Time-course and factors affecting movement control in acute low back pain: A prospective cohort study in a primary care setting

Abstract

Background: A subgroup of low back pain (LBP) patients present with movement control impairment (MCI). Although there has been extensive research in this area, there is a lack of knowledge of how movement control develops over time and the factors that impact MCI after an acute LBP-episode. Objective : The investigation followed the time-course of MCI in the first three months after an onset of acute LBP-episode, including a baseline-effect evaluation of various demographic, physical and psychosocial characteristics on MCI. Methods : Within this prospective cohort study, 68 subjects with an acute onset of LBP of less than four weeks duration were recruited. In conclusion, 56 subjects were assessed three times at four, eight and twelve weeks. Questionnaire data was collected using an online survey, including demographic data, pain intensity, recurrence of LBP, disability, depression, pain-related activity patterns, activity level and the use of physiotherapy treatment. In addition, a physical examination was performed at the same time points (TP) to assess MCI. For the data analysis, we performed a regression analysis, using proportional odds models. Results : The majority of the participants presented with MCI during the measurement period, although with highly individual courses. The evaluation of baseline and time effects for disability, pain-related activity patterns and physical treatment confirmed interactions with MCI. In contrast, pain intensity and recurrent episodes of LBP revealed effects on MCI only in the adjusted model in combination with other variables. Conclusions : MCI plays a significant role in a subgroup of subjects in the course of LBP after an acute onset of symptoms. Physiotherapy treatment showed short time effects on MCI and might be essential in stratified care in a primary care setting. Further longitudinal studies are needed to assess the association of those different physical and psychosocial characteristics of MCI to calculate their time-interaction on MCI. This is due to the multidimensional nature of LBP and the underlying mechanisms of MCI still being unidentified.