Identifying Subgroups of Patients With Chronic Nonspecific Low Back Pain Based on a Multifactorial Approach: Protocol For a Prospective Study

Abstract

BackgroundLow back pain, especially nonspecific chronic low back pain (LBP), the leading cause of disability worldwide, represents both social and economic problems. Different therapeutic management techniques can be used, but their effects vary. Clinicians and researchers attribute the variation in the efficacy of therapeutic and management techniques to the heterogeneity of the nonspecific chronic low back pain population, and they agree that nonspecific chronic LBP must be subgrouped.ObjectiveThis study aims to identify nonspecific chronic LBP subgroups based on a multifactorial approach, including biomechanical, physical, and psychosocial data.MethodsA total of 100 nonspecific chronic LBP patients and 30 healthy participants aged between 18 and 60 years will be recruited for this prospective study. A psychosocial profile will be established using questionnaires on anxiety, depression, functional disability, pain, fear of pain, avoidance belief, and physical activity. A physical capacity evaluation will be conducted. It will evaluate flexibility of the hips, lumbar spine, and lateral thoracolumbar segment, as well as trunk (extensor and flexor) muscle endurance. The subjects will perform functional daily life activities, such as walking, object lifting, forward bending, sit-to-stand, stand-to-sit, balance, and usual postures. Full body kinematics, kinetics, and surface electromyography of the trunk and hip muscles will be assessed during these tasks. The clustering classification methods for the statistical analysis will be determined according to the data and will be used to identify the subgroups of nonspecific chronic LBP patients.ResultsData collection started in September 2017 and will be completed with the inclusion of all the participants (100 nonspecific chronic LBP and 30 control). The study results will be published in peer-reviewed journals and presented at relevant international conferences.ConclusionsNumerous studies have showed that the therapeutic management of nonspecific chronic LBP is difficult and has inconstant effects caused by the complexity and heterogeneity of nonspecific chronic LBP. Identifying subgroups with a multifactorial approach is more comprehensive and closer to the pathophysiology of nonspecific chronic LBP. It also represents benefit interests and a challenge both clinically and socially. The perspective of this study is expected to support clinicians for a more adapted therapeutic management for each subgroup.

Cross-cultural adaptation and validity of the Spanish fear-avoidance components scale and clinical implications in primary care

“…The FACS contains 20 separate items that are scored from 0 ("completely disagree") to 5 ("completely agree"), with a total possible score of 100. Five severity levels are available for clinical interpretation: subclinical (0-20), mild (21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40), moderate (41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55)(56)(57)(58)(59)(60), severe (61-80), and extreme (81-100) [16].…”

“…Following this line, in primary care there are clinical prediction rules to identify patient prognosis to certain type of treatment [57]. Also, subgroup classification of patient with chronic LBP are available, based on a multifactorial approach, including psychological factors such as anxiety, depression, functional disability, pain, and FA beliefs [58]. Even clinical prediction models to inform clinical decision-making after some type of surgery are being developed, which includes FA [59].…”

Hipervigilância postural e percepção da postura correta sentada em indivíduos com e sem dor lombar

“…It is known that the human biological system is integrated in a complex way and dysfunctions and complaints are multifactorial. 1 In the present study, only two variables (perception of correct sitting posture and postural hypervigilance) were analyzed in a linear observational form, which could not justify the relationship between them.…”

“…Sabe-se que o sistema biológico humano é integrado de forma complexa e que as disfunções e queixas são multifatoriais. 1 No presente estudo, foram analisadas apenas duas variáveis (percepção da postura sentada correta e hipervigilância postural) de uma forma observacional linear, que não conseguiu justificar a relação entre elas.…”

“…Low back pain is complex and multifactorial, with global dysfunctions covering structural, biomechanical, and psychosocial changes, such as functional disability, social isolation, and absence and/or low productivity at work. 1 One of the deficiencies in structure and function resulting from this complaint may be deficit in neuromuscular control, such as difficulty in relaxing the paravertebral muscles during total trunk flexion, and decreased muscle resistance when compared to asymptomatic individuals. 2 Thus, the musculature can be activated to try to prevent structural lesions and symptoms of low back pain.…”