Low back pain – Novel technology improves patient assessment

Clinicians frequently encounter patients suffering from low back pain with degraded lumbar movement and movement control. Measuring lumbar movement is difficult because existing measurement systems such as visual observation lack accuracy and comprehensiveness. Researchers from Tampere University and Zurich University of Applied Sciences developed a mobile and low-cost measurement system that overcomes these limitations and provides valid and reliable measures of lumbar movement.

Low back pain is a very common symptom and the leading cause of disability worldwide. Only a small proportion of patients have a well-understood pathological cause, e.g. a vertebral fracture. All others have no specific cause of pain and their treatment is difficult, although many clinicians notice distinguishable clinical features in daily practice. One important feature is degraded lumbar movement and movement control, but this is difficult to quantify because current measurement systems lack accuracy, reliability, validity, comprehensiveness and practicality. To overcome these limitations, researchers from Tampere University, UKK Institute, Hocoma AG and Zurich University of Applied Sciences developed a mobile and low-cost measurement system (Valedo®) that overcomes these limitations and provides valid and reliable measures of lumbar movement.



In this project, the researchers tested whether the novel measurement system fulfils the basic criteria for measurement systems: validity and reliability. They tested it against an exact gold standard, a reference system frequently used in movement science, and found it to provide valid and reliable measures of lumbar movements. Because these results were encouraging, they used it to investigate several questions with clinical relevance: the associations between low back pain intensity, fatigue and decline of lumbar movement control as well as the effect of exercise on lumbar movement control, in people with physically demanding jobs (nurses) who are at great risk of developing chronic low back pain. The researchers found that low back pain indeed reduces lumbar movement control: the higher the pain, the more movement control is affected. Moreover, they found that fatigue also affects movement control: patients with low back pain use different compensation strategies than pain-free people. Finally, they found that exercise may reverse or reduce deterioration of lumbar movement control and could therefore be beneficial for people who are at great risk of developing chronic low back pain. The results supported the development of Valedo®, a highly sucessfull therapy tool used by clinicans.

Broad-based Finnish-Swiss research project

The project concluded in 2014. The Swiss partners were funded by the Innosuisse agency of the Swiss Confederation. The Finnish partners were financed by the Social Insurance Institution of Finland and the Pirkanmaa Hospital District.

In a follow-up project funded by Innosuisse, this study group has begun to integrate the novel measurement system with an additional precise measurement system, further improving its quality. The continuing interest of funding organisations indicate the clinical, scientific and economic potential of this technology.

The partners had the common aim of developing a novel measurement system to enable clinicians to measure lumbar movement objectively and ultimately improve care for patients without a specific cause of low back pain.

List of scienfitic peer reviewed publications:

1. Ernst, M.J., et al., Determination of thoracic and lumbar spinal processes by their percentage position between C7 and the PSIS level. BMC Res Notes, 2013. 6: p. 58.

2. Bauer, C.M., et al., Concurrent validity and reliability of a novel wireless inertial measurement system to assess trunk movement. J Electromyogr Kinesiol, 2015. 25(5): p. 782-90.

3. Bauer, C.M., et al., Pain intensity attenuates movement control of the lumbar spine in low back pain. J Electromyogr Kinesiol, 2015. 25(6): p. 919-27.

4. Hugli, A.S., et al., Adherence to home exercises in non-specific low back pain. A randomised controlled pilot trial. J Bodyw Mov Ther, 2015. 19(1): p. 177-85.

5. Rausch Osthoff, A.K., et al., Measuring lumbar reposition accuracy in patients with unspecific low back pain: systematic review and meta-analysis. Spine (Phila Pa 1976), 2015. 40(2): p. E97-E111.

6. Schelldorfer, S., et al., Low back pain and postural control, effects of task difficulty on centre of pressure and spinal kinematics. Gait Posture, 2015. 41(1): p. 112-8.

7. Bauer, C.M., et al., Reliability of lumbar movement dysfunction tests for chronic low back pain patients. Man Ther, 2016. 24: p. 81-4.

8. Bauer, C.M., et al., The effect of muscle fatigue and low back pain on lumbar movement variability and complexity. J Electromyogr Kinesiol, 2017. 33: p. 94-102.

9. Rast, F.M., et al., Reproducibility of a new signal processing technique to assess joint sway during standing. J Biomech, 2017. 51: p. 133-136.

10. Bauer, C., Reliability and Validity of Lumbopelvic Kinematics Related to Nonspecific Low Back Pain, in Departement of Medicine and Life Science. 2018, University of Tampere: Tampere, Finland.