A rationale for the provision of extrinsic feedback towards management of low back pain

Knowledge and use of extrinsic feedback characteristics: A survey of current practice among Brazilian physical therapists

OBJECTIVES

This study aimed to identify the knowledge about the different characteristics of and the use of extrinsic feedback (EF) by Brazilian physical therapists.

METHODS

This is a cross-sectional study, and we used an internet-based survey with questions about knowledge and application of extrinsic feedback in clinical practice. We analyzed the responses in relation to the best available evidence on motor control and learning. We recruited Brazilian registered physical therapists from different regions in Brazil. Participants' demographics and survey responses were analyzed using descriptive statistics.

RESULTS

Two hundred and forty-six Brazilian physical therapists participated in the study. Most participants affirmed not knowing the definition of EF (55.69%), confirmed using some form of EF in their clinical practice (86.59%), and reported using it in 50% to 90% of their patients (26.42%). Brazilian physical therapists reported using mainly summary feedback (69.10%) with external focus of attention (63.41%). Participants reported using concurrent feedback (82.83%) and delivered it after every exercise repetition (63.82%). Most participants (43.09%) did not assess learning retention. Answers were similar regardless of education level or time from graduation.

CONCLUSIONS

The results of this survey suggest that Brazilian physical therapists do not have sufficient knowledge about the different characteristics of EF; however, they do consider EF useful and use it for most of their patients. Brazilian physical therapists adopted adequate content characteristics of EF but not adequate use of timing characteristics of EF.

Feedback for the prevention and rehabilitation of work-related musculoskeletal disorders: A systematic review

BACKGROUND

Work-related musculoskeletal disorders (WRMSDs) remain a challenge despite research aimed at improving their prevention and treatment. Extrinsic feedback has been suggested for the prevention and rehabilitation of WRMSDs to improve sensorimotor control, and ultimately to reduce pain and disability. However, there are few systematic reviews on the effectiveness of extrinsic feedback for WRMSDs.

OBJECTIVE

To perform a systematic review investigating the effect of extrinsic feedback for the prevention and rehabilitation of WRMSDs.

METHODS

Five databases (CINAHL, Embase, Ergonomics Abstract, PsycInfo, PubMed) were searched. Studies of various designs assessing the effects of extrinsic feedback during work tasks on three outcomes (function, symptoms, sensorimotor control) in the context of prevention and rehabilitation of WRMSDs were included.

RESULTS

Forty-nine studies were included, for a total sample of 3387 participants (including 925 injured) who performed work-related tasks in the workplace (27 studies) or in controlled environments (22 studies). The use of extrinsic feedback was shown to be effective in controlled environments for short-term prevention of functional limitations and sensorimotor alterations (very limited to moderate evidence) and for improving, in injured participants, function, symptoms and sensorimotor control (moderate evidence). In the workplace, it was shown to be effective for short-term prevention of functional limitations (limited evidence). There was conflicting evidence regarding its effect for WRMSD rehabilitation in the workplace.

CONCLUSION

Extrinsic feedback is an interesting complementary tool for the prevention and rehabilitation of WRMSDs in controlled environments. More evidence is needed regarding its effect for the prevention and rehabilitation of WRMSDs in the workplace.

Effectiveness of a lumbopelvic monitor and feedback device to change postural behaviour: the ELF cluster randomised controlled trial

OBJECTIVES

The aim of this clustered, randomised controlled trial was to assess the effectiveness of a lumbopelvic postural feedback device for changing postural behaviour in a group of healthcare workers. We hypothesised that workers exposed to auditory postural feedback would reduce the number of times forward bending posture is adopted at work.

METHODS

This was a participant and assessor blinded, randomised, sham-controlled trial with blocked cluster random allocation. We recruited healthcare workers from aged care institutions. Healthcare sites were randomly allocated to the feedback or sham group (SG). A postural monitoring and feedback device was used to monitor and record lumbopelvic forward bending posture, and provided audio feedback whenever the user sustained lumbopelvic forward bending posture that exceeded predefined thresholds. The primary outcome measure was postural behaviour (exceeding thresholds). We used a robust variant of repeated measures mixed-effect model for assessing within-group and between-group differences in postural behaviour.

RESULTS

We recruited 19 sites, and 130 healthcare workers participated. There were no within-group changes on the number of times postural threshold was exceeded at 1-week follow-up (feedback group: -0.7, 95% CI -2.61 to 0.72; SG -0.3, -1.65 to 0.98), and no differences (0.05, 95% CI -1.83 to 1.94) between SG and feedback group.

CONCLUSIONS

Findings from this trial indicate that audio feedback provided by a postural monitor device did not reduce the number of times healthcare workers exceeded the postural threshold.

TRIAL REGISTRATION NUMBER

ACTRN12616000449437.

Strategies to assist uptake of pelvic floor muscle training for people with urinary incontinence: A clinician viewpoint

AIMS

The experiences and information needs of clinicians who use pelvic floor muscle training to manage urinary incontinence were explored.

METHODS

Qualitative methods were used to conduct thematic analysis of data collected from clinician focus groups and interviews. Participants were registered physiotherapists and continence nurses in Melbourne, Australia. Recruitment was through a combination of purposive and "snowball" sampling and continued until data adequacy was reached.

RESULTS

Twenty-eight physiotherapists and one continence nurse participated in seven focus groups and one interview. The main finding communicated by the participants was that pelvic floor muscle training requires comprehensive descriptions of program details in order for clinicians to implement evidence-based interventions. The following themes were identified: (1) pelvic floor muscle training tailored to the needs of each individual is essential; (2) training-specific cues and verbal prompts assist patients to learn and engage with exercises; and (3) clinicians can benefit from research summaries and reports that provide explicit and comprehensive descriptions and decision rules about intervention content and progression. The data indicated that some clinicians can have difficulty interpreting and applying research findings because it is not always well reported.

CONCLUSIONS

Clinicians who use pelvic floor muscle training to treat urinary incontinence advised can benefit from accessing explicit details of interventions tested in research and reported as effective. They viewed tailoring therapy to individual goals and the use of verbal prompts and visualization cues as important engagement strategies for effective exercise performance. Explicit reporting could be facilitated by using an exercise guideline template, such as the Consensus on Exercise Reporting Template (CERT).

Effectiveness of extrinsic feedback for management of non-specific low back pain: a systematic review protocol

INTRODUCTION

Low back pain is the greatest cause of years lived with disability worldwide and is linked with high societal and economic burden. Neuromuscular control impairments are a common clinical presentation in patients with non-specific low back pain. Musculoskeletal physiotherapists commonly use feedback as a part of the management of low back disorders. This systematic review will aim to assess the effectiveness of extrinsic biofeedback for reducing pain, disability and recurrence of pain in patients with non-specific low back pain.

METHODS AND ANALYSIS

Systematic searches will be performed in CINAHL, Embase, Medline, PsycInfo, Scopus and Web of Science. We will include randomised controlled trial studies, if the study recruited patients with non-specific low back pain; compared extrinsic feedback versus either placebo or control; another intervention; or in addition to an intervention versus that intervention alone; and have used pain, disability scores or low back pain recurrence as outcome measures. We will exclude studies with designs other than randomised controlled trials. We will assess the risk of bias within included studies using the PEDro scale, and the strength of evidence using the Grades of Recommendation, Assessment, Development and Evaluation approach.

ETHICS AND DISSEMINATION

Ethical approval and patient consent are not required since this is a systematic review based on published studies. The results of this study will be published in an international peer-reviewed journal.

PROSPERO REGISTRATION NUMBER

CRD42017077888.

Verbal augmented feedback in the rehabilitation of lower extremity musculoskeletal dysfunctions: a systematic review

Background

Verbal augmented feedback (VAF) is commonly used in physiotherapy rehabilitation of individuals with lower extremity musculoskeletal dysfunction or to induce motor learning for injury prevention. Its effectiveness for acquisition, retention and transfer of learning of new skills in this population is unknown.

Objectives

First, to investigate the effect of VAF for rehabilitation and prevention of lower extremity musculoskeletal dysfunction. Second, to determine its effect on motor learning and the stages of acquisition, retention and transfer in this population.

Design

Systematic review designed in accordance with the Centre for Reviews and Dissemination and reported in line with Preferred Reporting Items for Systematic Review and Meta-analysis.

Method

MEDLINE, Embase, PubMed and five additional databases were searched to identify primary studies with a focus on VAF for prevention and rehabilitation of lower extremity musculoskeletal dysfunction. One reviewer screened the titles and abstracts. Two reviewers retrieved full text articles for final inclusion. The first reviewer extracted data, whereas the second reviewer audited. Two reviewers independently assessed risk of bias and quality of evidence using Cochrane Collaboration’s tool and Grading of Recommendations Assessment, Development and Evaluation, respectively.

Results

Six studies were included, with a total sample of 304 participants. Participants included patients with lateral ankle sprain (n=76), postoperative ACL reconstruction (n=16) and healthy individuals in injury prevention (n=212). All six studies included acquisition, whereas retention was found in five studies. Only one study examined transfer of the achieved motor learning (n=36). VAF was found to be effective for improving lower extremity biomechanics and postural control with moderate evidence from five studies.

Conclusion

VAF should be considered in the rehabilitation of lower extremity musculoskeletal dysfunctions. However, it cannot be unequivocally confirmed that VAF is effective in this population, owing to study heterogeneity and a lack of high-quality evidence. Nevertheless, positive effects on lower extremity biomechanics and postural control have been identified. This suggests that further research into this topic is warranted where an investigation of long-term effects of interventions is required. All stages (acquisition, retention and transfer) should be evaluated.

Effectiveness of Physiotherapy interventions plus Extrinsic Feedback for neck disorders: A systematic review with meta-analysis

PURPOSE

To systematically review the effectiveness of Physiotherapy interventions combined with extrinsic feedback (EF) compared to Physiotherapy interventions alone or control for the management of neck pain and disability.

METHODS

Randomized clinical trials were searched and retrieved from six databases, from inception through August 2016. Risk of bias of included studies was assessed using the PEDro scale. When possible data were pooled and Meta-analyses were conducted. The quality and strength of evidence for each outcome was assessed using the GRADE approach.

RESULTS

Eight studies (n = 677) were included in the review. The pooled estimates suggested Physiotherapy intervention + EF was not superior to Physiotherapy intervention alone for disability (MD = -0.38; 95%CI = -0.91 to 0.18; I² = 82%), but was superior for pain (MD = -0.37; 95%CI = -0.73 to -0.01; I² = 68%). Physiotherapy intervention + EF was not superior than control for disability scores (SMD = -3.94; 95%CI = -12.06 to 4.18; I² = 92%). Physiotherapy intervention + EF intervention was more effective than control for pain scores at short-term (SMD = -1.44; 95%CI = -2.25 to-0.63; I² = 50%). Most studies did not specify nor use the ideal characteristics of EF.

CONCLUSION

There is very low quality of evidence that Physiotherapy intervention + EF is more effective than Physiotherapy intervention alone or control for short-term pain, but not for disability. Physiotherapy intervention plus EF was more effective than Physiotherapy alone for acute neck pain, but not for chronic pain or disability. There was high risk of bias within included studies. Future studies are likely to change the estimates of the effects of Physiotherapy intervention plus EF on neck rehabilitation.

Static postural sway of women with and without fibromyalgia syndrome: A cross-sectional study

BACKGROUND

There is a frequent complaint about balance problems among fibromyalgia syndrome patients; however, there are not enough studies that have shown static postural sway of women with fibromyalgia syndrome. This study aimed to compare static postural sway of women with and without fibromyalgia syndrome.

METHODS

This is a cross-sectional study in which twenty-nine women with fibromyalgia syndrome and 20 without took part. A posturography evaluation was performed in six different situations (bipedal, right tandem and left tandem, with eyes opened and closed), and questionnaires for clinical depression symptoms, clinical anxiety symptoms, sleep quality, and Visual Analogue Scales for Pain and Fatigue were applied. Mann-Whitney U test was used to check differences among groups; Wilcoxon matched-pair test was used to check differences intragroup; Cohen d coefficient was used to measure effect sizes and Pearson Correlation Coefficient was used for correlations among variables. Level of significance adopted was 5%.

FINDINGS

Women with fibromyalgia syndrome have presented worse postural sway than women without fibromyalgia syndrome in all situations (P<0.05), and worse scores in all questionnaires (P<0.05). In the eyes closed situations, women with fibromyalgia syndrome presented worse postural sway than women without in the same conditions.

INTERPRETATION

Women with fibromyalgia syndrome have worse performance in the static posture test, more prominent in reduced support bases with eyes closed. Pain, fatigue, depression and anxiety may have directly influenced postural sway in fibromyalgia syndrome patients.

Effectiveness of a lumbopelvic monitor and feedback device to change postural behaviour: a protocol for the ELF cluster randomised controlled trial

INTRODUCTION

Low back pain (LBP) is the most common, costly and disabling musculoskeletal disorder worldwide, and is prevalent in healthcare workers. Posture is a modifiable risk factor for LBP shown to reduce the prevalence of LBP. Our feasibility research suggests that postural feedback might help healthcare workers avoid hazardous postures. The Effectiveness of Lumbopelvic Feedback (ELF) trial will investigate the extent to which postural monitor and feedback (PMF) can reduce exposure to hazardous posture associated with LBP.

METHODS

This is a participant-blinded, randomised controlled trial with blocked cluster random allocation. Participants will include volunteer healthcare workers recruited from aged care institutions and hospitals. A postural monitoring and feedback device will monitor and record lumbopelvic forward bending posture, and provide audio feedback whenever the user sustains a lumbopelvic forward bending posture that exceeds predefined thresholds. The primary outcome measure will be postural behaviour (exceeding thresholds). Secondary outcome measures will be incidence of LBP, participant-reported disability and adherence. Following baseline assessment, we will randomly assign participants to 1 of 2 intervention arms: a feedback group and a no-feedback control group. We will compare between-group differences of changes in postural behaviour by using a repeated measures mixed-effect model analysis of covariance (ANCOVA) at 6 weeks. Postural behaviour baseline scores, work-related psychosocial factors and disability scores will be input as covariates into the statistical models. We will use logistic mixed model analysis and Cox's proportional hazards for assessing the effect of a PMF on LBP incidence between groups.

DISCUSSION

Posture is a modifiable risk factor for low back disorders. Findings from the ELF trial will inform the design of future clinical trials assessing the effectiveness of wearable technology on minimising hazardous posture during daily living activities in patients with low back disorders.

TRIAL REGISTRATION NUMBER

ACTRN12616000449437.

The effectiveness of a lumbopelvic monitor and feedback device to change postural behavior: a feasibility randomized controlled trial

STUDY DESIGN

Feasibility randomized controlled trial.

OBJECTIVES

To assess the feasibility of a trial to investigate the effectiveness of a lumbopelvic monitor as a feedback device for modifying postural behavior during daily work-related activities.

BACKGROUND

Frequent or sustained flexed postures play a role in the development or maintenance of nonspecific low back pain. The provision of postural feedback could help individuals with or at risk of nonspecific low back pain improve their postural awareness and avoid hazardous or pain-provoking postures.

METHODS

Sixty-two participants employed in a health care organization were randomly allocated into 1 of 3 groups: a control group, an intermittent feedback group, and a constant feedback group. Adherence and follow-up rates were assessed. Differences in postural pattern between baseline and follow-up measurements were used to assess the effectiveness of the lumbopelvic monitor as a postural feedback device.

RESULTS

Adherence was approximately 75%. With the exception of 1 center, the follow-up overall rates exceeded the a priori desired threshold of 80%. Within-group comparisons revealed no significant differences in postural pattern for the control group and intermittent feedback group. The constant feedback group showed a significant reduction in flexed posture at the follow-up period compared with the baseline period. Differences between groups did not reach statistical significance; however, the constant feedback group, compared with the control group, demonstrated an effect size (d) of 0.60.

CONCLUSION

The provision of constant postural feedback seems promising for promoting changes in postural behavior. This feasibility trial identified adherence and follow-up rates and sample-size estimates important to the conduct of a fully powered efficacy trial. Level of Evidence Therapy, level 2b-.

Validity and reliability of the Spineangel lumbo-pelvic postural monitor

OBJECTIVE

to determine the reliability and the concurrent validity of the Spineangel lumbo-pelvic postural monitoring device.

METHODS

the dynamic lumbo-pelvic posture of 25 participants was simultaneously monitored by the Spineangel and Fastrak devices. Participants performed six different functional tasks in random order. Within-task, within-session and between-day intraclass correlation coefficients (ICC(3,1), ICC(3,5), ICC(2,5), respectively) reliability were calculated for Spineangel measurements. Concurrent validity of the Spineangel was assessed by means of a Bland and Altman plot and by means of Pearson's correlation coefficient and paired t-test.

RESULTS

within-task, within-session and between-day ICC for the Spineangel were found to be excellent (>0.93). The Spineangel and Fastrak pelvic measurements were found to have a good correlation (R = 0.77).

CONCLUSION

the Spineangel is a reliable and valid device for monitoring general lumbo-pelvic movements when clipped on the belt or waistband of workers' clothing during various occupational activities.

PRACTITIONER SUMMARY

The Spineangel can be used for assessing lumbo-pelvic posture during work or daily-life activities. This device was found to provide reliable and valid measurements for lumbo-pelvic movements. Further research is required to determine whether the use of this device is clinically relevant for patients presenting with low back pain.