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Comparison of postural control between subgroups of persons with nonspecific chronic low back and healthy controls during the modified Star Excursion Balance Test

  • Shallan, Amjad (Department of Physical Therapy, School of Allied Health Professions, Loma Linda University) ;
  • Lohman, Everett (Department of Physical Therapy, School of Allied Health Professions, Loma Linda University) ;
  • Alshammari, Faris (Department of Physical Therapy, Faculty of Applied Medical Sciences, The Hashemite University) ;
  • Dudley, Robert (Department of Kinesiology, School of Behavioral and Applied Sciences, Azusa Pacific University) ;
  • Gharisia, Omar (Department of Physical Therapy, School of Allied Health Professions, Loma Linda University) ;
  • Al-Marzouki, Rana (Department of Physical Therapy, School of Allied Health Professions, Loma Linda University) ;
  • Hsu, Helen (Department of Physical Therapy, School of Allied Health Professions, Loma Linda University) ;
  • Daher, Noha (Department of Allied Health Studies, School of Allied Health Professions, Loma Linda University)
  • Received : 2019.06.20
  • Accepted : 2019.07.09
  • Published : 2019.09.30

Abstract

Objective: To compare the postural control between non-specific chronic low back pain (NSCLBP) subgroups and healthy people during dynamic balance performance using a modified Star Excursion Balance Test (mSEBT). Design: Cross-sectional study. Methods: Eighteen NSCLBP subjects (9 active extension pattern [AEP], 9 flexion pattern [FP]), and 10 healthy controls were enrolled in this study. All subjects performed mSEBT on their dominant leg on a force plate. Normalized reach distance and balance parameters, including the center of pressure (COP) displacement and velocity, were recorded. Results: There were significant differences in mean reach distances in both posterolateral and posteromedial (PM) reach directions between AEP and healthy subjects (p<0.001) and between FP and healthy subjects (p<0.001). However, there were no significant differences among the three groups in the anterior reach direction. Also, the results showed no significant differences in mean COP variables (velocity and displacement) between pooled NSCLBP and healthy subjects. However, the subjects were reclassified into AEP, FP and healthy groups and the results showed a significant difference in mean COP velocity in the PM direction between AEP and FP subjects (p=0.048), and between AEP and healthy subjects (p=0.024). Conclusions: The findings in this study highlight the heterogeneity of the individuals with NSCLBP and the importance of identifying the homogenous subgroups. Individuals with AEP and FP experience deficits in dynamic postural control compared to healthy controls. In addition, the findings of this study support the concept of the Multidimensional Classification System.

Keywords

References

  1. Walker BF, Muller R, Grant WD. Low back pain in Australian adults: prevalence and associated disability. J Manipulative Physiol Ther 2004;27:238-44. https://doi.org/10.1016/j.jmpt.2004.02.002
  2. Freburger JK, Holmes GM, Agans RP, Jackman AM, Darter JD, Wallace AS, et al. The rising prevalence of chronic low back pain. Arch Intern Med 2009;169:251-8. https://doi.org/10.1001/archinternmed.2008.543
  3. Hart LG, Deyo RA, Cherkin DC. Physician office visits for low back pain. Frequency, clinical evaluation, and treatment patterns from a U.S. national survey. Spine (Phila Pa 1976) 1995;20:11-9. https://doi.org/10.1097/00007632-199501000-00003
  4. Balague F, Mannion AF, Pellise F, Cedraschi C. Non-specific low back pain. Lancet 2012;379:482-91. https://doi.org/10.1016/S0140-6736(11)60610-7
  5. Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012;380:2163-96. https://doi.org/10.1016/S0140-6736(12)61729-2
  6. Maribo T, Schiottz-Christensen B, Jensen LD, Andersen NT, Stengaard-Pedersen K. Postural balance in low back pain patients: criterion-related validity of centre of pressure assessed on a portable force platform. Eur Spine J 2012;21:425-31. https://doi.org/10.1007/s00586-011-1981-5
  7. Winter DA. Biomechanics and motor control of human movement. Hoboken: John Wiley & Sons; 2009.
  8. Rainville J, Smeets RJ, Bendix T, Tveito TH, Poiraudeau S, Indahl AJ. Fear-avoidance beliefs and pain avoidance in low back pain--translating research into clinical practice. Spine J 2011;11:895-903. https://doi.org/10.1016/j.spinee.2011.08.006
  9. Mazaheri M, Coenen P, Parnianpour M, Kiers H, van Dieen JH. Low back pain and postural sway during quiet standing with and without sensory manipulation: a systematic review. Gait Posture 2013;37:12-22. https://doi.org/10.1016/j.gaitpost.2012.06.013
  10. Ruhe A, Fejer R, Walker B. Center of pressure excursion as a measure of balance performance in patients with non-specific low back pain compared to healthy controls: a systematic review of the literature. Eur Spine J 2011;20:358-68. https://doi.org/10.1007/s00586-010-1543-2
  11. Luoto S, Aalto H, Taimela S, Hurri H, Pyykko I, Alaranta H. One-footed and externally disturbed two-footed postural control in patients with chronic low back pain and healthy control subjects. A controlled study with follow-up. Spine (Phila Pa 1976) 1998;23:2081-9; discussion 2089-90. https://doi.org/10.1097/00007632-199810010-00008
  12. Ruhe A, Fejer R, Walker B. The test-retest reliability of centre of pressure measures in bipedal static task conditions--a systematic review of the literature. Gait Posture 2010;32:436-45. https://doi.org/10.1016/j.gaitpost.2010.09.012
  13. Ganesh GS, Chhabra D, Mrityunjay K. Efficacy of the star excursion balance test in detecting reach deficits in subjects with chronic low back pain. Physiother Res Int 2015;20:9-15. https://doi.org/10.1002/pri.1589
  14. Linens SW, Ross SE, Arnold BL, Gayle R, Pidcoe P. Posturalstability tests that identify individuals with chronic ankle instability. J Athl Train 2014;49:15-23. https://doi.org/10.4085/1062-6050-48.6.09
  15. Herrington L, Hatcher J, Hatcher A, McNicholas M. A comparison of Star Excursion Balance Test reach distances between ACL deficient patients and asymptomatic controls. Knee 2009;16:149-52. https://doi.org/10.1016/j.knee.2008.10.004
  16. Ganesh GS, Chhabra D, Pattnaik M, Mohanty P, Patel R, Mrityunjay K. Effect of trunk muscles training using a star excursion balance test grid on strength, endurance and disability in persons with chronic low back pain. J Back Musculoskelet Rehabil 2015;28:521-30. https://doi.org/10.3233/BMR-140551
  17. Appiah-Dwomoh EK, Muller S, Mayer F. Reproducibility of static and dynamic postural control measurement in adolescent athletes with back pain. Rehabil Res Pract 2018;2018:8438350. https://doi.org/10.1155/2018/8438350
  18. Hertel J, Braham RA, Hale SA, Olmsted-Kramer LC. Simplifying the star excursion balance test: analyses of subjects with and without chronic ankle instability. J Orthop Sports Phys Ther 2006;36:131-7. https://doi.org/10.2519/jospt.2006.36.3.131
  19. Hertel J, Miller SJ, Denegar CR. Intratester and intertester reliability during the Star Excursion Balance Tests. J Sport Rehabil 2000;9:104-16. https://doi.org/10.1123/jsr.9.2.104
  20. Kinzey SJ, Armstrong CW. The reliability of the star-excursion test in assessing dynamic balance. J Orthop Sports Phys Ther 1998;27:356-60. https://doi.org/10.2519/jospt.1998.27.5.356
  21. Shahbazi Moheb Seraj M, Sarrafzadeh J, Maroufi N, Ebrahimi Takamjani I, Ahmadi A, Negahban H. Comparison of postural balance between subgroups of nonspecific low-back pain patients Based on O'Sullivan classification system and normal subjects during lifting. Arch Bone Jt Surg 2019;7:52-60.
  22. Foster NE, Hill JC, Hay EM. Subgrouping patients with low back pain in primary care: are we getting any better at it? Man Ther 2011;16:3-8. https://doi.org/10.1016/j.math.2010.05.013
  23. Luomajoki H, Kool J, de Bruin ED, Airaksinen O. Reliability of movement control tests in the lumbar spine. BMC Musculoskelet Disord 2007;8:90. https://doi.org/10.1186/1471-2474-8-90
  24. O'Sullivan P. Diagnosis and classification of chronic low back pain disorders: maladaptive movement and motor control impairments as underlying mechanism. Man Ther 2005;10:242-55. https://doi.org/10.1016/j.math.2005.07.001
  25. Dankaerts W, O'Sullivan P, Burnett A, Straker L, Davey P, Gupta R. Discriminating healthy controls and two clinical subgroups of nonspecific chronic low back pain patients using trunk muscle activation and lumbosacral kinematics of postures and movements: a statistical classification model. Spine (Phila Pa 1976) 2009;34:1610-8. https://doi.org/10.1097/BRS.0b013e3181aa6175
  26. O'Sullivan P. Classification of lumbopelvic pain disorders--why is it essential for management? Man Ther 2006;11:169-70. https://doi.org/10.1016/j.math.2006.01.002
  27. Sheeran L, Sparkes V, Caterson B, Busse-Morris M, van Deursen R. Spinal position sense and trunk muscle activity during sitting and standing in nonspecific chronic low back pain: classification analysis. Spine (Phila Pa 1976) 2012;37:E486-95. https://doi.org/10.1097/BRS.0b013e31823b00ce
  28. Hemming R, Sheeran L, van Deursen R, Sparkes V. Regional spinal kinematics during static postures and functional tasks in people with non-specific chronic low back pain. Int J Ther Rehabil 2015. doi: 10.12968/ijtr.2015.22.Sup8.S8b.
  29. Hemming R, Sheeran L, van Deursen R, Sparkes V. Non-specific chronic low back pain: differences in spinal kinematics in subgroups during functional tasks. Eur Spine J 2018;27:163-70. https://doi.org/10.1007/s00586-017-5217-1
  30. Dankaerts W, O'Sullivan PB, Straker LM, Burnett AF, Skouen JS. The inter-examiner reliability of a classification method for non-specific chronic low back pain patients with motor control impairment. Man Ther 2006;11:28-39. https://doi.org/10.1016/j.math.2005.02.001
  31. Vibe Fersum K, O'Sullivan PB, Kvale A, Skouen JS. Inter-examiner reliability of a classification system for patients with nonspecific low back pain. Man Ther 2009;14:555-61. https://doi.org/10.1016/j.math.2008.08.003
  32. Onofrei RR, Amaricai E, Petroman R, Suciu O. Relative and absolute within-session reliability of the modified Star Excursion Balance Test in healthy elite athletes. PeerJ 2019;7:e6999. https://doi.org/10.7717/peerj.6999
  33. Olmsted LC, Carcia CR, Hertel J, Shultz SJ. Efficacy of the Star Excursion Balance Tests in detecting reach deficits in subjects with chronic ankle instability. J Athl Train 2002;37:501-6.
  34. Tsigkanos C, Gaskell L, Smirniotou A, Tsigkanos G. Static and dynamic balance deficiencies in chronic low back pain. J Back Musculoskelet Rehabil 2016;29:887-93. https://doi.org/10.3233/BMR-160721
  35. Gribble PA, Hertel J, Plisky P. Using the Star Excursion Balance Test to assess dynamic postural-control deficits and outcomes in lower extremity injury: a literature and systematic review. J Athl Train 2012;47:339-57. https://doi.org/10.4085/1062-6050-47.3.08
  36. Appiah-Dwomoh EK, Muller S, Hadzic M, Mayer F. Star Excursion Balance Test in young athletes with back pain. Sports (Basel) 2016;4:E44. https://doi.org/10.3390/sports4030044
  37. Gribble PA, Hertel J. Considerations for normalizing measures of the Star Excursion Balance Test. Meas Phys Educ Exerc Sci 2003;7:89-100. https://doi.org/10.1207/S15327841MPEE0702_3
  38. Carpes FP, Reinehr FB, Mota CB. Effects of a program for trunk strength and stability on pain, low back and pelvis kinematics, and body balance: a pilot study. J Bodyw Mov Ther 2008;12:22-30. https://doi.org/10.1016/j.jbmt.2007.05.001
  39. Behennah J, Conway R, Fisher J, Osborne N, Steele J. The relationship between balance performance, lumbar extension strength, trunk extension endurance, and pain in participants with chronic low back pain, and those without. Clin Biomech (Bristol, Avon) 2018;53:22-30. https://doi.org/10.1016/j.clinbiomech.2018.01.023
  40. Mergner T, Schweigart G, Maurer C, Blumle A. Human postural responses to motion of real and virtual visual environments under different support base conditions. Exp Brain Res 2005;167:535-56. https://doi.org/10.1007/s00221-005-0065-3
  41. Bray H, Moseley GL. Disrupted working body schema of the trunk in people with back pain. Br J Sports Med 2011;45:168-73. https://doi.org/10.1136/bjsm.2009.061978
  42. Waddell G, Newton M, Henderson I, Somerville D, Main CJ. A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain 1993;52:157-68. https://doi.org/10.1016/0304-3959(93)90127-B
  43. Hooper TL, James CR, Brismee JM, Rogers TJ, Gilbert KK, Browne KL, et al. Dynamic balance as measured by the YBalance Test is reduced in individuals with low back pain: a cross-sectional comparative study. Phys Ther Sport 2016;22:29-34. https://doi.org/10.1016/j.ptsp.2016.04.006
  44. Fullam K, Caulfield B, Coughlan GF, Delahunt E. Kinematic analysis of selected reach directions of the Star Excursion Balance Test compared with the Y-Balance Test. J Sport Rehabil 2014;23:27-35. https://doi.org/10.1123/JSR.2012-0114
  45. Hemmati L, Rojhani-Shirazi Z, Malek-Hoseini H, Mobaraki I. Evaluation of static and dynamic balance tests in single and dual task conditions in participants with nonspecific chronic low back pain. J Chiropr Med 2017;16:189-94. https://doi.org/10.1016/j.jcm.2017.06.001
  46. Dankaerts W, O'Sullivan P, Burnett A, Straker L. Differences in sitting postures are associated with nonspecific chronic low back pain disorders when patients are subclassified. Spine (Phila Pa 1976) 2006;31:698-704. https://doi.org/10.1097/01.brs.0000202532.76925.d2
  47. Madigan ML, Davidson BS, Nussbaum MA. Postural sway and joint kinematics during quiet standing are affected by lumbar extensor fatigue. Hum Mov Sci 2006;25:788-99. https://doi.org/10.1016/j.humov.2006.04.004