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Abstract Background Altered lower back muscle activity is proposed as a contributing factor to the reoccurrence and chronicity of low back pain (LBP). This study compared lumbar muscle activity during trunk extension in patients with continuous chronic LBP (CLBP), non-continuous CLBP, recurrent LBP (RLBP) and healthy subjects. Methods In 75 subjects (16 continuous CLBP, 15 non-continuous CLBP, 23 RLBP, 21 healthy controls), surface electromyographic (EMG) activity of the lumbar erector spinae (ES), multifidus (MF), latissimus dorsi (LD) and gluteus maximus (GM) was recorded during the concentric, holding and eccentric phase of a modified Biering Sorenson exercise. Results Continuous CLBP patients showed higher EMG activity in the ES and MF muscles compared to healthy controls in the concentric (p = 0.011; p = 0.009 respectively) and the holding phase (p = 0.015; p = 0.013). Higher EMG activity was observed in continuous CLBP compared to RLBP in the ES and MF muscles in the holding phase (p = 0.035; p = 0.037), and in the MF in the concentric phase (p = 0.046), but not in the ES (p = 0.062). No differences in muscle activity were established in either the concentric, holding, and eccentric phase for the LD and GM muscles. No differences were found between non-continuous CLBP and the other groups. Conclusions An enhanced muscle activity of the lumbar muscles during the concentric and holding phase was observed during trunk extension in patients with continuous CLBP compared to patients with RLBP and healthy subjects. No differences between groups are present in the GM and LD muscles during concentric and holding phases and for any muscle in the eccentric phase.

Introduction: In 2013, a study showed low guideline adherence regarding chronic low back pain (CLBP) in physiotherapy students concerning activity and work recommendations (47% and 16%)1. The aim of this study is to investigate if the 2020' physiotherapy students'attitudes and beliefs regarding CLBP and osteoarthritis (OA) and the guideline adherence have changed since 2013, by using the same protocol. Methods: Physiotherapy students in their 2nd and 4th year of education from 6 Belgian and 2 Dutch institutions participated. The attitudes and beliefs regarding CLBP and OA were measured using the Pain attitudes and beliefs scale (BAPS), the Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS) and a questionnaire regarding therapeutic exercise and knee OA. A clinical case vignette was used to measure the guideline adherence regarding CLBP. Results: In total, 2738 students participated, 1624 in 2013 and 1114 in 2020. Compared to 2013, students in 2020 scored lower on a biomedical orientation (p < 0.001) and higher on psychosocial orientations (p < 0.001) regarding CLBP and OA. Medium effect size (cohens'd = 0.548) was found on the psychosocial orientation of the PABS, other differences only had small effect sizes. In 2020, 54% provided clinical guidelines' consistent recommendations for activity and 28% for work, which significantly improved compared to 2013. Discussion: A positive shift occurred towards a more biopsychosocial approach between students of 2013 and 2020. However, the improved guideline adherence concerning activity and work recommendations remains low. Process evaluation: Additional clinical case vignette to measure clinical recommendations regarding OA would have strengthen this study. [ABSTRACT FROM AUTHOR]

Introduction: Although a positive correlation between patients' expectations and outcome after surgery appears evident, evidence is rather conflicting. This can be attributed to the lack of uniform, validated, and reliable methods to assess patients' expectations. A valid and reliable questionnaire to assess patients' expectations of lumbar spine surgery is not yet available in Dutch. Methods: The forward-backward translation method will be applied to the original Hospital for Special Surgery Lumbar Spine Surgery Expectations Survey [1]. The translations will be revised by an expert committee, including translators, methodologist, spinal surgery experts and psychology experts. The pre-final Dutch survey will be piloted in a sample (n = 50) of patients scheduled for lumbar surgery. Based on these results, the expert committee will improve the survey. The final survey will then be administered in a sample (n = 300) of patients twice before their spinal surgery. Based on the acquired data, validity (i.e. content, construct, and discriminative validity) and reliability (i.e. internal consistency and test-retest reliability) will determined. Results: Not applicable. Discussion: A Dutch validated survey for assessment of expectations of lumbar surgery patients may assist clinicians in determining the quality of spinal surgical care and any discrepancies that might exist between clinician and patient. Researchers will benefit as well, as uniform and valid surveys are essential to unravel the relation between pre-surgical patients' expectations and satisfaction following spinal surgery. Process evaluation: The study is currently in the backward-translation stage. Finding translators with the appropriate requirements according to the WHO guidelines proves to be challenging. [ABSTRACT FROM AUTHOR]

Introduction: Chronic Whiplash Associated Disorders (CWAD) are characterized by long-lasting symptoms of neck pain occurring after an acceleration-deceleration injury. Central sensitization (CS) has been suggested as the possible underlying mechanism for these symptoms, and is characterized by changes in the central nervous system. Besides CS, psychological factors are believed to play an important role in the experience of (chronic) pain. Methods: 72 CWAD patients and 55 healthy controls underwent electrical stimuli-based quantitative sensory testing (QST). Detection and pain thresholds (EPT), temporal summation (TS) and conditioned pain modulation (CPM) were examined. Spearman correlations and linear mixed models analyses were performed to assess respectively the hypothesized associations with and group differences in QST. Results: The Pain Catastrophizing magnification subscale correlated with left wrist EPT (r = -0.332; p = 0.004), and the Pain Anxiety Symptom Scale-20 with left wrist (r = -0.325; p = 0.005) and ankle (r = -0.330; p = 0.005) EPT. TS at the ankle correlated with the CS Inventory (r = 0.303; p = 0.010), Short Form 36 pain subscale (r = -0.325; p = 0.005), and Illness Perception Questionnaire revised consequences subscale (r = 0.325; p = 0.005). EPTs of left (p = 0.011) and right wrist (p = 0.023) were lower in the CWAD group, but CPM and TS did not differ between groups. Discussion: QST outcomes relate to psychological constructs, rather than to self-reported pain intensity and distribution. Local hyperalgesia was found in CWAD patients, but no differences in endogenous pain facilitation nor inhibition. Process evaluation: Both CWAD patients reporting unilateral as bilateral neck pain were included, which complicated the interpretation of distal hyperalgesia. [ABSTRACT FROM AUTHOR]

Introduction: There is abundant evidence for compromised movement performance in non-specific low back pain (NSLBP)1,2. It has been proposed that not only pain severity, but also cognitive-affective factors such as attention might influence movement3. The objective of this study is to review current knowledge concerning the effects of attention on movement-related outcomes in NSLBP. Methods: A systematic search was performed and reported following the PRISMA-guidelines. A comprehensive search strategy was used by using five electronic databases. Possible risk-of-bias was evaluated by using the adjusted version of the Newcastle-Ottawa Scale. Levels of evidence and conclusion were assigned according to guidelines of the Dutch Institute for Healthcare Improvement. Results: Twenty-two articles were included (ROB 18.2% -72.7%), the majority (77%) performed in chronic LBP.Limited evidence indicated attentional suppression (measured with coping strategy questionnaire) to be negatively associated with activity of the trunk muscles in acute NSLBP. Furthermore, limited evidence indicated that when attention is divided over tasks (i.e. dual-tasks) this results in lower variability of postural strategies in recurrent NSLBP and lower/delayed anticipatory trunk muscle activation in chronic NSLBP. Discussion: Ignoring pain effects trunk muscle activity in acute NSLBP. When attention is divided (i.e. dual-tasks), individuals with recurrent/chronic NSLBP are less capable to control their trunk muscles. Process evaluation: The different possibilities to operationalize 'attention' posed a difficulty. Included studies used two main operationalizations: 'attentional control of pain' (i.e. attention focus, attentional suppression/distraction) and 'attention as a capacity' (i.e. cognitive load of pain competes for available attentional resources for postural control). [ABSTRACT FROM AUTHOR]