Movement control tests for the lumbopelvic complex. Are these tests reliable and valid?

Clinically assessed lumbopelvic sensorimotor control tests in low back pain: are they actually valid? A systematic review according to COSMIN guidelines

BACKGROUND

Impairments in lumbopelvic sensorimotor control (SMC) are thought to be one of the underlying mechanisms for the recurrence and persistence of low back pain (LBP). As such, lumbopelvic SMC tests are frequently included in the clinical examination of patients with LBP.

OBJECTIVE

To evaluate convergent and known-groups validity of clinically assessed lumbopelvic SMC tests in patients with LBP according to COSMIN guidelines.

DESIGN

Systematic review METHODS: Five electronic databases were searched until December 2023. Studies examining convergent or known-groups validity of lumbopelvic SMC tests assessed via inspection or palpation in patients with LBP were included. Known-groups validity had to be assessed between patients with LBP and pain-free persons. Two independent researchers appraised risk of bias and quality of evidence (QoE) using the COSMIN Risk of Bias checklist and modified GRADE approach, respectively. Results for known-groups validity were reported separately for single tests and test-clusters.

RESULTS

Twelve studies (946 participants) were included. Three studies investigated convergent validity of three single tests. Regarding known-groups validity, six studies evaluated six single tests and four studies investigated two test-clusters. For only one test, both convergent and known-groups were assessed. The QoE for tests showing sufficient convergent or known-groups validity was (very) low, whereas QoE was moderate for single tests or test-clusters with insufficient known-groups validity.

CONCLUSION

All clinically assessed lumbopelvic SMC tests with sufficient convergent or known-groups validity had (very) low QoE. Therefore, test outcomes should be interpreted cautiously and strong reliance on these outcomes for clinical decision-making can currently not be recommended.

The test-retest reliability and minimal clinically important difference of the Dubousset Functional Test and its correlation with Rolland Morris disability questionnaire in chronic non-specific low back pain

OBJECTIVE

This study examines the test-retest reliability, the minimal clinically important difference (MCID), and its correlation with the Rolland Morris Disability Questionnaire (RMDQ) of the Dubousset Functional Test (DFT) in evaluating the functional capacity and dynamic balance of patients with chronic non-specific low back pain (cnsLBP).

METHODS

Seventy-five patients with cnsLBP aged 18 years and over were included. The Five-Repetition Sit-To-Stand Test (5R-STS), the subcomponents of the DFT (the Up and Walk Test, the Steps Test, the Down and Sitting Test, and the Dual-Tasking Test) were administered to the patients. Patients were rested for 1 h, and the DFT was applied again. Pain level was evaluated with the Visual Analogue Scale before the tests started and after the tests were completed. Self-report function assessment was made using the RMDQ.

RESULTS

The test-retest reliability of the subcomponents of the DFT was excellent. The ICCs were: 0.91, 0.86, 0.89, and 0.89, respectively. The standard measurement errors of the subcomponents of the DFT were 0.32, 0.12, 0.14, and 0.25, respectively. The subcomponents of the DFT were highly correlated with the RMDQ and 5R-STS with the correlation coefficients of 0,83, 0,83, 0,79, 0,83 and 0,81, 0,75, 0,73, and 0,82, respectively (p < 0.01). The MCIDs of the subcomponents were 0,60, 0,23, 0,27, and 0,48, respectively.

CONCLUSION

The DFT is reliable in evaluating patients' functional capacity and dynamic balance with cnsLBP without causing discomfort. It is simple, quick, and simultaneously assesses multiple areas contributing to spinal alignment, muscle integrity, and balance.

Reliability and validity of a novel Kinect-based software program for measuring a single leg squat

Background

The Single leg squat (SLS) is a movement screening test widely used in clinical settings. The SLS is highly subjective in its nature. Objective measures, such as 3D-motion analyses, are seldom used in daily clinical work. An interactive, Kinect-based 3D-movement analysis system, the Qinematic™, is proposed to be easily used in clinical settings to assess the SLS. The aim of this study was to establish the test-retest reliability and construct validity of Qinematic™ for assessing the SLS. A further aim was to identify angles of medial knee displacement, to summarise the discriminative ability of the SLS measured by Qinematic™.

Methods

We performed a test-retest reliability study (n = 37) of the SLS using Qinematic™ and a construct validity study, in which Qinematic™ data were compared with visual assessment of video-recorded SLS.

Results

Three variables (left knee down, right knee up and down) reached “substantial reliability” (ICC = 0.64–0.69). One variable, “left knee up”, showed a significant difference between the two test occasions (T1–6.34°, T2 0.66°, p = 0.013, ICC = 0.50), and “poor absolute reliability” was seen for all variables (SEM = 9.04–10.66, SDC = 25.06–29.55). A moderate agreement between the visual assessment and Qinematic™ data for various knee angles was shown (Kappa = 0.45–0.58). The best discriminative ability of the SLS was found at a knee angle of 6° (AUC = 0.82, sensitivity = 0.86, specificity = 0.78, PPV = 0.58, NPV = 0.94).

Conclusions

Qinematic™ shows a poor absolute reliability, and a substantial relative reliability, in measuring a SLS at the way down. This indicates that Qinematic™ should not be recommended for the use on an individual level, but it can possibly be used on a group level. The merged results of the construct validity study indicate that Qinematic™ at 6° of medial displacement can identify subjects with a knee over foot position. In summary, the use of the Qinematic™ net trajectory angle, which estimates the “line of best fit” cannot be recommended to assess a knee medial to foot position and should be reconsidered.

Movement Control Impairment and Low Back Pain: State of the Art of Diagnostic Framing

Background and objectives: Low back pain is one of the most common health problems. In 85% of cases, it is not possible to identify a specific cause, and it is therefore called Non-Specific Low Back Pain (NSLBP). Among the various attempted classifications, the subgroup of patients with impairment of motor control of the lower back (MCI) is between the most studied. The objective of this systematic review is to summarize the results from trials about validity and reliability of clinical tests aimed to identify MCI in the NSLBP population. Materials and Methods: The MEDLINE, Cochrane Library, and MedNar databases have been searched until May 2018. The criteria for inclusion were clinical trials about evaluation methods that are affordable and applicable in a usual clinical setting and conducted on populations aged > 18 years. A single author summarized data in synoptic tables relating to the clinical property; a second reviewer intervened in case of doubts about the relevance of the studies. Results: 13 primary studies met the inclusion criteria: 10 investigated inter-rater reliability, 4 investigated intra-rater reliability, and 6 investigated validity for a total of 23 tests (including one cluster of tests). Inter-rater reliability is widely studied, and there are tests with good, consistent, and substantial values (waiter's bow, prone hip extension, sitting knee extension, and one leg stance). Intra-rater reliability has been less investigated, and no test have been studied for more than one author. The results of the few studies about validity aim to discriminate only the presence or absence of LBP in the samples. Conclusions: At the state of the art, results related to reliability support the clinical use of the identified tests. No conclusions can be drawn about validity.

Test-retest reliability of a smartphone app for measuring core stability for two dynamic exercises

Background

Recently, there has been growing interest in using smartphone applications to assess gait speed and quantify isometric core stability exercise intensity. The purpose of this study was to investigate the between-session reliability and minimal detectable change of a smartphone app for two dynamic exercise tests of the lumbopelvic complex.

Methods

Thirty-three healthy young and active students (age: 22.3 ± 5.9 years, body weight: 66.9 ± 11.3 kg, height: 167.8 ± 10.3 cm) participated in this study. Intraclass correlation coefficient (ICC), coefficient of variation (%CV), and Bland–Altman plots were used to verify the reliability of the test. The standard error of measurement (SEM) and the minimum detectable difference (MDD) were calculated for clinical applicability.

Results

The ICCs ranged from 0.73 to 0.96, with low variation (0.9% to 4.8%) between days of assessments. The Bland–Altman plots and one-sample t-tests (p > 0.05) indicated that no dynamic exercise tests changed systematically. Our analyses showed that SEM 0.6 to 1.5 mm/s-2) and MDD (2.1 to 3.5 mm/s-2).

Conclusion

The OCTOcore app is a reliable tool to assess core stability for two dynamic exercises. A minimal change of 3.5 mm/s-2 is needed to be confident that the change is not a measurement error between two sessions.

Reliability and validity of a novel Kinect-based software program for measuring posture, balance and side-bending

Background

Clinical examinations are subjective and often show a low validity and reliability. Objective and highly reliable quantitative assessments are available in laboratory settings using 3D motion analysis, but these systems are too expensive to use for simple clinical examinations. Qinematic™ is an interactive movement analyses system based on the Kinect camera and is an easy-to-use clinical measurement system for assessing posture, balance and side-bending. The aim of the study was to test the test-retest the reliability and construct validity of Qinematic™ in a healthy population, and to calculate the minimal clinical differences for the variables of interest. A further aim was to identify the discriminative validity of Qinematic™ in people with low-back pain (LBP).

Methods

We performed a test-retest reliability study (n = 37) with around 1 week between the occasions, a construct validity study (n = 30) in which Qinematic™ was tested against a 3D motion capture system, and a discriminative validity study, in which a group of people with LBP (n = 20) was compared to healthy controls (n = 17). We tested a large range of psychometric properties of 18 variables in three sections: posture (head and pelvic position, weight distribution), balance (sway area and velocity in single- and double-leg stance), and side-bending.

Results

The majority of the variables in the posture and balance sections, showed poor/fair reliability (ICC < 0.4) and poor/fair validity (Spearman <0.4), with significant differences between occasions, between Qinematic™ and the 3D–motion capture system. In the clinical study, Qinematic™ did not differ between people with LPB and healthy for these variables. For one variable, side-bending to the left, there was excellent reliability (ICC =0.898), excellent validity (r = 0.943), and Qinematic™ could differentiate between LPB and healthy individuals (p = 0.012).

Conclusion

This paper shows that a novel software program (Qinematic™) based on the Kinect camera for measuring balance, posture and side-bending has poor psychometric properties, indicating that the variables on balance and posture should not be used for monitoring individual changes over time or in research. Future research on the dynamic tasks of Qinematic™ is warranted.