Abstract
BackgroundSørensen trunk extension endurance test performance predicts the development of low back pain and is a strong discriminator of those with and without low back pain. Performance may greatly depend on psychological factors, such as kinesiophobia, self-efficacy, and motivation. Virtual reality video games have been used in people with low back pain to encourage physical activity that would otherwise be avoided out of fear of pain or harm. Accordingly, we developed a virtual reality video game to assess the influence of immersive gaming on the Sørensen test performance.ObjectiveThe objective of our study was to determine the physiological and psychological predictors of time to task failure (TTF) on a virtual reality Sørensen test in participants with and without a history of recurrent low back pain.MethodsWe recruited 24 individuals with a history of recurrent low back pain and 24 sex-, age-, and body mass index–matched individuals without a history of low back pain. Participants completed a series of psychological measures, including the Center for Epidemiological Studies-Depression Scale, Pain Resilience Scale, Pain Catastrophizing Scale, Tampa Scale for Kinesiophobia, and a self-efficacy measure. The maximal isometric strength of trunk and hip extensors and TTF on a virtual reality Sørensen test were measured. Electromyography of the erector spinae, gluteus maximus, and biceps femoris was recorded during the strength and endurance trials.ResultsA two-way analysis of variance revealed no significant difference in TTF between groups (P=.99), but there was a trend for longer TTF in females on the virtual reality Sørensen test (P=.06). Linear regression analyses were performed to determine predictors of TTF in each group. In healthy participants, the normalized median power frequency slope of erector spinae (beta=.450, P=.01), biceps femoris (beta=.400, P=.01), and trunk mass (beta=−.32, P=.02) predicted TTF. In participants with recurrent low back pain, trunk mass (beta=−.67, P<.001), Tampa Scale for Kinesiophobia (beta=−.43, P=.01), and self-efficacy (beta=.35, P=.03) predicted TTF.ConclusionsTrunk mass appears to be a consistent predictor of performance. Kinesiophobia appears to negatively influence TTF for those with a history of recurrent low back pain, but does not influence healthy individuals. Self-efficacy is associated with better performance in individuals with a history of recurrent low back pain, whereas a less steep median power frequency slope of the trunk and hip extensors is associated with better performance in individuals without a history of low back pain.
Highlights
Low back pain (LBP) represents a significant societal and economic burden [1] with direct medical costs approaching US $100 billion annually in the United States alone [2]
The independent-sample t test revealed no significant differences between Healthy and LBP groups with one exception; the depression scores were significantly higher in the LBP group than in those the healthy group (Table 2)
A 2 Group (Healthy, LBP) x 2 Sex (Male, Female) two-way analysis of variance revealed no significant differences in group (F1,44=0.00, P=.99) or group by sex (F1,44=0.33, P=.57; Table 3); there was a marginal effect of sex (F1,44=3.89, P=.06), which reflected a tendency toward the longer to task failure (TTF) in female versus male participants
Summary
Low back pain (LBP) represents a significant societal and economic burden [1] with direct medical costs approaching US $100 billion annually in the United States alone [2]. These costs are driven primarily by the 10%-15% of individuals who develop chronic LBP [1,3]. Poor trunk extension endurance has been identified as a risk factor for the development of LBP [4]. Sørensen trunk extension endurance test performance predicts the development of low back pain and is a strong discriminator of those with and without low back pain. We developed a virtual reality video game to assess the influence of immersive gaming on the Sørensen test performance
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