The effect of chronic, non-specific low back pain on superficial lumbar muscle activity: a protocol for a systematic review and meta-analysis

Abstract

IntroductionChronic, non-specific low back pain is a major global cause of disability. One factor which might potentially contribute to ongoing pain is maladaptive variation in the level of activity in the lumbar musculature. Several studies have investigated this activity using surface electromyography, in varied muscles and during a number of functional activities. Due to differences in the applied methodology, the results have been difficult to compare, and previous reviews have been limited in scope. In this protocol, we aim to perform a comprehensive review of the effect of chronic low back pain on lumbar muscle activity.Methods and analysisThis protocol was informed by the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) and results will be reported in line with the PRISMA. Searches will be conducted on the Web of Science, PubMed, MEDLINE, EMBASE, ZETOC and CINAHL databases, along with a comprehensive review of grey literature and key journals. One reviewer will conduct the searches, but two independent reviewers will screen potential studies and assess the risk of bias within studies which meet the inclusion criteria. The Newcastle-Ottawa risk of bias tool, and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) guidelines will be used to assess the quality of the data. Meta-analysis will be conducted where appropriate on groups of studies with homogenous methodology. Where studies are too heterogeneous to allow for meta-analysis, meta-synthesis will instead be completed, comparing results in terms of net increases or decreases of activity.Ethics and disseminationThis review aims to identify common adaptations of muscle activity in people with low back pain and it is expected that the results will influence future research directions and future rehabilitation approaches. The results will be submitted for publication in a peer-reviewed journal and presented at conferences.Prospero registration numberCRD42019125156

Investigation of the Relationship Between Sagittal Curvature and Lumbar Extensor Muscle Volume in Patients with Lower Back Pain

“…There are studies in the literature arguing that the reduction in lumbar curvature is correlated with lower back pain (26). Although studies in the literature have reported that extensor muscles of patients with lower back pain are smaller compared to those of healthy volunteers (12,16), in the present study all participants were the patients with lower back pains, and when sagittal curvature angles and lower lumbar extensor muscle volumes were evaluated between these patients themselves, as is expected muscle volumes were greater in the patients with a larger curvature.…”

“…A greater muscle strength is needed to provide stability of lumbar vertebrae with a greater curvature, and force-generating capacity of a muscle is associated with the physical size of the muscle. This suggests variations in the size of the extensor muscle (15,16). This variation has been reported to be associated with the variation in lumbar curvature (17).…”

Microscopic changes in the spinal extensor musculature in patients experiencing chronic spinal pain: protocol for a systematic review

“…If there are discrepancies between the two reviewers on inclusion of certain studies in the meta-analysis or subgroup analysis, or whether or not to conduct the meta-analysis at all, then a third reviewer (DF) will determine the potential for meta-analysis. 34 …”

“…29 35 Similar to previous reviews, we will proceed with meta-analysis if the I 2 value is <50%. 34 36 …”

“…If the reviewers agree not to conduct meta-analysis due to the heterogeneity of pooled data, then meta-synthesis will be considered under expert guidance. 34 If the eligible studies cannot be pooled to conduct meta-synthesis, we would then consider presenting our findings in a narrative way. In narrative reporting, there will be full interpretation of the findings for each outcome measure.…”