Reliability of a new loaded rolling wheel system for measuring spinal stiffness in asymptomatic participants

Hadizadeh, Maliheh; Kawchuk, Greg; Parent, Éric

doi:10.1186/s12891-019-2543-y

Cited by 15 publications

(25 citation statements)

References 21 publications

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“…Global Stiffness (GS) was calculated as the average of the slope with the first and terminal data points removed. The comfort and safety of VT has been evaluated previously 26 as has its reliability in an asymptomatic population 14 .…”

Section: Participantsmentioning

confidence: 99%

“…A more recent version of this device, the VerteTrack (VT), has recently been developed. The VT has the ability to approximate mechanical indentation over a large spinal region, and, thereby, obtain a rapid measure of lumbar stiffness at each lumbar segment 14 . This potentially aids in quantifying segmental stiffness, and in turn, is thought to direct the application of SMT more accurately.…”

Section: Introductionmentioning

confidence: 99%

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The effect on clinical outcomes when targeting spinal manipulation at stiffness or pain sensitivity: a randomized trial

Nim

Kawchuk

Schiøttz‐Christensen

et al. 2020

Sci Rep

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The mechanisms underlying pain relief following spinal manipulative therapy (SMT) are not understood fully although biomechanical and neurophysiological processes have been proposed. As such, we designed this randomized trial to elucidate the contributions of biomechanical and neurophysiological processes. A total of 132 participants with low back pain were randomly assigned to receive SMT at either the lumbar segment measured as the stiffest or the segment measured as having the lowest pain threshold. The primary outcome was patient reported low back pain intensity following treatment. Secondary outcomes were biomechanical stiffness and neurophysiological pressure pain threshold. All outcomes were measured at baseline, after the fourth and final session and at 2-weeks follow-up. Data were analyzed using linear mixed models, and demonstrated that the SMT application site did not influence patient reported low back pain intensity or stiffness. However, a large and significant difference in pressure pain threshold was observed between groups. This study provides support that SMT impacts neurophysiological parameters through a segment-dependent neurological reflex pathway, although this do not seem to be a proxy for improvement. This study was limited by the assumption that the applied treatment was sufficient to impact the primary outcome. Treatment of low back pain. Low back pain (LBP) is now the number one cause for years lived disability worldwide 1. In most cases, a specific pathoanatomical cause of LBP cannot be identified 2. Without a specific therapeutic target, a predictably large and diverse spectrum of interventions are available to clinicians that range from joint mobilization to spinal fusion surgery 3. Given these almost endless possibilities, clinical guidelines rate education and exercise as first line therapy for low back pain often in combination with manual therapy 3. Although, these guideline recommendations are generally clear and unambiguous, it is challenging for clinicians to implement them in practice (e.g. which exercises to recommend, how often, and which patients to offer manual therapy etc.). Spinal manipulative therapy. Spinal manipulative therapy (SMT) is a manual therapy recommended as a second line intervention for LBP in most clinical guidelines 4. However, like other conservative treatments, there is little evidence or consensus regarding the specifics of SMT application such as which patients are likely to respond, which type of SMT should be used, and which dose/frequency of SMT is optimal. While the specific SMT technique does not seem to be important 5-7 , there are at least two theoretical rationales for where to apply SMT: at the site of greatest biomechanical dysfunction or the site of greatest pain sensitivity. As the goal of SMT is to restore normal function to segments with biomechanical dysfunctions 8 , it may be surprising to some that the evidence for identifying such dysfunction is sparse. A narrative review reported that clinicians use a variety of different ways to ...

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Section: Participantsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The effect on clinical outcomes when targeting spinal manipulation at stiffness or pain sensitivity: a randomized trial

Nim

Kawchuk

Schiøttz‐Christensen

et al. 2020

Sci Rep

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“…This is likely attributed to properties of the viscoelastic foam medium. In vivo testing observed the inverse relationship between load and stiffness, that is a positive relationship between load and stiffness [ 23 ]. It would be advantageous to identify on a human population a specific load that yeilds the most useful spinal stiffness information.…”

Section: Discussionmentioning

confidence: 99%

“…During spinal stiffness assessment, the VerteTrack applies discrete loads via addition of weighted plates (“plates”) with a nominal mass of 1 kg each (RIH + k plates; k = 0, 6). These loads were selected as they represent loads that have previously been used in VerteTrack studies [ 22 , 23 , 26 ] and are comparable to loads applied in other mechanical indentation studies [ 14 , 20 ]. Plates were numbered and always added in the same order for each indentation cycle.…”

Section: Methodsmentioning

confidence: 99%

“…A novel feature of the VerteTrack is a pair of rolling indentation wheels that enables stiffness assessment of an entire spinal region thereby minimising assessment time [ 22 ]. The VerteTrack has recently demonstrated excellent within-session test-retest reliability (intraclass correlation coefficient ICC 3, k 0.95–100) and good to excellent between-day reliability (ICC 3, k 0.82–0.93) in the clinical setting [ 23 ], however, its accuracy is unknown. Benchtop performance of a test instrument can be evaluated through measurement of precision (random error) and bias (systematic error) of the system under test (Fig.…”

Section: Introductionmentioning

confidence: 99%

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The bench-top accuracy of the VerteTrack spinal stiffness assessment device

et al. 2020

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Background The assessment of spinal stiffness by manual palpation in clinical settings has demonstrated both poor accuracy and reliability. More recently, mechanical methods for assessment of spinal stiffness have demonstrated superior accuracy and reliability. However, mechanical methods of spinal stiffness assessment can be expensive, time consuming and/or unsuited to clinical practice. While a new device has been designed to address these issues (VerteTrack), its benchtop performance remains unknown. Aim To measure the bench-top performance of VerteTrack. Methods A series of laboratory-based experiments were conducted in February 2018 to investigate the accuracy (precision and bias) of load and displacement measurements obtained by VerteTrack and then were compared against an appropriate reference standard. Measurements of both multiple-level continuous assessment (multiple spinal levels measured), and single-level assessment (single spinal level measured) were performed on a viscoelastic foam medium (AIREX® balance beam, Switzerland) and the resulting stiffness calculated. Results VerteTrack demonstrated high precision at all loads and displacements. There was minimal systematic measurement bias identified for applied versus reference load (mean bias = − 0.123 N; 95%CI − 0.182 to 0.428 N, p < .001), and no systematic measurement bias for measured versus reference displacement (mean difference = 0.02 mm; 95%CI − 0.09 to 0.14 mm, p < .001). The magnitude of stiffness obtained during multiple-level continuous assessment was on average 0.25 N/mm (2.79%) less than that for single-level assessment (95%CI − 0.67 to 0.17 N/mm, p < .001). Conclusions VerteTrack demonstrated high accuracy (high precision, low bias) under bench-top conditions. The difference in stiffness found between multiple versus single spinal levels should be considered in the research context, but is unlikely to be clinically relevant. The results of this study demonstrate that VerteTrack may be suitable for both single and multi-level spinal stiffness measurements in-vivo.

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Posterior to anterior spinal stiffness measured in a sample of 127 secondary care low back pain patients

Harsted

Nyirö

Downie

et al. 2021

Clinical Biomechanics

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Background:The sensation of spinal stiffness is a commonly reported symptom among back pain patients, with the clinical assessment of spinal stiffness usually being part of the decision-making process when deciding on providing manual treatment of low back pain. While any relationship between spinal stiffness and low back pain is likely to be multifactorial, prior exploration of this relationship has been overly simplistic (e.g., univariate regression analyses). The purpose of this study was to address this gap by taking a broader approach to compare instrumented measures of spinal stiffness to demographic characteristics, pain phenotypes, psychometrics, and spine-related disability in a sample of secondary care low back pain patients using multivariate regression analysis. Methods: Instrumented spinal stiffness measures from 127 patients in secondary care were used to calculate terminal and global spinal stiffness scores. A best subset analysis was used to find the subsets of 14 independent variables that most accurately predicted stiffness based on the evaluation of the adjusted R-square, Akaike Information Criteria, and the Bayesian Information Criteria. Findings: In the resulting multivariate models, sex (p < 0.001) and age (p < 0.001) were the primary determinants of terminal stiffness, while global stiffness was primarily determined by age (p = 0.003) and disability (p = 0.024). Interpretation: Instrumented measures of spinal stiffness are multifactorial in nature, and future research into this area should make use of multivariate analyses.

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Reliability of a new loaded rolling wheel system for measuring spinal stiffness in asymptomatic participants

Cited by 15 publications

References 21 publications

The effect on clinical outcomes when targeting spinal manipulation at stiffness or pain sensitivity: a randomized trial

The effect on clinical outcomes when targeting spinal manipulation at stiffness or pain sensitivity: a randomized trial

The bench-top accuracy of the VerteTrack spinal stiffness assessment device

Posterior to anterior spinal stiffness measured in a sample of 127 secondary care low back pain patients

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