A. Hofste1,2, R. Soer1,3, G. Groen2,3, J. van der Palen4,5, F. Geerdink1, F. Oosterveld1, H. Kiers6, A. Wolff2,3, H. Hermens7,8
1Saxion University of Applied Sciences, Faculty Physical Activity and Health, Enschede, Netherlands, 2University Medical Center Groningen, Anesthesiology, Groningen, Netherlands, 3University Medical Center Groningen, Pain Center, Groningen, Netherlands, 4University of Twente, Department of Research Methodology, Measurement and Data analysis, Enschede, Netherlands, 5Medisch Spectrum Twente, Medical School Twente, Enschede, Netherlands, 6University of Applied Sciences Utrecht, Institute for Human Movement Studies, Utrecht, Netherlands, 7University of Twente, Department of Biomedical Signals & Systems, Faculty of Electrical Engineering, Mathematics and Computer Science, Enschede, Netherlands, 8Roessingh Research and Development, Telemedicine Group, Enschede, Netherlands
Background: The lumbar multifidus (LM) is one of the muscles that contribute to the stability of the lumbar spine. Since the contribution of the LM is not well understood in relation to non-specific low back pain (LBP), this may limit physiotherapists in choosing the most appropriate treatment strategy.
Purpose: The aim of this study is to investigate clinical characteristics, in terms of LM function and morphology, between subacute and chronic LBP patients from a large clinical practice cohort compared to healthy controls.
Methods: A multicenter cross-sectional design was used. Subacute, chronic LBP patients, and healthy controls between 18 and 65 years of age were included. Several clinical tests were applied. Primary outcomes were the LM thickness from ultrasound measurements, trunk range of motion (ROM) from 3D kinematic tests, and median frequency and root mean square values of LM by electromyography (EMG) measurements. Comparisons between groups were made with ANOVA, p-values<0.05, with post hoc Bonferroni corrections were considered significant.
Results: A total of 161 participants are included, 50 healthy controls, 59 chronic LBP patients, and 52 subacute LBP patients. The trunk ROM and LM thickness were significantly larger in healthy controls compared to all LBP patients, but between LBP groups no differences were found. Between almost all group comparisons, there appeared no statistically significant differences in EMG outcomes.
Conclusion(s): Overall, the clinical characteristics LM morphology and LM function showed most differences between LBP patients and healthy controls. None of the clinical characteristics showed differences between subacute LBP patients and chronic LBP patients.
Implications: This research is performed in a clinical setting, which means that most testers were physiotherapists and performed the tests in their physiotherapy practice. All tests were clinical tests, which are often used in physiotherapy. This research design improves the generalization of our results to other clinical practices. Thereby, no other study showed data with statistical analysis of comparisons between subacute LBP, chronic LBP patient groups, and HCG on LM morphology and function in this clinical setting and with this number of participants.
Funding, acknowledgements: This study was funded by Raak Publiek, Netherlands organization for scientific research, project number: 2015-02-58P
Keywords: low back pain, lumbar multifidus, primary care
Topic: Musculoskeletal: spine
Did this work require ethics approval? Yes
Institution: Medisch Spectrum Twente, Enschede in the Netherlands
Committee: Medical Ethics Committee Twente, Enschede in the Netherlands
Ethics number: NL60064.044.16
All authors, affiliations and abstracts have been published as submitted.
