Verbruggen M1, De Becker K1, Vermeersch J1, Vaes P1
1Vrije Universiteit Brussel, Physiotherapy, Brussels, Belgium
Background: Lumbar motor control impairments are highly prominent in non-specific chronic low back pain (=NSCLBP) patients. Numerous studies associate NSCLBP with inadequate muscle coordination, strength and endurance. Consequently differences are observed in the motion analysis of frequent ADL activities like standing, walking, bending and sitting when comparing individuals without LBP with NSCLBP patients. Available test batteries to examine motor control impairments lack functional, ADL related tests for NSCLBP patients. In addition, often complex and expensive equipment and/or subjective scoring procedures are used. Moreover, none of these batteries proved to be sufficiently valid and reliable
Purpose: First an objective and functional test battery was developed to assess thoracolumbar motor control in NSCLBP patients, applicable in clinical practice. Second the thoracolumbar posture, measured by the Profiler©, of the NSCLBP group was compared to the healthy subjects to examine the hypothesis that NSCLBP patients show a diminished thoracolumbar motor control
Methods: An ADL inspired test battery included six functional tests, e.g. standing, sitting, walking and bending. The tests are: natural and standardized standing, standing pelvic tilt test, repositioning capacity test during sitting, the shuttle walk test and the Waiters Bow. In thirty minutes, two observers monitored the total test battery for each subject in a non-blinded but strictly standardized procedure. VAS-pain was registered after every test. The Profiler (Intophysio BVBA), a valid and reliable Inertial Sensor Real-Time Feedback System, contains
(1) two inertial skin sensors who were applied to the back (T10 and L3) of each subject and
(2) a central unit in which kinematic data were integrated. Thoracolumbar angles were registered and calculated by both sensors. This study was approved by the Medical Ethics Committee, UZ Brussel, Belgium (B.U.N. 143201836278)
Results: Forty-one subjects were included and divided into a NSCLBP group (N=21) and a healthy control group (N=20). The NSCLBP patients showed significant higher thoracolumbar angles during natural standing (p=0.046) and the anterior pelvic tilt (p=0.037) compared to the healthy subjects. Furthermore, a trend toward significant higher thoracolumbar angles was observed in the NSCLBP group for standardized standing (p=0.078), posterior pelvic tilt angle (p=0.073) and walking (p=0.052) when compared to the healthy subjects. Finally, a positive correlation was found between (1) pain and several motor control tests (r=0.350-0.434, p=0.025-0.005) and (2) pain and disability (r=0.706, p 0.001). A trend toward a significant correlation between disability and several motor control tests (r=0.267-0.291, p=0.064-0.092) was observe
Conclusion(s): The new, functional test battery showed significant higher thoracolumbar angles, measured by the Profiler, in the NSCLBP group but not for all tests. There were important trends toward significant differences, indicating a diminished motor control in the NSCLBP group. Therefore future research should focus on blinding observers, examining a larger sample sizes and the validation of the test battery
Implications: The current study emphasizes
(1) the importance of detecting motor control impairments in NSCLBP patients given that it shows a positive correlation with pain and (a trend) with disability and
(2) the lack of a golden standard test battery for measuring thoracolumbar motor contro
Keywords: Non-specific chronic low back pain, Motor control, Test battery
Funding acknowledgements: no funding was received for this research project
Purpose: First an objective and functional test battery was developed to assess thoracolumbar motor control in NSCLBP patients, applicable in clinical practice. Second the thoracolumbar posture, measured by the Profiler©, of the NSCLBP group was compared to the healthy subjects to examine the hypothesis that NSCLBP patients show a diminished thoracolumbar motor control
Methods: An ADL inspired test battery included six functional tests, e.g. standing, sitting, walking and bending. The tests are: natural and standardized standing, standing pelvic tilt test, repositioning capacity test during sitting, the shuttle walk test and the Waiters Bow. In thirty minutes, two observers monitored the total test battery for each subject in a non-blinded but strictly standardized procedure. VAS-pain was registered after every test. The Profiler (Intophysio BVBA), a valid and reliable Inertial Sensor Real-Time Feedback System, contains
(1) two inertial skin sensors who were applied to the back (T10 and L3) of each subject and
(2) a central unit in which kinematic data were integrated. Thoracolumbar angles were registered and calculated by both sensors. This study was approved by the Medical Ethics Committee, UZ Brussel, Belgium (B.U.N. 143201836278)
Results: Forty-one subjects were included and divided into a NSCLBP group (N=21) and a healthy control group (N=20). The NSCLBP patients showed significant higher thoracolumbar angles during natural standing (p=0.046) and the anterior pelvic tilt (p=0.037) compared to the healthy subjects. Furthermore, a trend toward significant higher thoracolumbar angles was observed in the NSCLBP group for standardized standing (p=0.078), posterior pelvic tilt angle (p=0.073) and walking (p=0.052) when compared to the healthy subjects. Finally, a positive correlation was found between (1) pain and several motor control tests (r=0.350-0.434, p=0.025-0.005) and (2) pain and disability (r=0.706, p 0.001). A trend toward a significant correlation between disability and several motor control tests (r=0.267-0.291, p=0.064-0.092) was observe
Conclusion(s): The new, functional test battery showed significant higher thoracolumbar angles, measured by the Profiler, in the NSCLBP group but not for all tests. There were important trends toward significant differences, indicating a diminished motor control in the NSCLBP group. Therefore future research should focus on blinding observers, examining a larger sample sizes and the validation of the test battery
Implications: The current study emphasizes
(1) the importance of detecting motor control impairments in NSCLBP patients given that it shows a positive correlation with pain and (a trend) with disability and
(2) the lack of a golden standard test battery for measuring thoracolumbar motor contro
Keywords: Non-specific chronic low back pain, Motor control, Test battery
Funding acknowledgements: no funding was received for this research project
Topic: Musculoskeletal: spine; Human movement analysis
Ethics approval required: Yes
Institution: Vrije Universiteit Brussel
Ethics committee: University Hospital VUBrussel
Ethics number: B.U.N. 143201836278
All authors, affiliations and abstracts have been published as submitted.
