A case-series exploring real-world postural behaviour change following physiotherapy for low back pain
Frederick A McClintock1, Andrew J Callaway1, Carol J Clark1
1Department of Rehabilitation and Sport Sciences, Bournemouth University, Bournemouth, UK.
Background:
Clinical assessment of low back pain provides limited information on posture and movement behaviour during daily life. Wearable sensors can quantify free-living lumbar kinematics. This case series explored whether real-world lumbar posture differed between a day recorded before and two weeks after a personalised physiotherapy session, and what behaviour preceded naturally occurring pain on each day.
Methods:
Five individuals with chronic, movement-evoked back pain were recruited. Lumbar posture was recorded with wearable sensors during a full day before and two weeks after a physiotherapy assessment and individualised postural advice, delivered by a physiotherapist blinded to sensor data, with pain events recorded in a diary. Within each participant, posture distributions were compared between days using the Wasserstein distance with block permutation tests, and time towards end-range flexion in the 5-15 min before pain was compared with random pain-free periods from the same day.
Findings:
Whole-day posture differed between days in three participants, alongside marked differences in activity. Time towards end-range flexion changed in the direction of the postural advice in four of five participants. Pain was preceded by more time towards end-range flexion in three participants, matching the clinical assessment in two. Pain events fell in four participants, and all five reported reduced disability.
Interpretation:
In this small case series, wearable sensors captured individual differences in real-world postural behaviour and in the behaviour preceding pain, which did not always match the clinical assessment. Without repeated baseline measurements, differences cannot be attributed to the intervention, and the findings are hypothesis-generating.