Effects of spinal manipulation on trunk proprioception in subjects with chronic low back pain during symptom remission. The Measurement of Lumbar Proprioception in Individuals With and Without Low Back Pain Short-term effect on pain and function of neurophysiological education and sensorimotor retraining compared to usual physiotherapy in patients with chronic or recurrent non-specific low back pain, a pilot randomized controlled trial Spinal mobilization of postpartum low back and pelvic girdle pain: an evidence-based clinical rule for predicting responders and nonresponders. Repositioning accuracy and movement parameters in low back pain subjects and healthy control subjects Comparing spinal manipulation with and without Kinesio Taping® in the treatment of chronic low back pain. Reliability and Validity of a New Objective Tool for Low Back Pain Functional Assessment Development of new protocols and analysis procedures for the assessment of LBP by surface EMG techniques. Neuromuscular strategies for lumbopelvic control during frontal and sagittal plane movement challenges differ between people with and without low back pain. Comparison between Kinesio Taping and a Traditional Physical Therapy Program in Treatment of Nonspecific Low Back Pain Effects of two 4-week proprioceptive neuromuscular facilitation programs on muscle endurance, flexibility, and functional performance in women with chronic low back pain. Immediate Effects of Region-Specific and Non–Region-Specific Spinal Manipulative Therapy in Patients With Chronic Low Back Pain: A Randomized Controlled Trial Specific Trunk and General Exercise Elicit Similar Changes in Anticipatory Postural Adjustments in Patients With Chronic Low Back Pain: A Randomized Controlled Trial Lumbar Paraspinal Muscle Function, Perception of Lumbar Position, and Postural Control in Disc Herniation-Related Back Pain Inclusion and exclusion criteria used in non-specific low back pain trials: a review of randomised controlled trials published between 2006 and 2012 Implementing evidence-informed policy into practice for health care professionals managing people with low back pain in Australian rural settings: a preliminary prospective single-cohort study. The quantification of low back disorder using motion measures. Methodology and validation.
OBJECTIVE The purpose of this study was to examine the immediate effects of spinal manipulative therapy ( SMT ) on trunk proprioception in subjects with asymptomatic chronic low back pain ( CLBP ) and determine if those effects lasted 1 week . METHODS This unbalanced r and omized controlled crossover design examined 33 subjects with CLBP .  Proprioception was tested via joint position sense , threshold to detect passive motion ( TTDPM ) , direction of motion ( DM ) , and force reproduction . Each subject received lumbar manipulation or a sham procedure followed by proprioception retest . This procedure was repeated 1 week later using the opposing treatment . Subjects receiving SMT in the second session returned a third time receiving the sham procedure again . RESULTS Spinal manipulative therapy produced an effect for TTDPM in the manipulation first group ( P = .008 ) , the sham procedure produced an effect for joint position sense in the sham first group ( P = .005 ) . Spinal manipulative therapy had a 1-week effect for the manipulation first group ( P = .006 ) . No effect was noted for either DM or force reproduction . CONCLUSIONS Results suggest SMT had minimal immediate effect on trunk proprioception . The effects noted occurred in session 1 , implicating learning as a potential source . Learning , from repetitive proprioception training , may enhance neuromuscular control in subjects with CLBP before the use of therapeutic exercise . Subjects showed smaller deficits than previously reported for TTDPM or DM , suggesting proprioception deficits may correlate with pain level Study Design . A clinical trial comparing a  back pain group with a pain‐free group .  Objectives . To investigate whether proprioceptive deficits existed in a group of individuals reporting low back pain . Summary of Background Data . Little work has so far been conducted on the measurement of proprioception in the spine . Those studies that have been carried out , however , have failed to identify proprioceptive deficits in individuals with back pain . Previous work on peripheral joints has revealed that proprioception is affected with muscular or joint injury or degeneration . Methods . Forty individuals took part in the study , 20 with back pain and 20 with no pain . Participants were required to reproduce a predetermined target position , in st and ing and four‐point kneeling , 10 times in 30 seconds . A computer screen was used to provide visual feedback on position . A mean deviation from the target position was obtained for each individual . A measurement of left elbow position sense was conducted in five individuals from each group to establish differences in short‐term motor memory between the groups . Results . There were no differences between the subject groups in terms of short‐term motor memory ( P > 0.05 ) . A two‐way analysis of variance between subject groups and position to identify differences in accuracy ( deviation from the target ) found that there were differences between subject groups in either position ( P < 0.05 ) . There was no significant difference in accuracy between the positions used ( P > 0.05 ) . Conclusions . Differences in proprioception do exist between individuals with back pain and those free from back pain . Further research needs to be undertaken on proprioceptive exercise programs and their effect on back pain Background Non-specific chronic low back pain ( NSCLBP ) is a major health problem . Identification of subgroups and appropriate treatment regimen was proposed as a key priority by the Cochrane Back Review Group . We developed a multimodal treatment ( MMT ) for patients with moderate to severe disability and medium risk of poor outcome .  MMT includes a ) neurophysiological education on the perception of pain to decrease self-limitation due to catastrophizing believes about the nature of NSCLBP , b ) sensory training of the lower trunk because these patients predominantly show poor sensory acuity of the trunk , and c ) motor training to regain definite movement control of the trunk . A pilot study was conducted to investigate the feasibility of MMT , prior to a larger RCT , with focus on patients ’ adherence and the evaluation of short-term effects on pain and disability of MMT when compared to usual physiotherapy . Method We conducted a r and omised controlled trial ( RCT ) in a primary care physiotherapy centre in Switzerl and . Outcome assessment was 12 weeks after baseline . Patients with NSCLBP , considerable disability ( five or more points on the Rol and  and Morris Disability Question naire ( RMDQ ) and medium or high risk of poor outcome on the Keele Start Back Tool ( KSBT ) were r and omly allocated to either MMT or usual physiotherapy treatment ( UPT ) by an independent research assistant . Treatment included up to 16 sessions over 8 to 12 weeks . Both groups were given additional home training of 10 to 30 minutes to be performed five times per week . Adherence to treatment was evaluated in order to assess the feasibility of the treatment . Assessment s were conducted by an independent blinded person . The primary outcome was pain ( NRS 0 - 10 ) and the secondary outcome was disability ( RMDQ ) . Between-group effects with Student ’s t-test or the Mann-Whitney U test and the st and ardized mean difference of the primary outcome were calculated . Results Twenty-eight patients ( 46 % male , mean age 41.5 years ( SD 10.6 ) ) were r and omized to MMT ( n = 14 ) or UPT ( n = 14 ) . Patients ’ adherence to treatment was > 80 % in both groups . Pain reduction ( NRS ; [ 95 % CI ] ) was 2.14 [ 1.0 to 3.5 ] in the MMT and 0.69 [ -2.0 to 2.5 . ] in the UPT . The between-group difference was 1.45 [ 0.0 to 4.0 ] ( p = 0.03 ) , representing a moderate effect size of 0.66 [ -0.1 to 1.5 ] . Reduction in disability on the RMDQ was 6.71 [ 4.2 to 9.3 ] in MMT and 4.69 [ 1.9 to 7.4 ] in UPT , with a non-significant between-group difference of 2.02 [ -1.5 to 5.6 ] ( p = 0.25 ) . The required sample size for a RCT with six months follow-up was estimated at 170 patients . Conclusions MMT was found to be feasible and to significantly reduce pain in the short term when compared with UPT . A future RCT with a six-month follow-up would require approximately 170 patients .Trial registration Current Controlled Trials IS RCT N66262199 . Registered 8 January 2014 OBJECTIVE To develop a clinical prediction rule ( CPR ) for identifying postpartum women with low back pain ( LBP ) and /or pelvic girdle pain ( PGP ) whose functional disability scores improve with a high-velocity thrust technique ( HVTT ) conducted by a physical therapist . DESIGN Prospect i ve cohort . SETTING Outpatient physical therapy departments . PARTICIPANTS Sixty-nine postpartum women referred to physical therapy with the complaint of LBP and /or PGP . METHODS Subjects underwent a physical examination and a HVTT to the lumbopelvic region . MAIN OUTCOME MEASURES Success with treatment was determined by the use of percent changes in disability scores and served as the reference st and ard for determining accuracy of the examination variables . Variables with univariate prediction of success and nonsuccess were combined into multivariate CPRs . RESULTS Fifty-five subjects ( 80 % ) had success with the HVTT . A CPR for success with 4 criteria was identified . The presence of 2 of 4 criteria ( positive likelihood ratio=3.05 ) increased the probability of success from 80 % to 92 % . A CPR for treatment failure with 3 criteria was identified . The presence of 2 of 3 criteria ( positive likelihood ratio=11.79 ) increased the probability of treatment failure from 20 % to 75 % . CONCLUSIONS The pretest probability of success ( 80 % ) is sufficient to reassure the clinician about the decision to use a HVTT to the lumbopelvic region in postpartum women with LBP and /or PGP . If 2 of 3 criteria for treatment failure are met in the CPR , an alternative approach is warranted . An intervention such as the HVTT is compelling , given the need to minimize pharmaceutical remedies in women who are potentially breast-feeding post partum Study Design : A control group study with repeated measures . Objective : To compare  trunk repositioning parameters  in chronic low back pain ( LBP ) and healthy subjects . Summary and background data : Recent evidence suggests that chronic LBP patients exhibit deficits in trunk proprioception and motor control . Trunk repositioning and the various spatio-temporal parameters related to it can be used to evaluate sensori-motor control and movement strategies . Methods : Fifteen control subjects and 16 chronic LBP subjects participated in this study . Subjects were required to reproduce different trunk position in flexion ( 15 ° , 30 ° and 60 ° ) and extension ( 15 ° ) . In the learning phase preceding each condition , visual feedback was provided . Following these learning trials , subjects were asked to perform ten consecutive trials without any feedback . Movement time , movement time variability and peak velocity were obtained and a temporal symmetry ratio was calculated . Peak angular position variability and absolute error in peak angular position were also calculated to evaluate spatial accuracy . Results : Two subgroups of LBP patients were identified . One subgroup of LBP subjects demonstrated longer movement time and smaller peak velocities and symmetry ratios than normal subjects . No group difference was observed for peak angular position variability and absolute error in peak angular position . Conclusion : Chronic LBP patients , when given a sufficient learning period , were able to reproduce trunk position with a spatial accuracy similar to control subjects . Some LBP subjects , however , showed modifications of movement time , peak velocity and acceleration parameters . We propose that the presence of persistent chronic pain could induce an alteration or an adaptation in the motor responses of chronic LBP subjects OBJECTIVES Chronic non-specific low back pain ( CNLBP ) is a prevalent problem among athletes that can cause long-lasting disability and time lost from sporting activities . Thus far , a variety of methods have been suggested to address this problem , including spinal manipulation ( SM ) and Kinesio Tape ® ( KT ) . The aim of this study was to investigate whether adding KT to SM can provide any extra effect in athletes with CNLBP or not . METHOD Forty-two athletes ( 21males , 21females ) with CNLBP were r and omized into two groups of SM ( n = 21 ) and SM plus KT ( n = 21 ) . Pain intensity , functional disability level and trunk flexor-extensor muscles endurance were assessed by Numerical Rating Scale ( NRS ) , Oswestry pain and disability index ( ODI ) , McQuade test , and unsupported trunk holding test , respectively . The tests were done before and immediately , one day , one week , and one month after the interventions and compared between the two groups . RESULTS After treatments , pain intensity and disability level decreased and endurance of trunk flexor-extensor muscles increased significantly in both groups . Repeated measures analysis , however , showed that there was no significant difference between the groups in any of the evaluations . CONCLUSIONS The findings of the present study showed that adding KT to SM does not appear to have a significant extra effect on pain , disability and muscle endurance in athletes with CNLBP . However , more studies are needed to examine the therapeutic effects of KT in treating these patients . CLINICAL TRIAL REGISTRY NUMBER ( I RCT .IR ) : I RCT 2016020624149N5 Study Design . Classification and functional assessment model for nonspecific low back pain ( LBP ) patients and controls on the basis of kinematic analysis parameters . Objective . Develop a logistic regression model using kinematic analysis variables to ( 1 ) discriminate between LBP patients and controls and ( 2 ) obtain objective parameters for LBP functional assessment . Summary of Background Data . Functional assessment of spinal disorders has been carried out traditionally by means of subjective scales . Objective functional techniques have been developed , which usually involve the application of external loads or the analysis of highly st and ardized trunk flexion-extension maneuvers . Few studies have used everyday activities such as sit-to-st and or lifting an object from the ground . They have shown that the motion patterns of LBP patients differ from those of healthy subjects . Nevertheless , very few studies have tried to correlate objective findings to the results of subjective scales , and no previous study has developed a LBP classification and functional assessment model on the basis of kinematic analysis of everyday activities . Methods . Sixteen controls and 39 LBP patients performed a sit-to-st and task , and lifted three different weights from a st and ing position . The vertical forces exerted and the relative positions of the lower limb and the cervical , thoracic , lumbar , and sacroiliac regions were recorded . Reliability was determined from repetitions of the tests performed by the control group . Binary logistic regression analyses were computed . The results of the selected regression equation were correlated to the Oswestry Disability Index scale results , to check the validity of the procedure for the measurement of functional disability . Results . Reliability of the parameters was good . The selected regression model used two variables , and correctly classified 97.3 % of the patients . High correlations were found between the results of this regression equation and the Oswestry Disability Index scale . Conclusion . It is possible to distinguish LBP patients from healthy subjects by means of the biomechanical analysis of everyday tasks . This kind of analysis can produce objective and reliable indexes about the patients ' degree of functional impairment Spectral parameters of the surface electromyographic ( EMG ) signal from lumbar back muscles assessed during a fatiguing isometric contraction can be used to classify different categories of low back pain ( LBP ) subjects and control subjects without LBP . In the test protocol currently used at the NeuroMuscular Research Center at Boston University , subjects contract their back muscles at 80 % of their maximal voluntary contraction ( MVC ) force . This fatigue-based protocol has been successfully applied to persons with subacute or chronic LBP ; those in acute pain , however , have not been included because of their inability to perform a maximal exertion . In this paper we will examine the force sensitivity of the currently used EMG parameters and also give an overview of some of our efforts to develop new test procedures . Our goal is to develop force-insensitive surface EMG parameters that can be used for classification purpose s in population s of subjects who develop low trunk extension forces . In addition , the development of a model to predict MVC from anthropometrical measurements will be presented Observation-based assessment s of movement are a st and ard component in clinical assessment of patients with non-specific low back pain . While aberrant motion patterns can be detected visually , clinicians are unable to assess underlying neuromuscular strategies during these tests . The purpose of this study was to compare coordination of the trunk and hip muscles during 2 commonly used assessment s for lumbopelvic control in people with low back pain ( LBP ) and matched control subjects .  Electromyography was recorded from hip and trunk muscles of 34 participants ( 17 with LBP ) during performance of the Active Hip Abduction ( AHAbd ) and Active Straight Leg Raise ( ASLR ) tests .  Relative muscle timing was calculated using cross-correlation . Participants with LBP demonstrated a variable strategy , while control subjects used a consistent proximal to distal activation strategy during both frontal and sagittal plane movements . Findings from this study provide insight into underlying neuromuscular control during commonly used assessment tests for patients with LBP that may help to guide targeted intervention approaches [ Purpose ] Nonspecific low back pain ( NSLBP ) is a very common but largely self-limiting condition . Several types of tape and their associated application methods are available for different conditions . The aim of the present study was to observe the effect of Kinesio taping ( KT ) compared with traditional management of NSLBP . [ Subjects and Methods ] Forty male and female patients with a mean age of 34.8±7.54 years were r and omly divided into two groups ; group 1 ( n=20 ) which underwent conventional physical therapy with KT , and group 2 ( n=20 ) , which underwent only conventional physical therapy . The intervention sessions for both groups were three times per week for four weeks . Outcomes were assessed for activities of daily living ( ADL ) using the Rol and -Morris Disability Question naire , pain severity using a visual analogue scale , and ranges of motion ( ROMs ) of trunk flexion and extension using the modified Schober ’s test . [ Results ] Significant differences in measures of pain , ADL , and trunk flexion and extension ROMs were observed post intervention within each group . In comparison , there were no significant differences in measures of pain , ADL , and trunk flexion and extension ROMs post intervention between groups . [ Conclusion ] A physical therapy program involving strengthening exercises for abdominal muscles and stretching exercises for back , hamstring , and iliopsoas muscles with or without Kinesio taping was beneficial in the treatment of chronic low back pain BACKGROUND AND PURPOSE Improving functional performance in patients with chronic low back pain is of primary importance . The purpose of this study was to examine the effects of 2 proprioceptive neuromuscular facilitation ( PNF ) programs on trunk muscle endurance , flexibility , and functional performance in subjects with chronic low back pain ( CLBP ) . SUBJECTS Eighty-six women ( 40.2+/-11.9 [ mean+/-SD ] years of age ) who had complaints of CLBP were r and omly assigned to 3 groups : rhythmic stabilization training , combination of isotonic exercises , and control . METHODS Subjects trained with each program for 4 weeks with the aim of improving trunk stability and strength . Static and dynamic trunk muscle endurance and lumbar mobility were measured before , at the end of , and 4 and 8 weeks after training . Disability and back pain intensity also were measured with the Oswestry Index . RESULTS Multivariate analysis of variance indicated that both training groups demonstrated significant improvements in lumbar mobility ( 8.6%-24.1 % ) , static and dynamic muscle endurance ( 23.6%-81 % ) , and Oswestry Index ( 29.3%-31.8 % ) measurements . DISCUSSION AND CONCLUSION Static and dynamic PNF programs may be appropriate for improving short-term trunk muscle endurance and trunk mobility in people with CLBP Background Manual therapists typically advocate the need for a detailed clinical examination to decide which vertebral level should be manipulated in patients with low back pain . However , it is unclear whether spinal manipulation needs to be specific to a vertebral level . Objective The purpose of this study was to analyze the immediate effects of a single , region-specific spinal manipulation defined during the clinical examination versus a single non – region-specific spinal manipulation ( applied on an upper thoracic vertebra ) in patients with chronic nonspecific low back pain for the outcome measures of pain intensity and pressure pain threshold at the time of the assessment . Design This was a 2-arm , prospect ively registered , r and omized controlled trial with a blinded assessor . Setting The study was conducted in an outpatient physical therapy clinic in Brazil . Patients The study participants were 148 patients with chronic nonspecific low back pain ( with pain duration of at least 12 weeks ) . R and omization The r and omization schedule was generated by an independent statistician and was concealed by using consecutively numbered , sealed , opaque envelopes . Interventions A single high-velocity manipulation was administered to the upper thoracic region of the participants allocated to the non – region-specific manipulation group and to the painful lumbar levels of the participants allocated to the region-specific manipulation group . Measurements Pain intensity was measured by a 0 to 10 numeric pain rating scale . Pressure pain threshold was measured using a pressure algometer . Limitations It was not possible to blind the therapist and participants . Results A total of 148 patients participated in the study ( 74 in each group ) . There was no loss to follow-up . Both groups improved in terms of immediate decrease of pain intensity ; however , no between-group differences were observed . The between-group difference for pain intensity and pressure pain threshold were 0.50 points ( 95 % confidence interval=−0.10 to 1.10 ) and −1.78 points ( 95 % confidence interval=−6.40 to 2.82 ) , respectively . No adverse reactions were observed . Conclusion The immediate changes in pain intensity and pressure pain threshold after a single high-velocity manipulation do not differ by region-specific versus non – region-specific manipulation techniques in patients with chronic low back pain Study Design . A r and omized controlled trial . Objective . To compare changes in self-rated disability , pain , and anticipatory postural adjustments between specific trunk exercise and general exercise in patients with chronic low back pain . Summary of Background Data . Chronic low back pain is associated with altered motor control of the trunk muscles . The best exercise to address altered motor control is unclear . Methods . Sixty-four patients with chronic low back pain were r and omly assigned to a specific trunk exercise group ( SEG ) that included skilled cognitive activation of the trunk muscles in addition to a number of other best practice exercises , whereas the general exercise group performed only seated cycling exercise . The training program lasted for 8 weeks . Self-rated disability and pain scores were collected before and after the training period . Electromyographic activity of various trunk muscles was recorded during performance of a rapid shoulder flexion task before and after training . Muscle onsets were calculated , and the latency time ( in ms ) between the onset of each trunk muscle and the anterior deltoid formed the basis of the motor control analysis . Results . After training , disability was significantly lower in the SEG ( d = 0.62 , P = 0.018 ) . Pain was reduced in both groups after training ( P < 0.05 ) , but was lower for the SEG ( P < 0.05 ) . Despite the general exercise group performing no specific trunk exercise , similar changes in trunk muscle onsets were observed in both groups after training . Conclusion . SEG elicited significant reductions in self-rated disability and pain , whereas similar between-group changes in trunk muscle onsets were observed . The motor control adaptation seems to reflect a strategy of improved coordination between the trunk muscles with the unilateral shoulder movement . Trunk muscle onsets during rapid limb movement do not seem to be a valid mechanism of action for specific trunk exercise rehabilitation programs Study Design . A follow-up study evaluating postural control , lumbar movement perception , and paraspinal muscle reflexes in disc herniation-related chronic low back pain ( LBP ) before and after discectomy .  Objectives . To assess the effect of discectomy on postural control , lumbar perception , and reflex activation of paraspinal muscles during sudden upper limb loading . Summary of Background Data . Impaired muscle function , postural control , and lumbar proprioception have been observed in LBP . However , they have not been studied in sciatica patients after surgery . Methods . The study included 20 patients selected for an operation for chronic LBP caused by disc herniation and 15 controls without chronic LBP . The paraspinal muscle responses for upper limb loading during unexpected and expected conditions were measured by surface electromyography . The ability to sense lumbar rotation was assessed in a previously vali date d motorized trunk rotation unit in the seated position . The postural control was measured with a vertical force platform . Pain , disability , and depression scores were recorded . Results . Patients had poorer lumbar perception ( P = 0.012 ) and postural control ( P < 0.05 ) than did healthy controls . The postural control remained unchanged , but lumbar perception ( P = 0.054 ) and the lumbar feed-forward control ( P = 0.043 ) improved after the surgery . Conclusions . The results demonstrate impaired lumbar proprioception and postural control in sciatica patients . During short-term follow-up after operative treatment , postural control does not seem to change , but impaired lumbar proprioception and feed-forward control of paraspinal muscles seem to recover Background Low back pain is a common health complaint result ing in substantial economic burden . Each year , upwards of 20 r and omised controlled trials ( RCTs ) evaluating interventions for non-specific low back pain are published . Use of the term non-specific low back pain has been criticised on the grounds of encouraging heterogeneity and hampering interpretation of findings due to possible heterogeneous causes , challenging meta-analyses . We explored selection criteria used in trials of treatments for nsLBP . Methods A systematic review of English- language reports of RCTs in nsLBP population sample s , published between 2006 and 2012 , identified from MEDLINE , EMBASE , and the Cochrane Library data bases , using a mixed- methods approach to analysis . Study inclusion and exclusion criteria were extracted , thematically categorised , and then descriptive statistics were used to summarise the prevalence by emerging category . Results We included 168 studies . Two inclusion themes ( anatomical area , and symptoms and signs ) were identified . Anatomical area was most reported as between costal margins and gluteal folds ( n = 8 , 5 % ) , while low back pain ( n = 150 , 89 % ) with or without referred leg pain ( n = 27 , 16 % ) was the most reported symptom . Exclusion criteria comprised 21 themes . Previous or scheduled surgery ( n = 84 , 50 % ) , pregnancy ( n = 81 , 48 % ) , malignancy ( n = 78 , 46 % ) , trauma ( n = 63 , 37 % ) and psychological conditions ( n = 58 , 34 % ) were the most common . Sub-themes of exclusion criteria mostly related to neurological signs and symptoms : nerve root compromise ( n = 44 , 26 % ) , neurological signs ( n = 34 , 20 % ) or disc herniation ( n = 30 , 18 % ) . Specific conditions that were most often exclusion criteria were spondylolisthesis ( n = 35 , 21 % ) , spinal stenosis ( n = 31 , 18 % ) or osteoporosis ( n = 27 , 16 % ) . Conclusion RCTs of interventions for non-specific low back pain have incorporated diverse inclusion and exclusion criteria . Guidance on st and ardisation of inclusion and exclusion criteria for nsLBP trials will increase clinical homogeneity , facilitating greater interpretation of between-trial comparisons and meta-analyses . We propose a template for reporting inclusion and exclusion criteria OBJECTIVE To provide access to professional development opportunities for health care professionals , especially in rural Australian regions , consistent with recommendations in the Australian National Pain Strategy and state government policy . DESIGN AND SETTING A preliminary prospect i ve , single-cohort study design , which aligned health policy with evidence -informed clinical practice , evaluated the implementation and effectiveness of an interprofessional , health care provider pain education program ( hPEP ) for management of nonspecific low back pain ( nsLBP ) in rural Western Australia . INTERVENTION The 6.5-hour hPEP intervention was delivered to 60 care providers ( caseload nsLBP 19.8 % ± 22.5 ) at four rural WA regions . OUTCOME MEASURES Outcomes were recorded at baseline and 2 months post-intervention regarding attitudes , beliefs ( modified Health Care Providers Pain and Impairment Relationship Scale [ HC-PAIRS ] ) , Back Pain Beliefs Question naire [ BBQ ] ) , and self-reported evidence -based clinical practice ( knowledge and skills regarding nsLBP , rated on a 5-point Likert scale with 1 = nil and 5 = excellent ) . RESULTS hPEP was feasible to implement . At 2 months post-hPEP , responders ' ( response rate 53 % ) improved evidence -based beliefs were indicated by HC-PAIRS scores : baseline mean ( SD ) [ 43.2 ( 9.3 ) ] ; mean difference ( 95 % CI ) [ -5.9 ( -8.6 to -3.1 ) ] ; and BBQ baseline [ 34.3 ( 6.8 ) ] ; mean difference [ 2.1 ( 0.5 to 3.6 ) ] . Positive shifts were observed for all measures of clinical knowledge and skills ( P < 0.001 ) and increased assistance with planning lifestyle changes ( P < 0.001 ) , advice on self-management ( P = 0.010 ) , and for decreased referrals for spinal imaging ( P = 0.03 ) . CONCLUSIONS This policy-into- practice educational program is feasible to implement in rural Western Australia ( WA ) . While preliminary data are encouraging , a further r and omized controlled trial is recommended STUDY DESIGN Trunk angular motion features were used as a means to quantify the extent of a low back disorder in healthy people and patients with chronic low back disorders . OBJECTIVE To refine and vali date a previously reported means of quantifying the extent of a low back disorder . SUMMARY AND BACKGROUND Many assessment tools of low back disorder are subjective . A quantitative assessment tool would facilitate the tracking of the recovery and help document the appropriateness of treatments . METHODS The trunk motion characteristics of 374 healthy people and 335 patients with chronic low back disorders of varying severity were documented as they flexed and extended their trunks in five different planes of motion . The trunk motion features were normalized as a function of age and gender . Four classification techniques were used to assess the ability of the quantitative motion measure to identify those with and without low back disorders . In addition , 31 patients were observed longitudinally to determine whether the motion measures agreed with observed changes in back pain symptoms . RESULTS The quantitative trunk motion measure distinguished between people with low back disorders and healthy people between 88 % and 94 % of the time , depending on which classification system was used . Sensitivity and specificity varied between 83 % and 97 % . The quantitative measure also showed promise as a means to distinguish between muscle-based and structure-based low back disorders . Prospect i ve findings indicated that the quantification system agreed well with clinical observations of progress . CONCLUSIONS The quantification of trunk motion  can serve as a measure of the extent of a low back disorder . When considered along with other clinical information , the ability to assess and treat low back disorders is enhanced
This systematic review covered all the relevant literature , but none of the included studies offered a valid , reliable and feasible method to assess neuromotor capacity in everyday physiotherapy clinical practice
BACKGROUND Physiotherapists and clinicians require methods that can be used in everyday practice for measuring proprioception of the trunk in individuals with non-specific low back pain ( NSLBP ) .
OBJECTIVE Our objective was to conduct a systematic literature review of methods used for assessment of proprioception of the trunk in individuals with non-specific low back pain .