Disability and Rehabilitation
ISSN: 0963-8288 (Print) 1464-5165 (Online) Journal homepage: http://www.tandfonline.com/loi/idre20
Physical functioning of low back pain patients: perceived physical functioning and functional capacity, but not physical activity is affected Willemijn M.J. van Rooij, Rachel Senden, Ide C. Heyligers, Paul M. A. H. Cuppen, Wouter L. W. van Hemert & Bernd Grimm To cite this article: Willemijn M.J. van Rooij, Rachel Senden, Ide C. Heyligers, Paul M. A. H. Cuppen, Wouter L. W. van Hemert & Bernd Grimm (2015): Physical functioning of low back pain patients: perceived physical functioning and functional capacity, but not physical activity is affected, Disability and Rehabilitation To link to this article: http://dx.doi.org/10.3109/09638288.2015.1019010
Published online: 04 Mar 2015.
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Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=idre20 Download by: [University of Lethbridge]
Date: 06 October 2015, At: 04:10
http://informahealthcare.com/dre ISSN 0963-8288 print/ISSN 1464-5165 online Disabil Rehabil, Early Online: 1–7 ! 2015 Informa UK Ltd. DOI: 10.3109/09638288.2015.1019010
RESEARCH PAPER
Physical functioning of low back pain patients: perceived physical functioning and functional capacity, but not physical activity is affected Willemijn M.J. van Rooij1, Rachel Senden1, Ide C. Heyligers1, Paul M. A. H. Cuppen2, Wouter L. W. van Hemert1, and Bernd Grimm1 AHORSE Department of Orthopaedic Surgery and Traumatology, Atrium Medical Centre Heerlen, The Netherlands and 2Cheiron Medical Centre Waalre, Waalre, The Netherlands
Disability and Rehabilitation
1
Abstract
Keywords
Purpose: Physical functioning is a multidimensional construct covering perceived functioning, functional capacity and actual physical activity. Currently, the assessment of physical functioning in low back pain (LBP) patients has been limited to only one or two of these aspects. This study evaluates physical functioning of LBP patients by assessing the three individual aspects using questionnaires and ambulant sensor-based measurements. Methods: Actual physical activity, functional capacity and perceived functioning were measured in 26 patients undergoing patient specific treatment before, direct and 3–4 weeks after the first treatment using, respectively, sensor-based activity monitoring, sensor-based motion analysis test and the Oswestry questionnaire. Patients were compared to a healthy control group. Results: Perceived functioning and functional capacity, but not actual physical activity is impaired in pre-treatment LBP patients. After treatment, patients improved in perceived physical functioning and functional capacity approaching healthy levels, however only slight (p40.05) improvements in actual physical activity were found. Moreover, only few and weak correlations were found between the different aspects of physical functioning. Conclusion: Perceived functioning, actual physical activity and functional capacity are three independent outcome dimensions, being complementary but not redundant. Especially, perceived functioning and physical capacity need attention when evaluating LBP patients during rehabilitation.
Actual physical activity, functional capacity, low back pain, perceived function, physical functioning History Received 27 July 2014 Revised 8 February 2015 Accepted 10 February 2015 Published online 4 March 2015
ä Implications for Rehabilitation
Perceived physical functioning and physical capacity are negatively affected by low back pain and improve after treatment. Low back pain patients perform their daily activity independent of pain and complaints. Inertia sensor-based motion analysis can objectify treatment effects showing low back pain patients their progress in rehabilitation. New interventions can be justified with inertia sensor technology in low back pain patients.
Introduction Low back pain (LBP) is a major health problem. The 2010 Global Burden of Disease Study estimated that LBP is among the top 10 diseases and injuries that account for the highest number of disability-adjusted life-years worldwide [1]. About 4–33% of the population suffers LBP, and its lifetime prevalence is 58–84%. Its annual incidence has been estimated in 28 episodes per 1000 persons, with the highest incidence in prime-aged workers (aged 25–64 years) [2]. It is the first cause of work loss and
Address for correspondence: Willemijn M.J. van Rooij, AHORSE Department Orthopaedic Surgery and Traumatology, Atrium Medical Centre Heerlen, Henri Dunanstraat 5, 6419 PC Heerlen, The Netherlands. Tel: +31 455766416. E-mail: [email protected]
absenteeism [3]. This highlights the high socio-economic impact of LBP. LBP causes restrictions in physical functioning which may affect the quality of life of individuals [2,4–6]. Physical functioning is a multi dimensional construct covering various aspects of health such as perceived physical functioning, actual physical activity and functional capacity to perform activities [7–9]. Until now, the assessment of physical functioning in LBP patients has mainly been limited to perceived physical functioning, which is based on clinical scoring systems such as the Oswestry Low Back Pain Disability Questionnaire (OLBPDQ). Questionnaires are popular and widely accepted in clinical practice as they are easy, non-invasive, relatively fast, cheap and therefore practical for clinical use. However, they evaluate only the perception-based physical functioning, which is dominated by pain, suffers a ceiling effect and is
Disability and Rehabilitation
2
W. M. J. van Rooij et al.
subject to bias [10,11]. In the current clinical practice, the functional capacity and actual physical activity are not regularly evaluated in LBP patients. Nowadays, functional capacity can objectively be assessed by inertia sensor-based motion analysis (IMA). In contrast to the complex laboratory-based motion analysis systems which is the golden standard for measuring function, IMA is ambulant, easy and fast to use, low cost and not depending on laboratory settings. The validity, reliability and suitability of IMA has been shown in different patients groups such as patients with end stage knee osteoarthritis and patients having knee arthroplasty [12–14]. However, IMA has never been used in LBP patients. The physical activity can be assessed by accelerometer-based activity monitoring (AM), more precisely than the popular used pedometers, which are limited to step counting only and therefore do not reflect the actual physical activity which comprises more than just walking. The advances in sensor technology resulted in small ambulant sensors having a long battery life and a large storage capacity (up to 7 days) which allows to monitor subjects for extended periods of time in daily life with minimal convenience to the patient. AM has become increasingly popular during the last years to objectively quantify activity levels providing insight into activity events, more specifically the type, duration, frequency and intensity of activities that subjects perform in daily life. AM has been validated and applied in several patients groups like stroke patients, patients with intermittent claudication [15], elderly subjects and orthopedic knee patients [16,17]. However, to our knowledge, physical functioning of LBP patients has never been evaluated using accelerometer-based activity monitoring. This study evaluated the three aspects of physical functioning, including perceived physical functioning, functional capacity and actual physical activity in patients with LBP. More specifically, physical functioning of LBP patients was compared to that of healthy subjects, changes in physical functioning of LBP patients due to treatment were examined and correlations between the three aspects of physical functioning were investigated.
Methods Subjects A group of 26 patients with chronic LBP (43.6 ± 13.2 years, 15
ISSN: 0963-8288 (Print) 1464-5165 (Online) Journal homepage: http://www.tandfonline.com/loi/idre20
Physical functioning of low back pain patients: perceived physical functioning and functional capacity, but not physical activity is affected Willemijn M.J. van Rooij, Rachel Senden, Ide C. Heyligers, Paul M. A. H. Cuppen, Wouter L. W. van Hemert & Bernd Grimm To cite this article: Willemijn M.J. van Rooij, Rachel Senden, Ide C. Heyligers, Paul M. A. H. Cuppen, Wouter L. W. van Hemert & Bernd Grimm (2015): Physical functioning of low back pain patients: perceived physical functioning and functional capacity, but not physical activity is affected, Disability and Rehabilitation To link to this article: http://dx.doi.org/10.3109/09638288.2015.1019010
Published online: 04 Mar 2015.
Submit your article to this journal
Article views: 56
View related articles
View Crossmark data
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=idre20 Download by: [University of Lethbridge]
Date: 06 October 2015, At: 04:10
http://informahealthcare.com/dre ISSN 0963-8288 print/ISSN 1464-5165 online Disabil Rehabil, Early Online: 1–7 ! 2015 Informa UK Ltd. DOI: 10.3109/09638288.2015.1019010
RESEARCH PAPER
Physical functioning of low back pain patients: perceived physical functioning and functional capacity, but not physical activity is affected Willemijn M.J. van Rooij1, Rachel Senden1, Ide C. Heyligers1, Paul M. A. H. Cuppen2, Wouter L. W. van Hemert1, and Bernd Grimm1 AHORSE Department of Orthopaedic Surgery and Traumatology, Atrium Medical Centre Heerlen, The Netherlands and 2Cheiron Medical Centre Waalre, Waalre, The Netherlands
Disability and Rehabilitation
1
Abstract
Keywords
Purpose: Physical functioning is a multidimensional construct covering perceived functioning, functional capacity and actual physical activity. Currently, the assessment of physical functioning in low back pain (LBP) patients has been limited to only one or two of these aspects. This study evaluates physical functioning of LBP patients by assessing the three individual aspects using questionnaires and ambulant sensor-based measurements. Methods: Actual physical activity, functional capacity and perceived functioning were measured in 26 patients undergoing patient specific treatment before, direct and 3–4 weeks after the first treatment using, respectively, sensor-based activity monitoring, sensor-based motion analysis test and the Oswestry questionnaire. Patients were compared to a healthy control group. Results: Perceived functioning and functional capacity, but not actual physical activity is impaired in pre-treatment LBP patients. After treatment, patients improved in perceived physical functioning and functional capacity approaching healthy levels, however only slight (p40.05) improvements in actual physical activity were found. Moreover, only few and weak correlations were found between the different aspects of physical functioning. Conclusion: Perceived functioning, actual physical activity and functional capacity are three independent outcome dimensions, being complementary but not redundant. Especially, perceived functioning and physical capacity need attention when evaluating LBP patients during rehabilitation.
Actual physical activity, functional capacity, low back pain, perceived function, physical functioning History Received 27 July 2014 Revised 8 February 2015 Accepted 10 February 2015 Published online 4 March 2015
ä Implications for Rehabilitation
Perceived physical functioning and physical capacity are negatively affected by low back pain and improve after treatment. Low back pain patients perform their daily activity independent of pain and complaints. Inertia sensor-based motion analysis can objectify treatment effects showing low back pain patients their progress in rehabilitation. New interventions can be justified with inertia sensor technology in low back pain patients.
Introduction Low back pain (LBP) is a major health problem. The 2010 Global Burden of Disease Study estimated that LBP is among the top 10 diseases and injuries that account for the highest number of disability-adjusted life-years worldwide [1]. About 4–33% of the population suffers LBP, and its lifetime prevalence is 58–84%. Its annual incidence has been estimated in 28 episodes per 1000 persons, with the highest incidence in prime-aged workers (aged 25–64 years) [2]. It is the first cause of work loss and
Address for correspondence: Willemijn M.J. van Rooij, AHORSE Department Orthopaedic Surgery and Traumatology, Atrium Medical Centre Heerlen, Henri Dunanstraat 5, 6419 PC Heerlen, The Netherlands. Tel: +31 455766416. E-mail: [email protected]
absenteeism [3]. This highlights the high socio-economic impact of LBP. LBP causes restrictions in physical functioning which may affect the quality of life of individuals [2,4–6]. Physical functioning is a multi dimensional construct covering various aspects of health such as perceived physical functioning, actual physical activity and functional capacity to perform activities [7–9]. Until now, the assessment of physical functioning in LBP patients has mainly been limited to perceived physical functioning, which is based on clinical scoring systems such as the Oswestry Low Back Pain Disability Questionnaire (OLBPDQ). Questionnaires are popular and widely accepted in clinical practice as they are easy, non-invasive, relatively fast, cheap and therefore practical for clinical use. However, they evaluate only the perception-based physical functioning, which is dominated by pain, suffers a ceiling effect and is
Disability and Rehabilitation
2
W. M. J. van Rooij et al.
subject to bias [10,11]. In the current clinical practice, the functional capacity and actual physical activity are not regularly evaluated in LBP patients. Nowadays, functional capacity can objectively be assessed by inertia sensor-based motion analysis (IMA). In contrast to the complex laboratory-based motion analysis systems which is the golden standard for measuring function, IMA is ambulant, easy and fast to use, low cost and not depending on laboratory settings. The validity, reliability and suitability of IMA has been shown in different patients groups such as patients with end stage knee osteoarthritis and patients having knee arthroplasty [12–14]. However, IMA has never been used in LBP patients. The physical activity can be assessed by accelerometer-based activity monitoring (AM), more precisely than the popular used pedometers, which are limited to step counting only and therefore do not reflect the actual physical activity which comprises more than just walking. The advances in sensor technology resulted in small ambulant sensors having a long battery life and a large storage capacity (up to 7 days) which allows to monitor subjects for extended periods of time in daily life with minimal convenience to the patient. AM has become increasingly popular during the last years to objectively quantify activity levels providing insight into activity events, more specifically the type, duration, frequency and intensity of activities that subjects perform in daily life. AM has been validated and applied in several patients groups like stroke patients, patients with intermittent claudication [15], elderly subjects and orthopedic knee patients [16,17]. However, to our knowledge, physical functioning of LBP patients has never been evaluated using accelerometer-based activity monitoring. This study evaluated the three aspects of physical functioning, including perceived physical functioning, functional capacity and actual physical activity in patients with LBP. More specifically, physical functioning of LBP patients was compared to that of healthy subjects, changes in physical functioning of LBP patients due to treatment were examined and correlations between the three aspects of physical functioning were investigated.
Methods Subjects A group of 26 patients with chronic LBP (43.6 ± 13.2 years, 15
