Fear of movement is not associated with trunk movement variability during gait in patients with low back pain

Abstract

BACKGROUND: Literature describing differences in motor control between low back pain (LBP) patients and healthy controls is very inconsistent, which may be an indication for the existence of subgroups. Pain-related psychological factors might play a role causing these differences. PURPOSE: To examine the relation between fear of movement and variability of kinematics and muscle activation during gait in LBP patients. STUDY DESIGN: Cross-sectional experimental design. PATIENT SAMPLE: Thirty-one Chinese LBP patients. OUTCOME MEASURES: Self-report measures: Visual Analog Score for pain; TAMPA-score; Physiologic measures: electromyography, range of motion. FUNCTIONAL MEASURES: LBP history; the physical load of profession, physical activity. METHODS: Patients were divided in high and low fear of movement groups. Participants walked on a treadmill at four speeds: very slow, slow, preferred and fast. Kinematics of the thorax and the pelvis were recorded, together with the electromyography of five bilateral trunk muscle pairs. Kinematic and electromyography data were analysed in terms of stride-to-stride pattern variability. Factor analysis was applied to assess interdependence of 11 variability measures. To test for differences between groups, a mixed-design multivariate analysis of variance was conducted. RESULTS: Kinematic variability and variability of muscle activation consistently loaded on different factors and thus represented different underlying variables. No significant Group effects on variability of kinematics and muscle activation were found (Hotelling's Trace F=0.237; 0.396, p=.959; .846, respectively). Speed significantly decreased kinematic variability and increased variability in muscle activation (Hotelling's Trace F=8.363; 4.595, p<.0001; <.0001, respectively). No significant interactions between Group and Speed were found (Hotelling's Trace F=0.204; 0.100, p=.762; .963, respectively). CONCLUSIONS: The results of this study do not support the hypothesis that variability in trunk kinematics and trunk muscle activation during gait in LBP patients are associated with fear of movement.

Sensing behavior change in chronic pain: A scoping review of sensor technology for use in daily life

“…6,46 Electromyography data can also be used to determine the presence of dysfunctional neuromuscular adaptations associated with self-reported disability 21 or to associate muscle recruitment patterns with specific pain behaviors (eg, protective posture). 6 In the included studies, the evidence on association between EMG data and fear of pain was somewhat contradictory 48,50,91 ; in some but not all studies, EMG data were correlated with pain-related anxiety, 50 catastrophizing, and “ignoring pain sensation.” 83 Electromyography data were investigated in relation to broader psychological variables such as depression or general anxiety but not consistently related to them. 29,50,59…”

“…Results of these studies in relation to psychological characteristics are mixed: some suggest that gait and posture are related to self-reported pain, depression and anxiety, 51 and fear of movement, 7,18,65 but others suggest no relationship. 48,91 Relationships found between movement kinematics and fear seemed somewhat stronger, 7,19,52,79 but not for the relationship between ROM and fear of movement (typically measured by the Tampa Scale of Kinesiophobia [TSK] 58 ) in back pain 41,48,71,91 and neck pain. 1,3,88 Task-specific fear might be expected to be more closely related to performance than broader fear of movement.…”

Machine learning approaches applied in spinal pain research

“…Although there is some evidence to support an association between the extent of pain and/or disability and the extent of physiological adaptations (Alsultan et al , 2020, Jacobs et al , 2017, Salehi, Rasouli, 2021, Schabrun et al , 2017 which can explain some variation in amongst people with spinal pain, this relationship doesn't always hold (Jacobs et al , 2016, Steele et al , 2014. Likewise, there are examples where the extent of psychological factors such as fear of movement, catastrophizing, and anxiety are associated with physiological features (Alsubaie, Martinez-Valdes, 2021, Alsultan, De Nunzio, 2020, Vaisy, Gizzi, 2015, Van Damme et al , 2014, but again, this is not always the case (Lima et al , 2018, Veeger et al , 2020.…”