Giesche Florian, Krause Frieder, Niederer Daniel, Wilke Jan, Engeroff Tobias, Vogt Lutz, Banzer Winfried
J Back Musculoskelet Rehabil. 2019;32(2):345-353. doi: 10.3233/BMR-181203.
Low back pain patients have been suggested to exhibit dysfunctional spinal movement patterns. However, there is a lack of clinically applicable but valid and reliable assessment tools, helping to discriminate normal and pathologically altered movement.
We aimed to examine whether kinematic parameters determined with an ultrasound-based motion analysis and thereof derived chromokinegraphical angle-time matrices (CATMAs) are able to discriminate between non-symptomatic and symptomatic movement behaviour in individuals with non-specific chronic (CLBP), specific low back pain (SLBP), and controls.
Thoracic and lumbar spine range of motion (ROM [∘]); angular velocity (V [∘/sec]) and side-to-side differences [%] during a lateral flexion movement were assessed in 17 healthy participants, 16 individuals with CLBP and 11 SLBP patients. CATMAs ratings of two investigators (6-item Likert scale) were dichotomised, classifying the observed movement as physiological or non-physiological. Intrarater and interrater reliability were estimated using kappa statistics and Cronbach's Alpha. T-tests and a ROC analysis to determine optimal cut-offs for the separation of the collectives as well as contingency tables for selectivity of the cut-offs (motor outcomes) were calculated.
CATMA ratings displayed partly moderate to good (rater B; i.e. CLBP vs. controls) and partly insufficient discriminant validity (rater A). Due to this, inter-rater reliability was poor (k= 0.061 to 0.135), while intra-rater-reliability was moderate to good for both raters (k= 0.329 to 0.625) except for SLBP vs. controls (rater A; k=-0.18). Regarding kinematics, group differences occurred neither in ROM nor in V (p> 0.05), but in terms of the relative side comparison between CLBP and controls (p<0.05). ROC analysis (CLBP vs. controls) revealed an optimal cut-off at side asymmetries of 16.9% (ROM) and 28.9% (V). Between SLBP patients and controls, no significant differences were observed neither in terms of the absolute values nor the relative side differences of both kinematic variables.
Side asymmetries of V and ROM may be used to differentiate between controls and individuals with CLBP. CATMAs appear to be of limited diagnostic value for the identification of pathological spine movement.
有研究表明，下背痛患者存在脊柱运动模式功能障碍。然而，目前缺乏临床适用且有效可靠的评估工具来区分正常和病理改变的运动。
我们旨在研究基于超声的运动分析所确定的运动学参数及其衍生的色动图角度-时间矩阵（CATMA）能否区分非特异性慢性下背痛（CLBP）、特异性下背痛（SLBP）患者及对照组个体的无症状和有症状运动行为。
对17名健康参与者、16名CLBP患者和11名SLBP患者进行胸腰椎活动度（ROM [°]）、角速度（V [°/秒]）以及侧屈运动时左右差异 [%] 的评估。两名研究者对CATMA进行评分（6项李克特量表），并将观察到的运动分为生理性或非生理性。使用kappa统计量和克朗巴哈系数估计评分者内和评分者间的可靠性。计算t检验和ROC分析以确定区分各组的最佳临界值，以及临界值（运动结果）的选择性列联表。
CATMA评分部分显示出中度到良好的判别效度（评分者B；即CLBP与对照组比较），部分显示出判别效度不足（评分者A）。因此，评分者间可靠性较差（k = 0.061至0.135），而评分者内可靠性对于两位评分者来说除了SLBP与对照组比较（评分者A；k = -0.18）外均为中度到良好（k = 0.329至0.625）。关于运动学，各组在ROM和V方面均未出现差异（p > 0.05），但在CLBP与对照组的相对侧比较方面存在差异（p < 0.05）。ROC分析（CLBP与对照组比较）显示，ROM侧不对称性为16.9%、V侧不对称性为28.9%时为最佳临界值。在SLBP患者与对照组之间，无论是运动学变量的绝对值还是相对侧差异均未观察到显著差异。
V和ROM的侧不对称性可用于区分对照组与CLBP个体。CATMA对于识别病理性脊柱运动的诊断价值似乎有限。
