Background: Despite central sensitization (CS) often presents in patients with chronic low back pain (CLBP), there is a lack of quantitative and qualitative analysis of the effect of CS on gait performance. The study aimed to investigate the daily-living gait performance of patients with CLBP with low and high CS levels (CLBP- and CLBP+, respectively). Method:Forty-two patients with CLBP were included. CS was assessed by Central Sensitization Inventory (CSI). Patients were classified according to low or high CSI score (23 CLBP- and 19 CLBP+). Patients wore a 3D accelerometer for about one week. From each patient, 4 days of accelerometer-data were randomly selected. For each day data, continuous gait cycles were extracted using a Fast Fourier Transform-based and a zero-cross method. For all gait cycles in one day, 36 gait outcomes representing variables related to pace, regularity, smoothness, local stability and predictability of gait were calculated. A Random Forest classifier was trained to classify CLBP- and CLBP+ groups based on gait outcomes and SHapley Additive exPlanations (SHAP) method was used to explain the differences between groups in gait outcomes. Results:The Random Forest classifier could accurately recognize the CLBP- and CLBP+ groups (accuracy = 84.4%, F1-score = 82.6%). SHAP reported that the most differences between CLBP- and CLBP+ groups were: index of harmonicity-vertical and harmonic ratio-mediolateral (gait smoothness), stride frequency variability- mediolateral/anteroposterior, stride length variability (gait variability), stride regularity-mediolateral (gait regularity), maximal Lyapunov exponent-vertical/mediolateral and maximal Lyapunov exponent per stride-vertical (gait stability), and sample entropy-anteroposterior (gait predictability). Conclusions: CLBP- and CLBP+ presented different motor control strategies. CLBP- presented a more “loose” control, including higher gait smoothness and stability. CLBP+ presented a more “tight” control, including a more regular, less variable and more predictable gait pattern.
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