Assessment instruments of movement quality in patients with non-specific low back pain: A systematic review and selection of instruments.

BACKGROUND: Observing and analyzing movement quality (MQ) in patients with non-specific low back pain (NS-LBP) is important in the clinical reasoning of primary care physiotherapists and exercise therapists. However, there is no standardized form of assessment. RESEARCH QUESTION: which MQ domains are measured with which instruments, and which activities are relevant, appropriate and methodologically sound for assessing MQ in patients with NS-LBP? METHODS: The study had three phases. In phase 1 we conducted a systematic review in PubMed, CINAHL and SPORTDiscus of literature published until October 2018. The selected studies measured MQ domains with instruments that enabled us to 1) compare MQ in self-paced dynamic activities of patients with NS-LBP and healthy controls, and/or 2) determine change over time of MQ in patients with NS-LBP. In phase 2 we established relevant dynamic activities to assess in patients with NS-LBP. In phase 3 we determined appropriateness and methodological qualities of the selected instruments. RESULTS: Thirty cross-sectional and three pre-post-test studies were eligible. The instruments consisted of complex (n = 19) and simple (n = 7) instrumented motion analysis systems and standardized observational tests (n = 7). We identified three domains representative for MQ: range of motion (ROM), inter-segmental coordination, and whole-body movements. In these domains, patients with NS-LBP significantly differed from healthy controls, respectively 7/12, 12/13 and 13/20 studies. Moreover, ROM and whole-body movements significantly improved over time in patients with NS-LBP (3/3 studies). Based on phase 3, we concluded that none of the instruments are appropriate to assess MQ in patients with NS-LBP in primary care. SIGNIFICANCE: Forward bending, lifting, and walking seem the most relevant activities to evaluate in patients with NS-LBP. However, we found no suitable instruments to measure ROM, inter-segmental coordination, or whole-body movements as determinants of MQ in these activities in daily practice. We therefore recommend such an instrument be developed.

How clinicians analyze movement quality in patients with non-specific low back pain: a cross-sectional survey study with Dutch allied health care professionals.

BACKGROUND: Observation of movement quality (MQ) is an indelible element in the process of clinical reasoning for patients with non-specific low back pain (NS-LBP). However, the observation and evaluation of MQ in common daily activities are not standardized within allied health care. This study aims to describe how Dutch allied health care professionals (AHCPs) observe and assess MQ in patients with NS-LBP and whether AHCPs feel the need to have a specific outcome measure for assessing MQ in patients with NS-LBP. METHODS: In this cross-sectional digital survey study, Dutch primary care AHCPs (n = 114) answered one open and three closed questions about MQ in NS-LBP management. Qualitative and quantitative analyses were applied. RESULTS: Qualitative analyses of the answers to the open questions revealed four main themes: 1) movement pattern features, 2) motor control features, 3) environmental influences and 4) non-verbal expressions of pain and exertion. Quantitative analyses clearly indicated that AHCPs observe MQ in the diagnostic (92%), therapeutic (91%) and evaluation phases (86%), that they do not apply any objective measurement of MQ and that 63% of the AHCPs consider it important to have a specific outcome measure to assess MQ. The AHCPs expressed added benefits and critical notes regarding clinical reasoning and quality of care. CONCLUSION: AHCPs recognize the importance of observing MQ in the assessment and management of LBP in a standardized way. However, there is no consensus amongst AHCPs how MQ should be standardized. Prior to standardization, it will be important to develop a theoretical framework to determine which observable and measurable dimensions of MQ are most valid and relevant for patients with NS-LBP to include in the assessment.

Description of movement quality in patients with low back pain: A qualitative study as a first step to a practical definition.

PURPOSE: As a first step to formulate a practical definition for movement quality (MQ), this study aims to explore how Dutch allied health care professionals (AHCPs) describe MQ of daily life activities in patients with low back pain (LBP). METHODS: In this qualitative cross-sectional digital survey study, Dutch AHCPs (n = 91) described MQ in open text (n = 91) and with three keywords (n = 90). After exploratory qualitative content analysis, the ICF linking rules (International Classification of Functioning, Disability and Health) were applied to classify MQ descriptions and keywords. FINDINGS: The identified meaningful concepts (MCs) of the descriptions (274) and keywords (239) were linked to ICF codes (87.5% and 80.3%, respectively), Personal factors (5.8% and 5.9%, respectively), and supplementary codes (6.6% and 13.8%, respectively). The MCs were linked to a total of 31 ICF codes, especially to b760 'control of voluntary movement functions', b7602 'coordination of voluntary movements', d4 'Mobility', and d230 'carry out daily routine'. Negative and positive formulated descriptions elucidated different MQ interpretations. CONCLUSIONS: Descriptions of MQ given by Dutch AHCPs in patients with LBP cover all ICF components. Coordination and functional movements are seen as the most elementary concepts of MQ. Variation in MQ descriptions and interpretations hinders defining MQ and indicates the necessity of additional steps.

Flexibility in embodied lexical-semantic representations.

According to an embodied view of language comprehension, language concepts are grounded in our perceptual systems. Evidence for the idea that concepts are grounded in areas involved in action and perception comes from both behavioral and neuroimaging studies (Glenberg [1997]: Behav Brain Sci 20:1-55; Barsalou [1999]: Behav Brain Sci 22:577-660; Pulvermueller [1999]: Behav Brain Sci 22:253-336; Barsalou et al. [2003]: Trends Cogn Sci 7:84-91). However, the results from several studies indicate that the activation of information in perception and action areas is not a purely automatic process (Raposo et al. [2009]: Neuropsychologia 47:388-396; Rueschemeyer et al. [2007]: J Cogn Neurosci 19:855-865). These findings suggest that embodied representations are flexible. In these studies, flexibility is characterized by the relative presence or absence of activation in our perceptual systems. However, even if the context in which a word is presented does not undermine a motor interpretation, it is possible that the degree to which a modality-specific region contributes to a representation depends on the context in which conceptual features are retrieved. In the present study, we investigated this issue by presenting word stimuli for which both motor and visual properties (e.g., Tennis ball, Boxing glove) were important in constituting the concept. Conform with the idea that language representations are flexible and context dependent, we demonstrate that the degree to which a modality-specific region contributes to a representation considerably changes as a function of context.