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STUDY DESIGN: Statistical Classification Model for nonspecific chronic low back pain (NS-CLBP) patients and controls based on parameters of motor control. OBJECTIVE: Develop a Statistical Classification Model to discriminate between 2 subgroups of NS-CLBP (Flexion Pattern [FP] and Active Extension Pattern [AEP]) and a control group using biomechanical variables quantifying parameters of motor control. SUMMARY OF BACKGROUND DATA: It has been well documented that many CLBP patients have motor control impairments of their lumbar spine. O'Sullivan proposed a mechanism-based classification system for NS-CLBP with motor control impairments based on a comprehensive subjective and physical examination to establish the relationship between pain provocation and spinal motor control. For the FP and AEP s, 2 groups defined by O'Sullivan and under investigation is this study, the motor control impairment is considered to be the mechanism maintaining their CLBP. No previous studies have used a Statistical Model with measurements of motor control impairment to subclassify NS-CLBP patients. METHODS: Thirty-three NS-CLBP patients (20 FP and 13 AEP) and 34 asymptomatic subjects had synchronized lumbosacral kinematics and trunk muscle activation recorded during commonly reported aggravating postures and movements. Biomechanical variables were quantified and a Statistical Classification Model was developed. RESULTS: The Statistical Model used 5 kinematic and 2 electromyography variables. The model correctly classified 96.4% of cases. CONCLUSION: Selected biomechanical variables were predictors for subgroup membership and were able to discriminate the 3 subgroups. This study adds further support toward the validation of the proposed classification system. [ABSTRACT FROM AUTHOR]

Introduction: In several countries1, direct access to physiotherapy (PT) for acute low back pain (aLBP) had a positive impact on clinical outcomes2 and health-care usage and costs3. The aim of this study is to investigate the effect of direct PT access on pain, disability and costs compared to usual care by the general practitioner (GP) for aLBP within the Belgian care system. Methods: Six hundred adults (French-speaking: n = 300; Dutch-speaking: n = 300) with aLBP (>24 hours and <6 weeks) will be recruited and semi-randomly allocated to the usual care or the direct PT pathway in this ethically approved study (CME2021/066). Primary outcomes include pain intensity, pain location and disability. Secondary, a cost-effectiveness analysis will evaluate the patient-and societal costs associated with aLBP and its treatment. Other secondary outcomes include beliefs and cognitions related to LBP, quality of life, work disability, amount of flare ups and perceived effect of change. All outcomes will be evaluated through validated questionnaires at baseline, during and at the end of intervention and at 3 months, 1 and 2 years following enrolment. Effects and relations will be investigated using, respectively, linear mixed models and multiple linear regression. Results: It is hypothesized that direct PT access will result in higher reductions in pain and disability and lower costs compared to usual care for aLBP. Discussion: The study results will be used to optimize the Belgian care pathway for aLBP. Process evaluation: Challenges to this trial include an unbiased organization within the Belgian care and political system and patient recruitment in the direct PT pathway. [ABSTRACT FROM AUTHOR]

Purpose: Musculoskeletal complaints (MSCs), a leading contributor to disability worldwide, have a major impact on health-related quality of life (HRQoL). Poor general health related to lifestyle factors such as smoking, alcohol consumption and physical inactivity can lead to a higher risk to suffer MSCs. For minority groups in Suriname such as the Maroons and the Indigenous peoples no research has been conducted regarding prevalence of MSCs, HRQoL and various lifestyle factors. The aims were to determine the prevalence of MSCs and HRQoL in two rural tribal villages in the forested interior of Suriname and to identify various lifestyle factors associated with HRQoL in these communities. Method: This was a cross-sectional community-based study using the Community Oriented Program for the Control of Rheumatic Diseases stage 1, phase 1 & 2 methodology in Goejaba, a Maroon village and Galibi, an Indigenous rural village. Sociodemographic data, self-reported comorbidities, past MSCs (for longer than seven days), lifestyle factors including smoking, alcohol use, body mass index (BMI) and physical activity (PA), and HRQoL (using the 36-item Short Form Survey (SF-36)) data were gathered among 153 Indigenous individuals in Galibi, and 516 Maroons in Goejaba. Regression models were constructed to explore associations between presence of MSCs, lifestyle factors and HRQoL. Results: High prevalence rates for past MSCs were reported in Galibi (72.4%) and Goejaba (58.3%). In both communities, respondents with MSCs reported significantly worse HRQoL than persons without MSCs. MSCs and the presence of comorbidities had a strong negative association with HRQoL, whereas PA positively influenced the physical and mental health domains of the SF-36. Smoking, alcohol use and BMI showed no association with HRQoL. Conclusions: In this first study, a high prevalence for MSCs was reported in an Indigenous and Maroon rural community in Suriname. MSCs and comorbidities had a significant negative impact on HRQoL. PA was associated with higher self-reported HRQoL. [ABSTRACT FROM AUTHOR]

Objectives: To determine the effect of different training schedules on the cross sectional area (CSA) of the lumbar multifidus muscle in patients with chronic low back pain.Methods: Each of 59 nine patients was randomly assigned to one of three programmes: 10 weeks of stabilisation training (group 1; n = 19); 10 weeks of stabilisation training combined with dynamic resistance training (group 2; n = 20); 10 weeks of stabilisation training combined with dynamic-static resistance training (group 3; n = 20). Before and after 10 weeks of training, multifidus CSAs were measured from standard computed tomography images at three different levels (upper end plate of L3 and L4, and lower end plate of L4).Results: The CSA of the multifidus muscle was significantly increased at all levels after training in group 3. In contrast, no significant differences were found in groups 1 and 2.Conclusions: General stabilisation exercises and dynamic intensive lumbar resistance training have no significant effect on the CSA of the lumbar multifidus muscle in patients with chronic low back pain. The static holding component between the concentric and eccentric phase was found to be critical in inducing muscle hypertrophy during the first 10 weeks. Treatment consisting of stabilisation training combined with an intensive lumbar dynamic-static strengthening programme seems to be the most appropriate method of restoring the size of the multifidus muscle. [ABSTRACT FROM AUTHOR]

Introduction/objectives: Musculoskeletal complaints (MSCs) are a major burden worldwide. In Suriname, a South American developing country, the epidemiology of MSCs and its related disorders is still unknown. Therefore, a cross-sectional survey was carried out to determine prevalence and risk factors of MSCs in urban areas of Suriname. Methods: This is the first Community Oriented Program for the Control of Rheumatic Diseases survey in a Caribbean Community. Trained interviewers collecting self-reported data conducted this house-to-house community-based survey. Data was analyzed using SPSS version 23 and Stata version 14.1. Results: The prevalence of MSCs was 62.1% with a higher prevalence rate among women compared with men (resp. 64.3% vs. 58.6%) (Odds ratio = 1.185; p ≤ 0.05). The most decisive self-reported variables associated with MSCs were older age (defined as ≥ 45 years) and moderate to heavy physical workload. The prevalence of MSCs was also associated with women, low educational level, smoking, alcohol use, high-intensity physical activity level, and body mass index (≥ 25 kg/m2). The highest prevalence of MSCs was found among African descendants (Maroons (68.8%) and Creoles (68.0%)), followed by the Indigenous (65.0%) and Asian descendants (Hindustani (64.3%) and Javanese (49.5%)). Most persons with MSCs (75.7%) reported multisite complaints with lower back, knee, and shoulder being the most frequently reported sites. In our study population, MSCs were not considered disabling (mean Health Assessment Questionnaire Disability Index score of 0.23). Conclusions: The prevalence of MSCs in this urban multi-ethnic Surinamese community is high; therefore, future research is needed to further explore the burden of MSCs in Suriname. Key Points • Musculoskeletal complaints are highly prevalent in different ethnic groups in an urban Surinamese community; almost two-thirds of the population reported MSCs with the highest prevalence rate among women and African descendants. • The most decisive self-reported variables associated with MSCs were older age (defined as ≥ 45 years) and moderate to heavy physical workload. Gender, educational level, smoking, alcohol use, high-intensity physical activity, and body mass index were also significantly associated with musculoskeletal complaints. [ABSTRACT FROM AUTHOR]

Introduction: Paucity of evidence on good practices in the rehabilitation of patients requiring single-and double level lumbar fusion surgery (LFS), leads to uncertainty and extensive variability in current rehabilitation regimes. Therefore, this study aims to formulate consensus statements on the optimal rehabilitation of LFS, representing the viewpoints of Belgian and Dutch experts on spinal surgery and rehabilitation. Methods: A modified Delphi study consisted of a 3-round online Delphi questionnaire, followed by an in-person consensus meeting. In each round, experts could suggest new items, and received feedback for reconsidered statements. The threshold for consensus agreement was set at =75%. Afterwards, perspectives of nine patients that underwent LFS were solicited through a questionnaire and patient focus group. Results: A total of 31 experts participated in the first online round, of which 27 (87%) completed all online rounds, and 17 (55%) attended the in-person consensus meeting. Consensus was reached on 122 statements relating to the pre-, peri-and postoperative rehabilitation of LFS, including the importance of uniform communication, patient-specific education and specific physiotherapeutic interventions. Patient perspective on optimal rehabilitation was gained from nine patients. Discussion: The final compilation of 122 consensus statements is a solid base for developing and implementing a novel and much-needed rehabilitation pathway for LFS. Benchmarking this consensus against patient perspectives helps understanding patient expectations and potential barriers for implementation. Process evaluation: These results represent the consensus established by Belgian and Dutch experts. Future research should consider transfer this consensus to other regions, including non-European countries. [ABSTRACT FROM AUTHOR]

STUDY DESIGN: A preliminary cross-sectional comparative study of adolescents with nonspecific chronic low back pain (NSCLBP) and healthy controls. OBJECTIVE: To investigate whether differences in spinal kinematic and trunk muscle activity exist in both usual and slump sitting in adolescents with NSCLBP. SUMMARY OF BACKGROUND: Evidence suggests that low back pain commonly develops in adolescence and increases the risk for low back pain in adulthood. Sitting is an important consideration in adolescents with NSCLBP: currently there are no reports investigating their motor control strategies in sitting. METHODS: Twenty-eight adolescents (14 female) with NSCLBP and 28 matched pain-free controls were recruited from a large cohort study. Pain subjects were subclassified based on O'Sullivan's classification system. Three-dimensional lumbo-pelvic kinematic data and the activation of 3 back and 2 abdominal muscles were recorded during usual and slump sitting. The flexion-relaxation phenomenon in sitting was also investigated. RESULTS: Spinal posture in usual and slump sitting were similar for adolescents with and without NSCLBP. However, differences were identified in both sitting conditions when those with NSCLPB were subclassified and compared with controls. Muscle activation differences were not consistently identified, with only lower levels of internal oblique activation in usual sitting in NSCLBP compared with pain-free controls showing significance. Flexion relaxation was observed in both iliocostalis and thoracic erector spinae in the NSCLBP group but not controls. CONCLUSION: This study provides preliminary results. Differences with sitting posture are only seen when adolescents with NSCLBP are classified. Trunk muscle activation is not a sensitive marker for discriminating subgroups of NSCLBP during adolescence. [ABSTRACT FROM AUTHOR]

The footnote of Fig. 2 in the published original version of the above article went missing and the correct figure is presented in this article.] [ABSTRACT FROM AUTHOR]

Objectives-To determine the effect of different training schedules on the cross sectional area (CSA) of the lumbar multifidus muscle in patients with chronic low back pain. Methods-Each of 59 nine patients was randomly assigned to one of three programmes: 10 weeks of stabilisation training (group 1; n = 19); 10 weeks of stabilisation training combined with dynamic resistance training (group 2; n = 20); 10 weeks of stabilisation training combined with dynamic-static resistance training (group 3; n = 20). Before and after 10 weeks of training, multifidus CSAs were measured from standard computed tomography images at three different levels (upper end plate of L3 and L4, and lower end plate of L4). Results--The CSA of the multifidus muscle was significantly increased at all levels after training in group 3. In contrast, no significant differences were found in groups 1 and 2. Conclusions-General stabilisation exercises and dynamic intensive lumbar resistance training have no significant effect on the CSA of the lumbar multifidus muscle in patients with chronic low back pain. The static holding component between the concentric and eccentric phase was found to be critical in inducing muscle hypertrophy during the first 10 weeks. Treatment consisting of stabilisation training combined with an intensive lumbar dynamic- static strengthening programme seems to be the most appropriate method of restoring the size of the multifidus muscle. [ABSTRACT FROM AUTHOR]