Disability measurement in persons with back pain: a validity study of spinal range of motion and velocity. Low Back Pain Recurrence in Occupational Environments Differences in motor recruitment and resulting kinematics between low back pain patients and asymptomatic participants during lifting exertions. Pelvis-Thorax Coordination in the Transverse Plane During Walking in Persons With Nonspecific Low Back Pain Is Work Status of Low Back Pain Patients Best Described by an Automated Device or by a Questionnaire? Osteopathic manipulative treatment in obese patients with chronic low back pain: a pilot study. Movement coordination of the lumbar spine and hip during a picking up activity in low back pain subjects The effect of exercise on the intensity of low back pain in pregnant women. Stretching in the Rehabilitation of Low-Back Pain Patients Evidence-based medicine and the challenge of low back pain: where are we now? Does respiration perturb body balance more in chronic low back pain subjects than in healthy subjects?
OBJECTIVE To evaluate the criterion validity and responsiveness to change of spine kinematic variables to assess disability in patients with low back pain . DESIGN Blinded comparison between spine kinematic variables , Oswestry disability question naire scores , and work status . SETTING Multidisciplinary occupational rehabilitation clinic of a university hospital . PATIENTS Population -based cohort of 111 patients with subacute work-related back pain who were absent from regular work for more than 4 weeks because of back pain . INTERVENTIONS This study was part of a population -based r and omized clinical trial . Patients were r and omized to 4 different methods of management : usual care , rehabilitation , ergonomics , or rehabilitation and ergonomics . MAIN OUTCOME MEASURES Oswestry disability question naire , kinematic analysis of the spine during flexion and extension of the trunk , and work status were collected at weeks 4 , 12 , 24 , and 52 after the back accident . RESULTS Kinematic variables were poorly to moderately related to work status and Oswestry question naire scores . Kinematic variables were also unresponsive to change in work status and Oswestry question naire scores over time . CONCLUSION Spine kinematics during flexion and extension of the trunk do not appear to be a valid measure of disability in patients with subacute and chronic back pain Study Design . Prospect i ve assessment of return to work after low back pain . Objective . To determine which factors or combination of factors best predict recurrence of low back pain ( defined 4 different ways ) when returning to full-duty work . Summary of Background Data . Recurrent back pain is one of the more costly health problems facing industry today . Few systematic evaluations of the various factors suspected of exacerbating low back pain have been reported in the literature . Methods . A total of 206 workers who reported low back pain were evaluated as they returned to full-duty work .  Five types of assessment s were performed including : 1 ) a  low back kinematic functional assessment s  , 2 )  evaluation of job physical dem and s  , 3 )  psychosocial assessment of the job environment , 4 )  self-reported impairment including perception of symptoms and psychological measures  , and 5 )  personal ( individual ) factors . One year after return to full duty workers were interviewed to assess who had a recurrence of low back pain according to 4 different definitions of low back pain ( symptom reports , medical visits , self-reported lost days , and employer-reported lost days due to back pain ) . Multiple logistic regression models were developed to assess the best combinations of predictors . Results . The most liberal definition of recurrence , recurrent symptoms , had a significantly greater recurrence rate at 58 % than all other outcome measures ( P = 0.0001 ) . The medical visit recurrence rate of 36 % was significantly greater than the more conservative lost time measures ( P = 0.0001 ) . The recurrence rate for self-reported lost time was 15 % , whereas the more conservative employer confirmed lost time measure was significantly lower at 10 % ( P = 0.0077 ) . Multivariate predictive models associated with the various recurrence definitions yielded sensitivities varying between 78 % and 80 % and specificity between 73 % and 80 % . Conclusion . Recurrence is greatly dependent on how one defines recurrence with symptom reporting yielding 5.5 times as many recurrences compared with employer confirmed lost time . In general , more quantitative measures of worker musculoskeletal function yielded the best predictions of recurrence when predicting the more restrictive definitions of recurrence ( employer confirmed lost time ) BACKGROUND Low back disorders are a prevalent problem in society today and may lead to chronic debilitating low back pain . Developing our underst and ing of temporal muscle and kinematic patterns during manual material h and ling tasks may provide insight for preventing the cascading series of events leading to chronic low back pain . METHODS Sixty-two low back pain patients and 61 asymptomatic participants performed a variety of lifting exertions  that varied in lift origin horizontal and vertical distance , lift asymmetry , and weight . Electromyographic activity of 10 trunk muscles as well as trunk and pelvic kinematics was recorded during each exertion . Differences in muscle activation and kinematic parameters were compared between low back pain patients and asymptomatic participants as a function of experimental conditions . FINDINGS Both the left and right erector spinae activated significantly earlier and were on significantly longer in low back pain patients compared to asymptomatic participants . The horizontal and vertical location of the lift influenced the EMG and kinematic differences between the low back pain patients and asymptomatic participants . INTERPRETATION These finding indicate that low back pain patients would be exposed to increase muscle activity result ing in higher spine loads for a greater length of time compared to asymptomatic participants . The longer exposure time to increased spine load may lead to greater risk of future low back injury and cascading events leading to debilitating low back pain . The longer muscle activation time suggests that low back pain patients have changed their motor program from an open to a closed loop system Study Design . Transverse pelvis and thorax rotations were studied during walking in 39 patients with nonspecific low back pain and 19 healthy participants . Objectives . To gain insight into the consequences of low back pain for gait and to identify clinical ly useful measures for characterizing the quality of walking in patients with low back pain . Summary of Background Data . Gait studies in patients with low back pain have reported a decrease in walking velocity . In normal gait , in-phase pelvis-thorax coordination ( synchronicity ) evolves toward antiphase coordination ( counterrotation ) as walking velocity increases . This study examined the effect of walking velocity on  pelvis and thorax rotations  in patients with low back pain . Methods .  Amplitudes of pelvis and thorax rotations  were calculated , and spectral analyses were performed . Pelvis-thorax coordination was characterized in terms of relative Fourier phase , and coupling strength was assessed by means of cross-spectral analysis . Results . In comparison with healthy participants , relative Fourier phase was significantly smaller in low back pain patients for walking velocities of 3.8 km/h and higher , whereas coupling strength was significantly higher for velocities from 1.4 to 3.0 km/h . No significant group differences were found in amplitude or spectral content of individual pelvis and thorax rotations . Conclusion . In comparison with healthy participants , the gait of patients with low back pain was characterized by a more rigid , less flexible pelvis-thorax coordination in the absence of significant differences in the kinematics of the component rotations . This result suggests that coordination measures are more adequate in assessing quality of walking in patients with low back pain than are kinematic measures pertaining to the individual segment rotations , and that conservative therapy should use methods aim ed at improving intersegmental coordination Study Design . A prospect i ve cohort study of patients with subacute occupational back pain . Objectives . To study the relation between a marketed opto‐electric device measuring trunk kinematics , a widely used specific functional capacity question naire , and work status in back pain patients , and to assess the responsiveness to change in work status of the opto‐electric device and the question naire . Summary of Background Data . Several instruments have been developed to evaluate the functional capacities of patients with back pain , but the relation between these instruments and work status has rarely been studied . Methods . The relation between the opto‐electric device , the question naire , and work status in patients with back pain was evaluated . The study population was a prospect i ve cohort of patients with subacute back pain who were absent from regular work for more than 4 weeks . All data were compiled blindly on the same day , at study entry ( 4 weeks after work accident ) , and at 12 , 24 , and 52 weeks after the work accident . The validity of the question naire and opto‐electric device scores was assessed with partial correlation analyses , st and ardized response mean , logistic regression analyses , and receiver operating characteristics curves . Results . The correlation between the question naire and opto‐electric device scores was low . The question naire scores were significantly related to work status , but the opto‐electric device scores were not . The question naire was responsive to change in work status , whereas the opto‐electric device was not . Conclusions . The opto‐electric device scores were not related to either functional capacity scores ( question naire ) or work status in patients with low back pain , and the opto‐electric device was not responsive to change in work status . Conversely , the question naire was related to work status and was responsive to change in work status BACKGROUND Obesity is frequently associated with various musculoskeletal disorders including chronic low back pain ( cLBP ) . Osteopathy is a discipline emphasizing the conservative treatment of the disease in an olistic vision . We design ed a r and omized controlled study to investigate whether Osteopathic Manipulative Treatment ( OMT ) combined with specific exercises ( SE ) is more effective than SE alone in obese patients with cLBP . METHODS nineteen obese females with cLBP , r and omized into 2 groups :  SE + OMT and SE were studied during the forward flexion of the spine using an optoelectronic system . A biomechanical model was developed in order to analyse kinematics and define angles of clinical interest . OUTCOME MEASURES kinematic of the thoracic and lumbar spine and pelvis during forward flexion , pain according to a visual analogue scale ( VAS ) , Rol and Morris Disability Question naire and Oswestry Low Back Pain Disability Question naire . RESULTS significant effects on kinematics were reported only for OMT + SE with an improvement in thoracic range of motion of nearly 20 % . All scores of the clinical scales used improved significantly . The greatest improvements occurred in the OMT + SE group . CONCLUSIONS combined rehabilitation treatment including Osteopathic Manipulative Treatment ( OMT + SE ) showed to be effective in improving biomechanical parameters of the thoracic spine in obese patients with cLBP . Such results are to be attributed to OMT , since they were not evident in the SE group . We also observed a reduction of disability and pain . The clinical results should be considered preliminary due to the small sample size The effect of  low back pain , with or without nerve root signs , on the joint coordination and kinematics of the lumbar spine and hips during everyday activities , such as picking up an object from the floor , are largely unknown . An experimental study was design ed to compare lumbar spine and hip joint kinematics and coordination in subjects with and without sub-acute low back pain , while picking up an object in a sitting position . A three-dimensional real-time electromagnetic tracking device was used to measure movements of the lumbar spine and hips . Sixty participants with subacute low back pain , with or without straight leg raise signs , and twenty healthy asymptomatic participants were recruited . The ranges of motions of lumbar spine and hips were determined . Movement coordination between the two regions was examined by cross-correlation . Results showed that mobility was significantly reduced in subjects with back pain , who compensated for limited motion through various strategies . The contribution of the lumbar spine relative to that of the hip was , however , found to be similar in all groups . The lumbar spine – hip joint coordination was substantially altered in subjects with back pain , in particular , those with a positive straight leg raise sign . We conclude that changes in the lumbar and hip kinematics were related to back pain and limitation in straight leg raise . Lumbar – hip coordination was mainly affected by the presence of positive straight leg raise sign when picking up an object in a sitting position OBJECTIVE To investigate the effect of exercise during pregnancy on the intensity of  low back pain  and kinematics of spine . METHOD A prospect i ve r and omized study was design ed . 107 women participated in an exercise program three times a week during second half of pregnancy for 12 weeks and 105 as control group . All filled a question naire between 17 - 22 weeks of gestation and 12 weeks later for assessment of their back pain intensity . Lordosis and flexibility of spine were measured by Flexible ruler and Side bending test , respectively , at the same times . Weight gain during pregnancy , Pregnancy length and neonatal weight were recorded . RESULT Low back pain intensity was increased in the control group . The exercise group showed significant reduction in the intensity of low back pain after exercise ( p<0.0001 ) . Flexibility of spine decreased more in the exercise group ( p<0.0001 ) . Weight gain during pregnancy , pregnancy length and neonatal weight were not different between the two groups . CONCLUSION Exercise during second half of the pregnancy significantly reduced the intensity of low back pain , had no detectable effect on lordosis and had significant effect on flexibility of spine The major objective of this investigation was to study the effectiveness of the physical conditioning program used at the University of Miami Comprehensive Pain and Rehabilitation Center in restoring certain elements of the functional abilities of individuals suffering from chronic low-back pain and to evaluate the effectiveness of using a systematic ally applied , aggressive stretching maneuver as an add-on therapy in the treatment of chronic low-back pain patients . The effect(s ) of the proposed stretching maneuver was evaluated . Twenty-eight chronic low-back pain patients were r and omly assigned to one of two groups . The control group underwent a multimodal rehabilitation program , and the experimental group underwent the same rehabilitation program in addition to the systematic stretching maneuver under investigation . The results obtained showed that patients undergoing the multimodal rehabilitation program with and without the proposed systematic stretching maneuver showed a significant improvement in their functional abilities as seen from the significant increase in the static strength of the back extensors , with corresponding significant increase in back muscle myoelectric signals . Also , a significant decrease in their pain level was reported after 2 weeks of continuous treatment . The use of the systematic stretching maneuver enhanced the functional gains of chronic low-back pain patients compared to the control group Low  back pain  has long been described as a challenge for both primary care physicians and specialists . Management of  low back pain  has also been criticized as frequently arbitrary , inappropriate , or ineffective . Contributing factors have been an inadequate evidence base and a need for more rigorous appraisal s of the available literature . Evidence -based medicine , an approach to clinical problem solving , is predicated on the premise that high- quality health care will result from practice s consistent with the best evidence . In contrast to the traditional medical paradigm that placed a heavy reliance on expert opinion , authority , and un systematic clinical observations , evidence -based medicine emphasizes the need for rigorous critical appraisal s of the scientific literature to inform medical decision making . Evidence -based medicine places strong weight on the requirement for valid studies , particularly r and omized controlled trials , to appropriately evaluate the effectiveness of health care interventions . Because of the rapidly increasing volume of medical literature , however , most clinicians are unable to keep up-to- date with all the new data . Two types of preprocessed evidence that can aid busy clinicians in medical decision making are systematic review s and evidence -based clinical practice guidelines . Like primary studies , systematic review s and clinical practice guidelines must adhere to high method ologic st and ards to reduce error and bias . As in other areas of medicine , the approach to the management of low back pain has been positively affected by the availability of more clinical trials and better use of critical appraisal techniques to evaluate and apply research findings . In addition to more rigorous primary studies , an increasing number of high- quality systematic review s and evidence -based clinical practice guidelines for low back pain are also available . Although some research gaps and method ologic shortcomings persist , the richer evidence base has greatly improved our underst and ing of what does and does not work for low back pain . Despite these advances , the best available evidence often does not inform everyday clinical decisions for low back pain . Nonetheless , there is widespread agreement that adherence to evidence -based practice will help improve low back pain patient outcomes and reduce arbitrary variations in care . This article review s basic principles of evidence -based medicine , discusses evidence -based medicine in the context of low back pain management , and summarizes some useful evidence -based medicine re sources OBJECTIVE To determine whether body balance is perturbed more in low back pain patients than in healthy subjects , under the concept of posturo-kinetic capacity . DESIGN Comparison of posturographic and respiratory parameters between low back pain and healthy subjects . BACKGROUND It has been demonstrated that respiratory movements constitute a perturbation to posture , compensated by movements of the spine and of the hips , and that low back pain is frequently associated with a loss of back mobility . METHOD Ten low back pain patients and ten healthy subjects performed five posturographic tests under three different respiratory rate conditions : quiet breathing ( spontaneous ) , slow breathing ( 0.1 Hz ) and fast breathing ( 0.5 Hz ) . RESULTS Intergroup comparison showed that the mean displacements of the center of pressure were greater for the low back pain group , especially along the antero-posterior axis , where respiratory perturbation is primarily exerted . Inter-condition comparison showed that in slow and fast breathing relatively to quiet breathing , the mean displacement of the center of pressure along the antero-posterior axis was significantly increased only for the low back pain group . CONCLUSION According to the results , respiration presented a greater disturbing effect on body balance in low back pain subjects . RELEVANCE This study provides information on the causes of the impaired body balance associated with chronic low back pain , which could be used to improve treatment strategy
The most commonly reported outcome was range of motion .
Interpretation : The literature to date offers limited and inconsistent evidence of kinematic/kinetic measures in low back pain patients that could be used clinical ly .
HighlightsCurrent low back pain assessment relies on subjective measures .Use of objective measures ( kinematics/kinetics ) is encouraged in low back pain assessment .This review highlights the heterogeneity of studies with low back pain and healthy subjects .
Background : Currently , there is a widespread reliance on self‐reported question naires to assess low back pain patients .
However , it has been suggested that objective measures of low back pain patients ' functional status should be used to aid clinical assessment .
The aim of this study is to systematic ally review which kinematic /kinetic parameters have been used to assess low back pain patients against healthy controls and to propose clinical kinematic/kinetic measures .