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Schouppe S.1, Clauwaert A.2, Van Damme S.2, Danneels L.1, Crombez G.2, Van Oosterwijck J.1,3,4
1Ghent University, Department of Rehabilitation Sciences and Physiotherapy, Ghent, Belgium, 2Ghent University, Department of Experimental-Clinical and Health Psychology, Ghent, Belgium, 3Research Foundation - Flanders (FWO), Brussels, Belgium, 4Pain in Motion international research group, www.paininmotion.be, Belgium
Background: Low back pain (LBP) is studied across several research domains as this forms one of the most common health issues of our society. It is known that pain induces changes in posture and in the way we move. Thus it is not surprising that disturbed motor function of the trunk is often observed in these patients. Furthermore, maladaptive thoughts, cognitions and emotions such as catastrophizing, fear and hypervigilance towards pain-related information often develop when pain persists and have been reported in those with LBP. Hence, it is likely that these psychological factors influence motor function.
Purpose: This systematic review summarized the evidence concerning the influence of fear and attentional processes on motor function in LBP.
Methods: A systematic search adhering to the PRISMA guidelines was performed in search engines PubMed, Web of Science, Embase, CINAHL and PsycArticles using a combination of predefined keywords regarding LBP, the fear avoidance model, and motor control and performance outcomes. Full text reports of experimental studies that examined the influence of 2 cognitive-affective factors, i.e. pain or movement related fear or attention, on motor function in clinical LBP were included. Methodological quality of the included studies was assessed using the Newcastle-Ottawa Scale (NOS) adapted for cross-sectional studies. The results were disseminated per type of LBP (acute, recurrent, or chronic).
Results: In total 1208 articles were retrieved, of which 51 were included and discussed. The influence of fear, attention or a combination of both on motor function was respectively discussed in 42, 5 and 4 articles. The main population studied was chronic (34 articles), followed by not-specified (9), mixed chronic-recurrent (4) and (sub)acute (4) LBP groups. Methodological issues included selection bias, lack of power analyses, and failure of blinding participants and researchers.
Conclusion(s): Catastrophizing was associated with increased trunk muscle activity, but reductions in force output, lower back muscle endurance, trunk coordination and range of motion during a straight leg raise and during trunk bending. Higher fear levels in LBP showed either no significant or negative associations with motor related functions such as muscle power, endurance, balance, coordination, kinematics and range of motion. The effects of attention are examined to a lesser extent. Distraction is the most discussed type of attention, and is associated with less muscle activity during gait, less trunk-pelvis coordination and variability, and decrease of postural balance during high difficulty tasks. Qualitative gait parameters and arm flexion reaction time are not influenced by distraction paradigms. Associations of activities of daily living with cognitive-affective factors depend on the type of tasks examined. In order to understand LBP chronicity future studies should try to differentiate and perform comparative analysis between different LBP populations (acute, recurrent, chronic).
Implications: The results from this review indicate an interplay between disturbed motor function and maladaptive cognitive processing. This implies that when physiotherapists aim to improve motor function it is important to assess and treat the presence of maladaptive cognitions as they will possibly influence treatment outcomes. Hence, a biopsychosocial treatment approach is suggested in these patients.
Funding acknowledgements: This study was funded by an interdisciplinary research grant (BOF14/IOP/067) from the Special Research Fund of Ghent University.
Topic: Musculoskeletal: spine
Ethics approval: Not applicable as this is a report from a systematic literature review.
All authors, affiliations and abstracts have been published as submitted.
