Discriminating Healthy Control and Two Clinical Subgroups of Nonspecific Chronic Low Back Pain Patients Using Trunk Muscle Activation and Lumbosacral Kinematics of Postures and Movements
Dankaerts, Wim × O'Sullivan, Peter Burnett, Angus Straker, Leon Davey, Paul Gupta, Ritu #
Spine vol:34 issue:15 pages:1610-1618
Study Design. Statistical Classification Model for nonspecific
chronic low back pain (NS-CLBP) patients and
controls based on parameters of motor control.
Objective. Develop a Statistical Classification Model to
discriminate between 2 subgroups of NS-CLBP (Flexion
Pattern [FP] and Active Extension Pattern [AEP]) and a
control group using biomechanical variables quantifying
parameters of motor control.
Summary of Background Data. It has been well documented
that many CLBP patients have motor control impairments
of their lumbar spine. O’Sullivan proposed a
mechanism-based classification system for NS-CLBP with
motor control impairments based on a comprehensive
subjective and physical examination to establish the relationship
between pain provocation and spinal motor
control. For the FP and AEP s, 2 groups defined by
O’Sullivan and under investigation is this study, the motor
control impairment is considered to be the mechanism
maintaining their CLBP. No previous studies have
used a Statistical Model with measurements of motor
control impairment to subclassify NS-CLBP patients.
Methods. Thirty-three NS-CLBP patients (20 FP and 13
AEP) and 34 asymptomatic subjects had synchronized
lumbosacral kinematics and trunk muscle activation recorded
during commonly reported aggravating postures
and movements. Biomechanical variables were quantified
and a Statistical Classification Model was developed.
Results. The Statistical Model used 5 kinematic and 2
electromyography variables. The model correctly classified
96.4% of cases.
Conclusion. Selected biomechanical variables were
predictors for subgroup membership and were able to
discriminate the 3 subgroups. This study adds further
support toward the validation of the proposed classification
Key words: low back pain, subclassification, electromyography,
motion analysis, posture, motor control impairment.