Subgroups Of Non-specific Low Back Pain Research Articles

Assessment of Spinal and Pelvic Kinematics Using Inertial Measurement Units in Clinical Subgroups of Persistent Non-Specific Low Back Pain.

Inertial measurement units (IMUs) offer a portable and quantitative solution for clinical movement analysis. However, their application in non-specific low back pain (NSLBP) remains underexplored. This study compared the spine and pelvis kinematics obtained from IMUs between individuals with and without NSLBP and across clinical subgroups of NSLBP. A total of 81 participants with NSLBP with flexion (FP; n = 38) and extension (EP; n = 43) motor control impairment and 26 controls (No-NSLBP) completed 10 repetitions of spine movements (flexion, extension, lateral flexion). IMUs were placed on the sacrum, fourth and second lumbar vertebrae, and seventh cervical vertebra to measure inclination at the pelvis, lower (LLx) and upper (ULx) lumbar spine, and lower cervical spine (LCx), respectively. At each location, the range of movement (ROM) was quantified as the range of IMU orientation in the primary plane of movement. The ROM was compared between NSLBP and No-NSLBP using unpaired t-tests and across FP-NSLBP, EP-NSLBP, and No-NSLBP subgroups using one-way ANOVA. Individuals with NSLBP exhibited a smaller ROM at the ULx (p = 0.005), LLx (p = 0.003) and LCx (p = 0.01) during forward flexion, smaller ROM at the LLx during extension (p = 0.03), and a smaller ROM at the pelvis during lateral flexion (p = 0.003). Those in the EP-NSLBP group had smaller ROM than those in the No-NSLBP group at LLx during forward flexion (Bonferroni-corrected p = 0.005), extension (p = 0.013), and lateral flexion (p = 0.038), and a smaller ROM at the pelvis during lateral flexion (p = 0.005). Those in the FP-NSLBP subgroup had smaller ROM than those in the No-NSLBP group at the ULx during forward flexion (p = 0.024). IMUs detected variations in kinematics at the trunk, lumbar spine, and pelvis among individuals with and without NSLBP and across clinical NSLBP subgroups during flexion, extension, and lateral flexion. These findings consistently point to reduced ROM in NSLBP. The identified subgroup differences highlight the potential of IMU for assessing spinal and pelvic kinematics in these clinically verified subgroups of NSLBP.

Automatic Low Back Pain Classification Using Inertial Measurement Units: A Preliminary Analysis

Low back pain (LBP) is a major health problem that has now become leading cause of disability worldwide. The majority of LBP has no specific pathological cause. Classification of non-specific LBP (NSLBP) into subgroups corresponding to the reported symptoms has been identified as an essential step towards the provision of personalised management and rehabilitation plans. Currently, clinicians classify low back pain patients into clinical subgroups based on clinical judgement and expertise, which is a time-consuming process open to human error. This paper introduces a novel approach for automatic classification of NSLBP patients into clinical subgroups on the basis of the MTw2 inertial measurement unit (MTw2 IMU tracker) motion data, which are portable units and thus desirable for clinical use. Four MTw2 IMU trackers tracking movement during a number of physical assessment tests were investigated in their ability to distinguish between clinically recognized NSLBP subgroups. Simple motion features such as the angular range of displacement were used in classification experiments to reflect how clinicians make decisions when classifying NSLBP. The achieved results were comparable to the state of art results in automatic NSLBP classification using optical motion capture data and demonstrated the feasibility of developing an automatic classification system on the basis of the MTw2 IMU tracker motion data obtained with an individual performing a battery of standard physical assessment tests. Further developments could address gaps in current medical and engineering literature and improve clinical outcomes.

Trunk Postural Muscle Timing Is Not Compromised In Low Back Pain Patients Clinically Diagnosed With Movement Coordination Impairments.

Trunk muscle timing impairment has been associated with nonspecific low back pain (NSLBP), but this finding has not been consistent. This study investigated trunk muscle timing in a subgroup of patients with NSLBP attributed to movement coordination impairment (MCI) and matched asymptomatic controls in response to a rapid arm-raising task. Twenty-one NSLBP subjects and 21 matched controls had arm motion and surface EMG data collected from seven bilateral trunk muscles. Muscle onset and offset relative to deltoid muscle activation and arm motion, duration of muscle burst and abdominal-extensor co-contraction time were derived. Trunk muscle onset and offset latencies, and burst and co-contraction durations were not different (p > .05) between groups. Patterns of trunk muscle activation and deactivation relative to arm motion were not different. Task performance was similar between groups. Trunk muscle timing does not appear to be an underlying impairment in the subgroup of NSLBP with MCI.

Does targeting manual therapy and/or exercise improve patient outcomes in nonspecific low back pain? A systematic review

BackgroundA central element in the current debate about best practice management of non-specific low back pain (NSLBP) is the efficacy of targeted versus generic (non-targeted) treatment. Many clinicians and researchers believe that tailoring treatment to NSLBP subgroups positively impacts on patient outcomes. Despite this, there are no systematic reviews comparing the efficacy of targeted versus non-targeted manual therapy and/or exercise. This systematic review was undertaken in order to determine the efficacy of such targeted treatment in adults with NSLBP.MethodMEDLINE, EMBASE, Current Contents, AMED and the Cochrane Central Register of Controlled Trials were electronically searched, reference lists were examined and citation tracking performed. Inclusion criteria were randomized controlled trials of targeted manual therapy and/or exercise for NSLPB that used trial designs capable of providing robust information on targeted treatment (treatment effect modification) for the outcomes of activity limitation and pain. Included trials needed to be hypothesis-testing studies published in English, Danish or Norwegian. Method quality was assessed using the criteria recommended by the Cochrane Back Review Group.ResultsFour high-quality randomized controlled trials of targeted manual therapy and/or exercise for NSLBP met the inclusion criteria. One study showed statistically significant effects for short-term outcomes using McKenzie directional preference-based exercise. Research into subgroups requires much larger sample sizes than traditional two-group trials and other included studies showed effects that might be clinically important in size but were not statistically significant with their samples sizes.ConclusionsThe clinical implications of these results are that they provide very cautious evidence supporting the notion that treatment targeted to subgroups of patients with NSLBP may improve patient outcomes. The results of the studies included in this review are too patchy, inconsistent and the samples investigated are too small for any recommendation of any treatment in routine clinical practice to be based on these findings. The research shows that adequately powered controlled trials using designs capable of providing robust information on treatment effect modification are uncommon. Considering how central the notion of targeted treatment is to manual therapy principles, further studies using this research method should be a priority for the clinical and research communities.

Classification in Nonspecific Low Back Pain: What Methods do Primary Care Clinicians Currently Use?

Postal survey. To describe the signs and symptoms that clinicians think represent nonspecific low back pain (NSLBP) subgroups, and to report the labels that clinicians give to those subgroups. The cause of most low back pain (LBP) cannot be diagnosed. Consequently, approximately 80% of primary care LBP presentations are most accurately labeled as NSLBP. Most Australian primary care clinicians think that NSLBP is heterogeneous and treat patients differently based on that heterogeneity. This research sought to identify the subgroups clinicians believe are recognizable within that heterogeneity. Analysis of survey data from 651 primary care clinicians from 6 professional disciplines: physiotherapy, manipulative physiotherapy, chiropractic, osteopathy, general medicine, and musculoskeletal medicine. There was little consensus among participating clinicians regarding the signs and symptoms that identify NSLBP subgroups. Most clinicians give labels to NSLBP subgroups that imply putative pathoanatomy, however, the evidence that these labels are valid is scant and controversial. A lack of consensus among participating clinicians regarding NSLBP subgroups and a lack of evidence for the validity of NSLBP subgrouping are a compelling argument for further research into this clinical practice.

Do primary-care clinicians think that nonspecific low back pain is one condition?

Postal survey. OBJECTIVES.: To determine whether Australian primary-care clinicians think that nonspecific low back pain (NSLBP) is one condition or a number of conditions (subgroups), and whether this belief influences their management of NSLBP. Most low back pain (LBP) remains a diagnostic enigma and results in approximately 80% of primary care LBP presentations being most accurately labeled as "nonspecific LBP." Manual therapy clinicians (chiropractors, osteopaths, physiotherapists) are trained to think that subgroups exist within the NSLBP population. This research sought to identify the extent to which these beliefs are widely held in primary care. A survey was conducted of 1,093 primary-contact clinicians from six professional disciplines (physiotherapists, manipulative physiotherapists, chiropractors, osteopaths, general medical practitioners, and musculoskeletal medicine practitioners). Completed questionnaires were returned by 651 (60%) clinicians. Of the primary-contact clinicians who responded, 93% do not think NSLBP is one condition. Seventy-four percent think that it is currently possible to recognize NSLBP subgroups. Ninety-three percent treat NSLBP differently based on patterns of signs and symptoms. The proportions of clinicians who hold these views were highest for physiotherapists and manipulative physiotherapists, and smallest for general medical practitioners and musculoskeletal medicine practitioners. Although assigning NSLBP patients to subgroups has not been validated, it is common in primary-care settings and influences case management. If subgroups exist within the NSLBP population, there are implications for research into the effects of treatment. Further research into the validity of subgroups is warranted.