Discriminating Healthy Control and Two Clinical Subgroups of Nonspecific Chronic Low Back Pain Patients Using Trunk Muscle Activation and Lumbosacral Kinematics of Postures and Movements

摘要

Study Design. Statistical Classification Model for nonspecificchronic low back pain (NS-CLBP) patients andcontrols based on parameters of motor control.Objective. Develop a Statistical Classification Model todiscriminate between 2 subgroups of NS-CLBP (FlexionPattern [FP] and Active Extension Pattern [AEP]) and acontrol group using biomechanical variables quantifyingparameters of motor control.Summary of Background Data. It has been well documentedthat many CLBP patients have motor control impairmentsof their lumbar spine. O’Sullivan proposed amechanism-based classification system for NS-CLBP withmotor control impairments based on a comprehensivesubjective and physical examination to establish the relationshipbetween pain provocation and spinal motorcontrol. For the FP and AEP s, 2 groups defined byO’Sullivan and under investigation is this study, the motorcontrol impairment is considered to be the mechanismmaintaining their CLBP. No previous studies haveused a Statistical Model with measurements of motorcontrol impairment to subclassify NS-CLBP patients.Methods. Thirty-three NS-CLBP patients (20 FP and 13AEP) and 34 asymptomatic subjects had synchronizedlumbosacral kinematics and trunk muscle activation recordedduring commonly reported aggravating posturesand movements. Biomechanical variables were quantifiedand a Statistical Classification Model was developed.Results. The Statistical Model used 5 kinematic and 2electromyography variables. The model correctly classified96.4% of cases.Conclusion. Selected biomechanical variables werepredictors for subgroup membership and were able todiscriminate the 3 subgroups. This study adds furthersupport toward the validation of the proposed classificationsystem.Key words: low back pain, subclassification, electromyography,motion analysis, posture, motor control impairment.Spine 2009;34:1610–1618