Impact of combined lumbar spine fusion and total hip arthroplasty on spine, pelvis, and hip kinematics during a sit to stand task.

Lumbar fusion is a risk factor for hip dislocation following total hip arthroplasty (THA). The objective was to compare joint/segment angles during sit-stand-sit in participants that had a THA with and without a lumbar fusion. The secondary objective was to compare pain, physical function, disability, and quality of life. This cross-sectional study includes participants that had THA and lumbar fusion (THA-fusion; n = 12) or THA only (THA-only; n = 12). Participants completed sit-stand-sit trials. Joint/segment angles were measured using electromagnetic motion capture. Angle characteristics were determined using principal component analysis. Hierarchical linear models examined relationships between angle characteristics and groups. Pain, physical function, and disability were compared using Mann-Whitney U tests. Upper lumbar spine was more extended during sit-stand-sit in the THA-fusion group (b = 42.41, P = 0.04). The pelvis was more posteriorly and anteriorly tilted during down and end sit-stand-sit phases, respectively, in the THA-fusion group (b = 12.21, P = 0.03). There were no significant associations between group and other angles. THA-fusion group had worse pain, physical function, disability, and quality of life. Although differences in spine joint, pelvis segment, and hip joint angles existed, these findings are unlikely to account for the increased incidence of hip dislocation after total hip arthroplasty in patients that had spine fusion.

Barriers to Physiotherapists' Use of Professional Development Tools for Chronic Pain: A Knowledge Translation Study.

Purpose: The Pain Science Division (PSD) is a special interest group of the Canadian Physiotherapy Association that serves physiotherapists who have an interest in better understanding and managing patients' pain. The PSD developed evidence-based resources for its members with the goal of improving patient care by supporting professional development. However, online metrics tracking access to these resources indicated that access was low. The purpose of this study was to identify the barriers PSD members encountered to the use of PSD resources and to recommend interventions to address these barriers guided by the Theory and Techniques Tool (TTT). Method: We distributed an online survey to PSD members across Canada. We used the TTT, a knowledge translation tool, to guide the design of the questionnaire and identify actionable findings. Results: Response rates from 621 non-student members and 1,470 student members were 26.9% and 1.4%, respectively. Based on the frequency of practising physiotherapists' (n = 167) agreement with items in the TTT, the primary barriers to use of the PSD resources were forgetting that the resources were available and forgetting to use them. Conclusions: The TTT can be used to identify barriers to use of professional development tools.

Objectif : la division science de la douleur (DSD) est un groupe d'intérêt de l'Association canadienne de physiothérapie destiné aux physiothérapeutes qui souhaitent mieux comprendre et gérer la douleur des patients. La DSD a préparé des ressources fondées sur des données probantes pour ses membres afin d'améliorer les soins aux patients grâce au perfectionnement professionnel. Cependant, les mesures virtuelles qui surveillent l'accès à ces ressources ont révélé que cet accès était limité. La présente étude visait à établir les obstacles auxquels se sont heurtés les membres de la DSD pour utiliser les ressources de la DSD et à recommander des interventions afin d'écarter ces obstacles en fonction de l'outil Theory and Techniques (TTT). Méthodologie : les chercheurs ont distribué un sondage en ligne aux membres de la DSD du Canada. Ils ont utilisé le TTT, un outil d'application des connaissances, pour orienter la conception du questionnaire et déterminer les résultats réalisables. Résultats : le taux de réponse des 621 membres non étudiants et des 1 470 membres étudiants s'établissait à 26,9 % et à 1,4 %, respectivement. D'après la fréquence d'accord des physiothérapeutes en exercice (n = 167) avec les points du TTT, l'oubli de l'existence des ressources ou l'oubli de les utiliser étaient les principaux obstacles à l'utilisation des ressources de la DSD. Conclusions : le TTT peut être utilisé pour déterminer les obstacles à l'utilisation d'outils de perfectionnement professionnel.

The Relationship Between Pain-Related Threat and Motor Behavior in Nonspecific Low Back Pain: A Systematic Review and Meta-Analysis.

OBJECTIVE: Although pain-related fear and catastrophizing are predictors of disability in low back pain (LBP), their relationship with guarded motor behavior is unclear. The aim of this meta-analysis was to determine the relationship between pain-related threat (via pain-related fear and catastrophizing) and motor behavior during functional tasks in adults with LBP. METHODS: This review followed PRISMA guidelines. MEDLINE, Embase, PsychINFO, and CINAHL databases were searched to April 2021. Included studies measured the association between pain-related fear or pain catastrophizing and motor behavior (spinal range of motion, trunk coordination and variability, muscle activity) during movement in adults with nonspecific LBP. Studies were excluded if participants were postsurgery or diagnosed with specific LBP. Two independent reviewers extracted all data. The Newcastle-Ottawa Scale was used to assess for risk of bias. Correlation coefficients were pooled using the random-effects model. RESULTS: Reduced spinal range of motion during flexion tasks was weakly related to pain-related fear (15 studies, r = -0.21, 95% CI = -0.31 to -0.11) and pain catastrophizing (7 studies, r = -0.24, 95% CI = -0.38 to -0.087). Pain-related fear was unrelated to spinal extension (3 studies, r = -0.16, 95% CI = -0.33 to 0.026). Greater trunk extensor muscle activity during bending was moderately related to pain-related fear (2 studies, r = -0.40, 95% CI = -0.55 to -0.23). Pain catastrophizing, but not fear, was related to higher trunk activity during gait (2 studies, r = 0.25, 95% CI = 0.063 to 0.42). Methodological differences and missing data limited robust syntheses of studies examining muscle activity, so these findings should be interpreted carefully. CONCLUSION: This study found a weak to moderate relationship between pain-related threat and guarded motor behavior during flexion-based tasks, but not consistently during other movements. IMPACT: These findings provide a jumping-off point for future clinical research to explore the advantages of integrated treatment strategies that target both psychological and motor behavior processes compared with traditional approaches.

The Effects of Data Padding Techniques on Continuous Relative-Phase Analysis Using the Hilbert Transform.

Continuous relative phase (CRP) analysis using the Hilbert transform is prone to end effects. The purpose was to investigate the impact of padding techniques (reflection, spline extrapolation, extraneous data, and unpadded) on end effects following Hilbert-transformed CRP calculations, using sinusoidal, nonsinusoidal, and kinematic data from a repeated sit-to-stand-to-sit task in adults with low back pain (n = 16, mean age = 30 y). CRP angles were determined using a Hilbert transform of sinusoidal and nonsinusoidal signals with set phase shifts, and for the left thigh/sacrum segments. Root mean square difference and true error compared test signals with a gold standard, for the start, end, and full periods, for all data. Mean difference and 95% bootstrapped confidence intervals were calculated to compare padding techniques using kinematic data. The unpadded approach showed near-negligible error using sinusoidal data across all periods. No approach was clearly superior for nonsinusoidal data. Spline extrapolation showed significantly less root mean square difference (all periods) when compared with double reflection (full period: mean difference = 2.11; 95% confidence interval, 1.41 to 2.79) and unpadded approaches (full period: mean difference = -15.8; 95% confidence interval, -18.9 to -12.8). Padding sinusoidal data when performing CRP analyses are unnecessary. When extraneous data have not been collected, our findings recommend padding using a spline to minimize data distortion following Hilbert-transformed CRP analyses.

Movement variability in adults with low back pain during sit-to-stand-to-sit.

BACKGROUND: Differences in movement variability may be related to a guarded response to pain or a less robust movement pattern, indicating a potential dysfunction in motor control. The study objective was to compare patterns of lumbo-pelvic coordinative variability, during repeated sit-to-stand-to-sit, in individuals with low back pain and healthy adults. METHODS: Participants were adults with low back pain (n = 16) and healthy controls (n = 21). Kinematics for the T12-L3, L3-S1, and hip segments were measured using electromagnetic motion capture during 10 sit-to-stand-to-sit trials. Continuous relative phase analysis using the Hilbert transform method determined coordination and variability of the Hip-L3S1, and L3S1-T12L3 segments, deconstructed into 4 periods (start/up/down/end). T-tests compared coordination and variability of the full task between groups, and a mixed ANOVA compared the effects of group and period for the two segments. FINDINGS: Across the full task, the low back pain group demonstrated more variable (mean difference = -6.95, 95% CI = -12.3 to -1.59) and greater out-of-phase behavior (mean difference = -22.6, 95% CI = -39.1 to -6.03) in the LHip-L3S1 segment. Group-period interaction effects revealed greater variability in the start period (mean difference = -0.325, 95% CI = -0.493 to -0.156) and more out-of-phase behavior in the start (mean difference = -0.350, 95% CI = -0.549 to -0.150) and end (mean difference = -0.354, 95% CI = -0.602 to -0.105) periods for the LHip-L3S1 segment. INTERPRETATION: Excessive variability may relate to reports of poor spinal proprioception in low back pain; however, based on our sample characteristics (low pain and disability) and lack of symptoms during the task, classifying our findings as dysfunctional may not be fully warranted.

Clinical and radiological investigation of thoracic spine extension motion during bilateral arm elevation.

STUDY DESIGN: Single-cohort laboratory-based study. OBJECTIVES: To measure thoracic spine extension motion during bilateral arm elevation using functional radiography and photographic image analysis. BACKGROUND: Impairment of thoracic spine extension motion may impact shoulder girdle function. Motion of the thoracic spine during arm movement has not been directly measured using functional radiographic analysis. METHODS: In 21 asymptomatic men, thoracic kyphosis was measured in neutral standing and in end-range bilateral arm elevation, using lateral radiographs and photographic image analysis. Using both measurement techniques, the difference in thoracic kyphosis between the 2 body positions was used to quantify the range of extension motion of the thoracic spine. Bland-Altman plots were used to examine the agreement between measurement techniques. The relationship between the amount of thoracic kyphosis in neutral standing and kyphosis in full bilateral arm elevation was also examined. RESULTS: The mean ± SD increase in thoracic extension with bilateral arm elevation was 12.8° ± 7.6° and 10.5° ± 4.4°, when measured from the radiographs and photographs, respectively. There was a significant correlation between the radiographic and photographic measurements of the amount of thoracic kyphosis measured in neutral posture (r = 0.71, P<.01) and for the kyphosis measured in full bilateral arm elevation (r = 0.79, P<.001). The mean difference between the 2 measurement techniques was 2.1° for kyphosis measured in neutral posture and 0.5° when measured in full bilateral arm elevation. The thoracic kyphosis angle measured in neutral posture was strongly correlated with the thoracic kyphosis angle measured in full bilateral arm elevation when measured with both radiographic (r = 0.80, P<.001) and photographic (r = 0.84, P<.001) techniques. CONCLUSION: In asymptomatic men, bilateral arm elevation is associated with movement of the thoracic spine toward extension, but the amount of movement is variable among individuals.