POSTURAL STABILTY AND GAIT SPATIO-TEMPORAL PARAMETERS IN PEOPLE WITH NON-SPECIFIC CHRONIC LOW BACK PAIN : AN OBSERVATIONAL COMPARATIVE STUDY

J.-L. Nephtali¹, J. Bertheau², M. Javaudin-Hocquart², C. Nguyen³, F. Rannou³, M.-M. Lefèvre-Colau³, A. Rören⁴

¹Université Paris-Saclay, Methodology and Statistics, Paris, France, ²Hôpital Cochin, Rehabilitation Department, Paris, France, ³Université Paris Cité, Faculty of Medicine, Paris, France, ⁴Université Paris Cité, Rehabilitation Department, Paris, France

Background: Low back pain is the leading cause of years lived with disability. Chronic low back pain can limit activities of daily living. Specific self-administrated questionnaires are used to assess the ability to stand and walk. Few studies have explored postural stability and gait spatiotemporal parameters in people with chronic low back pain.

Purpose: To compare postural stabilty and gait spatio-temporal parameters in people with non-specific chronic low back pain and in healthy people.

Methods: Monocentric retrospective comparative cross-sectional study including 118 participants with chronic low back pain [women: 79 (70%), age: 49.4 (16.5) years; BMI: 25.8 (5.2) kg. m^-², duration of low back pain: 5.7 (5.5) years, pain (VAS) 4.8 (2.5)/10] and 78 asymptomatic participants [women: 46 (59%), age: 37.6 (14.2) years; BMI: 23.0 (3.7) kg.m^-²]. Postural balance (30s eyes open then closed) and walking (2X10m on flat ground) measurements were performed with the Abilycare device including a stabilometric platform and 4 Xsens inertial sensors. We performed 10 comparisons of means between two independent groups and multiple linear regression models including pain as an explanatory variable (p<0.05, considered significant).

Results: After adjustment for age, sex and BMI, the speed sway [0.95 (0.4) VS 0.75 (0.12) s, p<0.001] and sway area [1.39 (1.4) VS 0.58 (0.36) mm2, p<0. 001], and step time [0.58 (0.06) VS 0.54 (0.05) s, p<0.001)] and double support time [0.26 (0.04) VS 0.24 (0.04) s, p=0.001) were increased in people with chronic low back pain. Pain intensity was not associated with these changes (p>0.08).

Conclusions: People with chronic low back pain have poorer postural stability and walk more slowly. Pain does not explain the decrease in postural stability and gait velocity in people with chronic low back pain. We lack information on minimal clinically relevant differences for postural stability and gait spatio-temporal parameters.

Implications: The results of this study open discussion on the need to add specific balance and gait training exercises into the rehabilitation program for people with chronic low back pain. Future studies should assess the association between postural stability, gait, spatio-temporal parameters, and pain and activity limitation. A randomized controlled study is needed to assess the efficacy of a rehabilitation program including specific balance and gait training exercises on pain and function in people with chronic low back pain.

Funding acknowledgements: No funding was received from any funding bodies in the public, commercial or not-for-profit sectors to carry out the work.

Keywords:
Chronic low back pain
Postural stability
Gait spatio-temporal parameters

Topics:
Musculoskeletal: spine
Disability & rehabilitation
Innovative technology: information management, big data and artificial intelligence

Did this work require ethics approval? No

Reason: The study was conducted in accordance with the principles of the Helsinki Declaration and the rules of good clinical practice. All patients were informed by our institution that their personal data, routinely collected as part of administrative and healthcare management processes, could be used for research purposes in the field of health, and provided written informed consent. Because patients' data were retrospectively retrieved from medical charts, formal approval by an institutional review board was not required according to the French Law of March 5, 2012 and its application decree (No. 2016-1537) for research involving humans in France.