Identifying Clinical Phenotypes in People Who Are Hispanic/Latino With Chronic Low Back Pain: Use of Sensor-Based Measures of Posture and Movement, Pain, and Psychological Factors

Towards the Real-World Analysis of Lumbar Spine Standing Posture in Individuals with Low Back Pain: A Cross-Sectional Observational Study

Prolonged periods of standing are linked to low back pain (LBP). Evaluating lumbar spine biomechanics in real-world contexts can provide novel insights into these links. This study aimed to determine if standing behaviour can be quantified, in individuals with LBP, in real-world environments. A three-stage design was used, (i) Verification of a bespoke algorithm characterising lumbar standing behaviour, (ii) Day-long assessment of standing behaviours of individuals with posture-related low back discomfort, and (iii) Case study application to individuals with clinical LBP. Analysis of standing posture across time included variability, fidgeting, and amplitude probability distribution function analysis. The study demonstrated that accelerometers are a valid method for extracting standing posture from everyday activity data. There was a wide variety of postures throughout the day in people with posture-related low back discomfort and people with clinical LBP. Frequency profiles ranged from slightly flexed to slightly extended postures, with skewed bell-shaped distributions common. Postural variability ranged from 3.4° to 7.7°, and fidgeting from 1.0° to 3.0°. This work presents a validated accelerometer-based method to capture, identify, and quantify real-world lumbar standing postures. The distinct characteristics of people with low back discomfort or pain highlight the importance of individualised approaches.

Psychologically Informed Physical Therapy Management of Chronic Musculoskeletal Pain in Culturally Diverse Populations: An Intervention Logic Model

Culturally and linguistically diverse (CALD) individuals are underrepresented in pain research, including studies of psychologically informed physical therapy (PIPT) for musculoskeletal pain. This perspective describes a conceptual framework for PIPT management of chronic musculoskeletal pain that identifies essential elements that can be culturally tailored to meet the needs of different CALD populations. Essential interventions, determinants of behavior change, and clinical outcomes were identified from studies of existing PIPT interventions for chronic pain. PIPT approaches shared the following essential interventions: 1) cognitive skill training, 2) general aerobic activity, 3) impairment-based therapeutic exercises, and 4) graded functional movement training. An intervention logic model was developed to conceptualize how these interventions might promote active coping behaviors and greater engagement in physical activity, therapeutic exercise, and functional mobility. The model included physical and cognitive-emotional processes that may contribute to behavioral changes that ultimately reduce pain-related disability. To illustrate the cultural tailoring of model constructs, we describe how intervention delivery and assessments were customized for Latino persons with chronic spine pain at a health center located near the United States-Mexico border. A literature review of sociocultural influences on the pain experience of Latino persons was conducted, and essential elements of the model were operationalized to ensure that therapeutic goals, language, content, and processes were compatible with Latino cultural beliefs, values, and behaviors. Future research using the proposed model to adapt and test PIPT interventions for other CALD populations may help identify shared and divergent mechanisms of treatment response for culturally tailored pain management programs. PERSPECTIVE: A novel conceptual framework may help inform the cultural tailoring of PIPT management approaches for chronic musculoskeletal pain by maintaining fidelity to essential treatment elements while also leveraging the unique sociocultural context of different CALD communities to improve health outcomes.