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De Carvalho D, Mackey S, To D, Summers A, Frey M, Romme K, Hogg-Johnson S, Howarth SJ. A systematic review and meta analysis of measurement properties for the flexion relaxation ratio in people with and without non specific spine pain. Sci Rep 2024; 14:3260. [PMID: 38332128 PMCID: PMC10853169 DOI: 10.1038/s41598-024-52900-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 01/24/2024] [Indexed: 02/10/2024] Open
Abstract
This review sought to identify, critically appraise, compare, and summarize the literature on the reliability, discriminative validity and responsiveness of the flexion relaxation ratio (FRR) in adults (≥ 18 years old) with or without spine pain (any duration), in either a clinical or research context. The review protocol was registered on Open Science Framework ( https://doi.org/10.17605/OSF.IO/27EDF ) and follows COSMIN, PRISMA, and PRESS guidelines. Six databases were searched from inception to June 1, 2022. The search string was developed by content experts and a health services librarian. Two pairs of reviewers independently completed titles/abstracts and full text screening for inclusion, data extraction, and risk of bias assessment (COSMIN RoB Toolkit). At all stages, discrepancies were resolved through consensus meetings. Data were pooled where possible with a three-level random effects meta-analyses and a modified GRADE assessment was used for the summary of findings. Following duplicate removal, 728 titles/abstracts and 219 full texts were screened with 23 included in this review. We found, with moderate certainty of evidence, that the cervical FRR has high test-retest reliability and lumbar FRR has moderate to high test-retest reliability, and with high certainty of evidence that the cervical and lumbar FRR can discriminate between healthy and clinical groups (standardized mean difference - 1.16 [95% CI - 2.00, - 0.32] and - 1.21 [- 1.84, - 0.58] respectively). There was not enough evidence to summarize findings for thoracic FRR discriminative validity or the standard error of measurement for the FRR. Several studies used FRR assuming responsiveness, but no studies were designed in a way that could confirm responsiveness. The evidence supports adequate reliability of FRR for the cervical and lumbar spine, and discriminative validity for the cervical and lumbar spine only. Improvements in study design and reporting are needed to strengthen the evidence base to determine the remaining measurement properties of this outcome.
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Affiliation(s)
- Diana De Carvalho
- Division of Population Health and Applied Health Sciences, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada.
| | - Sarah Mackey
- Division of Population Health and Applied Health Sciences, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Daphne To
- Department of Clinical Education, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Allyson Summers
- Division of Population Health and Applied Health Sciences, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Mona Frey
- Division of BioMedical Sciences, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Kristen Romme
- Health Sciences Library, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Sheilah Hogg-Johnson
- Division of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Samuel J Howarth
- Division of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, ON, Canada
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Jeong YG, Jeong YJ, Koo JW. Effect of chronic knee osteoarthritis on flexion-relaxation phenomenon of the erector spinae in elderly females. J Phys Ther Sci 2016; 28:1964-7. [PMID: 27512244 PMCID: PMC4968486 DOI: 10.1589/jpts.28.1964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Accepted: 04/07/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study investigated the flexion-relaxation phenomenon of the erector spinae
in elderly women with chronic knee osteoarthritis and determined whether the
flexion-relaxation phenomenon can be used as a pain evaluation tool in such cases.
[Subjects and Methods] Seventeen elderly females with chronic knee osteoarthritis and 13
healthy young females voluntarily participated in this study. They performed three
postural positions in 15 s: trunk flexion, complete trunk flexion, and trunk extension,
each for 5 s. While these positions were held, muscle activation of the thoracic and
lumbar erector spinae were measured using surface electromyography. The flexion-relaxation
rate was determined by dividing the values for trunk extension by those of complete trunk
flexion and by dividing the values for trunk flexion by those of complete trunk flexion.
[Results] According to our results, the flexion-relaxation phenomenon was different
between healthy young and elderly females with chronic knee osteoarthritis. Specifically,
there was a difference in the left thoracic erector spinae muscle, but not in the left and
right lumbar erector spinae or right thoracic spinae muscle. [Conclusion] Our study
demonstrated that the erector spinae muscle flexion-relaxation phenomenon can be used as a
pain evaluation tool in elderly females with chronic knee osteoarthritis.
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Affiliation(s)
- Yeon-Gyu Jeong
- Department of Physical Therapy, Sangji University, Republic of Korea; Department of Occupational and Environmental Medicine, College of Medicine, The Catholic University of Korea: Seoul 06591, Republic of Korea
| | - Yeon-Jae Jeong
- Rehabilitation Medicine Hanyang University Medical Center, Republic of Korea
| | - Jung-Wan Koo
- Department of Occupational and Environmental Medicine, College of Medicine, The Catholic University of Korea: Seoul 06591, Republic of Korea
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Park SS, Choi BR. Effects of lumbar stabilization exercises on the flexion-relaxation phenomenon of the erector spinae. J Phys Ther Sci 2016; 28:1709-11. [PMID: 27390399 PMCID: PMC4932040 DOI: 10.1589/jpts.28.1709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 02/15/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study evaluated the differences in the flexion-relaxation phenomenon (FRP) of the right and left erector spinae muscles in asymptomatic subjects and the effect of lumbar stabilization exercises on these differences. [Subjects and Methods] Twenty-six participants (12 in the exercise group and 14 in the control group) with a difference in the FRP in the right and left erector spinae muscles were recruited from among healthy students attending Silla University. The exercise group performed two lumbar stabilization exercises (back bridge exercise and hand-knee exercise) for 4 weeks. The control group did not exercise. [Results] No significant group-by-exercise interaction was found. The right and left erector spinae muscles did show a difference in FRP between the control and exercise groups (119.2 ± 69.2 and 131.1 ± 85.2 ms, respectively). In addition, the exercise group showed a significant decrease in post-exercise (50.0 ± 27.0 ms) compared to pre-exercise (112.3 ± 41.5 ms) differences in the right and left FRP. [Conclusion] These results suggest that lumbar stabilization exercises may counter asymmetry of the FRP in the erector spinae muscles, possibly preventing low back pain in the general population.
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Affiliation(s)
- San-Seong Park
- Department of Physical Therapy, College of Health and Welfare, Silla University, Republic of Korea
| | - Bo-Ram Choi
- Department of Physical Therapy, College of Health and Welfare, Silla University, Republic of Korea
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