Therefore, the aim of this study was to investigate the relationship between the cross-sectional area of the multifidus muscle and activities of daily living and severity of symptoms in outpatients with low back pain who underwent MRI at our hospital.
The study involved 219 patients diagnosed with lumbar disorders who underwent MRI between June 10, 2015, and July 16, 2016, based on physician prescription. The average age of participants was 62.9±13.4 years. The cross-sectional area of the lumbar multifidus muscle at the L4/5 level was measured using POP-Net Viewer (manufactured by Image One Co., Ltd.). Patients were divided into two age groups: middle-aged (40-64 years) and elderly (65-94 years). Each group was further categorized into three subgroups based on the size of their lumbar multifidus muscle cross-sectional area: small, medium, and large. The study assessed the impact of lumbar pain on daily life and symptom severity across these subgroups using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ). Statistical analysis was performed using the Steel-Dwass method for multiple comparisons, with a significance level set at 5%.
In the middle-aged group, no significant differences were observed among the three subgroups in any JOABPEQ categories. However, in the elderly group, significant differences were found: those in the small cross-sectional area subgroup had higher scores for walking function impairment compared to those in medium and large subgroups. Additionally, for the category of social life impairment, individuals in the small subgroup scored higher than those in the medium subgroup. In the category of psychological impairment, participants in the small subgroup had higher scores compared to those in the large subgroup.
The results of this study suggest that in the elderly group, the smaller the cross-sectional area of the multifidus muscle in the lower back, the greater the likelihood of a negative impact on walking function, social life, and mental state. As there was no difference in the degree of pain, it is possible that they have changed their lifestyle to prevent worsening of their symptoms.
These results indicate that it is important to consider the cross-sectional area of the multifidus muscle, age, and lifestyle when designing a rehabilitation program for patients with low back pain. Incorporating these factors into the rehabilitation plan will enable a customized approach that meets the specific needs of middle-aged and elderly patients and will lead to improved treatment outcomes and improved quality of life for patients.
the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire
Chronic low back pain
