Abstract
Altered spinal postures and altered motor control observed among people with non-specific low back pain have been associated with abnormal processing of sensory inputs. Evidence indicates that patients with non-specific low back pain have impaired lumbo-pelvic proprioceptive acuity compared to asymptomatic individuals. To systematically review seated lumbo-pelvic proprioception among people with non-specific low back pain. Five electronic databases were searched to identify studies comparing lumbo-pelvic proprioception using active repositioning accuracy in sitting posture in individuals with and without non-specific low back pain. Study quality was assessed by using a modified Downs and Black's checklist. Risk of bias was assessed using an adapted tool for cross-sectional design and case-control studies. We performed meta-analysis using a random effects model. Meta-analyses included subgroup analyses according to disability level, directional subgrouping pattern, and availability of vision during testing. We rated the quality of evidence using the GRADE approach. 16 studies met the eligibility criteria. Pooled meta-analyses were possible for absolute error, variable error, and constant error, measured in sagittal and transverse planes. There is very low and low certainty evidence of greater absolute and variable repositioning error in seated tasks among non-specific low back pain patients overall compared to asymptomatic individuals (sagittal plane). Subgroup analyses indicate moderate certainty evidence of greater absolute and variable error in seated tasks among directional subgroups of adults with non-specific low back pain, along with weaker evidence (low-very low certainty) of greater constant error. Lumbo-pelvic proprioception is impaired among people with non-specific low back pain. However, the low certainty of evidence, the small magnitude of error observed and the calculated "noise" of proprioception measures, suggest that any observed differences in lumbo-pelvic proprioception may be of limited clinical utility. CRD42018107671.
Highlights
Low back pain is a highly prevalent disabling musculoskeletal disorder and represents a significant burden for the society [1, 2]
Pooled meta-analyses were possible for absolute error, variable error, and constant error, measured in sagittal and transverse planes
There is very low and low certainty evidence of greater absolute and variable repositioning error in seated tasks among non-specific low back pain patients overall compared to asymptomatic individuals
Summary
Low back pain is a highly prevalent disabling musculoskeletal disorder and represents a significant burden for the society [1, 2]. Altered spinal postures and altered motor control have been associated with abnormal processing of sensory inputs, such as proprioception, in patients suffering from NSLBP that vary between the subgroups [6,7,8,9,10]. Evidence from recent systematic reviews [11,12,13] indicate that patients with NSLBP have significantly impaired lumbo-pelvic proprioceptive acuity compared to asymptomatic individuals. The precise association between NSLBP and proprioceptive deficits is unclear, as spinal proprioceptive impairments are not correlated with pain and disability [19, 20]. Altered spinal postures and altered motor control observed among people with non-specific low back pain have been associated with abnormal processing of sensory inputs. Evidence indicates that patients with non-specific low back pain have impaired lumbo-pelvic proprioceptive acuity compared to asymptomatic individuals.
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