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Chronic low back pain clinical outcomes present higher associations with the STarT Back Screening Tool than with physiologic measures: a 12-month cohort study.

Pagé I, Abboud J, O Shaughnessy J, Laurencelle L, Descarreaux M - BMC Musculoskelet Disord (2015)

Bottom Line: The SBST allowed for the identification of participants presenting higher levels of disability (ODI ≥24 %), pain (NRS ≥37 %) or fear of movement (TSK ≥41/68) over a 12-month period (AUC = 0.71 to 0.84, ps < 0.05).The SBST score was also correlated with disability at each follow-up (τ = 0.22 to 0.33, ps < 0.05) and with pain intensity and fear of movement at follow-ups.Among physiologic measures, only maximal voluntary contraction was correlated to disability, pain intensity or fear of movement during the follow-up (/τ/ = 0.26 to 0.32, ps < 0.05) and none was able to identify participants presenting higher levels of outcomes (AUC ps > 0.05).

View Article: PubMed Central - PubMed

Affiliation: Département des sciences de l'activité physique, Université du Québec à Trois-Rivières (UQTR), Trois-Rivières, Québec, Canada. Isabelle.Page1@uqtr.ca.

ABSTRACT

Background: Stratification strategies based on identifying patient's prognosis in order to guide patient care constitute one of the most prominent and recent approach in low back pain research. The STarT Back Screening Tool (SBST) although promising, has not been studied in patients with chronic low back pain (cLBP). Considering how challenging it is to translate research into practice, the value of integrating a new tool should be thoroughly assessed. The purpose was therefore to assess associations between the short- and long-terms clinical status and two types of variables, physiologic measures and the SBST, in participants with cLBP. The ability of both types of variables to discriminate between participants with and without higher levels of disability, pain, fear of movement and patient's global impression of change was also investigated.

Methods: Fifty-three volunteers with cLBP participated in an initial evaluation and follow-ups at 2-, 4-, 6- and 12-month. Physiologic measures (maximal voluntary contraction, maximal endurance and muscle activity evaluated during prone and lateral isometric tasks) and the SBST were assessed at baseline. Disability (Oswestry Disability Index, ODI), pain intensity (101-point Numerical Rating Scale, NRS), fear of movement (Tampa Scale for Kinesiophobia, TSK) and patient's global impression of change (7-point scale, PGIC) were evaluated at baseline and at each follow-up. Aside the use of correlation analyses to assess potential associations; ROC curves were performed to evaluate the discriminative ability of physiologic measures and the SBST.

Results: The SBST allowed for the identification of participants presenting higher levels of disability (ODI ≥24 %), pain (NRS ≥37 %) or fear of movement (TSK ≥41/68) over a 12-month period (AUC = 0.71 to 0.84, ps < 0.05). The SBST score was also correlated with disability at each follow-up (τ = 0.22 to 0.33, ps < 0.05) and with pain intensity and fear of movement at follow-ups. Among physiologic measures, only maximal voluntary contraction was correlated to disability, pain intensity or fear of movement during the follow-up (/τ/ = 0.26 to 0.32, ps < 0.05) and none was able to identify participants presenting higher levels of outcomes (AUC ps > 0.05).

Conclusion: Physiologic measures obtained during prone and lateral tests have limited associations with the clinical status over a 12-month period in patients with nonspecific chronic low back pain. On the other hand, the STarT Back Screening Tool is useful for the identification of patients who will present higher levels of disability, pain intensity and fear of movement over a year.

Trial registration: Clinicaltrials.gov NCT02226692.

No MeSH data available.


Related in: MedlinePlus

Matrices used in the recording of lumbar muscles activity during prone position tasks
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Fig2: Matrices used in the recording of lumbar muscles activity during prone position tasks

Mentions: EMG of right and left lumbar erector spinae was recorded during prone position tasks using two adhesive matrices of 64 electrodes (model ELSCH064; LISiN-OT Bioelettronica; Torino, Italy) as illustrated in Fig. 2. The array grid consisted of 64 electrodes, 13 rows × 5 columns (2 mm diameter, 12.5 mm inter-electrode distance). The electrode surfaces were separated from the skin by a small cavity (approximately 1 mm thick) filled with electrolyte gel (AC-CREAM250V; Spes Medica; Battipaglia, Italy). The center of each grid was located at L3 and two ground electrodes were placed on the right and left olecranon processes. Skin impedance was reduced by shaving body hair; gently abrading the skin with fine-grade sandpaper (Red Dot Trace Prep, 3 M; St. Paul, MN, USA), and wiping the skin with alcohol swabs. The bipolar EMG signals were amplified (64-channel surface EMG amplifier, SEA 64, LISiN-OT Bioelettronica; Torino, Italy; −3 dB bandwidth 10–500 Hz) by a factor of 5000, sampled at 2048 Hz, and converted to digital form by a 12-bit A/D converter. The data were collected using the OT Bioelettronica custom software and processed by Matlab (MathWorks; Natick, MA, USA).Fig. 2


Chronic low back pain clinical outcomes present higher associations with the STarT Back Screening Tool than with physiologic measures: a 12-month cohort study.

Pagé I, Abboud J, O Shaughnessy J, Laurencelle L, Descarreaux M - BMC Musculoskelet Disord (2015)

Matrices used in the recording of lumbar muscles activity during prone position tasks
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4541753&req=5

Fig2: Matrices used in the recording of lumbar muscles activity during prone position tasks
Mentions: EMG of right and left lumbar erector spinae was recorded during prone position tasks using two adhesive matrices of 64 electrodes (model ELSCH064; LISiN-OT Bioelettronica; Torino, Italy) as illustrated in Fig. 2. The array grid consisted of 64 electrodes, 13 rows × 5 columns (2 mm diameter, 12.5 mm inter-electrode distance). The electrode surfaces were separated from the skin by a small cavity (approximately 1 mm thick) filled with electrolyte gel (AC-CREAM250V; Spes Medica; Battipaglia, Italy). The center of each grid was located at L3 and two ground electrodes were placed on the right and left olecranon processes. Skin impedance was reduced by shaving body hair; gently abrading the skin with fine-grade sandpaper (Red Dot Trace Prep, 3 M; St. Paul, MN, USA), and wiping the skin with alcohol swabs. The bipolar EMG signals were amplified (64-channel surface EMG amplifier, SEA 64, LISiN-OT Bioelettronica; Torino, Italy; −3 dB bandwidth 10–500 Hz) by a factor of 5000, sampled at 2048 Hz, and converted to digital form by a 12-bit A/D converter. The data were collected using the OT Bioelettronica custom software and processed by Matlab (MathWorks; Natick, MA, USA).Fig. 2

Bottom Line: The SBST allowed for the identification of participants presenting higher levels of disability (ODI ≥24 %), pain (NRS ≥37 %) or fear of movement (TSK ≥41/68) over a 12-month period (AUC = 0.71 to 0.84, ps < 0.05).The SBST score was also correlated with disability at each follow-up (τ = 0.22 to 0.33, ps < 0.05) and with pain intensity and fear of movement at follow-ups.Among physiologic measures, only maximal voluntary contraction was correlated to disability, pain intensity or fear of movement during the follow-up (/τ/ = 0.26 to 0.32, ps < 0.05) and none was able to identify participants presenting higher levels of outcomes (AUC ps > 0.05).

View Article: PubMed Central - PubMed

Affiliation: Département des sciences de l'activité physique, Université du Québec à Trois-Rivières (UQTR), Trois-Rivières, Québec, Canada. Isabelle.Page1@uqtr.ca.

ABSTRACT

Background: Stratification strategies based on identifying patient's prognosis in order to guide patient care constitute one of the most prominent and recent approach in low back pain research. The STarT Back Screening Tool (SBST) although promising, has not been studied in patients with chronic low back pain (cLBP). Considering how challenging it is to translate research into practice, the value of integrating a new tool should be thoroughly assessed. The purpose was therefore to assess associations between the short- and long-terms clinical status and two types of variables, physiologic measures and the SBST, in participants with cLBP. The ability of both types of variables to discriminate between participants with and without higher levels of disability, pain, fear of movement and patient's global impression of change was also investigated.

Methods: Fifty-three volunteers with cLBP participated in an initial evaluation and follow-ups at 2-, 4-, 6- and 12-month. Physiologic measures (maximal voluntary contraction, maximal endurance and muscle activity evaluated during prone and lateral isometric tasks) and the SBST were assessed at baseline. Disability (Oswestry Disability Index, ODI), pain intensity (101-point Numerical Rating Scale, NRS), fear of movement (Tampa Scale for Kinesiophobia, TSK) and patient's global impression of change (7-point scale, PGIC) were evaluated at baseline and at each follow-up. Aside the use of correlation analyses to assess potential associations; ROC curves were performed to evaluate the discriminative ability of physiologic measures and the SBST.

Results: The SBST allowed for the identification of participants presenting higher levels of disability (ODI ≥24 %), pain (NRS ≥37 %) or fear of movement (TSK ≥41/68) over a 12-month period (AUC = 0.71 to 0.84, ps < 0.05). The SBST score was also correlated with disability at each follow-up (τ = 0.22 to 0.33, ps < 0.05) and with pain intensity and fear of movement at follow-ups. Among physiologic measures, only maximal voluntary contraction was correlated to disability, pain intensity or fear of movement during the follow-up (/τ/ = 0.26 to 0.32, ps < 0.05) and none was able to identify participants presenting higher levels of outcomes (AUC ps > 0.05).

Conclusion: Physiologic measures obtained during prone and lateral tests have limited associations with the clinical status over a 12-month period in patients with nonspecific chronic low back pain. On the other hand, the STarT Back Screening Tool is useful for the identification of patients who will present higher levels of disability, pain intensity and fear of movement over a year.

Trial registration: Clinicaltrials.gov NCT02226692.

No MeSH data available.


Related in: MedlinePlus