Clinically assessed lumbopelvic sensorimotor control tests in low back pain: are they actually valid? A systematic review according to COSMIN guidelines.

BACKGROUND: Impairments in lumbopelvic sensorimotor control (SMC) are thought to be one of the underlying mechanisms for the recurrence and persistence of low back pain (LBP). As such, lumbopelvic SMC tests are frequently included in the clinical examination of patients with LBP. OBJECTIVE: To evaluate convergent and known-groups validity of clinically assessed lumbopelvic SMC tests in patients with LBP according to COSMIN guidelines. DESIGN: Systematic review METHODS: Five electronic databases were searched until December 2023. Studies examining convergent or known-groups validity of lumbopelvic SMC tests assessed via inspection or palpation in patients with LBP were included. Known-groups validity had to be assessed between patients with LBP and pain-free persons. Two independent researchers appraised risk of bias and quality of evidence (QoE) using the COSMIN Risk of Bias checklist and modified GRADE approach, respectively. Results for known-groups validity were reported separately for single tests and test-clusters. RESULTS: Twelve studies (946 participants) were included. Three studies investigated convergent validity of three single tests. Regarding known-groups validity, six studies evaluated six single tests and four studies investigated two test-clusters. For only one test, both convergent and known-groups were assessed. The QoE for tests showing sufficient convergent or known-groups validity was (very) low, whereas QoE was moderate for single tests or test-clusters with insufficient known-groups validity. CONCLUSION: All clinically assessed lumbopelvic SMC tests with sufficient convergent or known-groups validity had (very) low QoE. Therefore, test outcomes should be interpreted cautiously and strong reliance on these outcomes for clinical decision-making can currently not be recommended.

The association between pain-related psychological variables and postural control in low back pain: A systematic review and meta-analysis.

BACKGROUND: Alterations in postural control have been found in individuals with low back pain (LBP), particularly during challenging postural tasks. Moreover, higher levels of negative pain-related psychological variables are associated with increased trunk muscle activity, reduced spinal movement, and worse maximal physical performance in individuals with LBP. RESEARCH QUESTION: Are pain-related psychological variables associated with postural control during static bipedal standing tasks in individuals with LBP? METHODS: A systematic review and meta-analysis were conducted. Pubmed, Web of Science, and PsycINFO were searched until March 2023. Studies were included if they evaluated postural control during static bipedal standing in individuals with LBP by measuring center of pressure (CoP) variables, and reported at least one pain-related psychological variable. Correlation coefficients between pain-related psychological variables and CoP variables were extracted. Study quality was assessed with the "Quality In Prognosis Studies" tool (QUIPS). Random-effect models were used to calculate pooled correlation coefficients for different postural tasks. Sub-analyses were performed for positional or dynamic CoP variables. Certainty of evidence was assessed with an adjusted "Grading of Recommendations, Assessment, Development, and Evaluations" tool (GRADE). The protocol was registered on PROSPERO (CRD42021241739). RESULTS: Sixteen studies (n = 723 participants) were included. Pain-related fear (16 studies) and pain catastrophizing (three studies) were the only reported pain-related psychological variables. Both pain-related fear (-0.04 < pooled r < 0.14) and pain catastrophizing (0.28 < pooled r < 0.29) were weakly associated with CoP variables during different postural tasks. For all associations, the certainty of evidence was very low. SIGNIFICANCE: Pain-related fear and pain catastrophizing are only weakly associated with postural control during static bipedal standing in individuals with LBP, regardless of postural task difficulty. Certainty of evidence is very low thus it is conceivable that future studies accounting for current study limitations might reveal different findings.

The Role of Back Muscle Dysfunctions in Chronic Low Back Pain: State-of-the-Art and Clinical Implications.

Changes in back muscle function and structure are highly prevalent in patients with chronic low back pain (CLBP). Since large heterogeneity in clinical presentation and back muscle dysfunctions exists within this population, the potential role of back muscle dysfunctions in the persistence of low back pain differs between individuals. Consequently, interventions should be tailored to the individual patient and be based on a thorough clinical examination taking into account the multidimensional nature of CLBP. Considering the complexity of this process, we will provide a state-of-the-art update on back muscle dysfunctions in patients with CLBP and their implications for treatment. To this end, we will first give an overview of (1) dysfunctions in back muscle structure and function, (2) the potential of exercise therapy to address these dysfunctions, and (3) the relationship between changes in back muscle dysfunctions and clinical parameters. In a second part, we will describe a framework for an individualised approach for back muscle training in patients with CLBP.

Understanding Discrepancies in a Person's Fear of Movement and Avoidance Behavior: A Guide for Musculoskeletal Rehabilitation Clinicians Who Support People With Chronic Musculoskeletal Pain.

BACKGROUND: Generic self-report measures do not reflect the complexity of a person's pain-related behavior. Since variations in a person's fear of movement and avoidance behavior may arise from contextual and motivational factors, a person-centered evaluation is required-addressing the cognitions, emotions, motivation, and actual behavior of the person. CLINICAL QUESTION: Most musculoskeletal rehabilitation clinicians will recognize that different people with chronic pain have very different patterns of fear and avoidance behavior. However, an important remaining question for clinicians is "How can I identify and reconcile discrepancies in fear of movement and avoidance behavior observed in the same person, and adapt my management accordingly?" KEY RESULTS: We frame a clinical case of a patient with persistent low back pain to illustrate the key pieces of information that clinicians may consider in a person-centered evaluation (ie, patient interview, self-report measures, and behavioral assessment) when working with patients to manage fear of movement and avoidance behavior. CLINICAL APPLICATION: Understanding the discrepancies in a person's fear of movement and avoidance behavior is essential for musculoskeletal rehabilitation clinicians, as they work in partnership with patients to guide tailored approaches to changing behaviors. J Orthop Sports Phys Ther 2023;53(5):1-10. Epub: 9 March 2023. doi:10.2519/jospt.2023.11420.

Clinical phenotypes and prognostic factors in persons with hip osteoarthritis undergoing total hip arthroplasty: protocol for a longitudinal prospective cohort study (HIPPROCLIPS).

BACKGROUND: Large heterogeneity exists in the clinical manifestation of hip osteoarthritis (OA). It is therefore not surprising that pain and disability in individuals with hip OA and after total hip arthroplasty (THA) cannot be explained by biomedical variables alone. Indeed, also maladaptive pain-related cognitions and emotions can contribute to pain and disability, and can lead to poor treatment outcomes. Traumatic experiences, mental disorders, self-efficacy and social support can influence stress appraisal and strategies to cope with pain, but their influence on pain and disability has not yet been established in individuals with hip OA undergoing THA. This study aims (1) to determine the influence of traumatic experiences and mental disorders on pain processing before and shortly after THA (2) to identify preoperative clinical phenotypes in individuals with hip OA eligible for THA, (3) to identify pre- and early postoperative prognostic factors for outcomes in pain and disability after THA, and (4) to identify postoperative clinical phenotypes in individuals after THA. METHODS: This prospective longitudinal cohort study will investigate 200 individuals undergoing THA for hip OA. Phenotyping variables and candidate prognostic factors include pain-related fear-avoidance behaviour, perceived injustice, mental disorders, traumatic experiences, self-efficacy, and social support. Peripheral and central pain mechanisms will be assessed with thermal quantitative sensory testing. The primary outcome measure is the hip disability and osteoarthritis outcome score. Other outcome measures include performance-based measures, hip muscle strength, the patient-specific functional scale, pain intensity, global perceived effect, and outcome satisfaction. All these measurements will be performed before surgery, as well as 6 weeks, 3 months, and 12 months after surgery. Pain-related cognitions and emotions will additionally be assessed in the early postoperative phase, on the first, third, fifth, and seventh day after THA. Main statistical methods that will be used to answer the respective research questions include: LASSO regression, decision tree learning, gradient boosting algorithms, and recurrent neural networks. DISCUSSION: The identification of clinical phenotypes and prognostic factors for outcomes in pain and disability will be a first step towards pre- and postoperative precision medicine for individuals with hip OA undergoing THA. TRIAL REGISTRATION: ClinicalTrials.gov: NCT05265858. Registered on 04/03/2022.

The development and measurement properties of the Dutch version of the fear-avoidance components scale (FACS-D) in persons with chronic musculoskeletal pain.

OBJECTIVES: The Fear-Avoidance Components Scale (FACS) is a recently developed patient-reported instrument assessing different constructs related to the fear-avoidance model of pain. The aim was to translate the original English FACS into Dutch (FACS-D) and assess its measurement properties in persons with chronic musculoskeletal pain. METHODS: The original English FACS (20 item-scale, range: 0-100) was translated in Dutch through standard forward-backward translation methodology. The FACS-D's measurement properties were evaluated in 224 persons with chronic musculoskeletal pain. Internal consistency, test-retest reliability and measurement error were assessed with the Cronbach's alpha coefficient (α), intraclass correlation coefficient (ICC), and standard error of measurement (SEM). Construct validity was assessed through inter-item correlation analyses, exploratory factor analysis, association with other fear-avoidance-related constructs, and hypothesis testing. RESULTS: Internal consistency, test-retest reliability and hypotheses testing were good (α=0.92; ICC=0.92, CI 0.80-0.96; 7/8 hypotheses confirmed). Similar to the original FACS and other translated versions, a two-factor model best fit the data. However, the item distribution differed from other versions. One factor represented "pain-related cognitions and emotions" and a second factor represented "avoidance behaviour." In contrast to the original FACS, low inter-item correlations for item 12 were found. The FACS-D was more strongly associated with fear-avoidance-related constructs of pain severity, perceived disability, feelings of injustice, and depressive/anxiety symptoms than the other fear-avoidance-related scales studied here. CONCLUSIONS: The FACS-D demonstrated good reliability and construct validity, suggesting that it may be a useful measure for Dutch-speaking healthcare providers. Two clinically relevant factors, with a different item distribution than the original FACS, were identified: one covering items on pain-related cognitions and emotions, and one covering items on avoidance behaviour. The stronger association between FACS-D and fear-avoidance related constructs suggests that the FACS-D may be more effective in evaluating the cognitive, emotional and behavioural constructs of pain-related fear-avoidance than other similar measures.

The Relationship Between Pain-Related Psychological Factors and Maximal Physical Performance in Low Back Pain: A Systematic Review and Meta-Analysis.

Theoretical frameworks explain how pain-related psychological factors may influence the physical performance. In this systematic review and meta-analysis, we evaluated the evidence regarding the relationship between the pain-related psychological factors and the maximal physical performance in patients with low back pain (LBP). Pubmed, Embase, CINAHL and Web of Science databases were searched from inception to May 2022. Cross-sectional or longitudinal studies reporting cross-sectional measures of association between at least one pain-related psychological factor and a quantitatively measured outcome of maximal physical performance in patients with LBP were eligible for inclusion. Thirty-eight studies (n = 2,490; 27 cross-sectional studies, n = 1,647 (66%); 11 longitudinal studies, n = 843 (34%)) were included, with 92% of participants (n = 2,284) having chronic LBP. Results showed that pain-related fear, pain catastrophizing, and anticipated pain were consistently and negatively associated with the maximal physical performance in chronic LBP, whereas pain-self efficacy showed positive correlations. Overall, magnitudes of absolute pooled r-values were small (r ≤ 0.25), except for anticipated pain, which was moderately associated with maximal physical performance (r = -0.34 to -0.37). Subanalyses and sensitivity analyses yielded similar pooled correlation coefficients. Certainty of evidence using the GRADE recommendations was very low to moderate for pain-related fear, and very low to low for the other pain-related psychological factors. Prospero registration: CRD42021227486. PERSPECTIVE: Overall, small pooled correlation coefficients were shown between pain-related psychological factors and maximal physical performance in chronic LBP. Certainty of evidence was very low to low for all pain-related psychological factors other than pain-related fear. Future studies taking into account limitations of the current literature may therefore change these conclusions.

Are clinical outcomes of frozen shoulder linked to pain, structural factors or pain-related cognitions? An explorative cohort study.

BACKGROUND: In frozen shoulder (FS), inflammatory-fibrotic adaptations in capsuloligamentous structures are typically linked to perceived glenohumeral stiffness, glenohumeral range of motion (ROM) restrictions and decreased arm function. However, ROM restrictions based on muscle guarding are suggested as well. OBJECTIVES: To assess differences between pain, perceived stiffness, ROM restrictions and arm function at time of diagnosis and at four months follow-up and to assess whether perceived stiffness, ROM restrictions and arm function relate to pain, structural and/or cognitive factors. DESIGN: observational cohort study. METHODS: In persons with idiopathic FS, pain intensity at rest/at night/during activities (Numeric Rating Scale), perceived stiffness (Numeric Rating Scale), abduction/external rotation ROM (goniometry), and function (Disabilities of the Arm, Shoulder and Hand Questionnaire) were compared between both time points (Wilcoxon-signed rank tests). Spearman correlation coefficients assessed the relation between perceived stiffness, ROM and function on the one hand and structural factors (coracohumeral ligament (CHL) thickness and inferior glenohumeral recess (IGR) perimeter - arthroMRI), pain intensity and pain-related cognitions (Pain Catastrophizing Scale, Tampa Scale for Kinesiophobia) on the other hand. RESULTS: Twenty persons participated (14 female; 56±8yrs) and three persons dropped out at 4 months. Pain intensity, perceived stiffness, ROM and arm function improved over time. ROM was related to CHL-thickness and IGR-perimeter; perceived stiffness was related to pain intensity; and arm function was related to pain intensity and pain-related cognitions. CONCLUSION: Objectively measured ROM is related to structural factors, while patient-reported outcomes are related to pain intensity and/or pain-related cognitions. Perceived stiffness does not relate to structural factors.

Virtual reality distraction induces hypoalgesia in patients with chronic low back pain: a randomized controlled trial.

BACKGROUND: Attentional distraction from pain has been shown to be largely ineffective for obtaining a hypoalgesic effect in patients with chronic pain when compared to a control condition. It has been hypothesized that this may be due to the non-engaging types of distraction that have been used so far. Moreover, it is suggested that the hypoalgesic effects of distraction may be attenuated by pain-related cognitions and emotions, as they may increase the attention to pain. METHODS: In this randomized controlled trial, patients with chronic nonspecific low back pain in the intervention group (n = 42) performed a single exercise session with nonimmersive VR games, while those in the control group (n = 42) performed the same exercises without VR games. We investigated whether VR distraction had a hypoalgesic effect during and immediately after the exercises, and whether it reduced the time spent thinking of pain during the exercises. We further explored whether pain-related fear, pain catastrophizing and baseline pain intensity moderated the effects of VR distraction. RESULTS: VR distraction had a hypoalgesic effect during (Cohen's d = 1.29) and immediately after (Cohen's d = 0.85) the exercises, and it also reduced the time spent thinking of pain (Cohen's d = 1.31). Preliminary exploratory analyses showed that pain-related fear, pain catastrophizing and baseline pain intensity did not moderate the effects of VR distraction. CONCLUSIONS: Large effect sizes of VR distraction induced hypoalgesia were observed. This suggests that nonimmersive VR games can be used when it is deemed important to reduce the pain during exercises in patients with chronic nonspecific low back pain. TRIAL REGISTRATION: NCT02679300. This trial was registered on 10 February 2016.

The Association Between Fear of Movement, Pain Catastrophizing, Pain Anxiety, and Protective Motor Behavior in Persons With Peripheral Joint Conditions of a Musculoskeletal Origin: A Systematic Review.

OBJECTIVE: The aim of the study was to investigate alterations in motor behavior related to pain-related beliefs in persons with peripheral joint conditions. DESIGN: This is a systematic review. RESULTS: Our database search (PubMed, Web of Science, Embase, PsycINFO) identified 7390 articles (until September 2019), and nine articles (344 participants) were selected based on the eligibility criteria for selecting studies, i.e., studies in adults with primary peripheral joint conditions, assessing the influence of fear of movement, catastrophizing or anxiety on motor behavior in terms of kinematics, kinetics, and muscle activity during active movements.In the acute stage after knee or radius surgery, more catastrophizing and fear were associated with less active joint motion in the operated and adjacent joints. In knee patients in the chronic stage after surgery, increased hip adduction and knee valgus were linked to increased fear of movement during the performance of challenging tasks. Similar results were found in persons with nonsurgical chronic knee pain. During gait, no relation between lower limb kinematics and fear of movement was observed. CONCLUSIONS: Kinematic alterations appear in tandem with pain-related perceptions in acute stages after surgery. Altered kinematics influenced by pain-related beliefs are also seen in persons with chronic nonsurgical and surgical knee pain, when challenging tasks are performed.

Lumbar range of motion in chronic low back pain is predicted by task-specific, but not by general measures of pain-related fear.

BACKGROUND: Most studies fail to show an association between higher levels of pain-related fear and protective movement behaviour in patients with chronic low back pain (CLBP). This may be explained by the fact that only general measures of pain-related fear have been used to examine the association with movement patterns. This study explored whether task-specific, instead of general measures of pain-related fear can predict movement behaviour. METHODS: Fifty-five patients with CLBP and 54 healthy persons performed a lifting task while kinematic measurements were obtained to assess lumbar range of motion (ROM). Scores on the Photograph Daily Activities Series-Short Electronic Version (PHODA-SeV), Tampa Scale for Kinesiophobia and its Activity Avoidance and Somatic Focus subscales were used as general measures of pain-related fear. The score on a picture of the PHODA-SeV, showing a person lifting a heavy object with a bent back, was used as task-specific measure of pain-related fear. RESULTS: Lumbar ROM was predicted by task-specific, but not by general measures of pain-related fear. Only the scores on one other picture of the PHODA-SeV, similar to the task-specific picture regarding threat value and movement characteristics, predicted the lumbar ROM. Compared to healthy persons, patients with CLBP used significantly less ROM, except the subgroup with a low score on the task-specific measure of pain-related fear, who used a similar ROM. CONCLUSIONS: Our results suggest to use task-specific measures of pain-related fear when assessing the relationship with movement. It would be of interest to investigate whether reducing task-specific fear changes protective movement behaviour. SIGNIFICANCE: This study shows that lumbar range of motion in CLBP is predicted by task-specific, but not by general measures of pain-related fear. This suggests that both in clinical practice and for research purposes, it might be recommended to use task-specific measures of pain-related fear when assessing the relationship with movement behaviour. This may help to disentangle the complex interactions between pain-related fear, movement and disability in patients with CLBP.

The influence of cognitions, emotions and behavioral factors on treatment outcomes in musculoskeletal shoulder pain: a systematic review.

OBJECTIVE: To examine the predictive, moderating and mediating role of cognitive, emotional and behavioral factors on pain and disability following shoulder treatment. DATA SOURCES: Electronic databases (PubMed, Web of Science, Embase and PsycINFO) were searched until 14 January 2019. STUDY SELECTION: Studies including persons with musculoskeletal shoulder pain that describe the predictive, moderating or mediating role of baseline cognitive, emotional or behavioral factors on pain or disability following treatment were selected. RESULTS: A total of 23 articles, describing 21 studies and involving 3769 participants, were included. Three studies had a high risk of bias. There was no predictive role of baseline depression, anxiety, coping, somatization or distress on pain or disability across types of shoulder treatment. No predictive role of fear-avoidance beliefs was identified in patients receiving physiotherapy, which contrasted to the results found when surgical treatment was applied. Baseline catastrophizing was also not predictive for pain or disability in patients receiving physiotherapy. After conservative medical treatments, results on the predictive role of catastrophizing were inconclusive. Treatment expectations and baseline self-efficacy predicted pain and disability in patients receiving physiotherapy, which was not the case in patients receiving conservative medical treatment. Finally, there was a moderating role for optimism in the relationship between pain catastrophizing and disability in patients receiving physiotherapy. CONCLUSION: There is evidence that expectations of recovery and self-efficacy have a predictive role and optimism a moderating role on pain and/or disability following physiotherapy for musculoskeletal shoulder pain. After surgical treatment, fear-avoidance is a predictor of pain and disability.

Sensor-based postural feedback is more effective than conventional feedback to improve lumbopelvic movement control in patients with chronic low back pain: a randomised controlled trial.

BACKGROUND: Improving movement control can be an important treatment goal for patients with chronic low back pain (CLBP). Although external feedback is essential when learning new movement skills, many aspects of feedback provision in patients with CLBP remain currently unexplored. New rehabilitation technologies, such as movement sensors, are able to provide reliable and accurate feedback. As such, they might be more effective than conventional feedback for improving movement control. The aims of this study were (1) to assess whether sensor-based feedback is more effective to improve lumbopelvic movement control compared to feedback from a mirror or no feedback in patients with chronic low back pain (CLBP), and (2) to evaluate whether patients with CLBP are equally capable of improving lumbopelvic movement control compared to healthy persons. METHODS: Fifty-four healthy participants and 54 patients with chronic non-specific LBP were recruited. Both participant groups were randomised into three subgroups. During a single exercise session, subgroups practised a lumbopelvic movement control task while receiving a different type of feedback, i.e. feedback from movement sensors, from a mirror or no feedback (=control group). Kinematic measurements of the lumbar spine and hip were obtained at baseline, during and immediately after the intervention to evaluate the improvements in movement control on the practised task (assessment of performance) and on a transfer task (assessment of motor learning). RESULTS: Sensor-based feedback was more effective than feedback from a mirror (p < 0.0001) and no feedback (p < 0.0001) to improve lumbopelvic movement control performance (Sensor vs. Mirror estimated difference 9.9° (95% CI 6.1°-13.7°), Sensor vs. Control estimated difference 10.6° (95% CI 6.8°-14.3°)) and motor learning (Sensor vs. Mirror estimated difference 7.2° (95% CI 3.8°-10.6°), Sensor vs. Control estimated difference 6.9° (95% CI 3.5°-10.2°)). Patients with CLBP were equally capable of improving lumbopelvic movement control compared to healthy persons. CONCLUSIONS: Sensor-based feedback is an effective means to improve lumbopelvic movement control in patients with CLBP. Future research should focus on the long-term retention effects of sensor-based feedback. TRIAL REGISTRATION: clinicaltrials.gov NCT02773160 , (retrospectively registered on May 16th, 2016).

Serious Gaming to Support Exercise Therapy for Patients with Chronic Nonspecific Low Back Pain: A Feasibility Study.

OBJECTIVE: To investigate the feasibility of a functional exercise program supported by serious gaming for patients with chronic nonspecific low back pain (LBP). METHODS: Ten patients with chronic nonspecific LBP and an underlying motor control impairment were recruited. Subjects performed a partially supervised exercise program (36 sessions, 18 weeks) that included 30 minutes of general conditioning and 90 minutes of individually tailored functional motor control exercises (MCEs). Serious games (SGs) were used to (1) improve thoracolumbar dissociation and (2) to provide postural feedback during functional MCEs. The SGs were also available at home. RESULTS: Treatment satisfaction and the scores on the credibility/expectancy questionnaire were good and did not change throughout the intervention. Patients remained motivated throughout the rehabilitation program and no serious adverse events were reported. Overall, participants indicated that the SGs helped them to perform the home exercises more correctly, and as a consequence, they felt more confident doing them. However, the time needed to set up the games was a barrier for home use and participants would have found it useful to receive postural feedback during daily life activities. CONCLUSIONS: It is feasible to support a functional exercise program with SGs for patients with chronic nonspecific LBP, both in a supervised and a home environment. Time-efficiency and the integration of SGs in daily life activities are challenges that need to be addressed in the future.

Motion detection supported exercise therapy in musculoskeletal disorders: a systematic review.

INTRODUCTION: Musculoskeletal disorders (MSDs) are a burden on the healthcare system. Exercise therapy is an important part of MSD rehabilitation. Motion detection systems are developed to support exercise therapy settings. This systematic review aimed: 1) at investigating which types of motion detection systems have been used as a technological support for exercise therapy; 2) at investigating the characteristics of motion detection supported exercise therapy in relation to its clinical indications; and 3) at evaluating the effectiveness of motion detection supported exercise therapy, in MSD rehabilitation. EVIDENCE AQCUISITION: A systematic literature search for RCTs was performed in six databases (PubMed, CINAHL, EMBASE, ACM, Cochrane, and IEEE). Studies eligible for inclusion had to evaluate exercise therapy for persons with MSDs, provide a motion detection system capable of as well measuring active movement of the participant during exercise therapy as evaluating the movement in order to provide qualitative feedback, and should present at least one measure of the following ICF function (pain, muscle strength, mobility), activity (disease-related functional disability, balance) or participation (quality of life) level. Two reviewers independently screened articles, appraised study quality, extracted data, and evaluated effectiveness of selected outcome measures. This review was registered in the International prospective register of systematic reviews (Prospero) under registration number CRD42016035273. EVIDENCE SYNTHESIS: Nine RCTs (N.=432 participants) were included. Eight different motion detection technologies were used such as an accelerometer, gyroscope, magnetometer etc. All systems provided visual feedback. Knee disorders were evaluated most frequently, followed by low back pain and shoulder disorders. Therapy consisted of mobility, balance or proprioception exercises. Main outcomes were pain, disability, mobility and muscle strength. Motion detection supported exercise therapy showed similar or enhanced results on all outcomes compared to conventional exercise therapy. However, a limitation of this study was the low methodological quality of the studies. CONCLUSIONS: To date, a variety of motion detection systems have been developed to support the rehabilitation of MSDs. Results show similar effectiveness of motion detection supported exercise therapy compared to conventional exercise therapy. More research is needed to provide insight in the added value of motion detection systems in musculoskeletal rehabilitation.

Within/between-session reliability and agreement of lumbopelvic kinematics in the sagittal plane during functional movement control tasks in healthy persons.

A lack of adequate lumbopelvic movement control has been suggested as an underlying mechanism contributing to the development and persistence of low back pain and lower limb pathologies. The purpose of this study was to assess the within and between session reliability (i.e. the ability to discriminate between subjects), and the agreement (i.e. whether scores are identical on repeated measures) of lumbopelvic kinematics in the sagittal plane during functional movement control tasks. Kinematics were measured with a portable inertial measurement unit system. Twenty healthy subjects (mean age = 22 (±3.6) years, 15 females) performed four tasks on two occasions, five to seven days apart: standing bow (SB), lifting a box from the floor (LIFT), stance-to-sit-to-stance (SIT) and placing a box on an overhead shelf (OVERH). Participants were asked to keep the lumbar spine in a neutral lordosis during the tasks. The maximal deviations from the neutral starting position for the lumbar spine and hip were calculated. Intraclass correlations (ICCs), standard errors of measurement (SEM), minimal detectable changes and 95% limits of agreement were used to assess reliability and agreement. SB and LIFT were substantially reliable (ICC = 0.89-0.96), SIT was moderately to substantially reliable (ICC = 0.69-0.92) and OVERH was fairly to moderately reliable (ICC = 0.40-0.67). SEMs ranged between 1.1° and 3.1° for the lumbar spine and between 0.7° and 4.8° for the hip. Based on the substantial reliability and acceptable agreement, SB and LIFT are most appropriate to quantify lumbopelvic movement control during functional tasks.

Motor Control Training for the Shoulder with Smart Garments.

Wearable technologies for posture monitoring and posture correction are emerging as a way to support and enhance physical therapy treatment, e.g., for motor control training in neurological disorders or for treating musculoskeletal disorders, such as shoulder, neck, or lower back pain. Among the various technological options for posture monitoring, wearable systems offer potential advantages regarding mobility, use in different contexts and sustained tracking in daily life. We describe the design of a smart garment named Zishi to monitor compensatory movements and evaluate its applicability for shoulder motor control training in a clinical setting. Five physiotherapists and eight patients with musculoskeletal shoulder pain participated in the study. The attitudes of patients and therapists towards the system were measured using standardized survey instruments. The results indicate that patients and their therapists consider Zishi a credible aid for rehabilitation and patients expect it will help towards their recovery. The system was perceived as highly usable and patients were motivated to train with the system. Future research efforts on the improvement of the customization of feedback location and modality, and on the evaluation of Zishi as support for motor learning in shoulder patients, should be made.

Shoulder assessment according to the international classification of functioning by means of inertial sensor technologies: A systematic review.

This review investigates current protocols using Inertial Measurement Units (IMUs) in shoulder research, and outlines future paths regarding IMU use for shoulder research. Different databases were searched for relevant articles. Criteria for study selection were (1) research in healthy persons or persons with shoulder problems, (2) IMUs applied as assessment tool for the shoulder (in healthy subjects and shoulder patients) or upper limb (in shoulder patients), (3) peer-reviewed, full-text papers in English or Dutch. Studies with less than five participants and without ethical approval were excluded. Data extraction included (1) study design, (2) participant characteristics, (3) type/brand of IMU, (4) tasks included in the assessment protocol, and (5) outcomes. Risk of bias was assessed using the Downs and Black checklist. Scapulothoracic/glenohumeral and humerothoracic kinematics were reported in respectively 10 and 27 of the 37 included papers. Only one paper in healthy persons assessed, next to scapulothoracic/glenohumeral kinematics, other upper limb joints. IMUs' validity and reliability to capture shoulder function was limited. Considering applied protocols, 39% of the protocols was located on the International-Classification-of-Functioning (ICF) function level, while 38% and 23% were on the 'capacity' and 'actual performance'-sublevel, of the ICF-activity level. Most available IMU-research regarding the shoulder is clinically less relevant, given the widely reported humerothoracic kinematics which do not add to clinical-decision-making, and the absence of protocols assessing the complete upper limb chain. Apart from knowledge on methodological pitfalls and opportunities regarding the use of IMUs, this review provides future research paths.

The Effectiveness of Technology-Supported Exercise Therapy for Low Back Pain: A Systematic Review.

Various technological systems have been developed to assist exercise therapy for low back pain. The aim of this systematic review was to provide an overview and to assess the effectiveness of the available technology-supported exercise therapy (TSET) programs for low back pain. The electronic databases Pubmed, Embase, Cochrane Central Register of Controlled Trials, PEDro, IEEE, and ACM were searched until January 2016. Randomized controlled trials (RCTs) using electronic technological systems simultaneously with exercise therapy for patients with low back pain were included. Twenty-five RCTs met the inclusion criteria. Seventeen studies involved patients with chronic low back pain, and electromyography biofeedback was the most prevalent type of technological support. This review shows that TSET seems to improve pain, disability, and quality of life for patients with low back pain, and that a standard treatment combined with an additional TSET program might be superior to a standard treatment alone. However, TSET seems not more effective compared to other interventions or a placebo intervention for improving these outcomes, which may partially be explained by the analytical approach of the current TSET-programs. For most technologies, only a limited number of RCTs are available, making it difficult to draw firm conclusions about the effectiveness of individual technological systems.