Changes in Trunk Variability and Stability of Gait in Patients with Chronic Low Back Pain: Impact of Laboratory versus Daily-Living Environments

Abstract

Background Individuals with chronic low back pain (CLBP) experience changes in gait control due to pain and/or fear. Although CLBP patients’ gait has been performed in laboratory environments, changes in gait control as an adaptation to unstructured daily living environments may be more pronounced than the corresponding changes in laboratory environments. We investigated the impacts of the environment and pathology on the trunk variability and stability of gait in CLBP patients. Methods CLBP patients (n=20) and healthy controls with no low-back pain history (n=20) were tasked with walking in a laboratory or daily-living environment while wearing an accelerometer on the low back. We calculated the stride-to-stride standard deviation and multiscale sample entropy as indices of “gait variability” and the maximum Lyapunov exponent as an index of “gait stability” in both the anterior-posterior and medial-lateral directions. The participants were assessed on the numerical rating scale for pain intensity, the Tampa Scale for Kinesiophobia, and the Roland–Morris Disability Questionnaire for quality of life (QOL). Results In a repeated-measures ANOVA, the standard deviation was affected by environment in the anterior-posterior direction and by group and environment in the medial-lateral direction. Multiscale sample entropy showed no effect in the anterior-posterior direction and showed both effects in the medial-lateral direction. Maximum Lyapunov exponents showed both effects in the anterior-posterior direction, but none in the medial-lateral direction. These changes of trunk motor control by CLBP patients were found to be related to pain intensity, fear of movement, and/or QOL in the daily-living environment but not in the laboratory environment. Conclusion These results revealed that CLBP patients exhibit changes in trunk variability and stability of gait depending on the environment, and they demonstrated that these changes are related to pain, fear, and QOL. We propose useful accelerometer-based assessments of qualitative gait in CLBP patients’ daily lives, as it would provide information not available in a general practice setting.

Association between functional disability with postural balance among patients with chronic low back pain

“…Furthermore, CLBP patients with high fear-avoidance beliefs were not only vigilant but also significantly restricted their range of motion during lumbar flexion and extension ( 18 ). Fear may also disrupt the automaticity of neural control pathways, leading to deficits in trunk motor control and increased trunk variability during maintaining balance, which may also increase the risk of LBP ( 33 ). Dynamic balance is a more difficult condition than static balance, which makes it easier to reveal the relationship between negative emotions and dynamic balance ability in YBT ( 34 ).…”

Sensing behavior change in chronic pain: A scoping review of sensor technology for use in daily life

“…Results of these studies in relation to psychological characteristics are mixed: some suggest that gait and posture are related to self-reported pain, depression and anxiety, 51 and fear of movement, 7,18,65 but others suggest no relationship. 48,91 Relationships found between movement kinematics and fear seemed somewhat stronger, 7,19,52,79 but not for the relationship between ROM and fear of movement (typically measured by the Tampa Scale of Kinesiophobia [TSK] 58 ) in back pain 41,48,71,91 and neck pain.…”

Are Morphometric and Biomechanical Characteristics of Lumbar Multifidus Related to Pain Intensity or Disability in People With Chronic Low Back Pain After Considering Psychological Factors or Insomnia?

“…People experiencing pain may reduce their physical activity level because they fear that any movement may aggravate their pain intensity, which in turn becomes a vicious cycle leading to disability (78,79). Fear may also disturb the neural control pathway for automaticity, resulting in deficits in trunk motor control and increased trunk variability during walking in uncontrolled daily-living environments (80), which may heighten the risk of LBP. Further, some people with CLBP believe that any painful movements may damage their spine or may intensify their suffering (81).…”