Stability threshold during seated balancing is sensitive to low back pain and safe to assess

N. Peter Reeves; Victor Giancarlo Sal y Rosas Celi; Ahmed Ramadan; John M. Popovich; Lawrence L. Prokop; Mathew A. Zatkin; Lisa A. DeStefano; Timothy J. Francisco; Jacob J. Rowan; Clark J. Radcliffe; Jongeun Choi; Nathan D. Cowdin; Jacek Cholewicki

doi:10.1016/j.jbiomech.2021.110541

Stability threshold during seated balancing is sensitive to low back pain and safe to assess

N. Peter Reeves, Victor Giancarlo Sal y Rosas Celi, Ahmed Ramadan, John M. Popovich, Lawrence L. Prokop, Mathew A. Zatkin, Lisa A. DeStefano, Timothy J. Francisco, Jacob J. Rowan, Clark J. Radcliffe, Jongeun Choi, Nathan D. Cowdin, Jacek Cholewicki

Department of Mechanical Engineering

Research output: Contribution to journal › Article › peer-review

1 Citation (Scopus)

Abstract

Challenging trunk neuromuscular control maximally using a seated balancing task is useful for unmasking impairments that may go unnoticed with traditional postural sway measures and appears to be safe to assess in healthy individuals. This study investigates whether the stability threshold, reflecting the upper limits in trunk neuromuscular control, is sensitive to pain and disability and is safe to assess in low back pain (LBP) patients. Seventy-nine subjects with non-specific LBP balanced on a robotic seat while rotational stiffness was gradually reduced. The critical rotational stiffness, K_Crit, that marked the transition between stable and unstable balance was used to quantify the individual's stability threshold. The effects of current pain, 7-day average pain, and disability on K_Crit were assessed, while controlling for age, sex, height, and weight. Adverse events (AEs) recorded at the end of the testing session were used to assess safety. Current pain and 7-day average pain were strongly associated with K_Crit (current pain p < 0.001, 7-day pain p = 0.023), reflecting that people experiencing more pain have poorer trunk neuromuscular control. There was no evidence that disability was associated with K_Crit, although the limited range in disability scores in subjects may have impacted the analysis. AEs were reported in 13 out of 79 total sessions (AE Severity: 12 mild, 1 moderate; AE Relatedness: 1 possibly, 11 probably, 1 definitely-related to the study). Stability threshold is sensitive to pain and appears safe to assess in people with LBP, suggesting it could be useful for identifying trunk neuromuscular impairments and guiding rehabilitation.

Original language	English
Article number	110541
Journal	Journal of Biomechanics
Volume	125
DOIs	https://doi.org/10.1016/j.jbiomech.2021.110541
Publication status	Published - 2021 Aug 26

Bibliographical note

Funding Information:
This publication was made possible in part by grant number U19 AT006057 from the National Center for Complementary and Integrative Health (NCCIH) at the National Institutes of Health. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of NCCIH. VS was supported by Dirección de Gestión de la Investigación at the PUCP through grant DGI-2017-496. The authors wish to thank Dr. Cody Priess for creating the robotic seat used to assess trunk neuromuscular control.

Publisher Copyright:
© 2021

All Science Journal Classification (ASJC) codes

Biophysics
Rehabilitation
Biomedical Engineering
Orthopedics and Sports Medicine

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10.1016/j.jbiomech.2021.110541

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Reeves, N. P., Sal y Rosas Celi, V. G., Ramadan, A., Popovich, J. M., Prokop, L. L., Zatkin, M. A., DeStefano, L. A., Francisco, T. J., Rowan, J. J., Radcliffe, C. J., Choi, J., Cowdin, N. D., & Cholewicki, J. (2021). Stability threshold during seated balancing is sensitive to low back pain and safe to assess. Journal of Biomechanics, 125, [110541]. https://doi.org/10.1016/j.jbiomech.2021.110541

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title = "Stability threshold during seated balancing is sensitive to low back pain and safe to assess",

abstract = "Challenging trunk neuromuscular control maximally using a seated balancing task is useful for unmasking impairments that may go unnoticed with traditional postural sway measures and appears to be safe to assess in healthy individuals. This study investigates whether the stability threshold, reflecting the upper limits in trunk neuromuscular control, is sensitive to pain and disability and is safe to assess in low back pain (LBP) patients. Seventy-nine subjects with non-specific LBP balanced on a robotic seat while rotational stiffness was gradually reduced. The critical rotational stiffness, KCrit, that marked the transition between stable and unstable balance was used to quantify the individual's stability threshold. The effects of current pain, 7-day average pain, and disability on KCrit were assessed, while controlling for age, sex, height, and weight. Adverse events (AEs) recorded at the end of the testing session were used to assess safety. Current pain and 7-day average pain were strongly associated with KCrit (current pain p < 0.001, 7-day pain p = 0.023), reflecting that people experiencing more pain have poorer trunk neuromuscular control. There was no evidence that disability was associated with KCrit, although the limited range in disability scores in subjects may have impacted the analysis. AEs were reported in 13 out of 79 total sessions (AE Severity: 12 mild, 1 moderate; AE Relatedness: 1 possibly, 11 probably, 1 definitely-related to the study). Stability threshold is sensitive to pain and appears safe to assess in people with LBP, suggesting it could be useful for identifying trunk neuromuscular impairments and guiding rehabilitation.",

author = "Reeves, {N. Peter} and {Sal y Rosas Celi}, {Victor Giancarlo} and Ahmed Ramadan and Popovich, {John M.} and Prokop, {Lawrence L.} and Zatkin, {Mathew A.} and DeStefano, {Lisa A.} and Francisco, {Timothy J.} and Rowan, {Jacob J.} and Radcliffe, {Clark J.} and Jongeun Choi and Cowdin, {Nathan D.} and Jacek Cholewicki",

note = "Funding Information: This publication was made possible in part by grant number U19 AT006057 from the National Center for Complementary and Integrative Health (NCCIH) at the National Institutes of Health. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of NCCIH. VS was supported by Direcci{\'o}n de Gesti{\'o}n de la Investigaci{\'o}n at the PUCP through grant DGI-2017-496. The authors wish to thank Dr. Cody Priess for creating the robotic seat used to assess trunk neuromuscular control. Publisher Copyright: {\textcopyright} 2021",

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AU - Reeves, N. Peter

AU - Sal y Rosas Celi, Victor Giancarlo

AU - Ramadan, Ahmed

AU - Popovich, John M.

AU - Prokop, Lawrence L.

AU - Zatkin, Mathew A.

AU - DeStefano, Lisa A.

AU - Francisco, Timothy J.

AU - Rowan, Jacob J.

AU - Radcliffe, Clark J.

AU - Choi, Jongeun

AU - Cowdin, Nathan D.

AU - Cholewicki, Jacek

N1 - Funding Information: This publication was made possible in part by grant number U19 AT006057 from the National Center for Complementary and Integrative Health (NCCIH) at the National Institutes of Health. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of NCCIH. VS was supported by Dirección de Gestión de la Investigación at the PUCP through grant DGI-2017-496. The authors wish to thank Dr. Cody Priess for creating the robotic seat used to assess trunk neuromuscular control. Publisher Copyright: © 2021

PY - 2021/8/26

Y1 - 2021/8/26

N2 - Challenging trunk neuromuscular control maximally using a seated balancing task is useful for unmasking impairments that may go unnoticed with traditional postural sway measures and appears to be safe to assess in healthy individuals. This study investigates whether the stability threshold, reflecting the upper limits in trunk neuromuscular control, is sensitive to pain and disability and is safe to assess in low back pain (LBP) patients. Seventy-nine subjects with non-specific LBP balanced on a robotic seat while rotational stiffness was gradually reduced. The critical rotational stiffness, KCrit, that marked the transition between stable and unstable balance was used to quantify the individual's stability threshold. The effects of current pain, 7-day average pain, and disability on KCrit were assessed, while controlling for age, sex, height, and weight. Adverse events (AEs) recorded at the end of the testing session were used to assess safety. Current pain and 7-day average pain were strongly associated with KCrit (current pain p < 0.001, 7-day pain p = 0.023), reflecting that people experiencing more pain have poorer trunk neuromuscular control. There was no evidence that disability was associated with KCrit, although the limited range in disability scores in subjects may have impacted the analysis. AEs were reported in 13 out of 79 total sessions (AE Severity: 12 mild, 1 moderate; AE Relatedness: 1 possibly, 11 probably, 1 definitely-related to the study). Stability threshold is sensitive to pain and appears safe to assess in people with LBP, suggesting it could be useful for identifying trunk neuromuscular impairments and guiding rehabilitation.

AB - Challenging trunk neuromuscular control maximally using a seated balancing task is useful for unmasking impairments that may go unnoticed with traditional postural sway measures and appears to be safe to assess in healthy individuals. This study investigates whether the stability threshold, reflecting the upper limits in trunk neuromuscular control, is sensitive to pain and disability and is safe to assess in low back pain (LBP) patients. Seventy-nine subjects with non-specific LBP balanced on a robotic seat while rotational stiffness was gradually reduced. The critical rotational stiffness, KCrit, that marked the transition between stable and unstable balance was used to quantify the individual's stability threshold. The effects of current pain, 7-day average pain, and disability on KCrit were assessed, while controlling for age, sex, height, and weight. Adverse events (AEs) recorded at the end of the testing session were used to assess safety. Current pain and 7-day average pain were strongly associated with KCrit (current pain p < 0.001, 7-day pain p = 0.023), reflecting that people experiencing more pain have poorer trunk neuromuscular control. There was no evidence that disability was associated with KCrit, although the limited range in disability scores in subjects may have impacted the analysis. AEs were reported in 13 out of 79 total sessions (AE Severity: 12 mild, 1 moderate; AE Relatedness: 1 possibly, 11 probably, 1 definitely-related to the study). Stability threshold is sensitive to pain and appears safe to assess in people with LBP, suggesting it could be useful for identifying trunk neuromuscular impairments and guiding rehabilitation.

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Stability threshold during seated balancing is sensitive to low back pain and safe to assess

Abstract

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