Muscle reflex classification of low-back pain

It has been well documented that low-back pain (LBP) patients have longer muscle response latencies to perturbation than healthy controls. These muscle responses appear to be reflexive and not voluntary in nature, and as a result, might be useful for objectively classifying LBP. The goal of the study was to develop an objective and accurate method for classifying LBP using a sudden load-release protocol. Subjects were divided into two groups: learning group (20 patients and 20 controls), and holdout group (15 patients and 12 controls). Subjects exerted isometric trunk force against a cable in four different directions. Following cable release, the trunk was suddenly displaced eliciting a muscle reflex response. Reflex latencies for muscles switching-on and shutting-off were determined using electromyogram signals from 8 trunk muscles. Independent t tests were performed on the learning group to determine which reflex parameters were to be entered into logistic regression analysis to produce a classification model. The holdout group was used to validate this classification model. The three-parameter model was able to correctly classify 83% of the learning group, and 81% of the holdout group. Using reflex parameters appears to be an accurate and objective method for classifying LBP.