Functional electromechanical dynamometer is a new, reliable, and safe tool to assess trunk muscle strength in young adults with non-specific chronic low back pain.

Video observation study. To establish the validity of determining effort level by visual observation of a lifting test. Determining effort level during a lifting test is critical for interpretation of test performance, yet the validity of these determinations has not been established in patients with chronic nonspecific low back pain. Fifteen healthy subjects and 16 patients with chronic nonspecific low back pain performed a standardized lifting test as outlined in the Isernhagen Work System Functional Capacity Evaluation. The lifts were videotaped and independently observed by 9 trained observers, who rated effort levels using an Isernhagen Work System categorical scale and a Borg Category Ratio scale. External effort indexes were established to control for effort at group level. Validity of the observer ratings was analyzed by means of a sensitivity and specificity analysis and correlations between performances and observer ratings. Interrater reliability was analyzed by means of intraclass correlation coefficients and Cohen kappa. External indexes differ significantly between patients with chronic low back pain and healthy subjects, indicating that at group level, patients did not perform maximally. Submaximal performances were correctly rated in 85% to 90% (healthy subjects) and in 100% (patients with chronic nonspecific low back pain) of the cases. "Maximal" performances were correctly rated in 46% to 53% (healthy subjects) and in 5% to 7% (patients with chronic nonspecific low back pain) of the cases. Correlations between performances and observer ratings were r = 0.90 to r = 0.92 (healthy subjects) and r = 0.82 (patients with chronic nonspecific low back pain). Reliability: intraclass correlation coefficient, r = 0.76 (patients with chronic nonspecific low back pain) to r = 0.87 (healthy), Kappa K = 0.50 (patients with chronic nonspecific low back pain) to r = 0.58 (healthy subjects). Effort level can be determined validly by means of visual observation.

Although neuromuscular electrical stimulation (NMES) has been used as a safe and relevant complement to voluntary resistance training, its effectiveness in increasing quadriceps femoris muscle strength and mass in healthy young and older adults has not been determined. The aim of this scoping review was to assess the effects of NMES on quadriceps muscle strength and mass in healthy young and older adults. CENTRAL, Pedro, MEDLINE, and PubMed were searched from inception to September 2019. Randomized controlled trials (RCTs) that compared NMES with control group or voluntary resistance training for healthy young and older adults were included. Study characteristics, primary and secondary outcome parameters, and details of the NMES intervention were extracted by 2 reviewers. Only studies for which full text was available in English were included. Thirty-two RCTs including 796 healthy participants were identified as being eligible for young adults, and 5 RCTs including 123 healthy participants were identified as being eligible for older adults. The available evidence strongly suggests that NMES improves quadriceps muscle strength compared with a control group in young adults, but its efficacy seems lower than that of voluntary resistance training. The available limited evidence regarding the effects of NMES on quadriceps muscle mass compared with control in young adults is inconclusive, with 3 RCTs showing positive effects and 3 RCTs not showing positive effects. The very limited available evidence from 5 RCTs in older adults suggests that NMES might be beneficial for increasing quadriceps muscle strength and mass. Overall, the evidence indicates that NMES is an efficacious method for increasing quadriceps muscle strength in young adults, whereas its impact on muscle mass requires further investigations. In addition, the effectiveness of NMES needs to be confirmed in older adults on the basis of more high-quality RCTs with larger sample sizes. This scoping review of 37 RCTs including 919 people is the first study, to the authors' knowledge, to show that the use of NMES increases quadriceps muscle strength in young adults and might improve quadriceps muscle strength compared with control interventions in older adults. In both young and older adults, the effects of NMES on quadriceps muscle mass are still unclear.

Chronic low back pain (CLBP) is burdensome and interferes with psychological and physical functioning of those affected. Past research has examined interpersonal (e.g., attachment insecurity) or intrapersonal factors (e.g., emotion regulation [ER]) involved in chronic pain. However, to enhance our understanding of CLBP's biopsychosocial underpinnings, more empirical integration of both intra- and interpersonal factors involved in CLBP is needed. Thus, our study examined the independent and joint associations of insecure attachment dimensions and ER strategies with CLBP severity and interference. We recruited 242 US adults with CLBP through Prolific Academic, an online participant pool. Participants from Prolific Academic were eligible for the study if they were at least 18 years of age, resided in the US, reported CLBP at least half the days over the past 6 months (>3 months), and used prescribed pain medication for their CLBP. Data collection was between November 2021 and February 2022. Eligible participants filled out a Qualtrics survey which consisted of measures assessing insecure attachment dimensions, ER strategies, as well as demographical information. Outcome variables in the present study were CLBP severity and interference. We ran multiple linear regression models to examine the associations between ER strategies and insecure attachment dimensions as predictors, and CLBP severity or interference as predicted variables, after controlling for sex as a covariate; we also conducted moderation analyses to investigate the interactions between ER strategies and insecure attachment dimensions when testing associations with CLBP severity or interference. Our results indicated that, after controlling for ER strategies, anxious attachment was positively associated with CLBP interference but not pain severity (CI: 0.101 to 0.569; CI: -0.149 to 0.186); avoidant attachment was not associated with CLBP interference or severity (CI: -0.047 to 0.511; CI: -0.143 to 0.256). After adjusting for anxious and avoidant attachment, emotional expression and expressive suppression were positively associated with CLBP severity (CI: 0.037 to 0.328; CI: 0.028 to 0.421) but not interference (CI: -0.003 to 0.403; CI: -0.406 to 0.143). Furthermore, emotional expression was associated with CLBP severity and interference at low and medium levels of avoidant attachment (CI: 0.165 to 0.682; CI: 0.098 to 0.455); expressive suppression and cognitive reappraisal did not interact with attachment dimensions when examining CLBP severity or interference (CIs: LLs ≤ -0.291 to ULs ≥ 0.030). Our study shows that anxious attachment may be an interpersonal risk factor related to CLBP, above and beyond intrapersonal ERs, as anxious attachment was associated with higher levels of pain interference. Furthermore, emotional expression was associated with increased CLBP severity and interference, particularly among individuals at low and medium levels of avoidant attachment. Existing studies on chronic pain have mostly focused on examining intrapersonal or interpersonal correlates in isolation. The present study extends our understanding of CLBP by considering the role of interpersonal factors (i.e., insecure attachment dimensions), in combination with intrapersonal ER strategies. Given the correlational nature of the present study, longitudinal studies are needed to establish causality between psychosocial correlates and CLBP symptoms. Ultimately, we hope our integrated approach will facilitate the development of treatments and interventions tailored to address patients' attachment-related needs, enhancing the management and maintenance of CLBP among patients.

To develop a standardized, reliable, valid spine model of active trunk movements that accurately discriminates kinematic patterns of patients with chronic non-specific low back pain from those of healthy subjects. Comparative cohort study. Healthy subjects (n = 25) and patients with chronic non-specific low back pain (n = 25) aged 30-65 years. Subjects performed 7 trunk movements from a seated position at non-imposed speed during 2 sessions. Nine markers on bony landmarks measured range of motion and speed of 5 spinal segments, recorded by 8 optoelectronic cameras. Both groups showed good-excellent reliability in all movements for range of motion and speed of all spinal segments (intraclass correlation (ICC), 0.70-0.96; standard error of measurement, expressed as a percentage, 19.4-3.3%). The minimal detectable change in the patient group was 16.7-53.7%. Range of motion and speed in all spinal segments for trunk flexion, rotation, and flexion with rotation differed significantly between groups (p < 0.001), with large/very large effect sizes (Cohen's d = 1.2-2). Binary logistic regression yielded sensitivities/specificities of 92%/84% for range of motion and 92%/80% for speed. Kinematic variables are valid, reliable measures and can be used clinically to diagnose chronic non-specific low back pain, manage treatment, and as quantitative outcome measures for clinical trial interventions.

The function of trunk muscles in chronic nonspecific low back pain (CNLBP) is controversially discussed, and trunk muscle function in sedentary occupation workers is poorly understood. To investigate whether muscle function differs between sedentary occupation workers with and without CNLBP and to determine the association between functional limitations and muscle function. This study included 32 sedentary occupation workers (16 workers with CNLBP and 16 age- and sex-matched workers without CNLBP). Group differences in isokinetic trunk flexion-extension strength, muscle cocontraction, endurance time (Biering-Sorensen test) and electromyographic muscle fatigue were assessed. The association of these parameters and Oswestry Disability Index (ODI) score were examined in the CNLBP group. Participants with CNLBP had lower trunk extensor (-20%) and flexor (-18%) strength and less cocontraction (-22%) than participants without CNLBP, but due to large variability in both groups these differences were not statistically significant. Trunk muscle endurance and fatigue were comparable between groups. Variance in endurance time explained 28% of variance in the ODI-score in the CNLBP group (R2= 0.277). In patients with CNLBP, greater functional disability was associated with lower endurance. Further evidence is necessary to elucidate whether specifically training endurance performance may be beneficial for sedentary occupation workers.

Assessment of the Reliability of the Leg Lateral Reach Test to Measure Thoraco-Lumbo-Pelvic Rotation in Individuals With Chronic Low Back Pain

Background Illness perceptions may influence coping behaviors as well as treatment and recovery among patients with chronic pain including low back pain (LBP). These perceptions may vary across different conditions. The Brief Illness Perception Questionnaire (BIPQ) is used as an instrument to assess the patients' perception of illness. Although the BIPQ has been previously translated into Persian, its psychometric properties have not been evaluated among patients with chronic nonspecific LBP. The aim of this study was to determine the reliability and validity of the Persian BIPQ in patients with chronic nonspecific LBP. Methods 116 patients with chronic nonspecific LBP with a mean (standard deviation) age of 36.4 years (10.7) participated in this cross-sectional study. Fifty patients were reexamined after 10 to 12 days for test-retest reliability. Internal consistency reliability, construct validity, concurrent criterion validity, and structural validity were evaluated. The concurrent validity was examined by using the Short Form-36 Health Survey. Results There were no floor and ceiling effects. Cronbach's alpha for the total score was 0.90. The intraclass correlation coefficient (ICC) for test-retest reliability was 0.90. The standard error of measurement and the minimal detectable change was found to be 3.26 and 9.04, respectively. The convergent correlations confirmed the construct validity. The concurrent criterion validity was demonstrated by significant negative correlations with the SF-36. The Exploratory Factor Analysis produced the 2 factors (emotional illness representations and cognitive illness representations) with an eigenvalue >1.0 that jointly accounted for 58.86% of the total variance. Conclusion The Persian BIPQ is a reliable and 2-factor instrument and can be used for assessing illness perception in patients with chronic nonspecific LBP.

Background: Low back pain referred as pain localized between the 12th rib and the inferior gluteal folds with included leg pain sometimes not, most cases are nonspecific but in about 10% of cases a specific cause is identified. The major causes of low back pain are weakness of superficial trunk muscles, abdominal muscles and motor control or delayed activation of deep muscles (multifidus and transversus abdominis). Hence Core Stabilization exercise provides greater support to the spine, control of lumbar deep muscles and pelvis, and integration of activity of superficial and deep trunk muscles. Aim:The aim of the study is to determine the efficacy of core muscle stabilization exercise in chronic nonspecific low back pain patients. Search Method: Studies were collected from databases Google scholar, PubMed, Cochrane library, Research gate, CINAHL Medicine. Methodology: Inclusion criteria was Randomized or quasi-randomized controlled trial studies and Experimental study design. Sample size was 245 articles, 188 articles were collected from Google scholar, 28 articles from PubMed, and 29 articles from Cochrane library. Methodology of the Study was designed as Systematic review. Results: Out of 245 published studies, we selected 14 articles which describing about efficacy of core muscle stabilization exercise in chronic nonspecific low back pain, among which 8 articles discussed about the effectiveness of core stabilization exercise, 2 articles about lumbar stabilization, 2 articles about Pilates based exercise, 2 articles about segmental stabilization in reducing chronic nonspecific low back pain. Conclusion: By reviewing the study, we conclude that core muscle stabilization exercise is effective in reducing the chronic nonspecific low back pain (CNSLBP).

There is a lack of studies investigating the effects of instrument-assisted soft tissue mobilization on chronic low back pain, and the level of evidence is low. This study aimed to examine and compare the time-dependent effects of two different instrument-assisted soft tissue mobilization protocols in individuals with chronic nonspecific low back pain. This was a comparative study. University Physiotherapy and Rehabilitation department in Cyprus. Seventy-four patients with chronic nonspecific low back pain were randomized into two groups (Group 1 (n = 37) and Group 2 (n = 37)). 6 sessions were implemented with the participants, twice weekly for 3 weeks. The same instrument-assisted soft tissue mobilization protocol (7-step) was applied to both groups, but in different positions (fixed prone vs. extended child pose and knee flexion-extension). Pain levels (visual analogue scale), spinal mobility (Modified Schober Test), flexibility (Sit and Reach Test, Maximal Hip Flexion Active Knee Extension Test, Active Knee Extension Test, Thoracolumbar Fascia Flexibility Test), muscle endurance of trunk extensors (The Biering-Sorenson Test), and disability (Oswestry Disability Index) were assessed. The pain and disability values of both groups decreased, and their spinal mobility, spinal flexibility, hamstring flexibility, thoracolumbar fascia flexibility, and endurance values increased after the 1st and 6th interventions (P < .05). Intra-group comparisons revealed a significant improvement only in pain levels at rest in the group in which instrument-assisted soft tissue mobilization was applied during functional exercises (P < .05). Both instrument-assisted soft tissue mobilization methods instantly reduced levels of pain and disability and improved spinal mobility, flexibility, and trunk extensor endurance. Applying instrument-assisted soft tissue mobilization with functional exercises to individuals with chronic nonspecific low back pain is more effective in reducing pain levels at rest. Low back pain, fascia, spine, soft tissue therapy, comparative study.

(124) Perceived Injustice Mediates the Relationship between Chronic Pain Stigma and Chronic Low Back Pain (CLBP) Severity

Relationship Between Patient-Reported Chronic Low Back Pain Severity and Medication Resources

BACKGROUND: The possibility of the presence of central sensitization (CS) among chronic nonspecific low back pain (CNSLBP) patients to predict treatment response by related outcome measures has not been adequately explored. The purpose of this pilot study was to determine the feasibility of a study to compare “McKenzie exercise program” (MEP) and “conventional physiotherapy program” (CPP) outcomes for participants with CNSLBP, investigate whether any difference in outcome was related to CS, disability, fear-avoidance beliefs and trunk flexors and extensors muscles endurance, and to inform the design of a main study.OBJECTIVE: The present study tests whether MEP reduces CS better in CNSLBP patients having CS compared to CPP.METHODS: Forty-two patients with CNSLBP were randomly allocated into two groups. The experimental group (n = 22) received only MEP and control group (n = 20) received only CPP. Each group received specific weekly treatment five times during the study for 2 months. Outcome measures were CS Inventory-Gujarati (CSI-G) for the presence of CS, numerical pain rating scale (NPRS) for pain intensity, pressure pain threshold (PPT) by pressure algometry, Roland–Morris Disability Questionnaire-Gujarati (RMDQ-G) for disability, Fear-avoidance-beliefs Questionnaire-Gujarati (FABQ-G) for fear-avoidance beliefs, and trunk flexors and extensors endurance tests.RESULTS: Both the groups showed a decrease in NPRS, CSI-G, RMDQ-G, and FABQ-G scores and increase in PPT and trunk flexors and extensors endurance scores. However, decrease in NPRS, CSI-G, RMDQ-G, and FABQ-G scores and increase in PPT scores were significantly better in the experimental group. In contrast, control group performed significantly better on trunk flexors and extensors endurance scores.CONCLUSION: McKenzie exercises are effective in reducing pain, pain sensitization, disability and fear avoidance beliefs; however, it does not improve trunk flexors and extensors endurance in CNSLBP patients with or without CS.

There is a relation between deficits of the proprioceptive system and movement control dysfunction in patients with chronic low back pain (LBP) but, the exact mechanism of this relation is unknown. Exercise therapy has been recognized as an effective method for low back pain treatment. In spite of this, it is not clear which of the various exercise therapy programs lead to better results. Therefore, the present analyze the efficacy of a HUBER study aims to exercise system mediated sensorimotor training protocol on proprioceptive system, lumbar movement control (LMC) and quality of life (QOL) in patients with chronic non-specific LBP. Quasi-experimental study. 53 patients with chronic non-specific LBP (mean age 37.55 ± 6.67 years,and Body Mass Index (BMI) 22.4 ± 3.33) were selected by using Roland-Morris Disability Questionnaire (RMQ) and were assigned into two experimental (N= 27) and control groups (N= 26) The experimental group underwent a five-week (10 sessions) Sensorimotor training by using the Human Body Equalizer (HUBER) spine force under the supervision of an investigator. The movement control battery tests, the HUBER machine testing option, goniometer and visual analogue scale used for movement control, neuromuscular coordination, proprioception and LBP assessment respectively. The assessments were completed in pre-test and after five weeks. The paired and sample T tests were used for data analysis in SPSS program version 18 (Significance level were set at a P value < 0.05). The HUBER system mediated sensorimotor training demonstrated significant improvement in the proprioceptive system, LMC and QOL (P= 0.001). Also There was a significant reduction in the pain scores of subjects with chronic non-specific LBP in the sensorimotor group (P= 0.001). In this study, only the short term effects of the sensorimotor training were examined. The results suggest that a sensorimotor training program causes significant improvement in patients with chronic non-specific LBP. Future research should be carried out with a larger sample size to examine the long term effects of the sensorimotor training program on treatment of patients with chronic non-specific LBP. Considering the efficacy of the sensorimotor training, it is recommended that this intervention should be applied to treatment of patients with chronic non-specific LBP in the future.

ABSTRACTIntroduction: The aim was to compare core stability and general exercises (GEs) in chronic low back pain (LBP) patients based on lumbopelvic stability (LPS) assessment through three endurance core stability tests. There is a controversy about preference of core stability exercise (CSE) over other types of exercise for chronic LBP. Studies which have compared these exercises used other outcomes than those related to LPS. As it is claimed that CSE enhances back stability, endurance tests for LPS were used. Materials and Methods: A 16-session CSE program and a GE program with the same duration were conducted for two groups of participants. Frequency of interventions for both groups was three times a week. Forty-three people (aged 18–60 years) with chronic non-specific LBP were alternately allocated to core stability (n = 22) or GE group (n = 21) when admitted. The primary outcomes were three endurance core stability tests including: (1) trunk flexor; (2) trunk extensor; and (3) side bridge tests. Secondary outcomes were disability and pain. Measurements were taken at baseline and the end of the intervention. Results: After the intervention, test times increased and disability and pain decreased within groups. There was no significant difference between two groups in increasing test times (p = 0.23 to p = 0.36) or decreasing disability (p = 0.16) and pain (p = 0.73). Conclusions: CSE is not more effective than GE for improving endurance core stability tests and reducing disability and pain in chronic non-specific LBP patients.

BackgroundEvaluating trunk strength is an important aspect of the physical examination of people with low back pain (LBP). Thus, reliable, valid, and easily applied measurement tools are needed to quantify trunk muscle strength and monitor changes in response to interventions. ObjectivesTo determine within-day and between-day test re-test reliability and criterion validity of a handheld dynamometer (HHD) to evaluate maximum isometric trunk strength in people with chronic LBP and asymptomatic individuals. DesignReliability and criterion validity study. MethodsTwenty adult participants with chronic, non-specific LBP and 35 asymptomatic individuals participated. Isometric trunk flexion, extension, and rotation strength were evaluated with the HHD (Active force 2) and the within-day and between-day reliability were determined with intraclass correlation coefficients (ICC2,1) and the standard error of the measurements (SEM), minimal detectable change (MDC), and the limits of agreement (LOA) using Bland-Altman plots. Criterion validity was evaluated using Pearson correlation coefficients to compare HHD measurements to isokinetic dynamometry for both isometric trunk flexion and extension strength. ResultsGood to excellent within-day and between-day reliability was observed for people with LBP and asymptomatic individuals with (ICC2,1) of 0.73–0.93 and 0.62–0.92 respectively. A moderate to strong correlation was found between measurements with the HHD and the isokinetic dynamometer with a correlation of r = 0.68–0.78 and r = 0.56–0.59 for people with LBP and asymptomatic participants respectively. ConclusionA HHD is a reliable, valid, and clinically applicable tool for the measurement of trunk strength in adults with and without chronic LBP.