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Christe G, Benaim C, Jolles BM, Favre J. Changes in spinal motor behaviour are associated with reduction in disability in chronic low back pain: A longitudinal cohort study with 1-year follow-up. Eur J Pain 2024; 28:1116-1126. [PMID: 38299715 DOI: 10.1002/ejp.2245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 01/01/2024] [Accepted: 01/18/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND The need to improve spinal motor behaviour in chronic low back pain (CLBP) rehabilitation remains unclear. The objective of this study was to test if changes in spinal motor behaviour were associated with changes in disability after an interdisciplinary rehabilitation program (IRP) in patients with CLBP. METHODS Seventy-one patients with CLBP participating in an IRP were included. Spinal motor behaviour was assessed with biomechanical (lumbar angular amplitude and velocity, erector spinae muscle activity and duration of the task), cognitive-emotional (task-specific fear [PRF]) and pain-related (movement-evoked pain [MEP]) measures during a lifting task before and after the IRP. Disability was measured before and after the IRP, and at 3-month and 1-year follow-ups. RESULTS After adjusting for confounders, changes in disability were significantly associated with MEP changes (β adj. = 0.49, p < 0.001) and PRF changes (β adj. = 0.36, p = 0.008), but not with changes in any of the biomechanical measures. MEP at the end of IRP was also associated with disability at 3 months (β adj. = 0.37, p = 0.001) and 1 year (β adj. = 0.42, p = 0.01). Biomechanical measures at the end of the IRP were not associated with disability, except for the duration of the task that was significantly associated with reduction of disability at 3 months (β non-adj = 0.5, p < 0.001). CONCLUSIONS Pain-related and cognitive-emotional measures of spinal motor behaviour were associated with reduction in disability following an IRP. Future research is needed to further investigate causal relationships between spinal motor behaviour and disability. SIGNIFICANCE STATEMENT This study supports a multidimensional understanding and analysis of spinal motor behaviour, integrating the cognitive-emotional, pain-related and biomechanical domains. It also supports the consideration of spinal motor behaviour as a potentially important treatment target in chronic low back pain management. Moreover, it suggests that reducing movement-evoked pain and task-specific fear may have more influence on disability than changing lumbar amplitude, lumbar angular velocity or erector muscle activity, which may have important implications for rehabilitation.
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Affiliation(s)
- Guillaume Christe
- Department of Physiotherapy, HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Charles Benaim
- Department of Physical Medicine and Rehabilitation, Orthopedic Hospital, Lausanne University Hospital, Lausanne, Switzerland
- Department of Musculoskeletal Rehabilitation, Clinique Romande de Réadaptation, Sion, Switzerland
| | - Brigitte M Jolles
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Institute of Microengineering, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Julien Favre
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- The Sense Innovation and Research Center, Lausanne, Sion, Switzerland
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Errabity A, Calmels P, Han WS, Bonnaire R, Pannetier R, Convert R, Molimard J. The effect of low back pain on spine kinematics: A systematic review and meta-analysis. Clin Biomech (Bristol, Avon) 2023; 108:106070. [PMID: 37595368 DOI: 10.1016/j.clinbiomech.2023.106070] [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: 04/28/2023] [Revised: 08/09/2023] [Accepted: 08/11/2023] [Indexed: 08/20/2023]
Abstract
BACKGROUND Although impairments in dorso-lumbar spine mobility have been previously reported in patients with low back pain, its exact mechanism is not yet clear. Therefore, the purpose of this systematic review and meta-analysis is to investigate and compare spinal kinematics between subjects with and without low back pain and identify appropriate tools to evaluate it. METHODS The PubMed, Scopus and Web of Science databases were searched for relevant literature. The search strategy was mainly focused on studies investigating lumbar kinematics in subjects with and without low back pain during clinical functional tests, gait, sports and daily functional activities. Papers were selected if at least one of these outputs was reported: lumbar range of motion, lumbar velocity, lumbar acceleration and deceleration, lordosis angle or lumbar excursion. FINDINGS Among 804 papers, 48 met the review eligibility criteria and 29 were eligible to perform a meta-analysis. Lumbar range of motion was the primary outcome measured. A statistically significant limitation of the lumbar mobility was found in low back pain group in all planes, and in the frontal and transverse planes for thoracic range of motion, but there is no significant limitation for pelvic mobility. The amount of limitation was found to be more important in the lumbar sagittal plane and during challenging functional activities in comparison with simple activities. INTERPRETATION The findings of this review provide insight into the impact of low back pain on spinal kinematics during specific movements, contributing to our understanding of this relationship and suggesting potential clinical implications.
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Affiliation(s)
- Aicha Errabity
- Mines Saint-Etienne, Univ Lyon, Univ Jean Monnet, INSERM, U 1059 Sainbiose, Centre CIS, Saint-Etienne, France; Thuasne, BP243, 92307 Levallois-Perret, Cedex, France.
| | - Paul Calmels
- Université Jean Monnet, Saint-Etienne, service de médecine physique et réadaptation - CHU-Saint Etienne, Lyon1, Université Savoie Mont-Blanc, Laboratoire Inter Universitaire de biologie de la Motricité, F-42023 Saint-Etienne, France
| | - Woo-Suck Han
- Mines Saint-Etienne, Univ Lyon, Univ Jean Monnet, INSERM, U 1059 Sainbiose, Centre CIS, Saint-Etienne, France
| | - Rébecca Bonnaire
- Institut Clément Ader (ICA), Université de Toulouse, CNRS, IMT Mines Albi, INSA, ISAE-SUPAERO, UPS Campus Jarlard, F-81013 Albi, France
| | | | | | - Jérome Molimard
- Mines Saint-Etienne, Univ Lyon, Univ Jean Monnet, INSERM, U 1059 Sainbiose, Centre CIS, Saint-Etienne, France
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Christe G, Benaim C, Luthi F, Jolles BM, Favre J. Reduction in pain-related fear is not associated with improvement in spinal biomechanics but with decrease in movement-evoked pain in patients with chronic low back pain. Pain Pract 2023; 23:290-300. [PMID: 36479806 DOI: 10.1111/papr.13191] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 10/10/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS While a causal relationship between pain-related fear and spinal movement avoidance in patients with chronic low back pain (CLBP) has frequently been postulated, evidence supporting this relationship is limited. This study aimed to test if decreases in pain-related fear or catastrophizing were associated with improvements in spinal biomechanics, accounting for possible changes in movement-evoked pain. METHODS Sixty-two patients with CLBP were assessed before and after an interdisciplinary rehabilitation program (IRP). Pain-related fear was assessed with general and task-specific measures. Lower and upper lumbar angular amplitude and velocity as well as paraspinal muscle activity were recorded during five daily-life tasks to evaluate spinal biomechanics. Relationships were tested with multivariable linear regression analyses. RESULTS The large decreases in pain-related fear and catastrophizing following the IRP were scarcely and inconsistently associated with changes in spinal biomechanics (< 3% of the models reported a statistically significant association). Results remained comparable for activities inducing more or less fear, for specific or general measures of pain-related fear, and for analyses performed on the entire population or limited to subgroups of patients with higher levels of task-specific fear. In contrast, reductions in task-specific pain-related fear were significantly associated with decreases in movement-evoked pain in all tasks (r = 0.26-0.62, p ≤ 0.02). CONCLUSION This study does not support an association between pain-related fear and spinal movement avoidance. However, it provides evidence supporting a direct relationship between decreased pain-related fear and decreased movement-evoked pain, possibly explaining some mechanisms of the rehabilitation programs.
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Affiliation(s)
- Guillaume Christe
- Department of Physiotherapy, HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland.,Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Charles Benaim
- Department of Physical Medicine and Rehabilitation, Orthopedic Hospital, Lausanne University Hospital, Lausanne, Switzerland.,Department of Musculoskeletal Rehabilitation, Clinique Romande de Réadaptation, Sion, Switzerland
| | - François Luthi
- Department of Physical Medicine and Rehabilitation, Orthopedic Hospital, Lausanne University Hospital, Lausanne, Switzerland.,Department of Musculoskeletal Rehabilitation, Clinique Romande de Réadaptation, Sion, Switzerland
| | - Brigitte M Jolles
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Institute of Microengineering, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Julien Favre
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,The Sense Innovation and Research Center, Lausanne and Sion, Switzerland
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Abd Rahman NA, Li S, Schmid S, Shaharudin S. Biomechanical factors associated with non-specific low back pain in adults: A systematic review. Phys Ther Sport 2023; 59:60-72. [PMID: 36516512 DOI: 10.1016/j.ptsp.2022.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022]
Abstract
Low back pain (LBP) can result in increased direct medical and non-medical costs to patients, employers, and health care providers. This systematic review aimed to provide a better understanding of the biomechanical factors associated with chronic non-specific LBP in adults. SCOPUS, ScienceDirect, MEDLINE, and Web of Science databases were searched. In total, 26 studies were included and significant differences were noted between healthy controls and LBP patients in various motion. Biomechanical factors among adults with non-specific LBP were altered and differed as compared to healthy controls in various motion might be to compensate the pain during those motions. This review highlighted the biomechanical differences across those with non-specific LBP and healthy adults. Both groups showed a similar level of pain during functional tasks but LBP patients suffered from a moderate level of disability. Future studies should not rely on questionnaire-based pain scale only. The biomechanical factors summarized in this review can be used to diagnose non-specific LBP accurately, and as modifiable targets for exercise-based intervention.
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Affiliation(s)
- Nur Athirah Abd Rahman
- Exercise & Sports Science Programme, School of Health Sciences, Universiti Sains Malaysia, 16150, Kota Bharu, Malaysia
| | - Shuoqi Li
- Exercise & Sports Science Programme, School of Health Sciences, Universiti Sains Malaysia, 16150, Kota Bharu, Malaysia; School of Sports Science, Nantong University, 226019, Nantong, China
| | - Stefan Schmid
- Bern University of Applied Sciences, School of Health Professions, Division of Physiotherapy, Spinal Movement Biomechanics Group, 3008, Bern, Switzerland; University of Basel, Faculty of Medicine, 4056, Basel, Switzerland
| | - Shazlin Shaharudin
- Exercise & Sports Science Programme, School of Health Sciences, Universiti Sains Malaysia, 16150, Kota Bharu, Malaysia.
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Fayad J, Eltes PE, Lazary A, Cristofolini L, Stagni R. Stereophotogrammetric approaches to multi-segmental kinematics of the thoracolumbar spine: a systematic review. BMC Musculoskelet Disord 2022; 23:1080. [PMID: 36503435 PMCID: PMC9743750 DOI: 10.1186/s12891-022-05925-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 10/12/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Spine disorders are becoming more prevalent in today's ageing society. Motion abnormalities have been linked to the prevalence and recurrence of these disorders. Various protocols exist to measure thoracolumbar spine motion, but a standard multi-segmental approach is still missing. This study aims to systematically evaluate the literature on stereophotogrammetric motion analysis approaches to quantify thoracolumbar spine kinematics in terms of measurement reliability, suitability of protocols for clinical application and clinical significance of the resulting functional assessment. METHODS Electronic databases (PubMed, Scopus and ScienceDirect) were searched until February 2022. Studies published in English, investigating the intersegmental kinematics of the thoracolumbar spine using stereophotogrammetric motion analysis were identified. All information relating to measurement reliability; measurement suitability and clinical significance was extracted from the studies identified. RESULTS Seventy-four studies met the inclusion criteria. 33% of the studies reported on the repeatability of their measurement. In terms of suitability, only 35% of protocols were deemed suitable for clinical application. The spinous processes of C7, T3, T6, T12, L1, L3 and L5 were the most widely used landmarks. The spine segment definitions were, however, found to be inconsistent among studies. Activities of daily living were the main tasks performed. Comparable results between protocols are however still missing. CONCLUSION The literature to date offers various stereophotogrammetric protocols to quantify the multi-segmental motion of the thoracolumbar spine, without a standard guideline being followed. From a clinical point of view, the approaches are still limited. Further research is needed to define a precise motion analysis protocol in terms of segment definition and clinical relevance.
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Affiliation(s)
- Jennifer Fayad
- grid.6292.f0000 0004 1757 1758Department of Industrial Engineering, Alma Mater Studiorum – Università di Bologna, Bologna, Italy ,National Centre for Spinal Disorders, Budapest, Hungary
| | - Peter Endre Eltes
- National Centre for Spinal Disorders, Budapest, Hungary ,In Silico Biomechanics Laboratory, National Centre for Spinal Disorders, Budapest, Hungary
| | - Aron Lazary
- National Centre for Spinal Disorders, Budapest, Hungary
| | - Luca Cristofolini
- grid.6292.f0000 0004 1757 1758Department of Industrial Engineering, Alma Mater Studiorum – Università di Bologna, Bologna, Italy
| | - Rita Stagni
- grid.6292.f0000 0004 1757 1758Department of Electrical, Electronic and Information Engineering “Guglielmo Marconi”, Alma Mater Studiorum – Università Di Bologna, Bologna, Italy
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Christe G, Aussems C, Jolles BM, Favre J. Patients With Chronic Low Back Pain Have an Individual Movement Signature: A Comparison of Angular Amplitude, Angular Velocity and Muscle Activity Across Multiple Functional Tasks. Front Bioeng Biotechnol 2021; 9:767974. [PMID: 34869281 PMCID: PMC8634715 DOI: 10.3389/fbioe.2021.767974] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/26/2021] [Indexed: 11/28/2022] Open
Abstract
Despite a large body of evidence demonstrating spinal movement alterations in individuals with chronic low back pain (CLBP), there is still a lack of understanding of the role of spinal movement behavior on LBP symptoms development or recovery. One reason for this may be that spinal movement has been studied during various functional tasks without knowing if the tasks are interchangeable, limiting data consolidation steps. The first objective of this cross-sectional study was to analyze the influence of the functional tasks on the information carried by spinal movement measures. To this end, we first analyzed the relationships in spinal movement between various functional tasks in patients with CLBP using Pearson correlations. Second, we compared the performance of spinal movement measures to differentiate patients with CLBP from asymptomatic controls among tasks. The second objective of the study was to develop task-independent measures of spinal movement and determine the construct validity of the approach. Five functional tasks primarily involving sagittal-plane movement were recorded for 52 patients with CLBP and 20 asymptomatic controls. Twelve measures were used to describe the sagittal-plane angular amplitude and velocity at the lower and upper lumbar spine as well as the activity of the erector spinae. Correlations between tasks were statistically significant in 91 out of 99 cases (0.31 ≤ r ≤ 0.96, all p < 0.05). The area under the curve (AUC) to differentiate groups did not differ substantially between tasks in most of the comparisons (82% had a difference in AUC of ≤0.1). The task-independent measures of spinal movement demonstrated equivalent or higher performance to differentiate groups than functional tasks alone. In conclusion, these findings support the existence of an individual spinal movement signature in patients with CLBP, and a limited influence of the tasks on the information carried by the movement measures, at least for the twelve common sagittal-plane measures analysed in this study. Therefore, this work brought critical insight for the interpretation of data in literature reporting differing tasks and for the design of future studies. The results also supported the construct validity of task-independent measures of spinal movement and encouraged its consideration in the future.
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Affiliation(s)
- Guillaume Christe
- Department of Physiotherapy, HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Camille Aussems
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Brigitte M. Jolles
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Institute of Microengineering, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Julien Favre
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Christe G, Darlow B, Pichonnaz C. Changes in physiotherapy students' beliefs and attitudes about low back pain through pre-registration training. Arch Physiother 2021; 11:13. [PMID: 33993879 PMCID: PMC8126429 DOI: 10.1186/s40945-021-00106-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 03/17/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Implementation of best-practice care for patients with low back pain (LBP) is an important issue. Physiotherapists' who hold unhelpful beliefs are less likely to adhere to guidelines and may negatively influence their patients' beliefs. Pre-registration education is critical in moving towards a biopsychosocial model of care. This study aimed to investigate the changes in 2nd year physiotherapy students' beliefs about LBP after a module on spinal pain management and determine whether these changes were maintained at the end of academic training. METHODS During three consecutive calendar years, this longitudinal cohort study assessed physiotherapy students' beliefs with the Back Pain Attitudes Questionnaires (Back-PAQ) in their 1st year, before and after their 2nd year spinal management learning module, and at the end of academic training (3rd year). Unpaired t-tests were conducted to explore changes in Back-PAQ score. RESULTS The mean response rate after the spinal management module was 90% (128/143 students). The mean (± SD) Back-PAQ score was 87.73 (± 14.21) before and 60.79 (± 11.44) after the module, representing a mean difference of - 26.95 (95%CI - 30.09 to - 23.80, p < 0.001). Beliefs were further improved at the end of 3rd year (- 7.16, 95%CI - 10.50 to - 3.81, p < 0.001). CONCLUSIONS A spinal management learning module considerably improved physiotherapy students' beliefs about back pain. Specifically, unhelpful beliefs about the back being vulnerable and in need of protection were substantially decreased after the module. Improvements were maintained at the end of academic training one-year later. Future research should investigate whether modifying students' beliefs leads to improved clinical practice in their first years of practice.
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Affiliation(s)
- Guillaume Christe
- Department of Physiotherapy, HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, University Hospital and University of Lausanne (CHUV-UNIL), Lausanne, Switzerland
| | - Ben Darlow
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Claude Pichonnaz
- Department of Physiotherapy, HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
- Department of Musculoskeletal Medicine, University Hospital and University of Lausanne (CHUV-UNIL), Lausanne, Switzerland
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