Comparing lumbo-pelvic kinematics in people with and without back pain: a systematic review and meta-analysis

Pelvic and Spinal Motion During Walking in Persons With Transfemoral Amputation With and Without Low Back Pain

OBJECTIVE

Low back pain (LBP) is prevalent in people with transfemoral amputation (TFA), imposing significant disability. Yet, limited data exist describing spine kinematics in people with and without LBP despite the suggestion that gait adaptations required to walk with a prosthesis may be associated or causative of LBP. Hence, the purpose of this study was to determine if there were any differences in pelvic and spinal kinematics in persons with TFA with and without LBP.

DESIGN

With the use of a lower body model combined with a regional spine model, pelvic, lumbar, and thoracic kinematics were recorded while walking and compared for participants with TFA with (n = 12) and without (n = 11) self-reported LBP.

RESULTS

Opposite patterns of motion were observed between groups in sagittal and transverse lumbar kinematics but inferential analysis using the χ test was unable to confirm that these differing patterns were independently related to LBP.

CONCLUSIONS

For community ambulators with TFA who report low levels of LBP, differences in lumbar and thoracic motion do not seem to be independently related to LBP. Results may not generalize to those with higher levels of LBP and associated disability.

Assessing the clinical utility of combined movement examination in symptomatic degenerative lumbar spondylosis

OBJECTIVES

The aim of this study is to report the development and validation of a low back computer-aided combined movement examination protocol in normal individuals and record treatment outcomes of cases with symptomatic degenerative lumbar spondylosis.

DESIGN

Test-retest, following intervention.

BACKGROUND

Self-report assessments and combined movement examination were used to record composite spinal motion, before and following neurosurgical and pain medicine interventions.

METHODS

151 normal individuals aged from 20 years to 69 years were assessed using combined movement examination between L1 and S1 spinal levels to establish a reference range. Cases with degenerative low back pain and sciatica were assessed before and after therapeutic interventions with combined movement examination and a battery of self-report pain and disability questionnaires. Change scores for combined movement examination and all outcome measures were derived.

FINDINGS

Computer-aided combined movement examination validation and intraclass correlation coefficient with 95% confidence interval and least significant change scores indicated acceptable reliability of combined movement examination when recording lumbar movement in normal subjects. In both clinical cases lumbar spine movement restrictions corresponded with self-report scores for pain and disability. Post-intervention outcomes all showed significant improvement, particularly in the most restricted combined movement examination direction.

INTERPRETATION

This study provides normative reference data for combined movement examination that may inform future clinical studies of the technique as a convenient objective surrogate for important clinical outcomes in lumbar degenerative spondylosis. It can be used with good reliability, may be well tolerated by individuals in pain and appears to change in concert with validated measures of lumbar spinal pain, functional limitation and quality of life.

Concurrent validity and reliability of a novel wireless inertial measurement system to assess trunk movement

INTRODUCTION

Assessment of movement dysfunctions commonly comprises trunk range of motion (ROM), movement or control impairment (MCI), repetitive movements (RM), and reposition error (RE). Inertial measurement unit (IMU)-systems could be used to quantify these movement dysfunctions in clinical settings. The aim of this study was to evaluate a novel IMU-system when assessing movement dysfunctions in terms of concurrent validity and reliability.

METHODS

The concurrent validity of the IMU-system was tested against an optoelectronic system with 22 participants. The reliability of 14 movement dysfunction tests were analysed using generalizability theory and coefficient of variation, measuring 24 participants in seven trials on two days.

RESULTS

The IMU-system provided valid estimates of trunk movement in the primary movement direction when compared to the optoelectronic system. Reliability varied across tests and variables. On average, ROM and RM were more reliable, compared to MCI and RE tests.

DISCUSSION

When compared to the optoelectronic system, the IMU-system is valid for estimates of trunk movement in the primary movement direction. Four ROM, two MCI, one RM, and one RE test were identified as reliable and should be studied further for inter-subject comparisons and monitoring changes after an intervention.

Computer-aided combined movement examination of the lumbar spine and manual therapy implications: Case report

Combined movement examination (CME) of the lumbar spine has been recommended for clinical examination as it confers information about mechanical pain patterns. However, little quantitative study has been undertaken to validate its use in manual therapy practice. This study used computer aided CME to develop a normal reference range, and to guide provisional diagnosis and management. Two cases were assessed, before and after manual therapy using CME, a pain Visual Analogue Scale, the Roland Morris Low Back Pain and Disability Questionnaire and the Short Form (SF-12) Health Survey. Diagnosis and management were guided by comparing each CME pattern with the age and gender matched reference range. Self-reports data and CME total change scores were markedly improved for both cases, particularly for the most painful and restricted CME directions. This report describes how computer-aided CME and a normal reference range may be used objectively to inform a diagnosis and as an outcome measure in cases of mechanical LBP. Future investigations of cases with specific lumbar pathologies are required to validate this concept.