University of Groningen, University Medical Center Groningen, Department of Human Movement Sciences, Groningen, Netherlands.
University of Groningen, University Medical Center Groningen, Center for Rehabilitation, Groningen, the Netherlands.
Comput Biol Med. 2022 May;144:105329. doi: 10.1016/j.compbiomed.2022.105329. Epub 2022 Feb 16.
Central sensitization (CS) is often present in patients with chronic low back pain (CLBP). Gait impairments due to CLBP have been extensively reported; however, the association between CS and gait is unknown. The present study examined the association between CS and CLBP on gait during activities of daily living.
Forty-two patients with CLBP were included. CS was assessed through the Central Sensitization Inventory (CSI), and patients were divided in a low and high CS group (23 CLBP- and 19 CLBP+, respectively). Patients wore a tri-axial accelerometer device for one week. From the acceleration signals, gait cycles were extracted and 36 gait outcomes representing quantitative and qualitative characteristics of gait were calculated. A Random Forest was trained to classify CLBP- and CLBP + based on the gait outcomes. The maximum Youden index was computed to measure the diagnostic test's ability and SHapley Additive exPlanations (SHAP) indexed the gait outcomes' importance to the classification model.
The Random Forest accurately (84.4%) classified the CLBP- and CLBP+. Youden index was 0.65, and SHAP revealed that the gait outcomes' important to the classification model were related to gait smoothness, stride frequency variability, stride length variability, stride regularity, predictability, and stability.
CLBP- and CLBP + patients had different motor control strategies. Patients in the CLBP- group presented with a more "loose control", with higher gait smoothness and stability, while CLBP + patients presented with a "tight control", with a more regular, less variable, and more predictable gait pattern.
中枢敏化（CS）常存在于慢性下背痛（CLBP）患者中。CLBP 导致的步态障碍已有广泛报道；然而，CS 与步态之间的关系尚不清楚。本研究旨在探讨 CS 与 CLBP 患者日常活动中的步态之间的关系。
共纳入 42 例 CLBP 患者。通过中枢敏化量表（CSI）评估 CS，将患者分为低 CS 组和高 CS 组（分别为 23 例 CLBP-和 19 例 CLBP+）。患者佩戴三轴加速度计一周。从加速度信号中提取步态周期，并计算 36 项代表步态定量和定性特征的步态指标。随机森林模型用于基于步态指标对 CLBP-和 CLBP+进行分类。计算最大 Youden 指数以衡量诊断测试的能力，Shapley 加法解释（SHAP）索引步态指标对分类模型的重要性。
随机森林模型能准确（84.4%）对 CLBP-和 CLBP+进行分类。Youden 指数为 0.65，SHAP 揭示了对分类模型重要的步态指标与步态平滑度、步频变异性、步长变异性、步长规律性、可预测性和稳定性有关。
CLBP-和 CLBP+患者具有不同的运动控制策略。CLBP-组患者表现出更“宽松的控制”，具有更高的步态平滑度和稳定性，而 CLBP+患者表现出更“紧张的控制”，具有更规则、变异性更小、更可预测的步态模式。
