Nishi Yuki, Shigetoh Hayato, Fujii Ren, Osumi Michihiro, Morioka Shu
Department of Neurorehabilitation, Graduate School of Health Science, Kio University, Nara, Japan.
Department of Rehabilitation Medicine, Nishiyamato Rehabilitation Hospital, Nara, Japan.
J Pain Res. 2021 Jun 10;14:1675-1686. doi: 10.2147/JPR.S310775. eCollection 2021.
Individuals with chronic low back pain (CLBP) experience changes in gait control due to pain and/or fear. Although CLBP patients' gait has been performed in laboratory environments, changes in gait control as an adaptation to unstructured daily living environments may be more pronounced than the corresponding changes in laboratory environments. We investigated the impacts of the environment and pathology on the trunk variability and stability of gait in CLBP patients.
CLBP patients (n=20) and healthy controls with no low-back pain history (n=20) were tasked with walking in a laboratory or daily-living environment while wearing an accelerometer on the low back. We calculated the stride-to-stride standard deviation and multiscale sample entropy as indices of "gait variability" and the maximum Lyapunov exponent as an index of "gait stability" in both the anterior-posterior and medial-lateral directions. The participants were assessed on the numerical rating scale for pain intensity, the Tampa Scale for Kinesiophobia, and the Roland-Morris Disability Questionnaire for quality of life (QOL).
In a repeated-measures ANOVA, the standard deviation was affected by environment in the anterior-posterior direction and by group and environment in the medial-lateral direction. Multiscale sample entropy showed no effect in the anterior-posterior direction and showed both effects in the medial-lateral direction. Maximum Lyapunov exponents showed both effects in the anterior-posterior direction, but none in the medial-lateral direction. These changes of trunk motor control by CLBP patients were found to be related to pain intensity, fear of movement, and/or QOL in the daily-living environment but not in the laboratory environment.
These results revealed that CLBP patients exhibit changes in trunk variability and stability of gait depending on the environment, and they demonstrated that these changes are related to pain, fear, and QOL. We propose useful accelerometer-based assessments of qualitative gait in CLBP patients' daily lives, as it would provide information not available in a general practice setting.
慢性下腰痛（CLBP）患者由于疼痛和/或恐惧会出现步态控制的改变。尽管CLBP患者的步态已在实验室环境中进行研究，但作为对非结构化日常生活环境适应的步态控制变化可能比实验室环境中的相应变化更为显著。我们研究了环境和病理状况对CLBP患者步态中躯干变异性和稳定性的影响。
CLBP患者（n = 20）和无下腰痛病史的健康对照者（n = 20）被要求在实验室或日常生活环境中行走，同时在腰部佩戴加速度计。我们计算了步幅间标准差和多尺度样本熵作为“步态变异性”指标，以及最大Lyapunov指数作为前后和内外侧方向上“步态稳定性”指标。参与者接受疼痛强度数字评定量表、运动恐惧坦帕量表以及罗兰-莫里斯残疾问卷的生活质量（QOL）评估。
在重复测量方差分析中，标准差在前后方向受环境影响，在内外侧方向受组和环境影响。多尺度样本熵在前后方向无影响，在内外侧方向有两种影响。最大Lyapunov指数在前后方向有两种影响，但在内外侧方向无影响。发现CLBP患者这些躯干运动控制的变化与日常生活环境中的疼痛强度、运动恐惧和/或生活质量有关，而与实验室环境无关。
这些结果表明，CLBP患者的躯干变异性和步态稳定性会根据环境而变化，并且表明这些变化与疼痛、恐惧和生活质量有关。我们提出基于加速度计的CLBP患者日常生活中定性步态评估是有用的，因为它将提供一般临床环境中无法获得的信息。
