Chronic low back pain lowers balance test scores among people who are middle-aged

BackgroundPeople who are middle aged are at risk for chronic low back pain (CLBP) which can impair balance. Identifying an appropriate balance test may help to detect balance deficits for this particular age group.ObjectiveTo assess balance on the dominant and non-dominant limbs among middle-aged people, (CLBP = 25 and Painfree = 25).MethodsStatic balance included the 30 s single limb stance test and dynamic balance was assessed using the modified Star Excursion Balance test (mSEBT) for anterior, posterolateral, posteromedial directions and composite score on both limbs (dominant and non-dominant) using a randomized limb and direction order for mSEBT and normalized to percent of leg length, (%LL).ResultsNo group differences were found among the SLS on either limb, (p > 0.05). The control group reached further anteriorly (78%LL) and with the composite (83%LL) compared to the CLBP group, (72%LL) and (75%LL), respectively. The dominant limb had longer reaches for both groups in the posterolateral and composite directions compared to non-dominant limb.ConclusionThe dynamic balance test may be more sensitive than the SLS test among individuals who are middle-aged and have CLBP. The results support that CLBP group could not reach as far in the anterior direction and composite score resulting in lower dynamic balance compared to the controls. In addition, there were inter-limb differences in both groups during the dynamic balance test which implies both limbs should be assessed among people who are middle-aged with or without chronic low back pain.

Does physical performance demonstrate patient-reported outcomes after lumbar spine surgery?

BACKGROUND

Due to time and setting constraints in clinical practice, performing a comprehensive assessment with both questionnaires and physical performance tests may not be possible. This study aimed to demonstrate the relationship between physical performance and patient-reported outcomes in patients after Lumbar Spine Surgery (LSS).

METHODS

A cross-sectional study was conducted with 50 participants who were followed up at least six months after LSS. Participants were evaluated using the Visual Analog Scale (VAS) for activity and rest, Modified Oswestry Disability Index (mODI), Lumbar Spine Instability Questionnaire (LSIQ), One Leg Stance Test (OLST), Semi-Tandem Stance Test (STST), 4 m Gait Speed Test (4MGS), and Timed Up and Go Test (TUG).

RESULTS

OLST was moderately correlated with the mODI (r=-0.442, p < 0.01). STST moderately correlated with mODI (r=-0.356, p < 0.05). TUG was strongly correlated with mODI (r = 0.564, p < 0.01). In addition, TUG showed a moderate correlation with a-VAS and LSIQ, respectively (r1 = 0.392, r2 = 0.475, p < 0.01). A strong correlation was found between 4MGS and mODI (r=-0.535, p < 0.01). 4MGS had a moderate correlation with LSIQ (r=-0.374, p < 0.01). A regression model summary showed that the TUG, OLST, and STST were not related to r-VAS, a-VAS, mODI, and LSIQ (p > 0.01). Higher gait speed on the 4MGS test was strongly associated with lower mODI scores (standardized ß=-0.538, p = 0.021).

CONCLUSION

Less activity pain and disability are associated with good balance and performance. 4MGS can mostly predict patient-reported function in patients after LSS.

Long-Term Follow-Up of a Person-Centered Prehabilitation Program Based on Cognitive-Behavioral Physical Therapy for Patients Scheduled for Lumbar Fusion

OBJECTIVE

Long-term follow-ups of prehabilitation programs for lumbar spine surgery are lacking, and more comprehensive evaluations are needed. In the current study, we evaluated the long-term effects of a prehabilitation program compared with conventional care in relation to lumbar fusion surgery in patients with degenerative disc disease.

METHODS

Patients (n = 118) receiving lumbar fusion surgery were included in a multicenter randomized controlled trial, involving 1 university hospital and 2 spine clinics. The intervention was a person-centered prehabilitation program based on cognitive-behavioral physical therapy that targeted psychological presurgical risk factors, physical activity, and overall health. The control group received conventional preoperative care. Patient-reported outcome measures (PROMs) included assessments at 8 time-points: low back disability (primary outcome), back pain intensity, leg pain intensity, pain catastrophizing, fear of movement, anxiety and depressive mood, health-related quality of life, and patient-specific functioning. Physical activity and physical capacity were assessed at 5 time points. Linear mixed models were used to analyze the effects of the intervention.

RESULTS

There were no significant differences between groups at the 12- and 24-month follow-ups for any outcome, except for the One Leg Stand test 1 year following surgery, in favor of the control group. There were significant improvements for both groups, from baseline to the 12- and 24-month follow-ups for all physical capacity test and patient-reported outcome measures, except for leg pain and self-efficacy for exercise.

CONCLUSION

No long-term effects were found for the prehabilitation program compared to conventional care. Physical activity did not improve over time, despite significantly improved self-reported functioning and physical capacity measurements.

IMPACT

These findings have implications for the current understanding of the long-term effects of prehabilitation and suggest that future research should focus on programs promoting physical activity both before and after lumbar spine surgery to decrease the risk of long-term adverse health outcomes.

Get Back, a person-centred digital programme targeting physical activity for patients undergoing spinal stenosis surgery-a study protocol of a randomized feasibility study

BACKGROUND

Spinal stenosis is the most common reason for elective spine surgery, and the cardinal symptom is leg pain and discomfort when walking. Patients with spinal stenosis have a decreased level of physical activity and thereby an increased risk of poor health. Get Back is a person-centred digital programme that strives to support patients being physically active after surgery. The aim is to explore if Get Back, in its present format (referred to as Get Backfeasibility), is feasible and contributes to detectable change in variables related to intervention content.

METHODS

Thirty patients planned for decompression surgery due to central lumbar spinal stenosis who present with low physical activity, pain catastrophizing or fear of movement, will be included in a randomized feasibility study. All patients will be randomly allocated to either Get Backfeasibility or usual physical therapy. Get Backfeasibility aims to increase the patient's physical activity level by combining a person-centred and cognitive behavioural approach. It comprises 10 video and telephone sessions led by a physical therapist over 12 weeks (pre/postoperatively). Outcomes are treatment fidelity (treatment dose, adherence, and content), process feasibility (recruitment, intervention use, and acceptability of measurements and intervention), and variables related to the intervention content (steps per day, physical activity level, pain catastrophizing, fear of movement, and general self-efficacy). Treatment fidelity and feasibility data will be assessed during the full study period (12 weeks). Physical activity, physical capacity, and patient-reported outcomes will be assessed digitally at baseline (2 weeks preoperatively) and 11-12 weeks postoperatively. Variables related to the intervention content will be monitored weekly through a digital application. Feasibility data will be analysed descriptively and inferentially using a nonparametric approach, data from repeated measures will be displayed graphically and data from telephone interviews will be analysed using content analysis with a descriptive manifest approach.

DISCUSSION

The results will provide information on whether Get Back in its present format is feasible and can be evaluated for effectiveness in a larger randomized controlled trial, for patients with a low physical activity level and a high fear of movement who are undergoing decompression surgery.

TRIAL REGISTRATION

Registered at ClinicalTrails.gov 04/08/2023, registration no. NCT05806593.

Acute effects of proprioceptive neuromuscular facilitation exercises on the postural strategy in patients with chronic low back pain

INTRODUCTION

Active treatments focused on improvement in motor function are postulated in chronic low back patients (CLBP).

OBJECTIVE

to establish the acute effects of PNF exercise on the postural control strategy.

METHODS

The sway of the body was tested before intervention in fifty-three CLBP patients and after that participants were randomly assigned into the intervention PNF group (n = 25). Mean velocity (VEL) and sample entropy (SEn), over the center of pressure in the mediolateral (ML) and anterior-posterior (AP) planes served to estimate the postural strategy and automaticity levels in the neuromuscular controller. Tandem and one-leg standing tests (OLST) with eyes open and eyes closed were used.

RESULTS

Pain intensity decreased after the intervention. The VEL was no longer vision-dependent in both planes. The SEn decreased immediately after the exercise and either returned to or even exceeded the baseline values in the OLST ML plane.

CONCLUSION

A single session of PNF exercise may have a beneficial effect on pain and postural control in CLBP patients. The statistically significant pain relief combined with newly acquired better control of posture may have encouraged the PNF group participants to a subconscious exploration of the stability area. Postural movements were more automatized in OLST in the delayed test.

Association ankle function and balance in community-dwelling older adults

Background and purpose

Ankle function declines with age. The objective of this study was to investigate the association between ankle function and balance in older adults, with a focus on range of motion (ROM) and strength.

Methods

This was a cross-sectional study that included 88 healthy community-dwelling older adults. Ankle mobility was measured while bearing weight (lunge test) and not bearing weight. The plantar-flexor muscle strength was assessed using a hand-held dynamometer. Balance was measured in terms of dynamic balance and mobility (timed up and go test), monopodal and bipodal static balance with open and closed eyes (single-leg stand test and platform measures), and margins of stability (functional reach test). Linear correlation and multiple regression analyses were conducted with a 95% CI.

Results and discussion

Most participants had limited ankle mobility (n = 75, 86%). Weight-bearing ankle dorsiflexion ROM was the strongest predictor of dynamic balance and included general mobility and stability (Radj2 = [0.34]; β = [-0.50]). In contrast, plantar-flexor muscle strength was a significant predictor of static standing balance with open eyes (Radj2 = [0.16–0.2]; β = [0.29–0.34]). Overall, weight-bearing ankle dorsiflexion ROM was a more representative measure of balance and functional performance; however, a non-weight-bearing mobility assessment provides complementary information. Therefore, both measures can be used in clinical practice.

Conclusion

This study supports the concept that ankle mobility contributes to the performance of dynamic tasks, while the plantar-flexor muscle strength helps to develop a standing static balance. Identification of alterations in ankle function is warranted and may assist in the design of tailored interventions. These interventions can be used in isolation or to augment conventional balance training in order to improve balance performance in community-dwelling older adults.

The Effect of Proprioceptive Exercises on Balance and Physical Function in Institutionalized Older Adults: A Randomized Controlled Trial

OBJECTIVES

To evaluate the efficacy of a proprioceptive exercise program on functional mobility, musculoskeletal endurance, dynamic and static balance, gait, and risk of falls in institutionalized older adults.

DESIGN

Randomized, single-blind, controlled trial.

SETTING

A Spanish nursing home in the autonomous community of Extremadura, Spain.

PARTICIPANTS

An initial sample was created by recruiting 148 older adult volunteers. The final sample (N=42) was randomly divided into 2 groups.

INTERVENTIONS

Both the control and experimental group received physical therapy treatment based on a combination of adapted exercises and other physical therapy techniques (physical therapy intervention program) for a period of 12 weeks. This program consisted of 45 minutes (group intervention) plus 100 minutes (individual intervention) a week, for a total of 36 sessions (29 hours). The experimental group received a proprioceptive training program during the same intervention period, which was conducted twice weekly (24 sessions), with each session lasting 55 minutes.

MAIN OUTCOME MEASURES

Timed Up and Go (TUG), Cooper, Tinetti, 1-leg stance, and the Morse Fall Scale (MFS).

RESULTS

Analysis of variance showed a time × group interaction in TUG score (F=10.41, P=.002), Cooper test (F=5.94, P=.019), Tinetti score (F=6.41, P=.015), and MFS scores (F=5.24, P=.028). Differences between groups were achieved for TUG scores (d=0.76), Tinetti scores (d=1.12), 1-leg stance test scores (d=0.77), and MFS scale scores (d=0.85). In the experimental group, within-group analyses showed pre- to post-treatment differences for TUG scores (d=0.72), Cooper test scores in meters (d=0.18), Tinetti scores (d=0.60), 1-leg stance scores (d=0.55), and MFS scores (d=0.42).

CONCLUSIONS

A proprioceptive exercise program demonstrated significant improvements compared with the control group in areas such as functional mobility, musculoskeletal endurance, balance, gait, and risk of falls in institutionalized older adults. This study may help to enhance our understanding of the impact of a specific protocol for a proprioceptive rehabilitation program.

A 4-week community aquatic physiotherapy program with Ai Chi or Bad Ragaz Ring Method improves disability and trunk muscle endurance in adults with chronic low back pain: A pilot study

OBJECTIVE

To investigate the efficacy of a 4-week community aquatic physiotherapy program with Ai Chi or the Bad Ragaz Ring Method (BRRM) on pain and disability in adults with chronic low back pain (CLBP).

METHODS

Adults with CLBP (n= 44; mean ± SD age, 52.6 ± 5.5 y; 37 women) were assigned to either an Ai Chi (n= 23) or BRRM (n= 21) program (4 weeks, twice weekly).

RESULTS

Both the Ai Chi (-1.4; 95% CI -2.6 to -0.2; p= .025) and BRRM (-2.0, 95% CI -3.1 to -0.8; p= 0.003) groups demonstrated significant pre- to post-treatment decreases in Roland-Morris Disability Questionnaire scores and improvements in prone bridge duration (Ai Chi: 11.7 s; 95% CI 1.6 to 21.8; p= 0.025; BRRM: 19.0 s; 95% CI 6.1 to 31.8; p= 0.006). The Ai Chi group revealed a significant improvement in single-leg stand test duration (2.9 s; 95% CI 0.1 to 5.7; p= 0.045) and the BRRM group reported significant decrease in pain intensity (-11.6; 95% CI -19.1 to -4.2; p= 0.004).

CONCLUSIONS

A 4-week aquatic physiotherapy program with Ai Chi or BRRM resulted in significant pre- to post-treatment improvements in disability and global core muscle endurance. Ai Chi appeared to have an additional benefit of improving single-leg standing balance and BRRM an additional benefit of reducing pain.

A Person-Centered Prehabilitation Program Based on Cognitive-Behavioral Physical Therapy for Patients Scheduled for Lumbar Fusion Surgery: A Randomized Controlled Trial

BACKGROUND

Prehabilitation programs have led to improved postoperative outcomes in several surgical contexts, but there are presently no guidelines for the prehabilitation phase before lumbar fusion surgery.

OBJECTIVE

The objective was to investigate whether a person-centered physical therapy prehabilitation program, based on a cognitive-behavioral approach, is more effective than conventional care in reducing disability and improving functioning after lumbar fusion surgery in patients with degenerative disk disease.

DESIGN

This study was a randomized controlled trial.

SETTING

The study took place at 2 private spine clinics and 1 university hospital.

PATIENTS

We prospectively enrolled 118 patients scheduled for lumbar fusion surgery.

INTERVENTION

The active intervention used a person-centered perspective and focused on promoting physical activity and targeting psychological risk factors before surgery. The control group received conventional preoperative care.

MEASUREMENTS

The primary outcome was the Oswestry Disability Index score. Secondary outcomes were back and leg pain intensity, catastrophizing, kinesiophobia, self-efficacy, anxiety, depression, health-related quality of life, and patient-specific functioning, physical activity, and physical capacity. Data were collected on 6 occasions up to 6 months postoperatively. A linear mixed model was used to analyze the change scores of each outcome.

RESULTS

No statistically significant between-group difference was found on the primary outcome (disability) over time (baseline to 6 months). Among secondary outcome measures, a statistically significant interaction effect ("Group × Time") was seen for the European Quality of Life 5 Dimensions Questionnaire. The largest between-group difference on the European Quality of Life 5 Dimensions Questionnaire index was seen 1 week prior to surgery and favored the active intervention. The largest between-group effect sizes at the 6-month follow-up favored the active intervention, and were seen for physical activity intensity, steps per day, and the One Leg Stand Test. Both groups reached the minimal important change for the primary outcome and, in several secondary outcomes (pain intensity, back and leg; pain catastrophizing; anxiety; health-related quality of life [EQ5D VAS]), already at 8-week follow-up.

LIMITATIONS

The participants' preoperative level of disability was lower than normative values, which suggests selection bias.

CONCLUSIONS

Both interventions led to clinically important changes, but it is not clear what kind of prehabilitation program is the most effective.

Use of the PREPARE (PREhabilitation, Physical Activity and exeRcisE) program to improve outcomes after lumbar fusion surgery for severe low back pain: a study protocol of a person-centred randomised controlled trial

Background

Following lumbar fusion surgery, a successful outcome is empirically linked to effective rehabilitation. While rehabilitation is typically postoperative, the phase before surgery – termed prehabilitation – is reportedly an ideal time to prepare the patient. There are presently no guidelines for prehabilitation before lumbar fusion surgery. Physical activity has well-known health benefits, and staying physically active despite pain is a major principle in non-pharmacological chronic low back pain treatment. Psychological factors such as fear of movement, pain catastrophizing and low self-efficacy are known to be barriers to staying active. No studies have investigated prehabilitation protocols that promote physical activity and target psychological risk factors before lumbar fusion surgery. The aim of our proposed randomised controlled trial is to investigate whether patients who undergo lumbar fusion surgery for degenerative disc disease experience better functioning with a physiotherapeutic prehabilitation program (PREPARE) based on a cognitive behavioural approach compared to conventional care.

Methods/Design

We will recruit 110 patients between 18–70 years of age with degenerative disc disease who are waiting for lumbar fusion surgery. These patients will be randomly assigned to receive either PREPARE or conventional care. PREPARE uses a person-centred perspective and focuses on promoting physical activity and targeting psychological risk factors before surgery. The primary outcome will be disability measured using the Oswestry Disability Index 2.0. Secondary outcomes will include functioning (patient-reported and performance-based), physical activity (accelerometer), health-related quality of life, back and leg pain intensity, pain catastrophizing, kinesiophobia, self-efficacy, depression, anxiety, satisfaction with treatment results and health economic factors. Data will be collected at baseline (preoperatively) after the intervention (preoperatively), 3 and 8 weeks, 3, 6, 12, 24 and 60 months postoperatively.

Discussion

We hypothesise that the focus on promoting physical activity and targeting psychological risk factors before surgery will decrease disability and help the patients to be more active despite pain both before and after surgery. We will use a combination of outcome measures both patient-reported and performance-based, as well as accelerometer data. This will provide a more comprehensive picture of the patient’s functioning than just patient-reported outcomes alone.

Trial registration

Current Controlled Trials ISCRTN17115599, Retrospectively Registered 18 May 2015.

The effectiveness of a video-supported group-based Otago exercise programme on physical performance in community-dwelling older adults: a preliminary study

OBJECTIVES

To evaluate the short-term effects of a video-supported group-based Otago exercise programme (OEP) on physical performance variables in independent community-dwelling older adults.

DESIGN

Preliminary randomized controlled trial.

SETTING

Local senior centre.

PARTICIPANTS

Fifty-one adults aged 65 and older with no cognitive impairment.

INTERVENTION

Participants were randomly allocated to the intervention group (IG) or to the control group (CG). During 4 months, IG participants performed the exercise routine.

MEASUREMENTS

The primary outcome measure was the Timed 'Up-and-Go' test (TUG). Secondary outcome measurements included functional balance, one-leg balance, lower-limb function and aerobic endurance. All data were collected before and after intervention.

RESULTS

TUG scores showed a significant reduction in the performance time in the IG compared to CG after intervention [IG 7.5 (2.0) vs CG 8.8 (1.9), mean difference -1.3seconds, 95% confidence interval (CI) of the difference -2.3 to -0.1; P=0.03]. Secondary outcomes also showed a significant improvement in the performance of the functional balance [IG 54.9 (2.5) vs CG 51.4 (5.3), mean difference 3.5 points, 95% CI 1.2 to 5.8; P=0.003], one-leg balance [IG 39.1 (21.6) vs CG 15.6 (12.1), mean difference 23.5seconds, 95% CI 13.3 to 33.7; P<0.001] and lower extremity strength [IG 8.7 (3.8) vs CG 10.9 (3.3), mean difference -2.2seconds, 95% CI -4.2 to -0.1; P=0.035] in the IG compared to CG.

CONCLUSION

This study shows that, from a short-term perspective, a video-supported group-based OEP programme can significantly improve the levels of mobility, functional balance, one-leg balance and lower extremity strength in community-dwelling older adults.

TRIAL REGISTRATION

ClincicalTrials.gov ID: NCT02218411.

Postural balance in low back pain patients: Intra-session reliability of center of pressure on a portable force platform and of the one leg stand test

Low back pain (LBP) patients have poorer postural control compared to healthy controls, and the importance of assessing and addressing balance is a matter of debate. In the clinic, balance is often tested by means of the one leg stand test (OLST) while research often employs center of pressure (CoP) on a force platform. Portable force platforms might be of clinical relevance, but their reliability for LBP patients in a clinical setting has not been demonstrated. As LBP patients are more dependent on vision compared to healthy controls, the ratio of tests performed with eyes open and eyes closed (Romberg Ratio) might be of clinical interest. This study aimed to assess postural balance in LBP patients by analyzing intra-session reliability of CoP parameters on a portable force platform, the Romberg Ratio, and the OLST. Furthermore, we aimed to determine whether CoP parameters and OLST measure identical aspects of postural stability. We examined 49 LBP patients and found acceptable reliability of the CoP parameters' trace length and velocity, whereas reliability regarding C90 area, the Romberg Ratio, and the OLST was poor. Correlations between the CoP parameters and OLST were insignificant. Reliability of trace length and velocity is acceptable and can be used as parameters when assessing CoP in LBP patients.