Abstract

In patients with chronic low back pain (CLBP), reduced lumbar flexion-relaxation and reduced variability of muscle activity distribution are reported as abnormal muscle activity. It is not known how abnormal muscle activity and pain-related factors are related to CLBP-based disability. Here, we performed an association rule analysis to investigated how CLBP disability, muscle activity, and pain-related factors in CLBP patients are related. Surface electromyographic signals were recorded from over the bilateral lumbar erector spinae muscle with four-channel electrodes from 24 CLBP patients while they performed a trunk flexion re-extension task. We calculated the average value of muscle activities of all channels and then calculated the flexion relaxation ratio (FRR) and the spatial variability of muscle activities. We also assessed the pain-related factors and CLBP disability by a questionnaire method. A clustering association rules analysis was performed to determine the relationships among pain-related factors, the FRR, and the variability of muscle activity distribution. The association rules of severe CLBP disability were divisible into five classes, including 'low FRR-related rules.' The rules of the mild CLBP disability were divisible into four classes, including 'high FRR-related rules' and 'high muscle variability-related rules.' When we combined pain-related factors with the FRR and muscle variability, the relationship between abnormal FRR/muscle variability and CLBP disability became stronger. Our findings thus highlight the importance of focusing on not only the patients' pain-related factors but also the abnormal motor control associated with CLBP, which causes CLBP disability.

Highlights

  • Low back pain (LBP) is one of the common symptoms and the most common cause of disability worldwide [1,2,3]

  • The association rules of severe chronic low back pain (CLBP) disability were divisible into five classes, including ‘low flexion-relaxation ratio (FRR)-related rules.’

  • The rules of the mild CLBP disability were divisible into four classes, including ‘high FRR-related rules’ and ‘high muscle variability-related rules.’

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Summary

Introduction

Low back pain (LBP) is one of the common symptoms and the most common cause of disability worldwide [1,2,3]. The severity and disability of LBP are associated with several factors including psychological, social, and biophysical factors, co-morbidities, and pain-processing mechanisms [4]. Psychological factors such as anxiety, depression, catastrophic thinking, kinesiophobia, and self-efficacy are often associated with disability in individuals with chronic low back pain (CLBP) [5,6,7,8,9,10,11]. In CLBP patients, the FRR is reportedly decreased, indicating that they cannot relax their spinal extensor muscles at the end range of lumbo-pelvic flexion [15, 17]

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