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: A systematic review of the literature shows that postural deficit may be dependent on experimental conditions in which patients with LBP have been assessed, and that between-group differences did not increase with increased complexity of sensory manipulations.
122 citations
TL;DR: The decreased postural stability in people with neck pain appears to be associated with the presence of pain and correlates with the extent of proprioceptive impairment, but appears unrelated to pain duration.
Abstract: Systematic literature review. To assess differences in center of pressure (COP) measures in patients suffering from non-specific neck pain (NSNP) or whiplash-associated disorder (WAD) compared to healthy controls and any relationship between changes in postural sway and the presence of pain, its intensity, previous pain duration and the perceived level of disability. Over the past 20 years, the center of pressure (COP) has been commonly used as an index of postural stability in standing. While several studies investigated COP excursions in neck pain and WAD patients and compared these to healthy individuals, no comprehensive analysis of the reported differences in postural sway pattern exists. Six online databases were systematically searched followed by a manual search of the retrieved papers. Papers comparing COP measures derived from bipedal static task conditions on a force plate of people with NSNP and WAD to those of healthy controls. Two reviewers independently screened titles and abstracts for relevance. Screening for final inclusion, data extraction and quality assessment were carried out with a third reviewer to reconcile differences. Ten papers met the inclusion criteria. Heterogeneity in study designs prevented pooling of the data and no direct comparison of data across the studies was possible. Instead, a qualitative data analysis was conducted. There was broad consensus that patients with either type of neck pain have increased COP excursions compared to healthy individuals, a difference that was more pronounced in people with WAD. An increased sway in antero-posterior direction was observed in both groups. Patients with neck pain (due to either NSNP or WAD) exhibit greater postural instability than healthy controls, signified by greater COP excursions irrespective of the COP parameter chosen. Further, the decreased postural stability in people with neck pain appears to be associated with the presence of pain and correlates with the extent of proprioceptive impairment, but appears unrelated to pain duration.
68 citations
Cites background from "Is there a relationship between pai..."
...We previously described that such a simple static setup is not only highly discriminative for non-specific low back pain [15] but also allowed the observation of a linear relationship between the perceived pain intensity and COP sway velocity [16]....
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...Pain severity has shown to be a determining factor in non-specific low back pain cases [16] where a significant, linear increase in postural sway was observed beginning at a NRS-11 score of 5....
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...As a linear relationship between pain intensity and COP sway velocity has been demonstrated in patients with non-specific low back pain [16], further research is necessary to investigate whether this also applies to people with neck pain....
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TL;DR: Postural control, as evidenced by increased oscillation of COP, is impaired in individuals with cLBP relative to controls, and differences are magnified by visual deprivation and unstable surface conditions.
Abstract: A preliminary case–control study. To assess postural control in individuals with and without non-specific chronic low back pain (cLBP) during quiet standing. cLBP affects 12–33 % of the adult population. Reasons for pain chronicity are yet poorly known. Change in postural control may be a risk factor for cLBP, although available studies are not conclusive. Sample consisted of 21 individuals with cLBP and 23 controls without cLBP. Balance was assessed using a force plate (Balance Master®, NeuroCom) by the modified clinical test of sensory interaction and balance, pain severity by the visual analogue scale, quality of life with the SF-36 Questionnaire, and functional disability with the Roland-Morris Questionnaire. Groups were homogeneous for age, weight, height and body mass index. Relative to controls, participants in the cLBP group had deficits in the postural control, with greater postural sway in the quiet standing condition with closed eyes closed on unstable surfaces (p < 0.05) for the following parameters: total COP oscillation [cLBP 1,432.82 (73.27) vs CG 1,187.77 (60.30)], root mean square sagittal plane [cLBP 1.21 (0.06) vs CG 1.04 (0.04)], COP area [cLBP 24.27 (2.47) vs CG 16.45 (1.79)] and mean speed of oscillation [cLBP 12.97 (0.84) vs CG 10.55 (0.70)]. Postural control, as evidenced by increased oscillation of COP, is impaired in individuals with cLBP relative to controls. Differences are magnified by visual deprivation and unstable surface conditions.
46 citations
TL;DR: A model for control of postural sway is proposed that suggests that subjects with LBP use more co-contraction and less cognitive control, to maintain a standing balance when compared to subjects without LBP.
38 citations
TL;DR: While the results show that none of the parameters alone lead to significant effects, the combination of neuromuscular and biomechanical parameters was associated with the impairment of postural control in individuals with LBP during standing.
Abstract: Background: There is a great number of people who require treatment for non-specific low back pain (LBP) yet the causes are still unclear. One proposed cause for LBP is impaired motor control and more specific an impaired postural control.
Objective: The purpose of this review is to provide an overview of postural control parameter differences in persons with and without non-specific LBP during quite standing.
Methods: A literature search in five databases from January 2000 until January 2018 was performed and was followed by a hand search. Twenty-one articles comparing healthy adults and adults with non-specific LBP in neuromuscular and/or biomechanical parameters during bipedal stance without external perturbation in lab studies were examined. Data extraction and quality assessment were independently performed by two persons. Factors such as study population, outcome measures, and results were extracted from the articles and included in this analysis.
Results: The results show that persons with and without non-specific LBP differed in several parameters of postural control such as the center of pressure displacement, postural control strategy, and muscle activation patterns.
Conclusion: While the results show that none of the parameters alone lead to significant effects, the combination of neuromuscular and biomechanical parameters was associated with the impairment of postural control in individuals with LBP during standing. Since the studies included in this analysis used different methodological procedures a replication of these studies with standardized procedures is imperative for the acquisition of more conclusive evidence on the differences in postural control during standing.
38 citations
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312 citations
TL;DR: A combination of measures reflective of different aspects of mediolateral postural stability during a rapid step task, quiet stance, and movement to the limits of stability were best able to predict faller status, with nonfallers better predicted than fallers.
Abstract: Background. The identification of specific risk factors for falls in community-dwelling elderly persons is required to detect early changes and permit a preventative approach to management. This study determines the ability of various laboratory measures and clinical tests of postural stability to prospectively predict fallers in community-dwelling elderly women. Methods. One hundred elderly women (65‐86 years, mean age 73 6 5 years) performed a reaction-time step task, a limits of stability, and a quiet stance balance task. Postural muscle timing and movement speed were recorded during the step task. Center of pressure (COP) motion was recorded in quiet stance and at the limits of stability. Four common clinical balance tests were performed, and balance confidence, medical and activity history questionnaires were completed. Subjects were followed up regularly for a 6-month period following testing to determine the frequency and characteristics of any falls that occurred. Predictive capabilities of the balance measures to determine fallers were determined through logistic regression models. Results. The clinical balance tests investigated were not able to predict fallers in this community-dwelling elderly population. A combination of variables from the laboratory tasks provided the best overall prediction rate (77%) of fallers (sensitivity 51%) and nonfallers (specificity 91%) from laboratory measures. Of these, step movement time and gluteus medius onset times were the factors best able to predict fallers. Alone, measures of COP motion in quiet stance and at the limits of stability had a poor ability to predict fallers, although they could correctly identify most nonfallers. Prediction was not significantly improved when clinical balance test results were added to the most predictive laboratory measures. Conclusions. Not all older adults with a reduction in balance ability reported a fall over a 6-month period. Of those who did, a combination of measures reflective of different aspects of mediolateral postural stability during a rapid step task, quiet stance, and movement to the limits of stability were best able to predict faller status, with nonfallers better predicted than fallers. These results emphasize the importance of the multifactorial nature of falls in the communitydwelling elderly population in that the clinical and laboratory measures did not predict a high proportion of fallers.
302 citations
"Is there a relationship between pai..." refers background in this paper
...There is evidence that higher COP sway is associated with a higher risk of falling in the elderly [24] and sustaining injuries as a consequence, although this is subject to debate [25,26]....
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TL;DR: Patients with NSLBP exhibit greater postural instability than healthy controls, signified by greater COP excursions and a higher mean velocity, and the decreased postural stability in NSL BP sufferers seems unrelated to the exact location and pain duration.
Abstract: Over the past 20 years, the center of pressure (COP) has been commonly used as an index of postural stability in standing. While many studies investigated COP excursions in low back pain patients and healthy individuals, no comprehensive analysis of the reported differences in postural sway pattern exists. Six online databases were systematically searched followed by a manual search of the retrieved papers. The selection criteria comprised papers comparing COP measures derived from bipedal static task conditions on a force-plate of non-specific low back pain (NSLBP) sufferers to those of healthy controls. Sixteen papers met the inclusion criteria. Heterogeneity in study designs prevented pooling of the data so only a qualitative data analysis was conducted. The majority of the papers (14/16, 88%) concluded that NSLBP patients have increased COP mean velocity and overall excursion as compared to healthy individuals. This was statistically significant in the majority of studies (11/14, 79%). An increased sway in anteroposterior direction was also observed in NSLBP patients. Patients with NSLBP exhibit greater postural instability than healthy controls, signified by greater COP excursions and a higher mean velocity. While the decreased postural stability in NSLBP sufferers further appears to be associated with the presence of pain, it seems unrelated to the exact location and pain duration. No correlation between the pain intensity and the magnitude of COP excursions could be identified.
281 citations
273 citations
TL;DR: Force platform balance tests provide valid information of postural control that can be used to predict fall risk even among older people without apparent balance problems or fall history, when the force platform is not available.
Abstract: Background. Inability to maintain balance while standing increases risk of falls in older people. The present study assessed whether center of pressure (COP) movement measured with force platform technology predicts risk for falls among older people with no manifest deficiency in standing balance. Methods. Participants were 434 community-dwelling women, aged 63-76 years. COP was measured in six stances on a force platform. Following balance tests, participants reported their falls with 12 monthly calendars. Incidence rate ratios (IRR) with 95% confidence intervals (CI) were computed from negative binomial regression models. For the analysis, those with>/=1 fall indoors were coded"indoor fallers,"those with>/=1 fall outdoors, but no indoor falls, were coded"outdoor fallers."Outcome in the models was number of falls. Analyses were repeated including only participants without fall history prior to follow-up. Results. Among 198 fallers, there were 57 indoor and 132 outdoor fallers. The participants in the highest COP movement tertile, irrespective of the balance test, had a two- to fourfold risk for indoor falls compared to participants in the lowest COP tertile of the test. Inability to complete the tandem stance was also a significant predictor of the fall risk. The trend for increased risk for indoor falls was found also for participants in the highest COP movement tertile and without fall history. The COP movement in balance tests was not associated with outdoor falls. Conclusion. Force platform balance tests provide valid information of postural control that can be used to predict fall risk even among older people without apparent balance problems or fall history. When the force platform is not available, tandem stance provides a screening tool to show increased fall risk in community-dwelling older people. Language: en
268 citations
"Is there a relationship between pai..." refers background in this paper
...There is evidence that higher COP sway is associated with a higher risk of falling in the elderly [24] and sustaining injuries as a consequence, although this is subject to debate [25,26]....
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