à Chicoutimi, Chicoutimi QC, Canada.,Research Centre on Health, CIUSSS du Saguenay-Lac-Saint-Jean, Chicoutimi, QC, Canada
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36
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Reduced Trunk Coupling in Persons With Recurrent Low Back Pain Is Associated With Greater Deep-to-Superficial Trunk Muscle Activation Ratios During the Balance-Dexterity Task. J Orthop Sports Phys Ther 2019; 49:887-898. [PMID: 31092122 DOI: 10.2519/jospt.2019.8756] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Motor control dysfunction persisting during symptom remission in persons with recurrent low back pain (LBP) may contribute to the recurrence of pain. OBJECTIVES To investigate trunk control in persons in remission from recurrent LBP and in back-healthy controls using a dynamic, internally driven balance task. No differences in task performance were expected between groups, but it was hypothesized that persons with recurrent LBP would exhibit greater trunk coupling, consistent with a trunk-stiffening strategy. METHODS In this cross-sectional controlled laboratory study, persons with and without recurrent LBP (n = 19 per group) completed the balance-dexterity task, which involved balancing on one limb in standing while compressing an unstable spring with the other. Task performance measures included center-of-pressure velocity under the stance limb and vertical force variability under the spring. Trunk coupling was quantified with the coefficient of determination (R2) of an angle-angle plot of thorax-pelvis frontal plane motion. Fine-wire and surface electromyography captured activations of paraspinals and abdominals. RESULTS There were no differences between groups for any task performance measure. The group in remission from recurrent LBP exhibited reduced trunk coupling, or more dissociated thorax and pelvis motion, compared to the healthy control group (P = .024). Trunk coupling in this group was associated moderately with the lumbar multifidus-to-erector spinae activation ratio (r = 0.618, P = .006) and weakly with the internal oblique-to-external oblique ratio (r = 0.476, P = .046). CONCLUSION The balance-dexterity task is a submaximal, internally driven unstable balance task during which more dissociated trunk motion was observed in persons in remission from recurrent LBP. Findings underscore the task-dependent nature of trunk control research and assessment in persons with recurrent LBP. J Orthop Sports Phys Ther 2019;49(12):887-898. Epub 15 May 2019. doi:10.2519/jospt.2019.8756.
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Nowotny AH, Calderon MG, de Souza PA, Aguiar AF, Léonard G, Alves BMO, Amorim CF, da Silva RA. Lumbar stabilisation exercises versus back endurance-resistance exercise training in athletes with chronic low back pain: protocol of a randomised controlled trial. BMJ Open Sport Exerc Med 2018; 4:e000452. [PMID: 30555717 PMCID: PMC6267311 DOI: 10.1136/bmjsem-2018-000452] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 09/14/2018] [Accepted: 10/03/2018] [Indexed: 02/07/2023] Open
Abstract
Background Chronic low back pain (CLBP) is an important disorder in athletes that may negatively affect their performance in competitions. The literature usually recommends physiotherapy based on exercises for back pain management in athletes. Recent evidence suggests that interventions based on lumbar muscle stabilisation exercises (LMSE) and back endurance-resistance exercises (BERE) may improve back pain and function performance. However, it is still unclear which type of exercise is more effective for the treatment of CLBP in athletes. Objective To compare the efficacy of LMSE versus BERE in athletes with CLBP. Design The study is a 2-arm, prospectively registered, randomised controlled trial. Setting The physical therapy clinical and biomechanics laboratory of the UNOPAR University. Participants 32 male athletes with CLBP, age between 18 and 40 years old, recruited from the local community. Intervention An 8-week intervention programme will be carried out with LMSE s versus BERE. Measurements Trunk neuromuscular patterns during balance tasks (unipodal and over a ball) using electromyography and force platform parameters, pain, disability, fear and avoidance will be assessed by a blinded assessor at baseline and at follow-up after 8 weeks of intervention period. Limitations The absence of blinding intervention and the exclusion of female athletes, seated sports and swimmers will affect the internal and external validity of the study. Conclusions The results of this study will elucidate which of these two interventions promote better results in trunk neuromuscular pattern, back pain and function in male athletes with CLBP.
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Affiliation(s)
| | | | | | - Andreo Fernando Aguiar
- Doctoral and Masters Programs in Rehabilitation Sciences UEL/UNOPAR, LAFUP-UNOPAR, Londrina-PR, Brazil
| | - Guillaume Léonard
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Research Center on Aging, Institute of Geriatrics, Université de Sherbrooke, Québec, Canada
| | - Bruno Mazziotti Oliveira Alves
- Master and Doctoral Program in Physical Therapy, University of City of São Paulo, UNICID, São Paulo, Brazil.,Paris Saint-Germain Departament of Physical Therapy and Biomechanics, Paris Saint-Germain Football Club, Paris, France
| | - Cesar Ferreira Amorim
- Master and Doctoral Program in Physical Therapy, University of City of São Paulo, UNICID, São Paulo, Brazil.,Département des Sciences de la Santé, Programme de physiothérapie de l'université McGill offert en extension à l'Université du Québec à Chicoutimi (UQAC), Saguenay, Québec, Canada.,Physical Therapy and Neuroscience Departments, Wertheims' Colleges of Nursing and Health Sciences and Medicine, Florida International University (FIU), Miami, Florida, United States
| | - Rubens Alexandre da Silva
- Doctoral and Masters Programs in Rehabilitation Sciences UEL/UNOPAR, LAFUP-UNOPAR, Londrina-PR, Brazil.,Département des Sciences de la Santé, Programme de physiothérapie de l'université McGill offert en extension à l'Université du Québec à Chicoutimi (UQAC), Saguenay, Québec, Canada
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Meier ML, Vrana A, Schweinhardt P. Low Back Pain: The Potential Contribution of Supraspinal Motor Control and Proprioception. Neuroscientist 2018; 25:583-596. [PMID: 30387689 PMCID: PMC6900582 DOI: 10.1177/1073858418809074] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Motor control, which relies on constant communication between motor and sensory systems,
is crucial for spine posture, stability and movement. Adaptions of motor control occur in
low back pain (LBP) while different motor adaption strategies exist across individuals,
probably to reduce LBP and risk of injury. However, in some individuals with LBP, adapted
motor control strategies might have long-term consequences, such as increased spinal
loading that has been linked with degeneration of intervertebral discs and other tissues,
potentially maintaining recurrent or chronic LBP. Factors contributing to motor control
adaptations in LBP have been extensively studied on the motor output side, but less
attention has been paid to changes in sensory input, specifically proprioception.
Furthermore, motor cortex reorganization has been linked with chronic and recurrent LBP,
but underlying factors are poorly understood. Here, we review current research on
behavioral and neural effects of motor control adaptions in LBP. We conclude that back
pain-induced disrupted or reduced proprioceptive signaling likely plays a pivotal role in
driving long-term changes in the top-down control of the motor system via motor
and sensory cortical reorganization. In the outlook of this review, we
explore whether motor control adaptations are also important for other (musculoskeletal)
pain conditions.
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Affiliation(s)
- Michael Lukas Meier
- Integrative Spinal Research, Department of Chiropractic Medicine, University Hospital Balgrist, Zurich, Switzerland
| | - Andrea Vrana
- Integrative Spinal Research, Department of Chiropractic Medicine, University Hospital Balgrist, Zurich, Switzerland
| | - Petra Schweinhardt
- Integrative Spinal Research, Department of Chiropractic Medicine, University Hospital Balgrist, Zurich, Switzerland.,Alan Edwards Center for Research on Pain, McGill University, Montreal, Quebec, Canada
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Areeudomwong P, Buttagat V. Proprioceptive neuromuscular facilitation training improves pain-related and balance outcomes in working-age patients with chronic low back pain: a randomized controlled trial. Braz J Phys Ther 2018; 23:428-436. [PMID: 30361077 DOI: 10.1016/j.bjpt.2018.10.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 10/09/2018] [Accepted: 10/09/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Proprioceptive neuromuscular facilitation training and general trunk exercises have been applied to treat chronic low back pain patients. However, there is currently little study to support the use of one treated intervention over the other to improve clinical outcomes and balance ability. OBJECTIVE To examine the effects of proprioceptive neuromuscular facilitation training on pain intensity, disability and static balance ability in working-age patients with chronic low back pain. METHODS Forty-four chronic low back pain participants aged 18-50 years were randomized either to a three-week proprioceptive neuromuscular facilitation training or to a control group receiving general trunk exercises. Pain intensity, disability and static balance ability were measured before and after the three-week intervention. RESULTS The proprioceptive neuromuscular facilitation training intervention showed a statistically significantly greater reduction in pain intensity and improved functional disability than the controls at three weeks (between-group difference: pain intensity 1.22 score, 95% CI: 0.58 to 1.88, p<0.001; disability 2.23 score, 95% CI: 1.22 to 3.24, p<0.001. The proprioceptive neuromuscular facilitation training intervention also had statistically better parameters of static balance ability than the control group (between-group difference: ellipse sway area during eye opened and closed conditions 129.09mm2, 95% CI: 64.93 to 175.25, p<0.01 and 336.27mm2, 95% CI: 109.67 to 562.87, p<0.05, respectively; the centre of pressure velocity during eye opened and eye closed conditions 6.68mm/s, 95% CI: 4.41 to 8.95, p<0.01 and 6.77mm/s, 95% CI: 4.01 to 9.54, p<0.01, respectively). CONCLUSION The three-week proprioceptive neuromuscular facilitation training provides better pain intensity, disability and static balance ability than general trunk exercises for working-age individuals with chronic low back pain but the effects do not reach the clinical meaningful level. The therapists should consider carefully when making recommendations regarding these interventions, taking into account effectiveness and costs.
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Affiliation(s)
- Pattanasin Areeudomwong
- Department of Physical Therapy, School of Health Science, Mae Fah Luang University, Chiang Rai, Thailand.
| | - Vitsarut Buttagat
- Department of Physical Therapy, School of Health Science, Mae Fah Luang University, Chiang Rai, Thailand
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40
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Diebo BG, Shah NV, Stroud SG, Paulino CB, Schwab FJ, Lafage V. Realignment surgery in adult spinal deformity. DER ORTHOPADE 2018; 47:301-309. [DOI: 10.1007/s00132-018-3536-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ghofrani M, Olyaei G, Talebian S, Bagheri H, Malmir K. Test-retest reliability of linear and nonlinear measures of postural stability during visual deprivation in healthy subjects. J Phys Ther Sci 2017; 29:1766-1771. [PMID: 29184286 PMCID: PMC5684007 DOI: 10.1589/jpts.29.1766] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Accepted: 07/07/2017] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study is to evaluate the reliability of linear and
nonlinear measures of the center of pressure (COP) during visual deprivation. [Subjects
and Methods] Fifteen young adults participated in this study. COP signals were recorded in
two conditions: eyes open and eyes closed. Three trials were performed in each condition
with a rest period of approximately 1 min. The intraclass correlation coefficients (ICCs)
and standard error of measurement (SEM) were calculated. [Results] The investigation of
ICC and SEM between trials showed that the Lyapunov exponent (ICC: 0.76–0.96, SEM: 0.03)
and total mean velocity (ICC: 0.71–0.95, SEM: 0.05) were more reliable and repeatable than
range and area (95% confidence ellipse), while area had the least reliability (ICC:
0.49–0.77, SEM: 0.56). [Conclusion] The Lyapunov exponent can be considered an appropriate
postural control index, and the evaluation of postural stability should be done by
considering linear and nonlinear tools.
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Affiliation(s)
- Masoud Ghofrani
- Physical Therapy Department, School of Rehabilitation, Tehran University of Medical Sciences and Health Services: Piche Shemiran, Enghelab Street, Tehran, PO Box 1148965141, Iran
| | - Golamreza Olyaei
- Physical Therapy Department, School of Rehabilitation, Tehran University of Medical Sciences and Health Services: Piche Shemiran, Enghelab Street, Tehran, PO Box 1148965141, Iran
| | - Saeed Talebian
- Physical Therapy Department, School of Rehabilitation, Tehran University of Medical Sciences and Health Services: Piche Shemiran, Enghelab Street, Tehran, PO Box 1148965141, Iran
| | - Hossein Bagheri
- Physical Therapy Department, School of Rehabilitation, Tehran University of Medical Sciences and Health Services: Piche Shemiran, Enghelab Street, Tehran, PO Box 1148965141, Iran
| | - Kazem Malmir
- Physical Therapy Department, School of Rehabilitation, Tehran University of Medical Sciences and Health Services: Piche Shemiran, Enghelab Street, Tehran, PO Box 1148965141, Iran
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