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: In this article, the authors explored the relationship between postural control and pain-related clinical outcomes in patients with chronic nonspecific low back pain (cNLBP) and healthy individuals.
Abstract: Objectives. To explore the relationship between postural control and pain-related clinical outcomes in patients with chronic nonspecific low back pain (cNLBP). Methods. Participants with cNLBP and healthy individuals were recruited. Muscle activities were recorded during internal and external perturbation tasks. Postural control capacity was assessed by muscle onset time and integrals of electromyography (iEMGs) of postural muscles during the phases of anticipatory postural adjustments (APAs) and compensatory postural adjustments (CPAs). Correlation analysis was employed to investigate the relationship between postural control capacity, pain, and disability. Results. Twenty-seven patients with cNLBP and 27 healthy participants were recruited. Gastrocnemius (GA) muscle onset time was earlier in the cNLBP group than in the control group in the internal perturbation task. The onset time of GA and erector spinae (ES) of the cNLBP group was later than that of the controls in the external perturbation task. Disability level moderately correlated with the iEMGs of rectus abdominis (RA), GA, and external oblique (EO) during APAs. Pain score moderately correlated with the iEMGs of RA, EO, and ES during CPAs of perturbation tasks. Conclusion. cNLBP participants had altered muscle activation strategy to maintain postural stability in response to perturbation. This study further discovered that pain-related disabilities of cNLBP participants were likely related to the APAs capacity, whereas the pain intensity may relate to the CPAs capacity. Pain and disability may therefore be related to the control process of the posture-related muscles.
8 citations
TL;DR: Although wearing rocker-sole shoes results in greater postural instability than flat-sole Shoes, long-term use of rocker -sole shoes did not appear to influence postural stability in people with CLBP.
Abstract: The clinical study from which participants in the current study were recruited was funded by a Masai GB Ltd. project grant.
8 citations
Dissertation•
28 May 2018
TL;DR: La lombalgie (LBP) touche 80% of the population mondiale adulte et devient chronique dans 10 a 15% des cas adultes, aucune cause ne peut etre clairement identifiee pour expliquer ces douleurs et l’on parle alors de lombalgia chronique « non-specifique » (NSCLBP).
Abstract: La lombalgie (LBP) touche 80% de la population mondiale adulte et devient chronique dans 10 a 15% des cas. Pour la grande majorite des cas adultes (85%), aucune cause ne peut etre clairement identifiee pour expliquer ces douleurs et l’on parle alors de lombalgie chronique « non-specifique » (NSCLBP). Chez l’enfant et l’adolescent, la prevalence de la NSCLBP est semblable a celle de l’adulte. Malgre la faible incidence de pathologies graves associees, la lombalgie de l’enfant et de l’adolescent implique, souvent dans sa prise en charge diagnostique, une exposition augmentee aux radiations et un stress parental important. Cependant, la presence d’anomalies radiologiques est aussi frequente dans la population asymptomatique que dans la population avec NSCLBP. Ceci remet en question l’interet clinique de la radiologie pour depister une cause possible de NSCLBP. Dans ce contexte, il est necessaire d’identifier de nouveaux outils, si possible non-irradiants et peu couteux, pour identifier des caracteristiques specifiques aux enfants et adolescents souffrant de NSCLBP et ainsi ameliorer la comprehension de cette pathologie.L’analyse electromyographique (EMG) de l’activite des muscles paravertebraux lombaires s’est averee cliniquement pertinente dans la population adulte pour discriminer les patients souffrant de NSCLBP des participants asymptomatiques. Plusieurs parametres EMG enregistres lors de differentes tâches ont ete identifies chez l’adulte pour caracteriser les participants NSCLBP. Les parametres EMG des muscles lombaires les plus couramment rapportes dans la litterature sont : un temps de maintien reduit ainsi qu’une fatigue musculaire acceleree pendant le test d’endurance des muscles extenseurs du tronc, la reduction ou l’absence du phenomene de flexion-relaxation (FRP) pendant la tâche de flexion maximale du tronc ainsi qu’un pattern atypique supportant l’hypothese de precaution pendant la marche a differentes vitesses. Si ces caracteristiques EMG specifiques aux patients souffrant de NSCLBP ont ete bien etablies chez l’adulte, la question est desormais de savoir ce qu’il en est chez l’enfant et l’adolescent souffrant de NSCLBP.Dans ce contexte clinique, l’objectif de ce travail doctoral etait d’evaluer les caracteristiques EMG decrites ci-dessus dans une cohorte d’enfants et d’adolescents souffrant de NSCLBP en comparaison a des participants asymptomatiques (CTRL). Pour y repondre, plusieurs etudes complementaires ont ete effectuees.Dans leur ensemble, les travaux de cette these de doctorat ont montre que les phenomenes EMG reportes dans une population adulte avec NSCLBP ne sont pas retrouves dans une population pediatrique avec NSCLBP. Ces resultats remettent en question le diagnostic et la prise en charge actuelle des enfants et adolescents souffrant de NSCLBP, qui est, a ce jour, calquee sur le modele adulte. Des etudes supplementaires sont cependant necessaires pour confirmer ces resultats sur une cohorte plus importante. Il serait aussi interessant d’evaluer une meme cohorte a partir de l’enfance jusqu’a l’âge adulte afin d’evaluer quels facteurs pourraient predire l’apparition des phenomenes rapportes dans la litterature adulte.
8 citations
TL;DR: Individuals with chronic LBP had worse postural control performance than matched controls, and it is possible to characterize those with and without LBP with CoP variables.
8 citations
TL;DR: In this article, the authors investigated whether young university students with neck pain have postural control deficits when compared to sex and age-matched asymptomatic subjects, and found that individuals with subclinical NP were more likely to fail the 90 s tandem test (p<0.05) in the force plate and univariate comparisons revealed significant difference in the tandem and single leg stance clinical test measurements.
8 citations
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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