Is there a relationship between pain intensity and postural sway in patients with non-specific low back pain?
TL;DR: COP mean velocity and sway area are closely related to self-reported pain scores and may be of clinical use as an objective monitoring tool for patients under treatment or rehabilitation.
Abstract: Increased center of pressure excursions are well documented in patients suffering from non-specific low back pain, whereby the altered postural sway includes both higher mean sway velocities and larger sway area. No investigation has been conducted to evaluate a relationship between pain intensity and postural sway in adults (aged 50 or less) with non-specific low back pain. Seventy-seven patients with non-specific low back pain and a matching number of healthy controls were enrolled. Center of pressure parameters were measured by three static bipedal standing tasks of 90 sec duration with eyes closed in narrow stance on a firm surface. The perceived pain intensity was assessed by a numeric rating scale (NRS-11), an equal number of patients (n = 11) was enrolled per pain score. Generally, our results confirmed increased postural instability in pain sufferers compared to healthy controls. In addition, regression analysis revealed a significant and linear increase in postural sway with higher pain ratings for all included COP parameters. Statistically significant changes in mean sway velocity in antero-posterior and medio-lateral direction and sway area were reached with an incremental change in NRS scores of two to three points. COP mean velocity and sway area are closely related to self-reported pain scores. This relationship may be of clinical use as an objective monitoring tool for patients under treatment or rehabilitation.
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TL;DR: It is suggested that fall risk, postural stability and sensory integration of balance should be considered as outcome measures in clinical management of persons with discogenic LBP and people with degenerative disc disorders of the lumbar spine.
Abstract: BACKGROUND: Even though studies have reported impaired postural ability (PS) and risk of fall in non-specific low back pain (LBP), evidence is relatively scarce in terms of discogenic LBP or in persons with degenerative disc disorders of the lumbar spine. OBJECTIVE: To determine the differences in terms of PS, fall risk and sensory integration of balance in persons with discogenic LBP as compared to healthy controls. METHODS: A cross sectional comparative study was conducted on 60 participants, out of which 30 had discogenic LBP and 30 were healthy controls. The variables of interest included PS, fall risk score (FRS) and clinical test of sensory integration of balance (CTSIB), and the data was collected using Biodex Balance SystemTM SD, with higher scores signifying poorer outcomes. RESULTS: Persons with discogenic LBP scored significantly (p < 0.05) higher in terms of overall PS index [Mean difference = 2.33 (95% CI 1.38, 3.28)], anteroposterior PS index [Mean difference = 1.87 (95% CI 0.84, 2.90)] and mediolateral PS index [Mean difference = 0.82 (95% CI 0.43, 1.21)], FRS [Mean difference = 2.92 (95% CI 2.36, 4.8)] and CTSIB [Mean difference = 1.67 (95% CI 1.28, 2.06)] as compared to healthy controls. Both healthy controls and persons with discogenic LBP revealed higher anteroposterior postural stability index as compared to mediolateral postural stability index (p < 0.001). CONCLUSIONS: Persons with discogenic low back pain exhibit greater risk of fall and poorer postural stability and sensory integration of balance as compared to healthy controls. It is suggested that fall risk, postural stability and sensory integration of balance should be considered as outcome measures in clinical management of such patients.
01 May 2016
TL;DR: The results of this study show the negative impact of LBP exacerbation on physical capacity in the elderly, and it is important that health professionals involved in elderly care are attentive in the assessment and interpretation of clinical conditions regarding LBP to prevent negative impacts on physical function.
Abstract: The purpose of this study was to compare physical capacity in elderly with and without acute low back pain (LBP). The Back Complaints in the Elders (BACE) consortium is a prospective study conducted in Brazil, Australia, and Netherlands. This subsample consists of elderly BACE Brazil study volunteers. This is an observational, cross-sectional, and comparative study with older adults aged ≥ 65 years who had a new episode (an agudization of symptoms) of LBP. Physical capacity was assessed using the Timed Up and Go test, Sit to Stand test, and normal Walking Speed test. Continuous variables were compared using a nonparametric Mann Whitney U test. A chi squared test was used for categorical variables. Significance level of α = 5%. The study included 104 elderly with mean age of 72.3 ± 4.2 years, classified into two groups: 52 elderly with LBP (GI) and 52 elderly without LBP (GII). The GI group showed worse performance in the Timed Up and Go (p = 0.000), Sit to Stand (p = 0.000) and normal Walking Speed (p = 0.002) tests than the GII group. Finally, the results of this study show the negative impact of LBP exacerbation on physical capacity in the elderly. Thus, it is important that health professionals involved in elderly care are attentive in the assessment and interpretation of clinical conditions regarding LBP to prevent negative impacts on physical function.
TL;DR: The neurosensory Posturotherapy is a simple method of diagnosis and treatment of neural dysfunction involved in neuropathic pain and balance disorders and represents a new therapeutic contribution in the management of subjects with specific chronic pain syndrome.
Abstract: Objectives Chronic pain syndromes are frequently associated with balance disorders [1] . For example, studies showed a linear relationship between pain and stability [1] in no-specific low back pain [2] . The reexamination of the links between nerves and pain [3] modifies the traditional perception of these chronic pain syndromes without organic cause and these neural dysfunctions. The aim of this communication is to propose a new, original and innovative clinical approach to the management of chronic pain syndrome by the use of postural investigation and neurosensory stimulation. Methods The neurosensory Posturotherapy [3] uses a simple methodology to understand neural physiology through a palpatory sensory evaluation and then to perform manual neurostimulation. These stimulations include the neural saturation of the dysfunctional nerve associated with a sideration of muscles innervated by the nerve being treated. This approach can be completed by plantar neurostimulations inducing postural remediation. Results Firstly, the dysfunction of a nerve is associated with hypertonia of the muscles which it innervates. Secondly, the nervi nervorum compose the intrinsic innervations of nerve sheath. They are polymodal receptors located at the periphery of the nerve sheath. They encode the mechanical information exerted on the nerve. The response of the mechanoreceptors increases with the intensity of the stimulation up to a plateau and then decreases from a threshold value. Thirdly, pressure and vibration, exerted with intensity higher than the threshold value, induces a saturation of the response of the mechanoreceptor. Lastly, the saturation points used by the treatment are most often found at the points of cutaneous emergence of the nerve. Conclusion The neurosensory Posturotherapy is a simple method of diagnosis and treatment of neural dysfunction involved in neuropathic pain and balance disorders. It represents a new therapeutic contribution in the management of subjects with specific chronic pain syndrome.
TL;DR: Physical function capacity measures are recommended as outcome measures for people with lower limb tendinopathy as discussed by the authors , but only eight studies recommended a physical function capacity measure, and pain was the most common criterion that was used to determine the progression of rehabilitation.
TL;DR: In this article, the authors evaluated single stance stability in young adults with lumbar derangement syndrome (LDS) and in the control group of the healthy subjects and found that patients with LDS showed significantly worse proprioceptive control.
Abstract: Maintaining body balance is a complex function based on the information deriving from the vestibular, visual, and proprioceptive systems. The aim of the study was to evaluate quiet single stance stability in young adults with lumbar derangement syndrome (LDS) and in the control group of the healthy subjects. The second aim of this study was to determine whether pain intensity, degree of disability, and the level of physical activity can influence postural control in patients with LDS. It is important to underline that selecting a homogeneous group of LBP patients using, for example, mechanical diagnosis and therapy method and Quebec Task Force Classification, can result in an increased sensitivity of the study. The study included 126 subjects: 70 patients with LDS (37 women, 33 men) and the control group 56 healthy volunteers (36 women, 20 men). In case of multiple group comparisons for variables with normal distribution, ANOVA post hoc test was used or, as the nonparametric equivalent, Kruskal-Wallis test. In all these calculations, the statistical significance level was set to . The stability index eyes open for the study group was 88.34 and for the control group 89.86. There was no significant difference in the level of postural control between the study and control groups ( ). The level of stability index eyes closed (SI EC) for the study group was 71.44 and for the control group 77.1. SI EC results showed significant differences in proprioceptive control during single leg stance between the study and control groups ( ). The level of pain intensity, the degree of disability, and physical activity level did not influence postural control in the study group with LDS. In summary, patients with LDS showed significantly worse proprioceptive control.
References
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TL;DR: In this article, the authors present guidelines for choosing among six different forms of the intraclass correlation for reliability studies in which n target are rated by k judges, and the confidence intervals for each of the forms are reviewed.
Abstract: Reliability coefficients often take the form of intraclass correlation coefficients. In this article, guidelines are given for choosing among six different forms of the intraclass correlation for reliability studies in which n target are rated by k judges. Relevant to the choice of the coefficient are the appropriate statistical model for the reliability and the application to be made of the reliability results. Confidence intervals for each of the forms are reviewed.
21,185 citations
"Is there a relationship between pai..." refers methods in this paper
...To test the reliability of the COP measures for this experimental setup for both controls and pain sufferers, the two-way random-effect intra-class correlation coefficient (ICC2,k) as described by Shrout and Fleiss [18] was computed using absolute agreement....
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...Shrout PE, Fleiss JL: Intraclass correlations: uses in assessing rater reliability....
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TL;DR: In this review, the basics of classic reliability theory are addressed in the context of choosing and interpreting an ICC and how the SEM and its variants can be used to construct confidence intervals for individual scores and to determine the minimal difference needed to be exhibited for one to be confident that a true change in performance of an individual has occurred.
Abstract: Reliability, the consistency of a test or measurement, is frequently quantified in the movement sciences literature. A common metric is the intraclass correlation coefficient (ICC). In addition, the SEM, which can be calculated from the ICC, is also frequently reported in reliability studies. However, there are several versions of the ICC, and confusion exists in the movement sciences regarding which ICC to use. Further, the utility of the SEM is not fully appreciated. In this review, the basics of classic reliability theory are addressed in the context of choosing and interpreting an ICC. The primary distinction between ICC equations is argued to be one concerning the inclusion (equations 2,1 and 2,k) or exclusion (equations 3,1 and 3,k) of systematic error in the denominator of the ICC equation. Inferential tests of mean differences, which are performed in the process of deriving the necessary variance components for the calculation of ICC values, are useful to determine if systematic error is present. If so, the measurement schedule should be modified (removing trials where learning and/or fatigue effects are present) to remove systematic error, and ICC equations that only consider random error may be safely used. The use of ICC values is discussed in the context of estimating the effects of measurement error on sample size, statistical power, and correlation attenuation. Finally, calculation and application of the SEM are discussed. It is shown how the SEM and its variants can be used to construct confidence intervals for individual scores and to determine the minimal difference needed to be exhibited for one to be confident that a true change in performance of an individual has occurred.
3,992 citations
"Is there a relationship between pai..." refers background or methods in this paper
...Weir JP: Quantifying test-retest reliability using the intraclass correlation coefficient and the SEM....
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...Secondly, given the linear relationship between pain intensity and, for example, mVel, a clinically significant decrease of two points on a pain NRS [20] is equivalent to a reduction in mean sway velocity of 3....
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...In addition, the 95% confidence intervals (CI) and the standard error of measurement (SEM) [20] were calculated....
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TL;DR: The results indicate that, for the present sample, the scales yield similar results in terms of the number of subjects who respond correctly to them and their predictive validity, however, when considering the remaining 3 criteria, the 101‐point numerical rating scale appears to be the most practical index.
Abstract: The measurement of subjective pain intensity continues to be important to both researchers and clinicians. Although several scales are currently used to assess the intensity construct, it remains unclear which of these provides the most precise, replicable, and predictively valid measure. Five criteria for judging intensity scales have been considered in previous research: ease of administration of scoring; relative rates of incorrect responding; sensitivity as defined by the number of available response categories; sensitivity as defined by statistical power; and the magnitude of the relationship between each scale and a linear combination of pain intensity indices. In order to judge commonly used pain intensity measures, 75 chronic pain patients were asked to rate 4 kinds of pain (present, least, most, and average) using 6 scales. The utility and validity of the scales was judged using the criteria listed above. The results indicate that, for the present sample, the scales yield similar results in terms of the number of subjects who respond correctly to them and their predictive validity. However, when considering the remaining 3 criteria, the 101-point numerical rating scale appears to be the most practical index.
2,921 citations
"Is there a relationship between pai..." refers methods in this paper
...The NSLBP participants were further asked to describe their pain intensity at the time of recording by means of an NRS-11, a rating scale ranging from 0 (no pain) to 10 (worst possible pain) [15]....
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Journal Article•
TL;DR: A set of criteria based upon biostatistical considerations for determining the interrater reliability of specific adaptive behavior items in a given setting was presented and guidelines for differentiating type of adaptive behavior that are statistically reliable from those that are reliable in a clinical or practical sense were delineated.
Abstract: A set of criteria based upon biostatistical considerations for determining the interrater reliability of specific adaptive behavior items in a given setting was presented. The advantages and limitations of extant statistical assessment procedures were discussed. Also, a set of guidelines for differentiating type of adaptive behavior that are statistically reliable from those that are reliable in a clinical or practical sense was delineated. Data sets were presented throughout in order to illustrate the advantages of recommended statistical procedures over other available ones.
2,017 citations
TL;DR: The studies reviewed show that bipedal static COP measures may be used as a reliable tool for investigating general postural stability and balance performance under specific conditions and recommendations for maximizing the reliability of COP data are provided.
500 citations
"Is there a relationship between pai..." refers methods in this paper
...Our results were derived using a protocol based on best evidence [16], nevertheless future studies are needed to confirm these findings using the same protocol....
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...Mean velocity (mVel) was chosen as the main COP parameter as this has consistently shown to be both reliable [16] and discriminative for NSLBP [1]....
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...The experimental setup was based on an earlier literature review where a best practice setup for obtaining reliable COP data was published [16]....
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