Anticipatory and compensatory postural adjustments in people with low back pain

A systematic review and meta-analysis

Michael F Knox, Lucy S Chipchase, Siobhan M Schabrun, Rick J Romero, Paul W M Marshall

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background context: Despite altered anticipatory (APAs) and compensatory postural adjustments (CPAs) being hypothesized to contribute to the onset and persistence of low back pain (LBP), results from studies comparing people with and without LBP are conflicting. Purpose: This systematic review aimed to determine whether APAs or CPAs are altered in the presence of acute and chronic LBP. Study design: A systematic review of studies was carried out. Patient sample: No patient sample was required. Outcome measures: Between group standardized mean differences and 95% confidence intervals for APAs ad CPAs Methods: A comprehensive search was conducted for articles comparing people with LBP (acute or chronic) to healthy controls for the onset or amplitude of muscle activity, center of pressure (COP), or kinematic responses to expected or unexpected perturbations. Two independent reviewers extracted data and assessed the methodological quality of relevant studies. Differences between people with and without LBP were calculated as standardized mean differences, and included in a meta-analysis if outcomes were homogeneous. Otherwise, a narrative synthesis was conducted. Results: Twenty-seven studies were included, of which the majority examined muscle onsets in response to expected and unexpected perturbations. Only two studies compared people with and without acute LBP, and results for these studies were conflicting. The results show delayed muscle onsets in response to expected and unexpected perturbations for people with chronic LBP when compared with healthy controls. No conclusive evidence for differences between people with and without chronic LBP for COP or kinematic responses. Conclusions: There is currently no convincing evidence of differences between people with and without acute LBP for APAs or CPAs. Conversely, delayed muscle onsets in people with chronic LBP suggest APAs and CPAs are altered in this population. However, the functional relevance of these delayed muscle onsets (eg, COP and kinematics) is unknown.

Original languageEnglish
Pages (from-to)1934-1949
Number of pages16
JournalSpine Journal
Volume18
Issue number10
DOIs
Publication statusPublished - Oct 2018

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Low Back Pain
Meta-Analysis
Muscles
Biomechanical Phenomena
Pressure
Pain Clinics
Outcome Assessment (Health Care)
Confidence Intervals

Cite this

Knox, Michael F ; Chipchase, Lucy S ; Schabrun, Siobhan M ; Romero, Rick J ; Marshall, Paul W M. / Anticipatory and compensatory postural adjustments in people with low back pain : A systematic review and meta-analysis. In: Spine Journal. 2018 ; Vol. 18, No. 10. pp. 1934-1949.
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abstract = "Background context: Despite altered anticipatory (APAs) and compensatory postural adjustments (CPAs) being hypothesized to contribute to the onset and persistence of low back pain (LBP), results from studies comparing people with and without LBP are conflicting. Purpose: This systematic review aimed to determine whether APAs or CPAs are altered in the presence of acute and chronic LBP. Study design: A systematic review of studies was carried out. Patient sample: No patient sample was required. Outcome measures: Between group standardized mean differences and 95{\%} confidence intervals for APAs ad CPAs Methods: A comprehensive search was conducted for articles comparing people with LBP (acute or chronic) to healthy controls for the onset or amplitude of muscle activity, center of pressure (COP), or kinematic responses to expected or unexpected perturbations. Two independent reviewers extracted data and assessed the methodological quality of relevant studies. Differences between people with and without LBP were calculated as standardized mean differences, and included in a meta-analysis if outcomes were homogeneous. Otherwise, a narrative synthesis was conducted. Results: Twenty-seven studies were included, of which the majority examined muscle onsets in response to expected and unexpected perturbations. Only two studies compared people with and without acute LBP, and results for these studies were conflicting. The results show delayed muscle onsets in response to expected and unexpected perturbations for people with chronic LBP when compared with healthy controls. No conclusive evidence for differences between people with and without chronic LBP for COP or kinematic responses. Conclusions: There is currently no convincing evidence of differences between people with and without acute LBP for APAs or CPAs. Conversely, delayed muscle onsets in people with chronic LBP suggest APAs and CPAs are altered in this population. However, the functional relevance of these delayed muscle onsets (eg, COP and kinematics) is unknown.",
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Anticipatory and compensatory postural adjustments in people with low back pain : A systematic review and meta-analysis. / Knox, Michael F; Chipchase, Lucy S; Schabrun, Siobhan M; Romero, Rick J; Marshall, Paul W M.

In: Spine Journal, Vol. 18, No. 10, 10.2018, p. 1934-1949.

Research output: Contribution to journalArticle

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T1 - Anticipatory and compensatory postural adjustments in people with low back pain

T2 - A systematic review and meta-analysis

AU - Knox, Michael F

AU - Chipchase, Lucy S

AU - Schabrun, Siobhan M

AU - Romero, Rick J

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N2 - Background context: Despite altered anticipatory (APAs) and compensatory postural adjustments (CPAs) being hypothesized to contribute to the onset and persistence of low back pain (LBP), results from studies comparing people with and without LBP are conflicting. Purpose: This systematic review aimed to determine whether APAs or CPAs are altered in the presence of acute and chronic LBP. Study design: A systematic review of studies was carried out. Patient sample: No patient sample was required. Outcome measures: Between group standardized mean differences and 95% confidence intervals for APAs ad CPAs Methods: A comprehensive search was conducted for articles comparing people with LBP (acute or chronic) to healthy controls for the onset or amplitude of muscle activity, center of pressure (COP), or kinematic responses to expected or unexpected perturbations. Two independent reviewers extracted data and assessed the methodological quality of relevant studies. Differences between people with and without LBP were calculated as standardized mean differences, and included in a meta-analysis if outcomes were homogeneous. Otherwise, a narrative synthesis was conducted. Results: Twenty-seven studies were included, of which the majority examined muscle onsets in response to expected and unexpected perturbations. Only two studies compared people with and without acute LBP, and results for these studies were conflicting. The results show delayed muscle onsets in response to expected and unexpected perturbations for people with chronic LBP when compared with healthy controls. No conclusive evidence for differences between people with and without chronic LBP for COP or kinematic responses. Conclusions: There is currently no convincing evidence of differences between people with and without acute LBP for APAs or CPAs. Conversely, delayed muscle onsets in people with chronic LBP suggest APAs and CPAs are altered in this population. However, the functional relevance of these delayed muscle onsets (eg, COP and kinematics) is unknown.

AB - Background context: Despite altered anticipatory (APAs) and compensatory postural adjustments (CPAs) being hypothesized to contribute to the onset and persistence of low back pain (LBP), results from studies comparing people with and without LBP are conflicting. Purpose: This systematic review aimed to determine whether APAs or CPAs are altered in the presence of acute and chronic LBP. Study design: A systematic review of studies was carried out. Patient sample: No patient sample was required. Outcome measures: Between group standardized mean differences and 95% confidence intervals for APAs ad CPAs Methods: A comprehensive search was conducted for articles comparing people with LBP (acute or chronic) to healthy controls for the onset or amplitude of muscle activity, center of pressure (COP), or kinematic responses to expected or unexpected perturbations. Two independent reviewers extracted data and assessed the methodological quality of relevant studies. Differences between people with and without LBP were calculated as standardized mean differences, and included in a meta-analysis if outcomes were homogeneous. Otherwise, a narrative synthesis was conducted. Results: Twenty-seven studies were included, of which the majority examined muscle onsets in response to expected and unexpected perturbations. Only two studies compared people with and without acute LBP, and results for these studies were conflicting. The results show delayed muscle onsets in response to expected and unexpected perturbations for people with chronic LBP when compared with healthy controls. No conclusive evidence for differences between people with and without chronic LBP for COP or kinematic responses. Conclusions: There is currently no convincing evidence of differences between people with and without acute LBP for APAs or CPAs. Conversely, delayed muscle onsets in people with chronic LBP suggest APAs and CPAs are altered in this population. However, the functional relevance of these delayed muscle onsets (eg, COP and kinematics) is unknown.

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