Title: Reliability and validity of lumbopelvic kinematics related to nonspecific low back pain
Authors : Bauer, Christoph
Advisors / Reviewers : Kankaanpää, Markku
Suni, Jana
Karppinen, Jaro
Heinonen, Ari
de Bruin, Eling
Extent : 107
Publisher / Ed. Institution : University of Tampere, Departement of Medicine and Life Science
Publisher / Ed. Institution: Tampere
Issue Date: 2018
License (according to publishing contract) : Licence according to publishing contract
Series : Acta Universitatis Tamperensis
Series volume: 2379
Language : English
Subjects : Low Back Pain; Movement Analysis; Kinematics; Validity; Reliability; Recurrence Quantification Analysis
Subject (DDC) : 617.5: Orthopaedic surgery
Abstract: Low back pain (LBP) poses substantial challenges for clinical management. In 80-90% of all LBP patients, symptoms are attributed as nonspecific LBP (NSLBP). Attempts to identify effective interventions for people with NSLBP have often been unsuccessful. Past studies often treated NSLBP as a homogenous entity, although many clinicians notice distinguishable subgroups in daily practice. Valid classification systems are needed and are priority for primary care of LBP patients. A basic component of many contemporary LBP classification systems is the examination of lumbopelvic and postural kinematics. This examination is problematic because simple measurement systems such as visual observation or goniometers lack accuracy, reliability, validity, comprehensiveness, and practicality. To overcome these limitations this doctoral thesis introduces a novel, wireless movement-analysis system based on inertial measurement units (IMUs). In using the novel IMU system, the aims of the studies conducted in this thesis were to assess: The concurrent validity of lumbopelvic kinematics (Study I), the reliability of lumbopelvic kinematics (Study II), the associations between NSLBP intensity and lumbopelvic kinematics (Study III), the associations between fatigue and NSLBP with non-linear lumbopelvic kinematics (Study IV), and the effect of exercise therapy on non-linear lumbopelvic kinematics (Study V). Studies I-IV were conducted at a movement laboratory. Asymptomatic controls and subjects with nonspecific LBP performed a series of lumbar movement tests, from which indices of lumbopelvic kinematics (e.g. range of motion, movement variability and complexity) were calculated. The concurrent validity of the IMU-system was tested against an optoelectronic system. The reliability of lumbopelvic kinematics was analysed by comparing repeated measures over two days. To analyse the association between NSLBP intensity and lumbopelvic kinematics participants with different levels of NSLBP intensity performed movement tests. To investigate the effect of fatigue and NSLBP participants performed a movement test prior and after fatiguing of the lumbar musculature. The effect of exercise therapy was investigated in a randomized controlled trial in study V: After randomization, the intervention group was treated twice a week for six months while the control group only attended the measurement sessions. Follow-up measurements were taken at post treatment and at twelve months follow-up. The IMU system is concurrently valid to measure lumbopelvic kinematics in the primary movement direction. However, the system appears less valid for assessing movements in non-primary directions. On average, measures of lumbar range of motion, movement variability and complexity are more reliable compared to measures of movement control impairments and reposition error. NSLBP intensity affects lumbopelvic kinematics, so that participants with higher intensity NSLBP showed more variable and less predictable lumbar movement. Fatigue affects lumbopelvic kinematics, and this effect depends on the presence of NSLBP. The painfree participants showed more complex and less predictable lumbar movement after an isometric endurance test than participants suffering from LBP. Painfree people might adjust to fatigue by reducing load on fatigued tissues while preserving task performance. Exercise therapy affects lumbopelvic kinematics, and when compared to no intervention it may reverse or reduce deterioration of lumbar movement control, by increasing or preserving the degree of movement variability. As a conclusion, this thesis identified concurrently valid and reliable indices of lumbopelvic kinematics related to nonspecific NSLBP. The association between 1) lumbopelvic kinematics and 2) NSLBP intensity, fatigue, and exercise therapy appears to be bidirectional: Painfree subjects show less variable lumbar movement than people with NSLBP, but they exhibit more complex and variable movement as a response to fatigue. Six months exercise therapy resulted in preserved, more variable and complex movement strategy. Therefore, a nonlinear or U-shaped relationship between movement complexity and variability with disease was identified. Future research should address questions such as improvements of the IMU system’s validity and define the optimal lumbar movement strategy that would be predictive for low back health in prevention and also in follow up of active physical rehabilitation.
Departement: Health Professions
Organisational Unit: Institute of Physiotherapy (IPT)
Publication type: Doctoral Thesis
ISBN: 978-952-03-0745-5
978-952-03-0746-2
ISSN: 1455-1616
1456-954X
URI: https://digitalcollection.zhaw.ch/handle/11475/12389
Other identifiers : http://urn.fi/URN:ISBN:978-952-03-0746-2
Appears in Collections:Publikationen Gesundheit

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