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Hotz Boendermaker S1
1University of Applied Science, Department of Physiotherapy, Winterthur, Switzerland
Background: Low back pain represents the most common musculoskeletal problem and its chronification represents a huge burden in terms of pain, suffering and health care expenditures. Fear of movement (FOM) is an important mediator in the transition from acute to chronic LBP (CLBP). The acquisition of FOM by social and associative learning, supports the continued avoidance of potentially painful activities and may finally result in decreased participation in daily life and/or physical deconditioning . Most importantly, sometime during the course from a subacute to a chronic state, physical and psychosocial impairments are reflected in the reorganization of sensorimotor and emotional brain circuits.
Purpose: The observation of potentially harmful and harmless daily activities was used to investigate the effect of CLBP on the action-observation network (AON), representing the automatic activation of sensorimotor-related neuronal and functional representations.
Methods: By using functional MRI, we investigated the AON and its visuo-motor functional connectivity (FC) by showing 5s video-clips of potentially harmful and harmless activities in 15 healthy subjects and 14 CLBP patients. After the presentation of the video clips participants had to rate the harmfulness of the observed activities on an 11-point visual analogue scale (VAS).
In addition, both groups filled in the State and Trait Anxiety Inventory (STAI) and for the subjective experience of fear of movement/(re)injury the German Version of the Tampa Scale for Kinesiophobia (TSK) for LBP patients and for the general population (TSK-G).
Results: CLBP patients and healthy controls showed similar event-related activation and FC within the AON in premotor, parietal and occipito-temporal cortices. Activities considered harmful evoked significantly stronger activity within the AON compared to harmless activities in both groups. Differences were small, although CLBP patients exhibited reduced activity in the right superior temporal sulcus and parietal areas. The fMRI findings were supported by concomitant behavioral measures that revealed equally perceived harmfulness of activities in both groups. Furthermore, there were no statistically significant differences in the STAI subscales and the TSK scores between the CLBP patients and the control group.
Conclusion(s): The engagement of visuo-motor networks and the subsequent motor representation induced by observation of daily activities is functional in CLBP patients. Although actual motor performance might be impaired due to persistent LPB. Furthermore, reduced temporal and parietal activations may indicate an altered on-line integration of multisensory information of the body in CLBP patients, supporting evidence of disrupted body image.
The visual presentation of movements might represent an attractive prospect to design future approaches for the treatment of LBP to facilitate motor functions in in particular in patients with high fear of movement. Observation is not a substitute for physical exercise. It should be perceived as a complementary technique as the effect of movement observation training is enhanced when it is combined with physical practice to improve motor behavior.
Implications: Among practitioners it is recognized that most interventions for the management of CLBP have only limited success. CLBP treatment approaches that target brain function might lead to an additional avenue for improved patient outcome.
Keywords: low back pain, fear of movement, action observation
Funding acknowledgements: Swiss National Science Foundation and Mrs. Frieda Mueller
Purpose: The observation of potentially harmful and harmless daily activities was used to investigate the effect of CLBP on the action-observation network (AON), representing the automatic activation of sensorimotor-related neuronal and functional representations.
Methods: By using functional MRI, we investigated the AON and its visuo-motor functional connectivity (FC) by showing 5s video-clips of potentially harmful and harmless activities in 15 healthy subjects and 14 CLBP patients. After the presentation of the video clips participants had to rate the harmfulness of the observed activities on an 11-point visual analogue scale (VAS).
In addition, both groups filled in the State and Trait Anxiety Inventory (STAI) and for the subjective experience of fear of movement/(re)injury the German Version of the Tampa Scale for Kinesiophobia (TSK) for LBP patients and for the general population (TSK-G).
Results: CLBP patients and healthy controls showed similar event-related activation and FC within the AON in premotor, parietal and occipito-temporal cortices. Activities considered harmful evoked significantly stronger activity within the AON compared to harmless activities in both groups. Differences were small, although CLBP patients exhibited reduced activity in the right superior temporal sulcus and parietal areas. The fMRI findings were supported by concomitant behavioral measures that revealed equally perceived harmfulness of activities in both groups. Furthermore, there were no statistically significant differences in the STAI subscales and the TSK scores between the CLBP patients and the control group.
Conclusion(s): The engagement of visuo-motor networks and the subsequent motor representation induced by observation of daily activities is functional in CLBP patients. Although actual motor performance might be impaired due to persistent LPB. Furthermore, reduced temporal and parietal activations may indicate an altered on-line integration of multisensory information of the body in CLBP patients, supporting evidence of disrupted body image.
The visual presentation of movements might represent an attractive prospect to design future approaches for the treatment of LBP to facilitate motor functions in in particular in patients with high fear of movement. Observation is not a substitute for physical exercise. It should be perceived as a complementary technique as the effect of movement observation training is enhanced when it is combined with physical practice to improve motor behavior.
Implications: Among practitioners it is recognized that most interventions for the management of CLBP have only limited success. CLBP treatment approaches that target brain function might lead to an additional avenue for improved patient outcome.
Keywords: low back pain, fear of movement, action observation
Funding acknowledgements: Swiss National Science Foundation and Mrs. Frieda Mueller
Topic: Pain & pain management; Musculoskeletal
Ethics approval required: Yes
Institution: Balgrist University Hospital
Ethics committee: Canton of Zurich
Ethics number: KEK-ZH-Nr. 2012-0029
All authors, affiliations and abstracts have been published as submitted.
