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Alsubaie AM, Sanderson A, Cabral HV, Martinez-Valdes E, Falla D. Spinal kinematic variability is increased in people with chronic low back pain during a repetitive lifting task. J Electromyogr Kinesiol 2023; 73:102832. [PMID: 37897835 DOI: 10.1016/j.jelekin.2023.102832] [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: 07/28/2023] [Revised: 09/26/2023] [Accepted: 10/13/2023] [Indexed: 10/30/2023] Open
Abstract
Changes in spinal kinematic variability have been observed in people with chronic non-specific LBP (CNSLBP) during the performance of various repetitive functional tasks. However, the direction of these changes (i.e., less or more kinematic variability) is not consistent. This study aimed to assess differences in kinematic variability of the 3D angular displacement of thoracic and lumbar spinal segments in people with CNSLBP compared to asymptomatic individuals during a repetitive lifting task. Eleven people with CNSLBP and 11 asymptomatic volunteers performed 10 cycles of multi-planar lifting movements while spinal kinematics were recorded. For the three planes of motion, point-by-point standard deviations (SDs) were computed across all cycles of lifting and the average was calculated as a measure of kinematic variability for both segments. People with CNSLBP displayed higher thoracic (F = 8.00, p = 0.010, ηp2 = 0.286) and lumbar kinematic variability (F = 5.48, p = 0.030, ηp2 = 0.215) in the sagittal plane. Moreover, group differences were observed in the transversal plane for thoracic (F = 7.62, p = 0.012, ηp2 = 0.276) and lumbar kinematic variability (F = 5.402, p = 0.031, ηp2 = 0.213), as well as in the frontal plane for thoracic (F = 7.27, p = 0.014, ηp2 = 0.267) and lumbar kinematic variability (F = 6.11, p = 0.022, ηp2 = 0.234), all showing higher variability in those with CNSLBP. A significant main effect of group was not detected (p > 0.05) for spinal range of motion (ROM). Thus, people with CNSLBP completed the lifting task with the same ROM in all three planes of motion as observed for asymptomatic individuals, yet they performed the lifting task with higher spinal kinematic cycle-to-cycle variation.
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Affiliation(s)
- Amal M Alsubaie
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom; Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Andy Sanderson
- Department of Sport and Exercise Sciences, Manchester Institute of Sport, Manchester Metropolitan University, Manchester, United Kingdom
| | - Hélio V Cabral
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Eduardo Martinez-Valdes
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
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Quirk DA, Johnson ME, Anderson DE, Smuck M, Sun R, Matthew R, Bailey J, Marras WS, Bell KM, Darwin J, Bowden AE. Biomechanical Phenotyping of Chronic Low Back Pain: Protocol for BACPAC. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:S48-S60. [PMID: 36315101 PMCID: PMC10403313 DOI: 10.1093/pm/pnac163] [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: 07/26/2022] [Revised: 10/12/2022] [Accepted: 10/21/2022] [Indexed: 04/27/2023]
Abstract
OBJECTIVE Biomechanics represents the common final output through which all biopsychosocial constructs of back pain must pass, making it a rich target for phenotyping. To exploit this feature, several sites within the NIH Back Pain Consortium (BACPAC) have developed biomechanics measurement and phenotyping tools. The overall aims of this article were to: 1) provide a narrative review of biomechanics as a phenotyping tool; 2) describe the diverse array of tools and outcome measures that exist within BACPAC; and 3) highlight how leveraging these technologies with the other data collected within BACPAC could elucidate the relationship between biomechanics and other metrics used to characterize low back pain (LBP). METHODS The narrative review highlights how biomechanical outcomes can discriminate between those with and without LBP, as well as among levels of severity of LBP. It also addresses how biomechanical outcomes track with functional improvements in LBP. Additionally, we present the clinical use case for biomechanical outcome measures that can be met via emerging technologies. RESULTS To answer the need for measuring biomechanical performance, our "Results" section describes the spectrum of technologies that have been developed and are being used within BACPAC. CONCLUSION AND FUTURE DIRECTIONS The outcome measures collected by these technologies will be an integral part of longitudinal and cross-sectional studies conducted in BACPAC. Linking these measures with other biopsychosocial data collected within BACPAC increases our potential to use biomechanics as a tool for understanding the mechanisms of LBP, phenotyping unique LBP subgroups, and matching these individuals with an appropriate treatment paradigm.
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Affiliation(s)
- D Adam Quirk
- Harvard School of Engineering and Applied Science, Harvard University, Cambridge, Massachusetts
| | - Marit E Johnson
- Department of Orthopaedic Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Dennis E Anderson
- Center for Orthopaedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Matthew Smuck
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California
| | - Ruopeng Sun
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California
| | - Robert Matthew
- Department of Physical Therapy and Rehabilitation Sciences, University of California, San Francisco, California
| | - Jeannie Bailey
- Department of Orthopaedic Surgery, University of California, San Francisco, California
| | - William S Marras
- Department of Integrated Systems Engineering, The Ohio State University, Columbus, Ohio
| | - Kevin M Bell
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jessa Darwin
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Anton E Bowden
- Department of Mechanical Engineering, Brigham Young University, Provo, Utah, USA
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Saraceni N, Campbell A, Kent P, Ng L, Straker L, O’Sullivan P. An Exploration of the Influence of Non-Biomechanical Factors on Lifting-Related LBP. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1903. [PMID: 36767270 PMCID: PMC9914774 DOI: 10.3390/ijerph20031903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 06/18/2023]
Abstract
Objective: The primary objective was to compare non-biomechanical factors between manual workers with and without a history of LBP related to lifting. A secondary objective was to investigate associations between the change in pain intensity during repeated lifting (termed pain ramp) and non-biomechanical factors tested in the LBP group. Methods: Manual workers currently in lifting occupations with and without a history of lifting-related LBP were recruited (21 LBP and 20 noLBP) and took part in a repeated (100) lift task. A series of non-biomechanical factors, including psychological, work-related, lifestyle, whole health and psychophysical factors, were collected. Psychophysical factors (pressure pain thresholds (PPTs) and fatigue) were also measured at different time points. Associations between pain ramp during lifting and non-biomechanical factors were investigated with linear regression. Results: The LBP group reported worse perceived sleep quality, more musculoskeletal pain sites other than LBP and greater symptoms related to gastrointestinal complaints and pseudo-neurology compared to the group with no history of LBP. The group with LBP were also slightly more worried about the lifting task and felt more fatigued at the end of the lifting task. The feeling of fatigue during lifting was positively associated with pain ramp in the LBP group. Anxiety and gastrointestinal complaints were weakly negatively associated with pain ramp during lifting. Conclusions: The group differences of poorer perceived sleep, greater non-specific health complaints, slightly more worry about the lifting task and more perceived fatigue in the LBP group highlight the complex and multi-factorial nature of LBP related to lifting. The feeling of fatigue was positively associated with pain ramp in the LBP group, suggesting a close relationship with pain and fatigue during lifting that requires further exploration.
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Affiliation(s)
- Nic Saraceni
- Curtin School of Allied Health, Curtin University, Bentley 6845, Western Australia, Australia
| | - Amity Campbell
- Curtin School of Allied Health, Curtin University, Bentley 6845, Western Australia, Australia
| | - Peter Kent
- Curtin School of Allied Health, Curtin University, Bentley 6845, Western Australia, Australia
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark Campusvej 55, 5230 Odense, Denmark
| | - Leo Ng
- Curtin School of Allied Health, Curtin University, Bentley 6845, Western Australia, Australia
| | - Leon Straker
- Curtin School of Allied Health, Curtin University, Bentley 6845, Western Australia, Australia
| | - Peter O’Sullivan
- Curtin School of Allied Health, Curtin University, Bentley 6845, Western Australia, Australia
- Body Logic Physiotherapy, Shenton Park 6008, Western Australia, Australia
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Concurrent validity of DorsaVi wireless motion sensor system Version 6 and the Vicon motion analysis system during lifting. BMC Musculoskelet Disord 2022; 23:909. [PMID: 36224548 PMCID: PMC9559006 DOI: 10.1186/s12891-022-05866-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 09/26/2022] [Indexed: 11/29/2022] Open
Abstract
Background Wearable sensor technology may allow accurate monitoring of spine movement outside a clinical setting. The concurrent validity of wearable sensors during multiplane tasks, such as lifting, is unknown. This study assessed DorsaVi Version 6 sensors for their concurrent validity with the Vicon motion analysis system for measuring lumbar flexion during lifting. Methods Twelve participants (nine with, and three without back pain) wore sensors on T12 and S2 spinal levels with Vicon surface markers attached to those sensors. Participants performed 5 symmetrical (lifting from front) and 20 asymmetrical lifts (alternate lifting from left and right). The global-T12-angle, global-S2-angle and the angle between these two sensors (relative-lumbar-angle) were output in the sagittal plane. Agreement between systems was determined through-range and at peak flexion, using multilevel mixed-effects regression models to calculate root mean square errors and standard deviation. Mean differences and limits of agreement for peak flexion were calculated using the Bland Altman method. Results For through-range measures of symmetrical lifts, root mean squared errors (standard deviation) were 0.86° (0.78) at global-T12-angle, 0.90° (0.84) at global-S2-angle and 1.34° (1.25) at relative-lumbar-angle. For through-range measures of asymmetrical lifts, root mean squared errors (standard deviation) were 1.84° (1.58) at global-T12-angle, 1.90° (1.65) at global-S2-angle and 1.70° (1.54) at relative-lumbar-angle. The mean difference (95% limit of agreement) for peak flexion of symmetrical lifts, was − 0.90° (-6.80 to 5.00) for global-T12-angle, 0.60° (-2.16 to 3.36) for global-S2-angle and − 1.20° (-8.06 to 5.67) for relative-lumbar-angle. The mean difference (95% limit of agreement) for peak flexion of asymmetrical lifts was − 1.59° (-8.66 to 5.48) for global-T12-angle, -0.60° (-7.00 to 5.79) for global-S2-angle and − 0.84° (-8.55 to 6.88) for relative-lumbar-angle. Conclusion The root means squared errors were slightly better for symmetrical lifts than they were for asymmetrical lifts. Mean differences and 95% limits of agreement showed variability across lift types. However, the root mean squared errors for all lifts were better than previous research and below clinically acceptable thresholds. This research supports the use of lumbar flexion measurements from these inertial measurement units in populations with low back pain, where multi-plane lifting movements are assessed.
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Krug RC, Silva MF, Lipp OV, O'Sullivan PB, Almeida R, Peroni IS, Caneiro JP. An investigation of implicit bias about bending and lifting. Scand J Pain 2022; 22:336-347. [PMID: 34821139 DOI: 10.1515/sjpain-2021-0145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 11/03/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Previous studies in a high-income country have demonstrated that people with and without low back pain (LBP) have an implicit bias that bending and lifting with a flexed lumbar spine is dangerous. These studies present two key limitations: use of a single group per study; people who recovered from back pain were not studied. Our aims were to evaluate: implicit biases between back posture and safety related to bending and lifting in people who are pain-free, have a history of LBP or have current LBP in a middle-income country, and to explore correlations between implicit and explicit measures within groups. METHODS Exploratory cross-sectional study including 174 participants (63 pain-free, 57 with history of LBP and 54 with current LBP). Implicit biases between back posture and safety related to bending and lifting were assessed with the Implicit Association Test (IAT). Participants completed paper-based (Bending Safety Belief [BSB]) and online questionnaires (Tampa Scale of Kinesiophobia; Back Pain Attitudes Questionnaire). RESULTS Participants displayed significant implicit bias between images of round-back bending and lifting and words representing "danger" (IATD-SCORE: Pain-free group: 0.56 (IQR=0.31-0.91; 95% CI [0.47, 0.68]); history of LBP group: 0.57 (IQR=0.34-0.84; 95% CI [0.47, 0.67]); current LBP group: 0.56 (IQR=0.24-0.80; 95% CI [0.39, 0.64])). Explicit measures revealed participants hold unhelpful beliefs about the back, perceiving round-back bending and lifting as dangerous (BSBthermometer: Pain-free group: 8 (IQR=7-10; 95% CI [7.5, 8.5]); history of LBP group: 8 (IQR=7-10; 95% CI [7.5, 9.0]); current LBP group: 8.5 (IQR=6.75-10; [7.5, 9.0])). There was no correlation between implicit and explicit measures within the groups. CONCLUSIONS In a middle-income country, people with and without LBP, and those who recovered from LBP have an implicit bias that round-back bending and lifting is dangerous.
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Affiliation(s)
- Roberto Costa Krug
- Physical Therapy Department, Graduate Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Marcelo Faria Silva
- Physical Therapy Department, Graduate Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Ottmar V Lipp
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, Australia
| | - Peter B O'Sullivan
- School of Allied Health, Curtin University, Perth, Australia
- Body Logic Physiotherapy, Shenton Park, Perth, Australia
| | - Rosicler Almeida
- Physical Therapy Department, Graduate Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Ian Sulzbacher Peroni
- Physical Therapy Department, Graduate Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - J P Caneiro
- School of Allied Health, Curtin University, Perth, Australia
- Body Logic Physiotherapy, Shenton Park, Perth, Australia
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Crea S, Beckerle P, De Looze M, De Pauw K, Grazi L, Kermavnar T, Masood J, O’Sullivan LW, Pacifico I, Rodriguez-Guerrero C, Vitiello N, Ristić-Durrant D, Veneman J. Occupational exoskeletons: A roadmap toward large-scale adoption. Methodology and challenges of bringing exoskeletons to workplaces. WEARABLE TECHNOLOGIES 2021; 2:e11. [PMID: 38486625 PMCID: PMC10936259 DOI: 10.1017/wtc.2021.11] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 08/03/2021] [Accepted: 08/08/2021] [Indexed: 03/17/2024]
Abstract
The large-scale adoption of occupational exoskeletons (OEs) will only happen if clear evidence of effectiveness of the devices is available. Performing product-specific field validation studies would allow the stakeholders and decision-makers (e.g., employers, ergonomists, health, and safety departments) to assess OEs' effectiveness in their specific work contexts and with experienced workers, who could further provide useful insights on practical issues related to exoskeleton daily use. This paper reviews present-day scientific methods for assessing the effectiveness of OEs in laboratory and field studies, and presents the vision of the authors on a roadmap that could lead to large-scale adoption of this technology. The analysis of the state-of-the-art shows methodological differences between laboratory and field studies. While the former are more extensively reported in scientific papers, they exhibit limited generalizability of the findings to real-world scenarios. On the contrary, field studies are limited in sample sizes and frequently focused only on subjective metrics. We propose a roadmap to promote large-scale knowledge-based adoption of OEs. It details that the analysis of the costs and benefits of this technology should be communicated to all stakeholders to facilitate informed decision making, so that each stakeholder can develop their specific role regarding this innovation. Large-scale field studies can help identify and monitor the possible side-effects related to exoskeleton use in real work situations, as well as provide a comprehensive scientific knowledge base to support the revision of ergonomics risk-assessment methods, safety standards and regulations, and the definition of guidelines and practices for the selection and use of OEs.
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Affiliation(s)
- Simona Crea
- Scuola Superiore Sant’Anna, The BioRobotics Institute, Pontedera, Italy
- IRCCS Fondazione Don Gnocchi, Florence, Italy
| | - Philipp Beckerle
- Chair of Autonomous Systems and Mechatronics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Institute for Mechatronic Systems, Technische Universität Darmstadt, Darmstadt, Germany
| | | | - Kevin De Pauw
- Human Physiology and Sports Physiotherapy Research Group, and Brussels Human Robotics Research Center (BruBotics), Vrije Universiteit Brussel, Brussels, Belgium
| | - Lorenzo Grazi
- Scuola Superiore Sant’Anna, The BioRobotics Institute, Pontedera, Italy
| | - Tjaša Kermavnar
- School of Design, and Confirm Smart Manufacturing Centre, University of Limerick, Limerick, Ireland
| | - Jawad Masood
- Processes and Factory of the Future Department, CTAG – Centro Tecnológico de Automoción de Galicia, Pontevedra, Spain
| | - Leonard W. O’Sullivan
- School of Design, and Confirm Smart Manufacturing Centre, University of Limerick, Limerick, Ireland
| | - Ilaria Pacifico
- Scuola Superiore Sant’Anna, The BioRobotics Institute, Pontedera, Italy
| | - Carlos Rodriguez-Guerrero
- Robotics and Multibody Mechanics Research Group, Department of Mechanical Engineering, Vrije Universiteit Brussel and Flanders Make, Brussel, Belgium
| | - Nicola Vitiello
- Scuola Superiore Sant’Anna, The BioRobotics Institute, Pontedera, Italy
- IRCCS Fondazione Don Gnocchi, Florence, Italy
| | | | - Jan Veneman
- Chair of COST Action 16116, Hocoma Medical GmbH, Zürich, Switzerland
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