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 journalReview article

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 anticipatory (APAs) or compensatory postural adjustments (CPAs) are altered in the presence of acute and chronic low back pain (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, 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 to 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 (e.g. COP and kinematics) are unknown.

PROSPERO REGISTRATION: CRD42016032815.

LanguageEnglish
JournalSpine Journal
DOIs
StateE-pub ahead of print - 12 Jun 2018
Externally publishedYes

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Low Back Pain
Meta-Analysis
Muscles
Biomechanical Phenomena
Confidence Intervals

Cite this

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title = "Anticipatory and compensatory postural adjustments in people with low back pain: a systematic review and meta-analysis",
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 anticipatory (APAs) or compensatory postural adjustments (CPAs) are altered in the presence of acute and chronic low back pain (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, 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 to 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 (e.g. COP and kinematics) are unknown.PROSPERO REGISTRATION: CRD42016032815.",
author = "Knox, {Michael F} and Chipchase, {Lucy S} and Schabrun, {Siobhan M} and Romero, {Rick J} and Marshall, {Paul W M}",
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doi = "10.1016/j.spinee.2018.06.008",
language = "English",
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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, 12.06.2018.

Research output: Contribution to journalReview article

TY - JOUR

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

T2 - Spine Journal

AU - Knox,Michael F

AU - Chipchase,Lucy S

AU - Schabrun,Siobhan M

AU - Romero,Rick J

AU - Marshall,Paul W M

N1 - Copyright © 2018. Published by Elsevier Inc.

PY - 2018/6/12

Y1 - 2018/6/12

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 anticipatory (APAs) or compensatory postural adjustments (CPAs) are altered in the presence of acute and chronic low back pain (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, 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 to 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 (e.g. COP and kinematics) are unknown.PROSPERO REGISTRATION: CRD42016032815.

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 anticipatory (APAs) or compensatory postural adjustments (CPAs) are altered in the presence of acute and chronic low back pain (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, 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 to 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 (e.g. COP and kinematics) are unknown.PROSPERO REGISTRATION: CRD42016032815.

U2 - 10.1016/j.spinee.2018.06.008

DO - 10.1016/j.spinee.2018.06.008

M3 - Review article

JO - Spine Journal

JF - Spine Journal

SN - 1529-9430

ER -