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Empirically derived back pain subgroups differentiated walking performance, pain, and disability.

Katie A Butera1, Emily J Fox2,3, Mark D Bishop2

  • 1Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, United States.

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Summary

Low back pain (LBP) subgroups were identified, with a "Maladaptive" group showing poorer walking ability and higher disability compared to an "Adaptive" group. This highlights distinct LBP profiles impacting daily function.

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Area of Science:

  • Biomedical engineering
  • Rehabilitation science
  • Pain research

Background:

  • Low back pain (LBP) is a primary cause of disability globally.
  • The specific factors contributing to LBP-related disability remain incompletely understood.
  • Identifying distinct LBP subgroups is crucial for targeted interventions.

Purpose of the Study:

  • To empirically derive and validate subgroups of individuals with LBP.
  • To assess sensory, psychological, and motor characteristics within these subgroups.
  • To evaluate the relationship between identified subgroups and functional outcomes.

Main Methods:

  • Seventy adults with LBP were assessed for sensory (temporal summation, conditioned pain modulation), psychological (affect, coping), and motor (trunk muscle activation) measures.
  • Hierarchical cluster analysis was employed to identify distinct LBP subgroups.
  • Subgroups were validated using measures of walking performance and clinical pain/disability indicators.

Main Results:

  • Two distinct LBP subgroups emerged: "Maladaptive" (n=21) and "Adaptive" (n=49).
  • The "Maladaptive" subgroup exhibited lower positive affect/coping, higher negative coping, reduced pain modulation, and atypical trunk muscle activation.
  • Significant differences were observed in walking performance and clinical outcomes, with the "Maladaptive" group demonstrating worse function and higher disability.

Conclusions:

  • The findings support the construct validity of a multidimensional approach to LBP subgrouping.
  • The identified "Maladaptive" subgroup presents with poorer functional capacity and greater disability.
  • Further longitudinal research is warranted to ascertain if the "Maladaptive" subgroup predicts long-term adverse outcomes like chronic pain or persistent disability.