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

Abstract

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.

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

“…It also affirmed flow as a useful concept in describing desired qualities of movement, since neither limited mobility nor adjustment to pain (actual or anticipated) necessarily undermined flow where adaptations were harmoniously embodied and enacted. Flow is very likely related to ‘fluency’, the second most common movement quality named by a large sample of physical therapists in the Netherlands (Van Dijk, Smorenburg, Visser, Heerkens, & Nijhuis‐van der Sanden, 2017; Van Dijk, Smorenburg, Visser, Nijhuis‐van der Sanden, & Heerkens, 2017). Clinical research could usefully foster recognition of emotional barriers to movement, since the methods to address them are distinct from those to address musculoskeletal barriers; drawing on expert observation (as sampled here) to foster better understanding in less experienced physiotherapists, since all will deal daily with complaints of pain, even if it is not the main focus.…”

“…Movement characteristics between people with and without low back pain overlap but vary substantially (Knechtle et al., 2021; Laird et al., 2014; Laird et al., 2019) in speed, range, flexion‐relaxation response, and lumbo‐pelvic synchrony (Laird et al., 2018), inside and outside clinic settings (Gizzi et al., 2018; Roeser et al., 2019), but intervening to change them has produced mixed reports of change in pain and function (Farragher et al., 2019; Kent et al., 2015; Laird et al., 2012; van Dieën et al., 2019). Although physiotherapists routinely observe and interpret pain‐related movement quality (Van Dijk, Smorenburg, Visser, Heerkens, & Nijhuis‐van der Sanden, 2017), no adequate assessment instruments exist (Van Dijk et al., 2020).…”

Distinguishing Patients With a Coordination Disorder From Healthy Controls Using Local Features of Movement Trajectories During the Finger-to-Nose Test

“…The need for objective and quantitative assessment of human movement to reinforce and support the use of clinical rating scales is evident [5], [33], [34]. A benefit of the presented method is that it can be applied to a broad range of human movements commonly used in clinical tests such as gait, static postural control, dynamic postural control, finger chasing, path drawing spirals, circles, squares, or figure-8 shapes, and fast alternating hand movements [11].…”

Detection of Typical Compensatory Movements during Autonomously Performed Exercises Preventing Low Back Pain (LBP)

“…Van Dijk et al outlined that healthcare professionals recognise the importance of a standardised way of observing movement quality, but a tool or assessment that could offer this kind of functionality, does not exist yet [ 8 ]. With the miniaturization of wearable technologies such as the development of microelectromechanical systems (MEMS), it has become feasible to use such systems in clinical assessments and especially in home- or gym- environments.…”