The Use of Sensors to Prevent, Predict Transition to Chronic and Personalize Treatment of Low Back Pain: A Systematic Review

Non-specific low back pain (NSLBP) is a highly prevalent condition that implies substantial expenses and affects quality of life in terms of occupational and recreational activities, physical and psychological health, and general well-being. The diagnosis and treatment are challenging processes due to the unknown underlying causes of the condition. Recently, sensors have been included in clinical practice to implement its management. In this review, we furthered knowledge about the potential benefits of sensors such as force platforms, video systems, electromyography, or inertial measure systems in the assessment process of NSLBP. We concluded that sensors could identify specific characteristics of this population like impaired range of movement, decreased stability, or disturbed back muscular activation. Sensors could provide sufferers with earlier diagnosis, prevention strategies to avoid chronic transition, and more efficient treatment approaches. Nevertheless, the review has limitations that need to be considered in the interpretation of results.FEDER/Aragon Government—Dept. of Science, University, and the Knowledge Society. Grant number [LMP97_21

The use of sensors to prevent, predict transition to chronic and personalize treatment of Low Back Pain: a systematic review

Non-specific low back pain (NSLBP) is a highly prevalent condition that implies substantial expenses and affects quality of life in terms of occupational and recreational activities, physical and psychological health, and general well-being. The diagnosis and treatment are challenging processes due to the unknown underlying causes of the condition. Recently, sensors have been included in clinical practice to implement its management. In this review, we furthered knowledge about the potential benefits of sensors such as force platforms, video systems, electromyography, or inertial measure systems in the assessment process of NSLBP. We concluded that sensors could identify specific characteristics of this population like impaired range of movement, decreased stability, or disturbed back muscular activation. Sensors could provide sufferers with earlier diagnosis, prevention strategies to avoid chronic transition, and more efficient treatment approaches. Nevertheless, the review has limitations that need to be considered in the interpretation of results

Distinction of non-specific low back pain patients with proprioceptive disorders from healthy individuals by linear discriminant analysis

The central nervous system (CNS) dynamically employs a sophisticated weighting strategy of sensory input, including vision, vestibular and proprioception signals, towards attaining optimal postural control during different conditions. Non-specific low back pain (NSLBP) patients frequently demonstrate postural control deficiencies which are generally attributed to challenges in proprioceptive reweighting, where they often rely on an ankle strategy regardless of postural conditions. Such impairment could lead to potential loss of balance, increased risk of falling, and Low back pain recurrence. In this study, linear and non-linear indicators were extracted from center-of-pressure (COP) and trunk sagittal angle data based on 4 conditions of vibration positioning (vibration on the back, ankle, none or both), 2 surface conditions (foam or rigid), and 2 different groups (healthy and non-specific low back pain patients). Linear discriminant analysis (LDA) was performed on linear and non-linear indicators to identify the best sensory condition towards accurate distinction of non-specific low back pain patients from healthy controls. Two indicators: Phase Plane Portrait ML and Entropy ML with foam surface condition and both ankle and back vibration on, were able to completely differentiate the non-specific low back pain groups. The proposed methodology can help clinicians quantitatively assess the sensory status of non-specific low back pain patients at the initial phase of diagnosis and throughout treatment. Although the results demonstrated the potential effectiveness of our approach in Low back pain patient distinction, a larger and more diverse population is required for comprehensive validation

Human Health Engineering Volume II

In this Special Issue on “Human Health Engineering Volume II”, we invited submissions exploring recent contributions to the field of human health engineering, i.e., technology for monitoring the physical or mental health status of individuals in a variety of applications. Contributions could focus on sensors, wearable hardware, algorithms, or integrated monitoring systems. We organized the different papers according to their contributions to the main parts of the monitoring and control engineering scheme applied to human health applications, namely papers focusing on measuring/sensing physiological variables, papers highlighting health-monitoring applications, and examples of control and process management applications for human health. In comparison to biomedical engineering, we envision that the field of human health engineering will also cover applications for healthy humans (e.g., sports, sleep, and stress), and thus not only contribute to the development of technology for curing patients or supporting chronically ill people, but also to more general disease prevention and optimization of human well-being

Development and preliminary evaluation of a digital health intervention to facilitate physical activity and exercise self-management in people with low back pain

Background: Low back pain (LBP) is the number one cause of dyability globally. In the majority of patients LBP is non-specific (NSLBP). Despite the well-established recommendations and guidelines, people with NSLBP find it difficult to engage in physical activity (PA) and exercise due to the complex nature of their pain. Digital interventions offer potential solution to encourage people with NSLBP to be active and exercise. However current interventions provide only general advice not considering the complexity of NSLBP and have shown poor outcomes. Aim: To explore the potential role of a digital intervention in promoting optimum exercise self-management in people with NSLBP. Methods: Following the MRC Guidance on the Development and Evaluation of Complex Interventions which advocates using theory, evidence, user testing and appropriate modelling and piloting, this project had 3 phases. Stage 1: identifying the evidence base using a systematic review and meta-analysis focussed on the effect of self-management interventions with exercise components, Stage 2: identifying or developing theory using a focus group study and a mixed methods survey involving stakeholders to identify the interventions functions to include in the intervention to deliver a tailored ESM for NSLBP. Stage 3: developing the BACK-to-FIT digital platform and preliminary evaluation. A prototype version of the website was developed with input from stage 1 and 2. Implementation and behaviour change theories informed this process. Primary outcome of the preliminary evaluation was usability, measured using System usability score (SUS). Secondary outcome measures were technology acceptance measured with TAM3 questionnaire, and potential health benefits measured with NPRS, exercise self-efficacy questionnaire (SSE), Oswestry disability index (ODI), Coping strategies questionnaire (CSQ-24) and level of PA (IPAQ-SF). User experience of the BACK-to-FIT was explored using semi-structured individual interviews. Results: Stage 1 : Demonstrated that self-management programmes with exercise components in them have moderate but significant, short-, intermediate- and long-term positive effect both on pain and disability in patients with chronic NSLBP. A vast heterogeneity was present in the content, frequency and duration of the interventions. Furthermore, not all exercise programmes were tailored according to persons’ need and capabilities. Stage 2: Results from focus group discussions involving 14 musculoskeletal physiotherapists indicated the key considerations when designing a tailored ESM programme for people with NSLBP and identified important components to include in a potential digital ESM intervention included: improving LBP education and awareness, strategies to improve self-monitoring and adherence, use of general and specific exercise, progression and regression of exercise and providing feedback. Findings from the survey with 71 LBP experts responded, revealed 17 key subjective questions and 5 physical tests together with 2 new tests suggested by experts when designing a tailored ESM intervention in NSLBP. Stage 3: The BACK-to-FIT digital platform, prototype version was developed using Intervention functions and behaviour change identified from stage 2. It consisted of 4 main modules involving one LBP education module and 3 exercise modules with 35 different exercises. Twelve participants used the intervention for four weeks and completed the follow up study; Age range 25-50 (mean 38.8), 50% male and 50% female. Primary outcome – mean usability score was 81.87 (47.5-95) measured out of 100. Secondary outcomes - the highest and lowest mean scores obtained for any TAM3 construct were 6.6 and 5.04 for computer anxiety and subjective norm constructs respectively. The highest possible score to achieve was 7. Secondary outcome scores for pain, disability, exercise self-efficacy, catastrophising and PA levels improved from 4.00 (NPRS), 15.33 (ODI), 37.5 (SEE), 9.08 (CSQ-24) and 1513.62 MET -minutes/week (IPAQ-SF) to 2.16 (NPRS), 9.00 (ODI) , 59.67 (SEE) , 5.41 (CSQ-24) and 2070.25 MET -minutes/week (IPAQ-SF) at 4-week follow-up. Feedback from interviews was mainly positive with some suggestions focused on future improvements of the interventions. Conclusion: BACK-to-FIT has been shown to be acceptable to potential end users, has very good usability and has potential for effectiveness. This intervention merits further development, and subsequent evaluation in a larger scale study

The effect of position on the lumbar intervertebral disc.

This thesis comprises three phases with a combined aim which was to investigate the effect of position on the lumbar intervertebral disc (IVD). The effect of position on the lumbar IVD in asymptomatic subjects and subjects with discogenic low back pain (DLBP) was explored using positional Magnetic Resonance Imaging (pMRI). Convenience samples of 11 asymptomatic and 34 DLBP subjects were recruited to have sagittal and axial pMRI scans performed in sitting (Neutral, Flexed and Extended), standing and lying (Supine and Prone extension) positions. The sagittal plane migration of the nucleus pulposus (NP) of each lumbar IVD in each position was measured from the sagittal and axial pMRI scans. Within and between group inferential analysis was performed using nonparametric tests. Both the asymptomatic and DLBP subjects demonstrated that position had statistically significant effects on the sagittal plane NP migration. Both groups demonstrated significantly greater posterior sagittal plane NP migration in Neutral and Flexed sitting positions compared to the other positions. However, between group comparisons identified that the asymptomatic subjects also demonstrated significantly greater posterior sagittal plane NP migration than the DLBP subjects. This pattern was more common in the upper lumbar IVDs (L1/2 and L2/3) between positions and less common in the lower IVDs (L4/5 and L5/S1) between positions. New knowledge regarding the behaviour of the lumbar IVD emerged from this research. The differences detected between the asymptomatic and DLBP subjects suggest that some current theories regarding DLBP may be incorrect. The results also support imaging of DLBP subjects in sitting positions as opposed to current supine positions. Although the limitations of the study reduce generalisation of the results, the implications for clinical practice, imaging and suggestions for further research from this work are important to improve understanding and conservative management of DLBP

Caractérisation électromyographique des lombalgies non-spécifiques chroniques de l'enfant et de l'adolescent

The majority of the worldwide population (80%) suffers from low back pain (LBP) over life. LBP becomes chronic (CLBP) in 10 to 15% of (all) adult cases yielding important functional and socio-economic adverse repercussions. The majority of LBP (85%) is classified as “non-specific” (NSCLBP), i.e. with an absence of any identified cause. LBP prevalence on children and adolescents is comparable to adults. Despite the low incidence of serious associated diseases, the fear of missing them increased patient’s exposure to radiation. However, an absence of significant correlation between radiology changes in the lower spine and low back pain was reported for school children. In this context, it is necessary to identify new tools, if possible non-irradiating and inexpensive, to identify specific characteristics of children and adolescents suffering from NSCLBP and thus improve the understanding of this pathology.An interesting tool, highlighted in adult population, is to evaluate surface electromyography (EMG) of low back muscles. Existing EMG phenomena were reported to discriminate adults with and without NSCLBP: reduced trunk muscle endurance, absence of flexion-relaxation phenomenon and guarding hypothesis during gait at different velocities. These EMG characteristics have not yet been confirmed for children and adolescents suffering of NSCLBP.This clinical context justifies the present doctoral work. The aim was to evaluate EMG characteristics in children and adolescents with NSCLBP in comparison with control participants. To achieve these objectives, several complementary studies were successively conducted.Taken together, the results of this doctoral work showed that the EMG characteristics frequently reported for NSCLBP in adults were absent or reduced in children and adolescent suffering from NSCLBP. These findings are inconsistent with the existing literature on adults and might affect the future therapeutic management of children and adolescents with NSCLBP, which is, to date, an imitation of the adult model. It would be interesting to confirm these results on the basis of a larger cohort and to reassess the same children and adolescents in adulthood to identify whether the EMG phenomenon, as known in NSCLBP adults, appears over time.La lombalgie (LBP) touche 80% de la population mondiale adulte et devient chronique dans 10 à 15% des cas. Pour la grande majorité des cas adultes (85%), aucune cause ne peut être clairement identifiée pour expliquer ces douleurs et l’on parle alors de lombalgie chronique « non-spécifique » (NSCLBP). Chez l’enfant et l’adolescent, la prévalence de la NSCLBP est semblable à celle de l’adulte. Malgré la faible incidence de pathologies graves associées, la lombalgie de l’enfant et de l’adolescent implique, souvent dans sa prise en charge diagnostique, une exposition augmentée aux radiations et un stress parental important. Cependant, la présence d’anomalies radiologiques est aussi fréquente dans la population asymptomatique que dans la population avec NSCLBP. Ceci remet en question l’intérêt clinique de la radiologie pour dépister une cause possible de NSCLBP. Dans ce contexte, il est nécessaire d’identifier de nouveaux outils, si possible non-irradiants et peu coûteux, pour identifier des caractéristiques spécifiques aux enfants et adolescents souffrant de NSCLBP et ainsi améliorer la compréhension de cette pathologie.L’analyse électromyographique (EMG) de l’activité des muscles paravertébraux lombaires s’est avérée cliniquement pertinente dans la population adulte pour discriminer les patients souffrant de NSCLBP des participants asymptomatiques. Plusieurs paramètres EMG enregistrés lors de différentes tâches ont été identifiés chez l’adulte pour caractériser les participants NSCLBP. Les paramètres EMG des muscles lombaires les plus couramment rapportés dans la littérature sont : un temps de maintien réduit ainsi qu’une fatigue musculaire accélérée pendant le test d’endurance des muscles extenseurs du tronc, la réduction ou l’absence du phénomène de flexion-relaxation (FRP) pendant la tâche de flexion maximale du tronc ainsi qu’un pattern atypique supportant l’hypothèse de précaution pendant la marche à différentes vitesses. Si ces caractéristiques EMG spécifiques aux patients souffrant de NSCLBP ont été bien établies chez l’adulte, la question est désormais de savoir ce qu’il en est chez l’enfant et l’adolescent souffrant de NSCLBP.Dans ce contexte clinique, l’objectif de ce travail doctoral était d’évaluer les caractéristiques EMG décrites ci-dessus dans une cohorte d’enfants et d’adolescents souffrant de NSCLBP en comparaison à des participants asymptomatiques (CTRL). Pour y répondre, plusieurs études complémentaires ont été effectuées.Dans leur ensemble, les travaux de cette thèse de doctorat ont montré que les phénomènes EMG reportés dans une population adulte avec NSCLBP ne sont pas retrouvés dans une population pédiatrique avec NSCLBP. Ces résultats remettent en question le diagnostic et la prise en charge actuelle des enfants et adolescents souffrant de NSCLBP, qui est, à ce jour, calquée sur le modèle adulte. Des études supplémentaires sont cependant nécessaires pour confirmer ces résultats sur une cohorte plus importante. Il serait aussi intéressant d’évaluer une même cohorte à partir de l’enfance jusqu’à l’âge adulte afin d’évaluer quels facteurs pourraient prédire l’apparition des phénomènes rapportés dans la littérature adulte

Wearable Sensors Applied in Movement Analysis

Recent advances in electronics have led to sensors whose sizes and weights are such that they can be placed on living systems without impairing their natural motion and habits. They may be worn on the body as accessories or as part of the clothing and enable personalized mobile information processing. Wearable sensors open the way for a nonintrusive and continuous monitoring of body orientation, movements, and various physiological parameters during motor activities in real-life settings. Thus, they may become crucial tools not only for researchers, but also for clinicians, as they have the potential to improve diagnosis, better monitor disease development and thereby individualize treatment. Wearable sensors should obviously go unnoticed for the people wearing them and be intuitive in their installation. They should come with wireless connectivity and low-power consumption. Moreover, the electronics system should be self-calibrating and deliver correct information that is easy to interpret. Cross-platform interfaces that provide secure data storage and easy data analysis and visualization are needed.This book contains a selection of research papers presenting new results addressing the above challenges

Modern Developments in Transcranial Magnetic Stimulation (TMS) – Applications and Perspectives in Clinical Neuroscience

Transcranial magnetic stimulation (TMS) is being increasingly used in neuroscience and clinics. Modern advances include but are not limited to the combination of TMS with precise neuronavigation as well as the integration of TMS into a multimodal environment, e.g., by guiding the TMS application using complementary techniques such as functional magnetic resonance imaging (fMRI), electroencephalography (EEG), diffusion tensor imaging (DTI), or magnetoencephalography (MEG). Furthermore, the impact of stimulation can be identified and characterized by such multimodal approaches, helping to shed light on the basic neurophysiology and TMS effects in the human brain. Against this background, the aim of this Special Issue was to explore advancements in the field of TMS considering both investigations in healthy subjects as well as patients

The safety and efficacy of mesenchymal stem cells for prevention or regeneration of intervertebral disc degeneration: a systematic review

General Posters: abstract no. GP86INTRODUCTION: Mesenchymal stem cells (MSCs) have been used to halt the progression or regenerate the disc with hopes to prevent or treat discogenic back pain. However, the safety and efficacy of the use of MSCs for such treatment in animal and human models at short and long term assessment (i.e. greater than 48 weeks) have not been systematically addressed. This study addressed a systematic review of comparative controlled studies addressing the use of MSCs to that of no treatment/saline for the treatment of disc degeneration. METHODS: Online databases were extensively searched. Controlled trials in animal models and humans were eligible for inclusion. Trial design, MSC characteristics, injection method, disc assessment, outcome intervals, and complication events were assessed. Validity of each study was assessed addressing trial design. Two individuals independently addressed the aforementioned. RESULTS: Twenty-two animal studies were included. No human comparative controlled trials were reported. All three types of MSCs (i.e. derived from bone marrow, synovial and adipose tissue) showed successful inhibition of disc degeneration progression. From three included studies, bone marrow derived MSC showed superior quality of disc repair when compared to other treatments, including TGF-β1, NP bilaminar co-culture and axial distraction regimen. However, osteophyte development was reported in two studies as potential complication of MSC transplantation. CONCLUSIONS: Based on animal models, the current evidence suggests that in the short-term MSC transplantation is safe and effective in halting disc degeneration; however, additional and larger studies are needed to assess the long-term regenerative effects and potential complications. Inconsistency in methodological design and outcome parameters prevent any robust conclusions. In addition, randomized controlled trials in humans are needed to assess the safety and efficacy of such therapy.published_or_final_versio