Description of movement quality in patients with low back pain: A qualitative study as a first step to a practical definition

Dijk, Margriet J. H van; Smorenburg, Nienke; Visser, Bart; Sanden, M.W.G. Nijhuis-van der; Heerkens, Yvonne

doi:10.1080/09593985.2017.1282998

Cited by 17 publications

(26 citation statements)

References 25 publications

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“…Complementary to our previous study [ 26 ], the results of this study will contribute to understanding the relevance of defining and operationalizing MQ in NS-LBP management.…”

Section: Introductionmentioning

confidence: 68%

“…As in our previous study, AHCPs link pain to MQ in patients with NS-LBP [26]. To analyze MQ, AHCPs observe non-verbal expressions of pain and exertion (e.g.…”

Section: Discussionmentioning

confidence: 89%

“…The extensive analysis of MQ during the therapeutic approach supports the idea that MQ plays a central role in clinical reasoning in the therapeutic approach [8–11, 26, 46], and it corresponds to Knudson’s Qualitative Diagnosis of Human Movement (QDM) [42]. The QDM focuses on preparation (knowledge of the activity, goal and performer), observation, diagnosis, evaluation and intervention in sports and exercise [42].…”

Section: Discussionmentioning

confidence: 99%

“…Coordination and functional movement are seen as the most elementary MQ concepts in patients with NS-LBP [26]. …”

Section: Introductionmentioning

confidence: 99%

“…In patients with NS-LBP, MQ is described as a multidimensional phenomenon that can be linked to the following components: Body Functions and Body Structures, Activities & Participation, Environmental factors and Personal factors of the ICF (International Classification of Functioning, Disability and Health) [ 26 , 27 ]. Coordination and functional movement are seen as the most elementary MQ concepts in patients with NS-LBP [ 26 ].…”

Section: Introductionmentioning

confidence: 99%

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How clinicians analyze movement quality in patients with non-specific low back pain: a cross-sectional survey study with Dutch allied health care professionals

Dijk

Smorenburg

Visser

et al. 2017

BMC Musculoskelet Disord

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BackgroundObservation of movement quality (MQ) is an indelible element in the process of clinical reasoning for patients with non-specific low back pain (NS-LBP). However, the observation and evaluation of MQ in common daily activities are not standardized within allied health care. This study aims to describe how Dutch allied health care professionals (AHCPs) observe and assess MQ in patients with NS-LBP and whether AHCPs feel the need to have a specific outcome measure for assessing MQ in patients with NS-LBP.MethodsIn this cross-sectional digital survey study, Dutch primary care AHCPs (n = 114) answered one open and three closed questions about MQ in NS-LBP management. Qualitative and quantitative analyses were applied.ResultsQualitative analyses of the answers to the open questions revealed four main themes: 1) movement pattern features, 2) motor control features, 3) environmental influences and 4) non-verbal expressions of pain and exertion. Quantitative analyses clearly indicated that AHCPs observe MQ in the diagnostic (92%), therapeutic (91%) and evaluation phases (86%), that they do not apply any objective measurement of MQ and that 63% of the AHCPs consider it important to have a specific outcome measure to assess MQ. The AHCPs expressed added benefits and critical notes regarding clinical reasoning and quality of care.ConclusionAHCPs recognize the importance of observing MQ in the assessment and management of LBP in a standardized way. However, there is no consensus amongst AHCPs how MQ should be standardized. Prior to standardization, it will be important to develop a theoretical framework to determine which observable and measurable dimensions of MQ are most valid and relevant for patients with NS-LBP to include in the assessment.

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“…Complementary to our previous study [ 26 ], the results of this study will contribute to understanding the relevance of defining and operationalizing MQ in NS-LBP management.…”

Section: Introductionmentioning

confidence: 68%

“…As in our previous study, AHCPs link pain to MQ in patients with NS-LBP [26]. To analyze MQ, AHCPs observe non-verbal expressions of pain and exertion (e.g.…”

Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

“…Coordination and functional movement are seen as the most elementary MQ concepts in patients with NS-LBP [26]. …”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

How clinicians analyze movement quality in patients with non-specific low back pain: a cross-sectional survey study with Dutch allied health care professionals

Dijk

Smorenburg

Visser

et al. 2017

BMC Musculoskelet Disord

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Guarding and flow in the movements of people with chronic pain: A qualitative study of physiotherapists’ observations

Williams,

Buono,

Gold

et al. 2023

European Journal of Pain

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BackgroundAmong the adaptations of movement consistently associated with disability in chronic pain, guarding is common. Based on previous work, we sought to understand better the constituents of guarding; we also used the concept of flow to explore the description of un/naturalness that emerged from physiotherapists' descriptions of movement in chronic pain. The aim was to inform the design of technical systems to support people with chronic pain in everyday activities.MethodsSixteen physiotherapists, experts in chronic pain, were interviewed while repeatedly watching short video clips of people with chronic low back pain doing simple movements; physiotherapists described the movements, particularly in relation to guarding and flow. The transcribed interviews were analysed thematically to elaborate these constructs.ResultsModerate agreement emerged on the extent of guarding in the videos, with good agreement that guarding conveyed caution about movement, distinct from biomechanical variables of stiffness or slow speed. Physiotherapists' comments on flow showed slightly better agreement, and described the overall movement in terms of restriction (where there was no flow or only some flow), of tempo of the entire movement, and as naturalness (distinguished from normality of movement).ConclusionsThese qualities of movement may be useful in designing technical systems to support self‐management of chronic pain.SignificanceDrawing on the descriptions of movements of people with chronic low back pain provided by expert physiotherapists to standard stimuli, two key concepts were elaborated. Guarding was distinguished from stiffness (a physical limitation) or slowness as motivated by fear or worry about movement. Flow served to describe harmonious and continuous movement, even when adapted around restrictions of pain. Movement behaviours associated with pain are better understood in terms of their particular function than aggregated without reference to function.

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Movement quality evaluation and its correlation with recommended functional measures in hip osteoarthritis

Olsen

Magnussen

Skjærven

et al. 2020

Physiotherapy Res Intl

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Objective: Hip osteoarthritis may cause compensational movement strategies that require extra physical and mental effort. Such aberrant functioning can be captured in movement quality evaluation. The objective of this study was to explore whether movement quality, evaluated as a multiperspective phenomenon, is reflected in commonly used and recommended functional measures in this group of patients. Methods: A cross-sectional study design was used. Baseline included 80 female and 21 male participants with hip osteoarthritis. Movement quality was evaluated by the Body Awareness Rating Scale-Movement Quality and Experience (BARS-MQE), part one, including 12 movement items. Correlation analyses (Pearson and Spearman) were performed to explore associations between BARS-MQE (sum score and single item scores), and scores on measures of physical capacity (Chair test, Stairs test, 6 minutes walking test; 6MWT), self-reported activity level (UCLA), function (HOOS subscales), pain during walking (NRS), self-efficacy (ASES) and health (EQ-5D-5L). Based on previous evidence, we hypothesized moderate associations between BARS-MQE and these measures. Results: BARS-MQE's sum score showed moderate associations with Stairs test, 6MWT and UCLA (r = −0.425 to 0.304) and weak associations (r = 0.29 to 0.12) with ASES Pain and Symptoms, HOOS ADL, Chair test, NRS, HOOS Pain and Sports, and EQ-5D-5L. No association was found between BARS-MQE and HOOS Symptoms and Quality of life. Movement quality in item 12, walking, demonstrated moderate or weak association with all included measures. Conclusion: In this study of participants diagnosed with hip osteoarthritis, movement quality evaluated by BARS-MQE was moderately reflected in measures of physical capacity and activity, but weakly reflected in self-reported measures of health problems. With its particular dynamic procedure and inclusion of the whole moving person, movement quality evaluation by the BARS-MQE was shown to provide supplementary information on functioning, scarcely captured by the commonly used and recommended measures.

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Description of movement quality in patients with low back pain: A qualitative study as a first step to a practical definition

Abstract: Descriptions of MQ given by Dutch AHCPs in patients with LBP cover all ICF components. Coordination and functional movements are seen as the most elementary concepts of MQ. Variation in MQ descriptions and interpretations hinders defining MQ and indicates the necessity of additional steps.

Cited by 17 publications

References 25 publications

How clinicians analyze movement quality in patients with non-specific low back pain: a cross-sectional survey study with Dutch allied health care professionals

How clinicians analyze movement quality in patients with non-specific low back pain: a cross-sectional survey study with Dutch allied health care professionals

Guarding and flow in the movements of people with chronic pain: A qualitative study of physiotherapists’ observations

Movement quality evaluation and its correlation with recommended functional measures in hip osteoarthritis

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