Non-specific Low Back Pain Patients Research Articles

BACK-to-MOVE: Machine learning and computer vision model automating clinical classification of non-specific low back pain for personalised management.

Low back pain (LBP) is a major global disability contributor with profound health and socio-economic implications. The predominant form is non-specific LBP (NSLBP), lacking treatable pathology. Active physical interventions tailored to individual needs and capabilities are crucial for its management. However, the intricate nature of NSLBP and complexity of clinical classification systems necessitating extensive clinical training, hinder customised treatment access. Recent advancements in machine learning and computer vision demonstrate promise in characterising NSLBP altered movement patters through wearable sensors and optical motion capture. This study aimed to develop and evaluate a machine learning model (i.e., 'BACK-to-MOVE') for NSLBP classification trained with expert clinical classification, spinal motion data from a standard video alongside patient-reported outcome measures (PROMs). Synchronised video and three-dimensional (3D) motion data was collected during forward spinal flexion from 83 NSLBP patients. Two physiotherapists independently classified them as motor control impairment (MCI) or movement impairment (MI), with conflicts resolved by a third expert. The Convolutional Neural Networks (CNNs) architecture, HigherHRNet, was chosen for effective pose estimation from video data. The model was validated against 3D motion data (subset of 62) and trained on the freely available MS-COCO dataset for feature extraction. The Back-to-Move classifier underwent fine-tuning through feed-forward neural networks using labelled examples from the training dataset. Evaluation utilised 5-fold cross-validation to assess accuracy, specificity, sensitivity, and F1 measure. Pose estimation's Mean Square Error of 0.35 degrees against 3D motion data demonstrated strong criterion validity. Back-to-Move proficiently differentiated MI and MCI classes, yielding 93.98% accuracy, 96.49% sensitivity (MI detection), 88.46% specificity (MCI detection), and an F1 measure of .957. Incorporating PROMs curtailed classifier performance (accuracy: 68.67%, sensitivity: 91.23%, specificity: 18.52%, F1: .800). This study is the first to demonstrate automated clinical classification of NSLBP using computer vision and machine learning with standard video data, achieving accuracy comparable to expert consensus. Automated classification of NSLBP based on altered movement patters video-recorded during routine clinical examination could expedite personalised NSLBP rehabilitation management, circumventing existing healthcare constraints. This advancement holds significant promise for patients and healthcare services alike.

Prevalence of Disability in Chronic Non-Specific Low Back Pain Patients

Background: Lower back pain (LBP) is the most frequent medical condition requiring rehabilitation in most countries, and it is also the most common medical issue among individuals with disabilities. Numerous illnesses, such as nephrolithiasis, endometriosis, tumors, fibromyalgia, and psychological disorders, can induce back pain that is not related to the spine. Objective: To determine the disability prevalence among patients with chronic non-specific low back pain Materials and Methods: The cross sectional observational study was conducted in the Department of Physical Medicine and Rehabilitation, Dhaka Medical College & Hospital, Dhaka. Total 103 cases diagnosed individuals with chronic non-specific low back pain after fulfilling enrollment criteria was enrolled in this study. Question about sex life (ODI-8) was asked at the end of the interview. Disability refers to impairment, activity limitation and participation restrictions that may occur with a health condition. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior gluteal folds with or without referred leg pain. Statistical analyses were carried out by using the Statistical Package for Social Sciences version 23.0 for Windows (SPSS Inc., Chicago, Illinois, USA). Results: Prevalence of the disability more than half (52.4%) of the patients had severe disability, 27(26.2%) had moderate, 14(13.6%) had crippled and 8(7.8%) had minimal disability. Conclusion: The prevalence of severe disability in Chronic Non-Specific Low Back Pain was 52.4%. The duration and severity of pain are significantly correlated with impairment.

Effect Of Triamcinolone Trigger Point Injection On Changes In TNF-α Levels And Oswestry Disability Index (ODI) Scores Non-Specific Low Back Pain (LBP) Patients

Background: Low back pain (LBP) is the most common musculoskeletal problem and a major cause of worldwide disability causing increased health costs and indirect costs associated with reduced or lost productivity. One of the therapeutic management of LBP is Triamcinolone trigger point injection. Until now, research on the effect of Triamcinolone trigger point injection on changes in TNF-α levels and Oswestry Disability Index (ODI) scores in Non-Specific LBP patients is still limited. Objective: To analyze the effect of Triamcinolone trigger point injection on changes in TNF-α levels and ODI scores before and after Triamcinolone trigger point injection in Non-Specific LBP patients. Methods: This is a quasi-experimental analytic observational study with a pre and post-test group design approach. Subjects were diagnosed with Non-Specific LBP who had met the inclusion criteria (acute pain less than 3 months, patient age 30-55 years, moderate-severe pain intensity, had never received a Triamcinolone trigger point injection) with the exclusion criteria patients experiencing severe pain. not only caused by NPB. The study subjects were checked for TNF-α levels and ODI scores before and after the Triamcinolone trigger point injection. Then a paired T-test was carried out. Results: During the study period September - November 2022 at the Neurology Outpatient Polyclinic, RSUP Dr. Kariadi Semarang obtained 32 subjects. There was a significant difference between changes in TNF-α levels before and after Triamcinolone trigger point injection (p=0.000). There was a significant difference in ODI scores before and after the Triamcinolone trigger point injection (p=0.000). There was no significant relationship between the risk factors for gender, occupation, BMI, physiotherapy, and changes in TNF-α levels with changes in the ODI score. Conclusion: There is a significant difference in changes in TNF-α levels and ODI scores before and after Triamcinolone trigger point injection.

Validity and Reliability of the Greek Version of Pittsburgh Sleep Quality Index in Chronic Non-Specific Low Back Pain Patients.

The purpose of this study was to investigate psychometric properties of the Greek translation of Pittsburgh Sleep Quality Index (GR-PSQI) in a Greek chronic non-specific low back pain (CNSLBP) sample, thus, providing insight on its clarity and acceptability as a widely used sleep assessment tool in clinical practice. Asymptomatic volunteers (n = 73) and CNSLBP volunteers (n = 47), participated in the study. For the assessment of construct validity, the known-groups method was used. Thus, all the participants (asymptomatic and CNSLBP) completed the GR-PSQI. For the assessment of concurrent validity, the CNSLBP participants additionally completed the following validated questionnaires for depression, insomnia and sleep quality: Beck Depression Inventory Questionnaire (BDI), Insomnia Severity Index (ISI), and Sleep Quality Numeric Rating Scale (SQNRS). For the assessment of test-retest reliability, the CNSLBP participants completed the GR-PSQI a second time, one week after the first time. The results showed excellent test-retest reliability (ICC = 0.969, SEM = 0.90, SDD = 2.49%) and internal consistency (Cronbach α = 0.985), moderate to good concurrent validity (from r = 0.556 to r = 0.860) among PSQI, BDI, SQNRS, and ISI, as well as excellent construct validity (p = 0.000) between the two groups. The Greek translation of PSQI could be a valuable tool for Greek healthcare professionals in both clinical and research environments.

Acute effect of dry needling on trunk kinematics and balance of patients with non-specific low back pain

BackgroundLimited knowledge exists about the effectiveness of dry needling (DN) concerning the torso kinematics in patients with non-specific low back pain (NS-LBP). Acute effects of DN in NS-LBP patients from a functional perspective were investigated. MethodsSixteen NS-LBP patients and 11 healthy individuals (HG) were examined. NS-LBP patients received a single session of DN at the lumbar region. Baseline and immediate post-treatment measurements during flexion-extension and lateral bending of the trunk were conducted for the NS-LBP patients. HG were measured only at baseline to be used as a reference of NS-LBP patients' initial condition. Algometry was applied in NS-LBP patients. Centre of pressure, range of motion of the trunk and its’ derivatives were obtained. FindingsHG performed significantly faster, smoother and with greater mobility in the performed tasks compared to the pre intervention measurements of the NS-LBP patients. For the NS-LBP patients, significant greater angular velocity in frontal plane and significant lower jerk in the sagittal plane were demonstrated post intervention. DN alleviated pain tolerance significantly at the L5 level. Regarding the effectiveness of the DN upon spine kinematics, their derivatives were more sensitive. InterpretationIt appeared that the pathological type of torso movement was acutely affected by DN. NS-LBP patients showcased smoother movement immediately after the intervention and better control as imprinted in the higher derivative of motion although range of motion did not improve. This quantitative variable may not be subjected to acute effects of DN but rather need additional time and training to be improved.

Effects of pilates exercises on radiographic lumbo-pelvic alignment and range of motion in non-specific low back pain patients

ObjectivesTo determine the effects of Pilates exercises on lumbo-pelvic alignment in non-specific low back pain (NSLBP) patients. MethodsTwenty-two patients (Male:7; Female:15) with NSLBP aged 20–65 years were recruited and classified based on a modified O'Sullivan's classification system into flexion pattern (FP) or active extension pattern (EP) groups. Oswestry Disability index (ODI), Roland-Morris Disability Questionnaire (RMDQ) as well as radiographic lumbar global range of motion (ROM) and lumbo-pelvic alignment were measured Pre- and immediately post-intervention and at 6- and 12-month. The intervention included supervised six-weeks Pilates program with 60 min per session and up to two sessions per week. ResultsLumbar lordosis, sacral slope and sacral inclination were found to be significantly different between the FP and EP groups based on the O'Sullivan's classification system. However, despite the significant changes in RMDQ (p = 0.001), no significant changes were found for any of the alignment parameters (p > 0.05) post intervention for both groups. For lumbar global ROM, a statistically significant change was observed for the EP group (p = 0.028) but not for the FP group (p = 0.249). No significant correlations were identified between any of the self-reported outcomes, radiographic alignment and ROM parameters. ConclusionsPatients self-perceived long-term functional improvements based on responding to questionnaires after Pilates exercises were not reflected in significant changes in lumbo-pelvic alignment or lumbar ROM. This may be due to the current cohort demonstrating within normal ranges due to the lesser severity of their condition, but further research is needed for clarification.

Comparison of Diet With and Without Strengthening Exercises Impacting Non-Specific Chronic Low Back Pain Patients in Obesity

Background: Dietetic variations have long been taken as an imperative factor for managing obesity in low back pain patients. Thus, to evaluate diet with and without exerciseto consider further the best regimen to counter this burning issue. Therefore, his study aimed to compare the effects of diet with and without strength training on non-specific low back pain in obese clients. Methods: Fifty-two patients with sedentary lifestyles, aged between 25-40 years, were assigned to two groups according to their BMI (Grade I &II obesity) and were assessed for their weight, Body Mass Index (BMI), Waist to Hip Ratio (WHR), Body Fat Percentage (BF %), Fat Mass (FM), Lean Mass (LM), Numeric Pain Rating Scale (NPRS), Oswestry Disability Index (ODI) and pushups for muscular endurance and strength were the outcome measures of interests. One group followed diet only (D), while the other followed diet plus strength (DS) training. After six weeks of intervention, patients were assessed again on the same parameters. Results: DS group revealed positive changes in all parameters, i.e., weight (0.00), BMI (0.00), WHR (0.01), BF% (0.00), FM (0.00), LM (0.01), NPRS (0.00), OLBPD (0.00), pushups (0.00), while D group showed insignificant results in WHR (p-value-0.736, before 0.88+0.1 after0.88-+0.1), LM (p-value-0.384, before 40.9+8.9 after 40.3+8.8) and Pushups (p-value 0.384, before 4.6+3.4 after 4.3+3.7). Conclusion: Six weeks of diet and diet plus strength training resulted in positive changes in pain and ODI. Still, the diet-plus strength exercise group overweighed the diet-only group in all parameters. Keywords: Diet, Exercise, Low Back Pain, Obesity.

Comparison of the efficacy of Transcutaneous Electrical Nerve Stimulation and Short Wave Diathermy on Patients with Chronic Nonspecific Low Back Pain

Background: Transcutaneous electrical nerve stimulation (TENS) is widely used as a therapeutic adjunct in the management of low back pain. It is a relatively safe, non-invasive, and easy-to-use modality, making it an attractive treatment option. For more than four decades, TENS has been applied in the treatment of acute and chronic pain syndromes. Short wave diathermy (SWD) is a modality that produces deep heating by converting electromagnetic energy to thermal energy. Short wave diathermy (SWD) is also a popular therapy for low back pain. Methods: This randomized controlled clinical trial was conducted to evaluate the comparative efficacy between TENS and SWD on chronic nonspecific low back pain patients. 120 patients with chronic low back pain were treated according to inclusion & exclusion criteria. Patients were equally distributed in three groups. Group-A patients (n=40) were treated with NSAID+ADL, Group-B patients (n=40) were treated with NSAID+ADL+TENS, and Group-C patients (n=40) were treated with NSAID+ADL+SWD. Written informed consent was obtained from all patients. Data were calculated and analyzed by computer-based software SPSS (Statistical Package for Social Science) Windows 16.0 version. Main outcome measure (s) Age, Sex, Occupational status, Socioeconomic status, Subjective pain intensity score, Visual Analogue Scale, Tenderness index, Disability due to pain, Spinal mobility index, and Oswestry disability Index. Results: The mean duration of pain was found to be 23.90±2.57 months in group A, 21.0+1.50 months in group B and 22.1±1.89 months in group C. The visual analog score was improved individually in group-A, group B and Group C after treatment, which was statistically significant (P<0.05). Oswestry disability questionnaire score was also improved individually in group-A, group B and Group C after treatment, which was statistically significant (P<0.05). In the case of comparison between group-B and Group C, this was not statistically significant (P>0.05). In this current study, it was observed that the entire variable individually improved in Group-A, Group B, and Group C. So, all three treatment groups benefited from drugs and therapy. But, these were not statistically significant (P>0.05) between Group B and Group C. Conclusion: Beneficial effects of TENS and SWD were seen in the study population, but no firm conclusion could be drawn. TAJ 2023; 36: No-2: 135-143

The Effect of Ultrasound and Neuromuscular Taping Interventions on Reducing Pain in Non-Specific Low Back Pain Patients

Low back pain (LBP) is a musculoskeletal disorder caused by poor ergonomics. LBP is defined as pain localized between the costal margin and the inferior gluteal fold that lasts for more than one day. The purpose of this study was to determine the effect of Ultrasound and Neuromuscular Taping interventions on reducing non-specific low back pain. This study used a quasi-experimental method with a one-group pre-and post-test design, and the research sample was given Ultrasound and Neuromuscular Taping interventions. The pain measurement tool used was the Visual Analog Scale (VAS). The normality test was performed using the Shapiro-Wilk test, and the effect test was performed using the Wilcoxon test. The results of this study showed that the pre-and post-intervention mean VAS scores were 6.7±1.766 and 1.7±0.674, respectively. With a value of p = 0.005 (p < 0.005), which indicates a significant difference between the VAS scores before and after Ultrasound and Neuromuscular Taping interventions. This value can be interpreted as evidence that the combination of these two interventions can reduce the degree of pain in non-specific low back pain conditions. In conclusion, the study found that there was a significant effect of Ultrasound and neuro-muscular taping (NMT) interventions on reducing pain in cases of non-specific low back pain.

Isokinetic trunk training on pain, disability, and strength in non-specific low back pain patients: A systematic review and meta-analysis.

Low back pain is one of the leading causes of disability globally, with a high economic and social burden. A decrease or imbalance in trunk strength has been associated with the occurrence of low back pain and its severity. Trunk strength training is helpful in the treatment of Non-specific low back pain (NSLBP) patients. However, we do not know the effects of trunk isokinetic training (IKT) on pain intensity, disability, and trunk strength. This systematic review aimed to determine the effects of trunk IKT in NSLBP patients on pain intensity, disability, and trunk flexor and extensor isokinetic strength. We searched PubMed, Web of Science, Scopus, CENTRAL, and PEDro, from January 2001 until March 2021 and updated to November 2022. Randomized controlled trials (RCTs) that investigated the effect of IKT in adult participants with NSLBP on pain intensity, disability, or isokinetic trunk strength were included. Mean difference (MD) and 95% confidence intervals (95% CI) were calculated for pain. Bias was assessed using the Cochrane risk of bias (RoB) tool and evidence certainty via Grading of Recommendations Assessment, Development and Evaluation (GRADE). Among 1750 retrieved articles, eight were included in this review. Meta-analysis comparing IKT (trunk isokinetic training, n= 134) with control groups (conventional exercises, n= 133) revealed that IKT decreases pain intensity (MD -1.50 (95% CI: -2.60; -0.39)) immediately post-intervention, and one month (MD -1.97 (95% CI: -2.92; -1.03)) and at six months follow-up (MD -2.48 (95% CI: -2.77; -2.19)), although with a very low to low quality according to the GRADE rating. Besides, IKT decreases disability and increases isokinetic trunk strength, but with scant evidence. Trunk IKT could be a novel clinical tool for pain management in patients with NSLBP, although evidence is scarce. In addition, few RCTs exist for IKT on disability or trunk isokinetic strength in patients with NSLBP. Therefore, further research on this topic is needed.

Dynamic postural control in women athletes with and without nonspecific low back pain with high and low pain-related anxiety- A case-control study

BackgroundLow back pain is common among athletes and it has been shown that postural control is altered in the general population with nonspecific low back pain (NSLBP). Psychological factors may also predispose individuals to risk of altered postural control. Dynamic postural control is essential to the performance of athletes. This study aimed to compare the dynamic postural control between women athletes with and without NSLBP with high and low pain-related anxiety.MethodsForty-five female athletes (15 NSLBP with high pain-related anxiety, 15 NSLBP with low pain-related anxiety, and 15 healthy (control)) were included. Pain-related anxiety was assessed using the Pain Anxiety Symptom Scale-20 (PASS-20). Based on the cut-off score of 30 for the total score of PASS-20, NSLBP patients were classified into two groups of low and high pain-related anxiety. Participants performed double-leg vertical drop jump (DVJ) and single-leg vertical jump (SVJ) tests on a Kistler force plate (type 9260AA6, Kistler Instruments Inc, Switzerland). The total root mean square (RMS) of the center of pressure (COP), COP displacement in the anteroposterior (AP), and mediolateral (ML) directions, COP mean velocity, and time to stabilization (TTS) in vertical, AP, and total directions were extracted from COP and ground reaction force data using MATLAB software. One-way Analysis of variance (ANOVA) and Welch’s ANOVA were employed to compare the groups. In case of significant findings, post hoc tests were performed.ResultsThe results showed that during DJV, athletes with high pain-related anxiety had significantly greater TTS in all total, AP, and ML directions than other groups (P < 0.05). Also, the control group showed greater total RMS distance during DJV than either NSLBP group. However, no significant differences in TTS and COP parameters were found between the groups during SVJ (P > 0.05).ConclusionsThe findings suggest that pain-related anxiety may contribute to athletes’ postural control strategies. Therefore, it is important to consider the level of pain-related anxiety during planning postural control exercises for women athletes with NSLBP.

Similar improvements in patient-reported outcomes for non-specific low back pain patients with and without lumbar spinal stenosis symptoms following a structured education and exercise therapy program

BackgroundPeople with nonspecific low back pain (NSLBP) can also experience overlapping symptoms of lumbar spinal stenosis (LSS), but the impact on treatment outcomes is unknown. This study investigated differences in treatment outcomes for disability, back pain intensity, and leg pain intensity following an education and exercise therapy program for NSLBP patients with and without comorbid LSS symptoms.MethodsThis was a longitudinal analysis of 655 Danish participants in the GLA:D® Back program; an education and exercise therapy program for people with persistent NSLBP. Participants were classified as having comorbid LSS symptoms based on self-report. Linear mixed models were used to assess differences in change in disability (Oswestry Disability Index [0-100]) and back and leg pain intensity (Numeric Rating Scale [0–10]) at 3-, 6-, and 12-months between those with and without LSS symptoms.Results28% of participants reported LSS symptoms. No certain differences in change in disability or back pain intensity improvement were observed at any time-point between those with and without LSS symptoms. Participants with LSS symptoms had slightly greater improvement in leg pain intensity at 6- (-0.7, 95% CI -1.2 to -0.2) and 12-months (-0.6, 95% CI -1.2 to -0.1).ConclusionCompared to those without LSS symptoms, patients with persistent NSLBP and LSS symptoms can expect similar improvements in disability and back pain intensity, and slightly greater improvements in leg pain intensity with treatment. Therefore, education and exercise therapy programs designed for NSLBP are likely helpful for those also experiencing LSS symptoms.

Comparison of the Efficacy of Transcutaneous Electrical Nerve Stimulation and Short Wave Diathermy on Patients with Chronic Nonspecific Low Back Pain

Background: Transcutaneous electrical nerve stimulation (TENS) is widely used as a therapeutic adjunct in the management of low back pain. It is a relatively safe, non-invasive, and easy-to-use modality, making it an attractive treatment option. For more than four decades, TENS has been applied in the treatment of acute and chronic pain syndromes. Short wave diathermy (SWD) is a modality that produces deep heating by converting electromagnetic energy to thermal energy. Short wave diathermy (SWD) is also a popular therapy for low back pain.&#x0D; Methods: This randomized controlled clinical trial was conducted to evaluate the comparative efficacy between TENS and SWD on chronic nonspecific low back pain patients. One hundred twenty patients with chronic low back pain were treated according to inclusion &amp; exclusion criteria. Patients were equally distributed in three groups. Group-A patients (n=40) were treated with NSAID+ADL, Group-B patients (n=40) were treated with NSAID+ADL+TENS, and Group-C patients (n=40) were treated with NSAID+ADL+SWD. Written informed consent was obtained from all patients. Data were calculated and analyzed by computer-based software SPSS (Statistical Package for Social Science) Windows 16.0 version. Main outcome measure (s): Subjective pain intensity score, visual analogue scale, tenderness index, disability due to pain, spinal mobility index, and Oswestry disability index.&#x0D; Results: The mean duration of pain was found to be 23.90±2.57 months in group A, 21.0+1.50 months in group B and 22.1±1.89 months in group C. The visual analog score was improved individually in group-A, group B and Group C after treatment, which was statistically significant (P&lt;0.05). Oswestry disability questionnaire score was also improved individually in group-A, group B and Group C after treatment, which was statistically significant (P&lt;0.05). In the case of comparison between Group B and Group C, this was not statistically significant (P&gt;0.05). In this current study, it was observed that the entire variable individually improved in Group-A, Group B, and Group C. So, all three treatment groups benefited from drugs and therapy. However, these were not statistically significant (P&gt;0.05) between Group B and Group C.&#x0D; Conclusion: Beneficial effects of TENS and SWD were seen in the study population, but no firm conclusion could be drawn.&#x0D; TAJ 2022; 36: No-1: 63-73

Evidence- and data-driven classification of low back pain via artificial intelligence: Protocol of the PREDICT-LBP study.

In patients presenting with low back pain (LBP), once specific causes are excluded (fracture, infection, inflammatory arthritis, cancer, cauda equina and radiculopathy) many clinicians pose a diagnosis of non-specific LBP. Accordingly, current management of non-specific LBP is generic. There is a need for a classification of non-specific LBP that is both data- and evidence-based assessing multi-dimensional pain-related factors in a large sample size. The "PRedictive Evidence Driven Intelligent Classification Tool for Low Back Pain" (PREDICT-LBP) project is a prospective cross-sectional study which will compare 300 women and men with non-specific LBP (aged 18-55 years) with 100 matched referents without a history of LBP. Participants will be recruited from the general public and local medical facilities. Data will be collected on spinal tissue (intervertebral disc composition and morphology, vertebral fat fraction and paraspinal muscle size and composition via magnetic resonance imaging [MRI]), central nervous system adaptation (pain thresholds, temporal summation of pain, brain resting state functional connectivity, structural connectivity and regional volumes via MRI), psychosocial factors (e.g. depression, anxiety) and other musculoskeletal pain symptoms. Dimensionality reduction, cluster validation and fuzzy c-means clustering methods, classification models, and relevant sensitivity analyses, will classify non-specific LBP patients into sub-groups. This project represents a first personalised diagnostic approach to non-specific LBP, with potential for widespread uptake in clinical practice. This project will provide evidence to support clinical trials assessing specific treatments approaches for potential subgroups of patients with non-specific LBP. The classification tool may lead to better patient outcomes and reduction in economic costs.

Transcranial direct current stimulation over dorsolateral prefrontal cortex improves postural stability in non-specific chronic low back pain patients with high fear of pain: A randomized sham-controlled trial.

Deficits in postural stability in response to environmental challenges are seen in chronic low back pain (CLBP) patients with high fear of pain (HFP). Hence, it is essential to follow effective approaches to treat postural stability deficits and improve the health status of these patients. The current study aimed to compare the effects of cathodal and anodal transcranial direct current stimulation (c-tDCS and a-tDCS) over the left dorsolateral prefrontal cortex (DLPFC) on postural stability in non-specific CLBP patients with HFP. In this randomized clinical trial study, 75 patients were randomly assigned to left DLPFC a-tDCS, left DLPFC c-tDCS and sham stimulation groups (n= 25 in each group). All groups received a single-session 2mA tDCS for 20 min, but the stimulation was slowly turned off after 30 s in the sham group. Before, immediately, 24 h and 1 week after the interventions, postural stability indices were assessed using a Biodex Balance System. A significant reduction in most indices was shown in both a-tDCS and c-tDCS groups after interventions (immediately, 24 h and 1 week follow-up) during static and dynamic postural tasks compared with the sham tDCS group (p< .01). In addition, some tests showed a significant difference between a-tDCS and c-tDCS (p< .05). The findings indicated positive effects of both a-tDCS and c-tDCS on the left DLPFC, with more efficacy of a-tDCS on postural stability in LBP patients with HFP.

Non-Specific Low Back Pain: An Inductive Exploratory Analysis through Factor Analysis and Deep Learning for Better Clustering.

Non-specific low back pain (NSLBP) is a significant and pervasive public health issue in contemporary society. Despite the widespread prevalence of NSLBP, our understanding of its underlying causes, as well as our capacity to provide effective treatments, remains limited due to the high diversity in the population that does not respond to generic treatments. Clustering the NSLBP population based on shared characteristics offers a potential solution for developing personalized interventions. However, the complexity of NSLBP and the reliance on subjective categorical data in previous attempts present challenges in achieving reliable and clinically meaningful clusters. This study aims to explore the influence and importance of objective, continuous variables related to NSLBP and how to use these variables effectively to facilitate the clustering of NSLBP patients into meaningful subgroups. Data were acquired from 46 subjects who performed six simple movement tasks (back extension, back flexion, lateral trunk flexion right, lateral trunk flexion left, trunk rotation right, and trunk rotation left) at two different speeds (maximum and preferred). High-density electromyography (HD EMG) data from the lower back region were acquired, jointly with motion capture data, using passive reflective markers on the subject's body and clusters of markers on the subject's spine. An exploratory analysis was conducted using a deep neural network and factor analysis. Based on selected variables, various models were trained to classify individuals as healthy or having NSLBP in order to assess the importance of different variables. The models were trained using different subsets of data, including all variables, only anthropometric data (e.g., age, BMI, height, weight, and sex), only biomechanical data (e.g., shoulder and lower back movement), only neuromuscular data (e.g., HD EMG activity), or only balance-related data. The models achieved high accuracy in categorizing individuals as healthy or having NSLBP (full model: 93.30%, anthropometric model: 94.40%, biomechanical model: 84.47%, neuromuscular model: 88.07%, and balance model: 74.73%). Factor analysis revealed that individuals with NSLBP exhibited different movement patterns to healthy individuals, characterized by slower and more rigid movements. Anthropometric variables (age, sex, and BMI) were significantly correlated with NSLBP components. In conclusion, different data types, such as body measurements, movement patterns, and neuromuscular activity, can provide valuable information for identifying individuals with NSLBP. To gain a comprehensive understanding of NSLBP, it is crucial to investigate the main domains influencing its prognosis as a cohesive unit rather than studying them in isolation. Simplifying the conditions for acquiring dynamic data is recommended to reduce data complexity, and using back flexion and trunk rotation as effective options should be further explored.

Investigation of Real-Time Diagnostic Ultrasound as a Means of Biofeedback Training in Transversus Abdominus Re-Education of Patients with Non-Specific Low Back Pain: A Prospective Randomized Controlled Pilot Study.

Background: It is believed that ultrasound-guided imaging of activation/contraction of the deep abdominal muscles (such as transervsus abdominis) is useful for assisting deep muscle re-education, which is often dysfunctional in non-specific low back pain (NSLBP). Thus, this pilot study aimed to evaluate the use of real-time ultrasound (US) as a feedback device for transverse abdominis (TrA) activation/contraction during an exercise program in chronic NSLBP patients. Methods: Twenty-three chronic NSLBP patients were recruited and randomly assigned to a US-guided (n = 12, 8 women, 47.6 ± 2.55 years) or control group (n = 11, 9 women, 46.9 ± 4.29 years). The same motor control-based exercise program was applied to both groups. All patients received physiotherapy twice per week for seven weeks. Outcome measures, tested at baseline and post-intervention, included Numeric Pain Rating Scale, TrA activation level (measured through a pressure biofeedback unit-based developed protocol), seven established motor control tests, Roland-Morris Disability Questionnaire and Hospital Anxiety and Depression Scale. Results: For each group, all outcome variables yielded statistical differences post-intervention (p < 0.05), indicating significant improvements. However, there were no significant group x time interactions for any of the outcomes (p > 0.05), thus, indicating no superiority of the US-guided group over the control. Conclusions: The addition of US as a visual feedback device for TrA re-education during a motor control exercise program was not proven superior to traditional physiotherapy.

Evaluation of Effect of Modic Changes on Treatment Outcomes of Nonspecific Low Back Pain Patients Presenting to 501 Hospitals Receiving Conservative Treatments

Background: Modic changes (MC) are among the pain generators in the lumbar spine and could affect back pain treatments. Objectives: The current study aimed to investigate the effect of MC on the treatment outcomes of low back pain (LBP) patients who underwent conservative treatments. Methods: This prospective cohort study was performed on 166 nonspecific LBP patients presenting to 501 Hospital receiving conservative treatments. The patients were categorized based on their MC status, which was determined using a magnetic resonance imaging scan at baseline. Japanese Orthopedic Association (JOA) score was considered a measure of back pain and disability using a valid and reliable questionnaire for each participant. The data were collected on the age, gender, and duration of pain for each participant. The follow-up JOA score was also calculated for each patient after 6-month conservative treatments. The patient was considered improved if the JOA change score was higher than 0. Results: The average baseline JOA score in MC patients was 14.3 (2.2); however, it was 14.4 (2.0) in patients without MC (P = 0.750). After 6-month conservative treatments, the average JOA score reached 16.7 (3.4) and 17.1 (2.9) in patients with and without MC, respectively. No statistically significant difference was observed in this regard (P = 0.540). The proportion of improved cases was 70.7%, 82.8%, 63.4%, and 50.0% in no MC, MC type I, MC type II, and MC type III, respectively, with no statistically significant difference among the groups (P = 0.561). Conclusions: A 6-month conservative treatment was a safe and effective approach to improving the clinical condition of patients with LBP. However, there was no association between the presence of MC or any specific type of MC and treatment outcomes.

Binary classification of non-specific low back pain condition based on the combination of B-mode ultrasound and shear wave elastography at multiple sites.

Introduction: Low back pain (LBP) is a prevalent and complex condition that poses significant medical, social, and economic burdens worldwide. The accurate and timely assessment and diagnosis of LBP, particularly non-specific LBP (NSLBP), are crucial to developing effective interventions and treatments for LBP patients. In this study, we aimed to investigate the potential of combining B-mode ultrasound image features with shear wave elastography (SWE) features to improve the classification of NSLBP patients. Methods: We recruited 52 subjects with NSLBP from the University of Hong Kong-Shenzhen Hospital and collected B-mode ultrasound images and SWE data from multiple sites. The Visual Analogue Scale (VAS) was used as the ground truth to classify NSLBP patients. We extracted and selected features from the data and employed a support vector machine (SVM) model to classify NSLBP patients. The performance of the SVM model was evaluated using five-fold cross-validation and the accuracy, precision, and sensitivity were calculated. Results: We obtained an optimal feature set of 48 features, among which the SWE elasticity feature had the most significant contribution to the classification task. The SVM model achieved an accuracy, precision, and sensitivity of 0.85, 0.89, and 0.86, respectively, which were higher than the previously reported values of MRI. Discussion: In this study, we aimed to investigate the potential of combining B-mode ultrasound image features with shear wave elastography (SWE) features to improve the classification of non-specific low back pain (NSLBP) patients. Our results showed that combining B-mode ultrasound image features with SWE features and employing an SVM model can improve the automatic classification of NSLBP patients. Our findings also suggest that the SWE elasticity feature is a crucial factor in classifying NSLBP patients, and the proposed method can identify the important site and position of the muscle in the NSLBP classification task.

Sensitivity and specificity of the flexion and extension relaxation ratios to identify altered paraspinal muscles' flexion relaxation phenomenon in nonspecific chronic low back pain patients.

Among the main methods used to identify an altered flexion relaxation phenomenon (FRP) in nonspecific chronic low back pain (NSCLBP), it has been previously demonstrated that flexion relaxation ratio (FRR) and extension relaxation ratio (ERR) are more objective than the visual reference method. To determine the sensitivity and specificity of the different methods used to calculate the ratios in terms of their ability to identify an altered FRP in NSCLBP. Forty-four NSCLBP patients performed a standing maximal trunk flexion task. Surface electromyography (sEMG) was recorded along the erector spinae longissimus (ESL) and multifidus (MF) muscles. Altered FRP based on sEMG was visually identified by three experts (current standard). Six FRR methods and five ERR methods were used both for the ESL and MF muscles. ROC curves (with areas under the curve (AUC) and sensitivity/specificity) were generated for each ratio. All methods used to calculate these ratios had an AUC higher than 0.9, excellent sensitivity (>90%), and good specificity (80-100%) for both ESL and MF muscles. Both FRP ratios (FRR and ERR) for MF and ESL muscles, appear to be an objective, sensitive and specific method for identifying altered FRP in NSCLBP patients.