Highlights
- •Low back pain is a debilitating condition with poor patient outcomes despite the high medical cost.
- •One reason for these poor outcomes may be the lack of objective metrics.
- •Motion-based metric can provide a unique perspective to assessing functional recovery.
Abstract
Background
Low back pain is a debilitating condition with poor patient outcomes despite the use
of a wide variety of diagnostic and treatment modalities. A lack of objective metrics
to support clinical decision-making may be a reason for these poor outcomes. This
study aimed to compare patient recovery following lumbar fusion surgery using an objective
motion-based metric (functional performance) and subjective patient-reported outcomes
for pain, disability and kinesophobia.
Methods
A prospective observational study was conducted on 121 patients that received a lumbar
fusion surgery. A wearable motion system was used to quantify three-dimensional multi-planar
lumbar motion and benchmark each patient's lumbar function prior to surgery and post-operatively
at follow-up time points for up to 2 years. Patient recovery profiles after surgery
were evaluated using the acquired functional motion data and compared to patient-reported
outcomes.
Findings
Our results found significant improvement after surgery in objective functional performance
as well as patient-reported pain, disability, and kinesophobia. However, we found
a delayed response in the objective metric, with meaningful improvement occurring
only 6 months after fusion surgery. In contrast, we found significant improvement
in all subjective scores as early as 6 weeks post-surgery.
Interpretation
Objective motion-based metric provides a unique perspective to assessing patient's
functional recovery. While it is associated with dimensions of pain, disability and
fear avoidance, it is also distinct and assesses a uniquely different dimension of
functional health. This information can form the basis for the use of objective metrics
to gauge patient recovery after lumbar fusion surgery.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Clinical BiomechanicsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Statistical Power Analysis for the Behavioral Sciences.Academic press, 2013
- Overtreating chronic back pain: time to back off?.J. Am. Board Fam. Med. 2009; 22: 62-68https://doi.org/10.3122/jabfm.2009.01.080102
- US spending on personal health care and public health, 1996-2013.Jama-J. Am. Med. Assoc. 2016; 316: 2627-2646https://doi.org/10.1001/jama.2016.16885
- The Oswestry disability index.Spine. 2000; 25: 2940-2952https://doi.org/10.1097/00007632-200011150-00017
- Spine kinematics predict symptom and lost time recurrence: how much recovery is enough?.J. Occup. Rehabil. 2013; 23: 329-335https://doi.org/10.1007/s10926-012-9413-x
- Longitudinal quantitative measures of the natural course of low back pain recovery.Spine (Phila Pa 1976). 2000; 25: 1950-1956
- Validity and reliability of sincerity test for dynamic trunk motions.Disabil. Rehabil. 2003; 25: 236-241https://doi.org/10.1080/0963828021000030945
- Differences among outcome measures in occupational low back pain.J. Occup. Rehabil. 2005; 15: 329-341https://doi.org/10.1007/s10926-005-5940-4
- Quantification of a meaningful change in low back functional impairment.Spine. 2009; 34: 2060-2065
- Low back functional health status of patient handlers.J. Occup. Rehabil. 2015; 25: 296-302https://doi.org/10.1007/s10926-014-9538-1
- Patient and practitioner experience with clinical lumbar motion monitor wearable technology.Health Technol-Ger. 2019; 9: 289-295https://doi.org/10.1007/s12553-019-00330-7
- Responsiveness of a patient specific outcome measure compared with the oswestry disability index v2.1 and roland and morris disability questionnaire for patients with subacute and chronic low back pain.Spine. 2008; 33: 2450-2457https://doi.org/10.1097/BRS.0b013e31818916fd
- The relationship between objective and subjective evaluation criteria in lumbar spinal stenosis.Acta Orthop. Traumatol. Turc. 2006; 40: 111-116
- The 6-minute walk - a new measure of exercise capacity in patients with chronic heart-failure.Can. Med. Assoc. J. 1985; 132: 919-923
- What low back pain is and why we need to pay attention.Lancet. 2018; 391: 2356-2367https://doi.org/10.1016/S0140-6736(18)30480-X
- Validity of PROMIS in minimally invasive transforaminal lumbar interbody fusion: a preliminary evaluation.J. Neurosurg. Spine. 2018; 29: 28-33https://doi.org/10.3171/2017.11.SPINE17989
- Biomechanical assessments of lumbar spinal function. How low back pain sufferers differ from normals. Implications for outcome measures research. Part I: kinematic assessments of lumbar function.J. Manipulative Physiol. Ther. 2004; 27: 57-62
- A normal database of dynamic trunk motion characteristics during repetitive trunk flexion and extension as a function of task asymmetry, age and gender.IEEE Trans. Rehab. Eng. 1994; 2: 137-146
- The classification of anatomic-based and symptom-based low-Back disorders using motion measure models.Spine. 1995; 20: 2531-2546https://doi.org/10.1097/00007632-199512000-00013
- The quantification of low back disorder using motion measures - methodology and validation.Spine. 1999; 24: 2091-2100https://doi.org/10.1097/00007632-199910150-00005
- Impairment magnification during dynamic trunk motions.Spine. 2000; 25: 587-595https://doi.org/10.1097/00007632-200003010-00009
- Low back pain recurrence in occupational environments.Spine (Phila Pa 1976). 2007; 32: 2387-2397https://doi.org/10.1097/BRS.0b013e3181557be9
- Current epidemiology of low back pain.J Hosp Management Health Policy. 2020; 4: 15
- The McGill pain questionnaire: major properties and scoring methods.Pain. 1975; 1: 277-299https://doi.org/10.1016/0304-3959(75)90044-5
- Lumbar spine range of motion as a measure of physical and functional impairment: an investigation of validity.Clin. Rehabil. 1999; 13: 211-218
- Disability measurement in persons with back pain: a validity study of spinal range of motion and velocity.Arch. Phys. Med. Rehabil. 2000; 81: 1394-1400
- The five-repetition sit-to-stand test: evaluation of a simple and objective tool for the assessment of degenerative pathologies of the lumbar spine.J. Neurosurg. Spine. 2018; 29: 380-387https://doi.org/10.3171/2018.2.SPINE171416
- Objective measures of functional impairment for degenerative diseases of the lumbar spine: a systematic review of the literature.Spine J. 2019; 19: 1276-1293
- Validity and reliability of a measurement of objective functional impairment in lumbar degenerative disc disease: the timed up and go (TUG) test COMMENTS.Neurosurgery. 2016; 79: 278
- A fear-avoidance beliefs questionnaire (Fabq) and the role of fear-avoidance beliefs in chronic low-Back-pain and disability.Pain. 1993; 52: 157-168https://doi.org/10.1016/0304-3959(93)90127-B
- Low back pain in the United States: incidence and risk factors for presentation in the emergency setting.Spine J. 2012; 12: 63-70https://doi.org/10.1016/j.spinee.2011.09.002
- Analysis of the convergent and discriminant validity of published lumbar flexion, extension, and lateral flexion scores.Spine. 2001; 26: E472-E478
Article info
Publication history
Published online: June 21, 2022
Accepted:
June 14,
2022
Received:
December 3,
2021
Identification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
