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Herrero P, Ríos-Asín I, Lapuente-Hernández D, Pérez L, Calvo S, Gil-Calvo M. The Use of Sensors to Prevent, Predict Transition to Chronic and Personalize Treatment of Low Back Pain: A Systematic Review. SENSORS (BASEL, SWITZERLAND) 2023; 23:7695. [PMID: 37765752 PMCID: PMC10534870 DOI: 10.3390/s23187695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/25/2023] [Accepted: 09/02/2023] [Indexed: 09/29/2023]
Abstract
Non-specific low back pain (NSLBP) is a highly prevalent condition that implies substantial expenses and affects quality of life in terms of occupational and recreational activities, physical and psychological health, and general well-being. The diagnosis and treatment are challenging processes due to the unknown underlying causes of the condition. Recently, sensors have been included in clinical practice to implement its management. In this review, we furthered knowledge about the potential benefits of sensors such as force platforms, video systems, electromyography, or inertial measure systems in the assessment process of NSLBP. We concluded that sensors could identify specific characteristics of this population like impaired range of movement, decreased stability, or disturbed back muscular activation. Sensors could provide sufferers with earlier diagnosis, prevention strategies to avoid chronic transition, and more efficient treatment approaches. Nevertheless, the review has limitations that need to be considered in the interpretation of results.
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Affiliation(s)
- Pablo Herrero
- IIS Aragon—iHealthy Research Group, C. de San Juan Bosco, 13, 50009 Zaragoza, Spain; (P.H.); (D.L.-H.); (L.P.); (M.G.-C.)
- Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, C. de Domingo Miral, S/N, 50009 Zaragoza, Spain;
| | - Izarbe Ríos-Asín
- Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, C. de Domingo Miral, S/N, 50009 Zaragoza, Spain;
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Av. de la Ilustración, 60, 18071 Granada, Spain
| | - Diego Lapuente-Hernández
- IIS Aragon—iHealthy Research Group, C. de San Juan Bosco, 13, 50009 Zaragoza, Spain; (P.H.); (D.L.-H.); (L.P.); (M.G.-C.)
- Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, C. de Domingo Miral, S/N, 50009 Zaragoza, Spain;
| | - Luis Pérez
- IIS Aragon—iHealthy Research Group, C. de San Juan Bosco, 13, 50009 Zaragoza, Spain; (P.H.); (D.L.-H.); (L.P.); (M.G.-C.)
- Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, C. de Domingo Miral, S/N, 50009 Zaragoza, Spain;
| | - Sandra Calvo
- IIS Aragon—iHealthy Research Group, C. de San Juan Bosco, 13, 50009 Zaragoza, Spain; (P.H.); (D.L.-H.); (L.P.); (M.G.-C.)
- Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, C. de Domingo Miral, S/N, 50009 Zaragoza, Spain;
| | - Marina Gil-Calvo
- IIS Aragon—iHealthy Research Group, C. de San Juan Bosco, 13, 50009 Zaragoza, Spain; (P.H.); (D.L.-H.); (L.P.); (M.G.-C.)
- Faculty of Physical Activity and Sports Sciences, Universidad de León, Cjón. Campus Vegazana, S/N, 24007 León, Spain
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Sung PS, Lee D, Hosmer E. The dynamic postural steadiness and stabilization time between older adults with and without recurrent low back pain. Gait Posture 2023; 100:114-119. [PMID: 36516645 DOI: 10.1016/j.gaitpost.2022.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/03/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Although postural control measures were reported to identify neuromuscular impairments, postural steadiness and stabilization time were not carefully investigated between subjects with and without recurrent low back pain (LBP). Research QuestionAre there group differences in the stabilization time, direction of sway, and dynamic postural steadiness index (DPSI) during one-leg standing? METHODS Thirty-four control subjects and 29 subjects with recurrent LBP participated in the study. Each subject stood upright on a single leg with and without visual input. The outcomes were measured for standing duration (sec), direction of sway, and the DPSI, which included the vertical steadiness index (VSI). The VSI assesses fluctuations to standardize the vertical ground reaction forces on the force plate. RESULTS The control group demonstrated significantly longer standing duration compared to the LBP group during the eyes-open condition (t = 3.55, p = 0.001). The LBP group demonstrated significantly faster stabilization time (t = 2.53, p = 0.01) in the sagittal plane. The DPSI demonstrated an excellent relationship with the VSI without visual input in the control group (r = 0.98, p = 0.001). The directions of sway demonstrated a significant interaction between groups (F = 9.29, p = 0.004). SIGNIFICANCE Although standing duration in the eyes-open condition decreased in the LBP group, a faster stabilization time in the sagittal plane was evident compared to the control group to adapt postural stability. These results indicated that vertical dynamic steadiness with visual input might be important to enhance compensatory postural control.
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Affiliation(s)
- Paul S Sung
- Department of Physical Therapy, Indiana Wesleyan University, 4201 South Washington Street, Marion, IN 46953, USA.
| | | | - Emily Hosmer
- Department of Health Sciences, Central Michigan University, Mount Pleasant, MI, USA
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Yang QH, Zhang YH, Du SH, Wang YC, Wang XQ. Association Between Smoking and Pain, Functional Disability, Anxiety and Depression in Patients With Chronic Low Back Pain. Int J Public Health 2023; 68:1605583. [PMID: 36960408 PMCID: PMC10027735 DOI: 10.3389/ijph.2023.1605583] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 02/27/2023] [Indexed: 03/09/2023] Open
Abstract
Objectives: Chronic low back pain (CLBP) accounts for a majority of the disability associated with LBP, which can produce long-term negative effects. This cross-sectional study aimed to investigate the association between smoking and pain, dysfunction and psychological status in patients with CLBP. Methods: The 54 patients with CLBP were recruited and divided into smoking and non-smoking groups. Their pain, dysfunction, anxiety, depression, fear and quality of life were evaluated. The amount of cigarettes smoked daily was recorded. Results: Significant differences in VAS, ODI, RMDQ and FABQ and the impact of LBP on life and work were found between smoking and non-smoking patients. In addition, a correlation was found between the daily cigarette smoking amount and VASmax, FABQtotal, SDS and FABQ-W. Moreover, a correlation was observed between the amount of cigarettes smoked daily and the degree of impact of low back pain on work. Conclusion: The study found that smoking affected the aggravation of symptoms in patients with CLBP, which indicated that patients with CLBP and people at risk of LBP should be aware of the harm caused by smoking.
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Affiliation(s)
- Qi-Hao Yang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Yong-Hui Zhang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Shu-Hao Du
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Yu-Chen Wang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Xue-Qiang Wang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
- Department of Rehabilitation Medicine, Shanghai Shangti Orthopaedic Hospital, Shanghai, China
- *Correspondence: Xue-Qiang Wang,
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Effects of low back pain on balance performance in elderly people: a systematic review and meta-analysis. Eur Rev Aging Phys Act 2021; 18:8. [PMID: 34090345 PMCID: PMC8180028 DOI: 10.1186/s11556-021-00263-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 05/17/2021] [Indexed: 11/20/2022] Open
Abstract
Background Research suggests that individuals with low back pain (LBP) may have poorer motor control compared to their healthy counterparts. However, the sample population of almost 90% of related articles are young and middle-aged people. There is still a lack of a systematic review about the balance performance of elderly people with low back pain. This study aimed to conduct a systematic review and meta-analysis to understand the effects of LBP on balance performance in elderly people. Methods This systematic review and meta-analysis included a comprehensive search of PubMed, Embase, and Cochrane Library databases for full-text articles published before January 2020. We included the articles that 1) investigated the elderly people with LBP; 2) assessed balance performance with any quantifiable clinical assessment or measurement tool and during static or dynamic activity; 3) were original research. Two independent reviewers screened the relevant articles, and disagreements were resolved by a third reviewer. Results Thirteen case-control studies comparing balance performance parameters between LBP and healthy subjects were included. The experimental group (LBP group) was associated with significantly larger area of centre of pressure movement (P < 0.001), higher velocity of centre of pressure sway in the anteroposterior and mediolateral directions (P = 0.01 and P = 0.02, respectively), longer path length in the anteroposterior direction (P < 0.001), slower walking speed (P = 0.05), and longer timed up and go test time (P = 0.004) than the control group. Conclusion The results showed that balance performance was impaired in elderly people with LBP. We should pay more attention to the balance control of elderly people with LBP.
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Karartı C, Özüdoğru A, Basat HÇ, Özsoy İ, Özsoy G, Kodak Mİ, Sezgin H, Uçar İ. Determination of Biodex Balance System Cutoff Scores in Older People With Nonspecific Back Pain: A Cross-sectional Study. J Manipulative Physiol Ther 2020; 44:85-94. [PMID: 33248744 DOI: 10.1016/j.jmpt.2020.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 07/19/2020] [Accepted: 07/19/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of this study was to determine cutoff scores for the Biodex Balance System (BBS) and verify if they could be used to discriminate older people with nonspecific low back pain (NSLBP) with poor postural performance from those with good postural performance. METHODS This cross-sectional study included 52 participants with NSLBP older than 65 years. One level of stability (level 5; intraclass correlation ≥0.70) and 2 conditions (eyes open and eyes closed) were selected for the testing procedure. Anterior-posterior stability index (APSI), medial-lateral stability index (MLSI), and overall stability index (OSI) scores were calculated. The participants were classified into 2 groups: high risk of falling and low risk of falling. Both the receiver operating characteristic and the area under the curve were used to determine the best BBS cutoff values. Binary logistic regression analysis was used to investigate the ability of BBS scores to predict risk of falling. RESULTS BBS cutoff scores in the eyes-open condition (APSI = 2.60, MLSI = 1.95, OSI = 2.95) and eyes-closed condition (APSI = 3.05, MLSI = 2.17, OSI = 3.25) were found to be sensitive and specific in determining postural performance. Participants with index values lower than the cutoff scores had, respectively, 6.42, 4.20, and 3.72 times lower risk of falling in the eyes-open condition and 3.33, 5.50, and 3.00 times lower risk of falling in the eyes-closed condition. The predictive characteristics of the models for risk analysis were excellent and good to excellent. CONCLUSION Our study shows that BBS cutoff scores are sensitive and specific in distinguishing between poor and good postural performance in older people with NSLBP.
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Affiliation(s)
- Caner Karartı
- Department of Physiotherapy and Rehabilitation, Kırşehir Ahi Evran University, Kırşehir, Turkey.
| | - Anıl Özüdoğru
- Department of Physiotherapy and Rehabilitation, Kırşehir Ahi Evran University, Kırşehir, Turkey
| | - Hakkı Çağdaş Basat
- Department of Orthopedics and Traumatology, Kırşehir Ahi Evran University, Kırşehir, Turkey
| | - İsmail Özsoy
- Department of Physiotherapy and Rehabilitation, Selçuk University, Konya, Turkey
| | - Gülşah Özsoy
- Department of Physiotherapy and Rehabilitation, Selçuk University, Konya, Turkey
| | - Muhammed İhsan Kodak
- Department of Physiotherapy and Rehabilitation, Kırşehir Ahi Evran University, Kırşehir, Turkey
| | - Hicabi Sezgin
- Department of Orthopedics and Traumatology, Kırşehir Ahi Evran University, Kırşehir, Turkey
| | - İlyas Uçar
- Department of Orthopedics and Traumatology, Kırşehir Ahi Evran University, Kırşehir, Turkey
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So BCL, Ng JKF, Au KCK. A 4-week community aquatic physiotherapy program with Ai Chi or Bad Ragaz Ring Method improves disability and trunk muscle endurance in adults with chronic low back pain: A pilot study. J Back Musculoskelet Rehabil 2020; 32:755-767. [PMID: 30689551 DOI: 10.3233/bmr-171059] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To investigate the efficacy of a 4-week community aquatic physiotherapy program with Ai Chi or the Bad Ragaz Ring Method (BRRM) on pain and disability in adults with chronic low back pain (CLBP). METHODS Adults with CLBP (n= 44; mean ± SD age, 52.6 ± 5.5 y; 37 women) were assigned to either an Ai Chi (n= 23) or BRRM (n= 21) program (4 weeks, twice weekly). RESULTS Both the Ai Chi (-1.4; 95% CI -2.6 to -0.2; p= .025) and BRRM (-2.0, 95% CI -3.1 to -0.8; p= 0.003) groups demonstrated significant pre- to post-treatment decreases in Roland-Morris Disability Questionnaire scores and improvements in prone bridge duration (Ai Chi: 11.7 s; 95% CI 1.6 to 21.8; p= 0.025; BRRM: 19.0 s; 95% CI 6.1 to 31.8; p= 0.006). The Ai Chi group revealed a significant improvement in single-leg stand test duration (2.9 s; 95% CI 0.1 to 5.7; p= 0.045) and the BRRM group reported significant decrease in pain intensity (-11.6; 95% CI -19.1 to -4.2; p= 0.004). CONCLUSIONS A 4-week aquatic physiotherapy program with Ai Chi or BRRM resulted in significant pre- to post-treatment improvements in disability and global core muscle endurance. Ai Chi appeared to have an additional benefit of improving single-leg standing balance and BRRM an additional benefit of reducing pain.
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Sung PS, Danial P. Trunk sway response to consecutive slip perturbations between subjects with and without recurrent low back pain. Musculoskelet Sci Pract 2018; 33:84-89. [PMID: 29274629 DOI: 10.1016/j.msksp.2017.12.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Revised: 10/24/2017] [Accepted: 12/13/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND Trunk sway responses following perturbations are critical to develop adequate prevention strategies. It is unclear how postural responses with a handheld task can validly be transferred to treadmill-induced slip perturbations in subjects with recurrent low back pain (LBP). OBJECTIVE To compare trunk sway angle, velocity, and reaction time following treadmill-induced perturbations while subjects with and without LBP held a tray. DESIGN Cross-sectional study. METHODS There were 30 subjects with LBP and 50 control subjects who participated in the study. Each participant stood on the treadmill while he/she held a tray to produce a functional task. Three levels of consecutive slips were introduced based on the specific duration, velocity, and displacement. RESULTS The trunk extension angle was significantly different (F = 4.22, p = 0.04) and demonstrated a significant interaction with groups and levels of perturbation (F = 6.83, p = 0.01). However, the reaction time was not significantly different based on the levels of perturbation (F = 0.43, p = 0.51). The LBP group increased trunk extension only at level 1 slip perturbation (t = 2.86, p = 0.005). CONCLUSION The increased trunk extension following the first perturbation indicated a delay in adjusting trunk stability in the LBP group. However, there was no group difference with higher magnitudes of perturbations. These results indicated that the LBP group was able to minimize trunk sway with higher perturbations following the first perturbation.
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Affiliation(s)
- Paul S Sung
- Doctoral Program in Physical Therapy/ Motion Analysis Center, Central Michigan University, USA.
| | - Pamela Danial
- Doctoral Program in Physical Therapy/ Motion Analysis Center, Central Michigan University, USA
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Sung PS, Danial P, Lee DC. Reliability of the Kinematic Steadiness Index during one-leg standing in subjects with recurrent low back pain. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 27:171-179. [PMID: 28980075 DOI: 10.1007/s00586-017-5314-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 08/29/2017] [Accepted: 09/24/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To assess the reliability of standing time and the Kinematic Steadiness Index (KSI) in one-leg standing compared with the Timed Up and Go (TUG) test while considering anthropometric factors in subjects with recurrent low back pain (LBP). METHODS Sixty-six individuals participated in the study. The data were collected on two different days, 1 week apart. The KSI of the core spine, using video motion-capture techniques, was based on the relative standing time and relative standstill time. The intraclass correlation coefficient (ICC2,1) was compared for the reliability between measures. The covariates, such as age, Body Mass Index, and the Oswestry Disability Index (ODI), were analyzed for any interactions based on these measures. RESULTS The standing time (t = - 1.01, p = 0.32) and the KSI (t = - 1.70, p = 0.09) were not significantly different between measures. The TUG results were not different between measures (t = 1.01, p = 0.32). The Cronbach's alpha for the standing time was 0.84, for KSI was 0.89, and for TUG was 0.76. The standing time and KSI demonstrated an interaction with age, while the TUG demonstrated an interaction with the ODI score. CONCLUSIONS The KSI during one-leg standing could help to develop a practical tool to justify quantity and quality of balance outcome measures, which identify balance deficits and core spine rehabilitation strategies in subjects with recurrent LBP.
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Affiliation(s)
- Paul S Sung
- Department of Physical Therapy/Motion Analysis Center, Herbert H. and Grace A. Dow College of Health Professions, Central Michigan University, Health Professions Building 1220, Mt. Pleasant, MI, 48859, USA.
| | - Pamela Danial
- Department of Physical Therapy/Motion Analysis Center, Herbert H. and Grace A. Dow College of Health Professions, Central Michigan University, Health Professions Building 1220, Mt. Pleasant, MI, 48859, USA
| | - Dongchul C Lee
- Theoretical Research in Nevro Corp., Redwood City, CA, USA
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Sung PS, Maxwell MJ. Kinematic chain reactions on trunk and dynamic postural steadiness in subjects with recurrent low back pain. J Biomech 2017. [PMID: 28645455 DOI: 10.1016/j.jbiomech.2017.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Although subjects with recurrent low back pain (LBP) demonstrate altered trunk control, the kinematic and kinetic responses of the trunk have not been carefully investigated. This study was conducted to compare the standing time, spine range of motion (ROM), and dynamic postural steadiness index (DPSI) based on visual condition between subjects with and without recurrent LBP during upright one leg standing. Sixty-three individuals participated in the study, including 34 control subjects and 29 subjects with recurrent LBP. The DPSI was a composite of the medio-lateral (MLSI), anterior-posterior (APSI), and vertical steadiness indices (VSI) on a force platform. The control group demonstrated longer standing time (s) during the eyes-open condition than the LBP group (26.82±6.03 vs. 19.87±9.36; t=2.96, p=0.01). Regarding spine ROM, visual condition was significantly different between groups (F=7.09, p=0.01) and demonstrated interactions with spine region and group (F=5.53, p=0.02). For the kinetic measures, there was a significant interaction between visual conditions and indices (F=25.30, p=0.001). In the LBP group, the DPSI was significantly correlated with the MLSI (r=0.59, p=0.002), APSI (r=0.44, p=0.03), and VSI (r=0.98, p=0.01) in the eyes-closed condition. Overall, the results of this study indicated that the LBP group decreased thorax and lumbar spine rotations during the eyes-closed condition. The LBP group also demonstrated positive correlations with the kinetic indices, enhancing dynamic postural steadiness in the eyes-closed condition in order to possibly avoid pain or further injury. This dynamic postural steadiness strategy is necessary to improve kinetic and kinematic chain reactions in the LBP group. This compensatory pattern supports the development of optimal postural correction strategies to prevent LBP recurrence and might represent a chain reaction to protect trunk control without visual input.
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Affiliation(s)
- Paul S Sung
- Department of Physical Therapy, Central Michigan University, United States.
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Lee PY, Lin SI, Liao YT, Lin RM, Hsu CC, Huang KY, Chen YT, Tsai YJ. Postural Responses to a Suddenly Released Pulling Force in Older Adults with Chronic Low Back Pain: An Experimental Study. PLoS One 2016; 11:e0162187. [PMID: 27622646 PMCID: PMC5021337 DOI: 10.1371/journal.pone.0162187] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 08/18/2016] [Indexed: 02/02/2023] Open
Abstract
Chronic low back pain (CLBP), one of the most common musculoskeletal conditions in older adults, might affect balance and functional independence. The purpose of this study was to investigate the postural responses to a suddenly released pulling force in older adults with and without CLBP. Thirty community-dwelling older adults with CLBP and 26 voluntary controls without CLBP were enrolled. Participants were required to stand on a force platform while, with one hand, they pulled a string that was fastened at the other end to a 2-kg or to a 4-kg force in the opposite direction at a random order. The number of times the participants lost their balance and motions of center of pressure (COP) when the string was suddenly released were recorded. The results demonstrated that although the loss of balance rates for each pulling force condition did not differ between groups, older adults with CLBP had poorer postural responses: delayed reaction, larger displacement, higher velocity, longer path length, and greater COP sway area compared to the older controls. Furthermore, both groups showed larger postural responses in the 4-kg pulling force condition. Although aging is generally believed to be associated with declining balance and postural control, these findings highlight the effect of CLBP on reactive balance when responding to an externally generated force in an older population. This study also suggests that, for older adults with CLBP, in addition to treating them for pain and disability, reactive balance evaluation and training, such as reaction and movement strategy training should be included in their interventions. Clinicians and older patients with CLBP need to be made aware of the significance of impaired reactive balance and the increased risk of falls when encountering unexpected perturbations.
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Affiliation(s)
- Pei-Yun Lee
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Sang-I Lin
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Ting Liao
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ruey-Mo Lin
- Department of Orthopedic, Tainan Municipal An-Nan Hospital-China Medical University, Tainan, Taiwan
| | - Che-Chia Hsu
- Department of Orthopedic, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Kuo-Yuan Huang
- Department of Orthopedic, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Yi-Ting Chen
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Ju Tsai
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- * E-mail:
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