Ippersiel Patrick, Côté-Picard Claudia, Roy Jean-Sébastien, Massé-Alarie Hugo
School of Physical and Occupational Therapy, McGill University, Quebec, Canada.
School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, University of Montreal, Quebec, Canada.
Eur J Pain. 2025 Apr;29(4):e70006. doi: 10.1002/ejp.70006.
Clustering helps identify patient subgroups with similar biopsychosocial profiles in acute low-back pain (LBP). Motor factors are common treatment targets and are associated with disability but have not been included in acute LBP cluster development. This study aimed to identify subgroups of individuals with acute LBP based on motor, sensory and psychological characteristics and to compare these subgroups regarding clinical outcomes.
Ninety-nine participants with acute LBP were recruited, and motor (bending range of motion [ROM], flexion relaxation), pain sensitivity (pressure-pain thresholds, temporal summation of pain) and psychological factors (pain catastrophising, kinesiophobia, self-efficacy) were measured, along with pain, disability and demographics.
Principal component analysis accounted for 66.03% of the variance. Four component scores were entered in a hierarchical linear clustering model, deriving 3 subgroups ('mild features' n = 39, 'sensorimotor' n = 35 and 'psychomotor' n = 25). Between-cluster comparisons revealed significant differences in motor, sensory and psychological variables (p < 0.05). Sensorimotor and psychomotor clusters had higher flexion-relaxation ratios (mean difference: > 0.2), greater disability (mean difference: > 7/100) and smaller ROM (mean difference: 7 cm) compared to the 'mild' group. The sensorimotor cluster mostly exhibited higher temporal summation of pain (mean difference: > 1.3/10) and lower pressure-pain thresholds (mean difference: > 1.2 kg/cm) than 'mild' and psychomotor clusters. The psychomotor cluster showed higher kinesiophobia (mean difference: > 6/44) and pain catastrophising (mean difference: > 12/52) than 'mild' and sensorimotor groups.
Findings indicate 3 subgroups, suggesting that motor factors may add granularity to acute LBP clusters. Stratified care based on these subgroups may help refine treatment pathways for acute LBP.
Including motor factors in cluster development adds a clinically relevant metric to describe people with acute LBP and generates insight into underlying mechanisms of motor adaptation. Longitudinal testing is required to see if these subgroups are differentially related to short- and long-term pain and disability.
聚类分析有助于识别急性下腰痛（LBP）中具有相似生物心理社会特征的患者亚组。运动因素是常见的治疗靶点，且与残疾相关，但尚未纳入急性LBP聚类分析。本研究旨在基于运动、感觉和心理特征识别急性LBP患者的亚组，并比较这些亚组的临床结局。
招募了99名急性LBP患者，测量了运动（弯腰活动范围[ROM]、屈曲放松）、疼痛敏感性（压痛阈值、疼痛时间总和）和心理因素（疼痛灾难化、运动恐惧、自我效能），以及疼痛、残疾情况和人口统计学数据。
主成分分析解释了66.03%的方差。将四个成分得分输入分层线性聚类模型，得出3个亚组（“轻度特征”n = 39、“感觉运动型”n = 35和“心理运动型”n = 25）。聚类间比较显示运动、感觉和心理变量存在显著差异（p < 0.05）。与“轻度”组相比，感觉运动型和心理运动型聚类的屈曲放松比值更高（平均差异：> 0.2），残疾程度更高（平均差异：> 7/100），ROM更小（平均差异：7厘米）。感觉运动型聚类大多表现出比“轻度”和心理运动型聚类更高的疼痛时间总和（平均差异：> 1.3/10）和更低的压痛阈值（平均差异：> 1.2千克/平方厘米）。心理运动型聚类比“轻度”和感觉运动型组表现出更高的运动恐惧（平均差异：> 6/44）和疼痛灾难化（平均差异：> 12/52）。
研究结果表明存在3个亚组，提示运动因素可能为急性LBP聚类增加粒度。基于这些亚组的分层护理可能有助于优化急性LBP的治疗途径。
在聚类分析中纳入运动因素增加了一个临床相关指标来描述急性LBP患者，并深入了解运动适应的潜在机制。需要进行纵向测试以确定这些亚组是否与短期和长期疼痛及残疾存在不同的关联。
