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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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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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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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Laffont I, Jourdan C, Coroian F, Blain H, Carre V, Viollet E, Tavares I, Fattal C, Gelis A, Nouvel F, Bakhti K, Cros V, Patte K, Schifano L, Porte M, Galano E, Dray G, Fouletier M, Rivier F, Morales R, Labauge P, Camu W, Combe B, Morel J, Froger J, Coulet B, Cottalorda J, Kouyoumdjian P, Jonquet O, Landreau L, Bonnin HY, Hantkié O, Nicolas P, Enjalbert M, Leblond C, Soua B, Coignard P, Guiraud D, Azevedo C, Mottet D, Fraisse P, Pastor E, Mercier J, Bourret R, Bousquet J, Pélissier J, Bardy B, Herisson C, Dupeyron A. [Living Lab MACVIA. Disability]. Presse Med 2015; 44 Suppl 1:S60-9. [PMID: 26482491 DOI: 10.1016/j.lpm.2015.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- I Laffont
- CHRU de Montpellier, département de médecine physique et de réadaptation, 34090 Montpellier, France; Movement to Health (M2H), Euromov, université de Montpellier, Montpellier, France.
| | - C Jourdan
- CHRU de Montpellier, département de médecine physique et de réadaptation, 34090 Montpellier, France
| | - F Coroian
- CHRU de Montpellier, département de médecine physique et de réadaptation, 34090 Montpellier, France; Movement to Health (M2H), Euromov, université de Montpellier, Montpellier, France
| | - H Blain
- Movement to Health (M2H), Euromov, université de Montpellier, Montpellier, France; CHRU de Montpellier, département de gériatrie, 34090 Montpellier, France
| | - V Carre
- CHRU de Montpellier, département de médecine physique et de réadaptation, 34090 Montpellier, France
| | - E Viollet
- CHU de Nîmes, hôpital Carémeau et du Grau du Roi, département de médecine physique et de réadaptation, 30029 Nîmes, France; CHU Carémeau, CEDMH, 30029 Nîmes, France
| | - I Tavares
- CHRU de Montpellier, département de médecine physique et de réadaptation, 34090 Montpellier, France
| | - C Fattal
- Association APPROCHE, CMRRF de Kerpape, BP 78, 56275 Ploemeur cedex, France
| | - A Gelis
- Centre Mutualiste Propara, 34000 Montpellier, France
| | - F Nouvel
- CHU Carémeau, CEDMH, 30029 Nîmes, France
| | - K Bakhti
- CHRU de Montpellier, département de médecine physique et de réadaptation, 34090 Montpellier, France; Movement to Health (M2H), Euromov, université de Montpellier, Montpellier, France
| | - V Cros
- CHRU de Montpellier, département de médecine physique et de réadaptation, 34090 Montpellier, France
| | - K Patte
- Institut Marin Saint-Pierre, 34250 Palavas les Flots, France
| | - L Schifano
- Institut Marin Saint-Pierre, 34250 Palavas les Flots, France
| | - M Porte
- CHU de Nîmes, hôpital Carémeau et du Grau du Roi, département de médecine physique et de réadaptation, 30029 Nîmes, France
| | - E Galano
- CHU de Nîmes, hôpital Carémeau et du Grau du Roi, département de médecine physique et de réadaptation, 30029 Nîmes, France
| | - G Dray
- École des Mines d'Alès, 30100 Alès, France
| | | | - F Rivier
- CHU de Montpellier, centre de référence Grand Sud des maladies neuromusculaires, département de neuropédiatrie, 34090 Montpellier, France
| | - R Morales
- CHRU de Montpellier, département de neurologie, 34090 Montpellier, France
| | - P Labauge
- CHRU de Montpellier, département de neurologie, 34090 Montpellier, France
| | - W Camu
- CHRU de Montpellier, département de neurologie, 34090 Montpellier, France
| | - B Combe
- CHRU de Montpellier, département de rhumatologie, 34090 Montpellier, France
| | - J Morel
- CHRU de Montpellier, département de rhumatologie, 34090 Montpellier, France
| | - J Froger
- Movement to Health (M2H), Euromov, université de Montpellier, Montpellier, France; CHU de Nîmes, hôpital Carémeau et du Grau du Roi, département de médecine physique et de réadaptation, 30029 Nîmes, France
| | - B Coulet
- CHRU de Montpellier, département de chirurgie orthopédique, 34090 Montpellier, France
| | - J Cottalorda
- CHRU de Montpellier, département de chirurgie orthopédique et plastique infantile, 34090 Montpellier, France
| | - P Kouyoumdjian
- CHU Carémeau, département de chirurgie orthopédique, 30029 Nîmes, France
| | - O Jonquet
- CHRU de Montpellier, département de réanimation, 34090 Montpellier, France
| | - L Landreau
- CHRU de Montpellier, département de réanimation, 34090 Montpellier, France
| | - H-Y Bonnin
- Movement to Health (M2H), Euromov, université de Montpellier, Montpellier, France; CHU de Nîmes, hôpital Carémeau et du Grau du Roi, département de médecine physique et de réadaptation, 30029 Nîmes, France
| | - O Hantkié
- Centre Bourgès, groupe Oc Santé, 34173 Castelneau-le-lez cedex, France
| | - P Nicolas
- Centre Bourgès, groupe Oc Santé, 34173 Castelneau-le-lez cedex, France
| | - M Enjalbert
- Centre Bouffard-Vercelli, 66290 Cerbère, France; Association APPROCHE, CMRRF de Kerpape, BP 78, 56275 Ploemeur cedex, France
| | - C Leblond
- Centre Bouffard-Vercelli, 66290 Cerbère, France
| | - B Soua
- Association ADAGES, Les Fontaines d'Ô, 34000 Montpellier, France
| | - P Coignard
- Association APPROCHE, CMRRF de Kerpape, BP 78, 56275 Ploemeur cedex, France
| | - D Guiraud
- Université de Montpellier, laboratoire d'informatique, de robotique et de microélectronique de Montpellier, 34090 Montpellier, France; Institut national de recherche en informatique et en automatique, LIRMM, université de Montpellier, 34090 Montpellier, France
| | - C Azevedo
- Université de Montpellier, laboratoire d'informatique, de robotique et de microélectronique de Montpellier, 34090 Montpellier, France; Institut national de recherche en informatique et en automatique, LIRMM, université de Montpellier, 34090 Montpellier, France
| | - D Mottet
- Movement to Health (M2H), Euromov, université de Montpellier, Montpellier, France
| | - P Fraisse
- Université de Montpellier, laboratoire d'informatique, de robotique et de microélectronique de Montpellier, 34090 Montpellier, France
| | - E Pastor
- CCAS de Lattes, 34970 Lattes, France
| | - J Mercier
- CHRU de Montpellier, U1046 Inserm, université Montpellier 1, 34090 Montpellier, France
| | - R Bourret
- CHRU de Montpellier, Direction générale, 34090 Montpellier, France
| | | | - J Pélissier
- Movement to Health (M2H), Euromov, université de Montpellier, Montpellier, France; CHU de Nîmes, hôpital Carémeau et du Grau du Roi, département de médecine physique et de réadaptation, 30029 Nîmes, France
| | - B Bardy
- Movement to Health (M2H), Euromov, université de Montpellier, Montpellier, France
| | - C Herisson
- CHRU de Montpellier, département de médecine physique et de réadaptation, 34090 Montpellier, France; Movement to Health (M2H), Euromov, université de Montpellier, Montpellier, France
| | - A Dupeyron
- Movement to Health (M2H), Euromov, université de Montpellier, Montpellier, France; CHU de Nîmes, hôpital Carémeau et du Grau du Roi, département de médecine physique et de réadaptation, 30029 Nîmes, France; CHU Carémeau, CEDMH, 30029 Nîmes, France
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