Locomotion Strategies of Low Back Pain Patients in a Dynamic Environment

Collision Avoidance Behavior Between Walkers: Locomotion Strategies of Patients With Chronic Non-Specific Low Back Pain

The biomechanical parameters studied in non-specific chronic low back pain patients in a locomotion task have so far focused on straight line walking. Although locomotion is primarily an automated action composed of repetitive patterns allowing movement from one place to another, walkers must respond to the environmental demands.These modifications show a flexible and adaptive approach to the constraints of the environment. In this study, the investigators are particularly interested in a task of crossing between two pedestrians, which is a standardised task that has shown its interest in the study of perceptual-motor co-ordination. In particular, it allows to study the mutual adaptation of speed and orientation between the two walkers.

Study Overview

• Status: Recruiting
• Conditions: Chronic Low-back Pain; Walking
• Intervention / Treatment: Behavioral: Quantified analysis of walking during a crossing task between two walkers

• Study Type: Observational
• Enrollment (Anticipated): 36

Contacts and Locations

• Study Contact: Name: Agathe Bilhaut, PhD student; Phone Number: +33 (0) 632030985; Email: agathe.bilhaut@univ-rennes2.fr
• Study Contact Backup: Name: Anne-Hélène Olivier, PhD; Email: anne-helene.olivier@univ-rennes2.fr

Study Locations

• France
  • Rennes, France, 35000
    • Recruiting
    • University of Rennes 2
    • Contact: Agathe Bilhaut, PhD student; Phone Number: +33 (0) 632030985; Email: agathe.bilhaut@univ-rennes2.fr
    • Contact: Anne-Hélène Olivier, PhD; Email: anne-helene.olivier@univ-rennes2.fr
    • Sub-Investigator: Mathieu Ménard, PhD
    • Sub-Investigator: Armel Crétual, PhD
    • Principal Investigator: Olivier Roze, MD
    • Sub-Investigator: Phillipe Carson Jouzel, MD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

• Sampling Method: Non-Probability Sample

Study Population

Patients with non-specific low back pain are recruited as part of their medical follow-up in a medical centre in France.

Description

Inclusion Criteria Non Specific Chronic Low Back Pain patients:

• Participants must have pain located between the thoracolumbar hinge and the lower gluteal fold, with or without pain in either leg.
• This pain must have been present for more than 12 weeks, on a daily or almost daily basis (at least 4 days out of 7)
• Participants must not be on any treatment or have been on stable analgesic treatment for at least 2 weeks prior to inclusion
• Participants must speak, read and understand French
• Participants must be between 18 and 65 years of age
• Participants must be able to understand simple commands and experimental instructions
• Participants must have normal or corrected vision
• Participants must have given informed consent to participate in the study
• Participants must be enrolled in or receiving social security benefits

Exclusion Criteria Non Specific Chronic Low Back Pain patients:

• Participants must not be pregnant or nursing mothers.
• Participants must not have cognitive or psychological impairments that are incompatible with compliance and/or understanding of the protocol
• Participants must not be unable to understand informed consent, or be under guardianship or conservatorship Subjects must not already be participating in another research protocol involving the human subject or in parallel
• Participants must not be persons deprived of liberty by judicial or administrative decision
• Participants must not be under psychiatric care
• The participants must not present neurological signs evoking a neurodegenerative disease responsible for walking disorders (parkinsonian syndrome, ...)
• The participants must not present warning signs (red flags) pointing to an underlying pathology requiring specific and/or urgent care such as
• Ongoing litigation following a work-related accident
• Pain related to a cancer diagnosis
• Associated spinal cord symptoms (pyramidal signs, coordination disorders, motor or sensory deficits, sphincter disorders, etc.)
• Pain following an infection (night sweats, fever, chills, intravenous drug abuse, immunodeficiency, recent surgery, urinary or skin infection, etc.)
• Recent or pathological fractures (traffic accidents, history of osteoporosis, chronic use of corticosteroids, advanced age, unexplained weight loss, fatigue, history of cancer, etc. )
• Vascular problems (cold feet, decreased peripheral arterial pulse, etc.)

Inclusion and Exclusion Criteria of control group :

Participants strictly meet the same inclusion and non-inclusion criteria as NSCLBP patients, but must not have ongoing chronic pain or a history of significant chronic pain (≥ 4/10 for at least 6 months). They are matched for age and gender. They must not have any pathologies that affect walking or posture. These individuals must be able to perform the studied movements without the appearance of discomfort or exaggerated fatigue.

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Non-Specific Low Back Pain patients; Participants must have pain located between the thoracolumbar hinge and the lower gluteal fold, with or without pain in either leg, present for more than 12 weeks, on a daily or almost daily basis (at least 4 days out of 7).	Behavioral: Quantified analysis of walking during a crossing task between two walkers; Functional test that reproduce a task of daily living.
Control group; Participant with no current or past chronic pain	Behavioral: Quantified analysis of walking during a crossing task between two walkers; Functional test that reproduce a task of daily living.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Threshold for motion adaptation	Thresholds of adaptation to movement will be identified by comparing the minimum crossing distance and the minimum predicted distance of crossing at the time the walkers first see each other.	Clinical assessment at base line

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Walking speed	Analysis of the walking speed of each walker for the control tests, i.e. where the walker has not encountered another walker.	Clinical assessment at base line
Inversion of crossing order	mpd(t) was assigned according to the final crossing order between two walkers in such a way that allowed for a positive mpd (tcross). In doing so, a positive mpd(tsee) suggests that crossing order was preserved along the entire interaction. Alternatively, a negative mpd (tsee) is the result of an inversion in crossing order between the two walkers.	Clinical assessment at base line
Contribution to collision avoidance	During the interaction period, a cumulative contribution must be made by both walkers to avoid a collision. Analysis of the contribution of each walker (speed and orientation).	Clinical assessment at base line
Minimum Predicted Distance	Minimum Predicted Distance (mpd) represents the theoretical crossing distance between the future positions of the participants, based on a linear extrapolation of their trajectory given their current position and speed at time (t). Any variation in mpd(t) indicates that a movement adaptation to avoid a collision has taken place between two walkers.	Clinical assessment at base line

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Temporal aspects of pain	Assessment of the impact of the variability of pain over time, i.e. the duration of painful episodes (in number of months).	Clinical assessment at base line
Pain intensity	Pain intensity reflects the overall magnitude of the patient's perceived pain experience. The investigators will assess this variable using a visual analogue scale (VAS) in paper format. The VAS is represented by a 100 mm long horizontal line with descriptors at both ends: on the left "no pain" and on the right "worst pain imaginable". The patient must then draw a mark on the line corresponding to his or her pain experience. "0" corresponds to "no pain" and "10" corresponds to "worst pain imaginable".	Clinical assessment at base line
Levels of anxiety and depression	Anxiety refers to fear, extreme worrying and hyperarousal symptoms. Depression refers to negative mood, loss of self-confidence, loss of motivation and pleasure. The investigators will use these measures using the Hospital Anxiety Depression Scale (HADS). This tool consists of 14 items scored from 0 to 3. Seven questions relate to anxiety (Total A) and 7 questions to the depressive dimension (Total D), resulting in two scores with a maximum total of 21 each. The higher the score, the more anxiety or depression the person has.	Clinical assessment at base line
Pain Catastrophizing	Catastrophizing refers to the cognitive process in which anxious patients dwell on the most negative consequences and refers here to the interpretation of pain as extremely threatening. The investigators will use the Pain Catastrophizing Scale (PCS) to assess three dimensions: rumination, amplification and helplessness. This scale consists of 13 items scored from 0 (not at all) to 4 (all the time) with a maximum score of 52. The higher the score, the greater the level of catastrophisation.	Clinical assessment at base line
Kinesiophobia	Fear of movement is characterized by pain-related fears and anxieties that often result in avoidance of movement that could cause or worsen an injury. The investigators will use the Tampa Scale Kinesiophobia (TSK). This scale consists of 17 items rated from 1 (strongly disagree) to 4 (strongly agree) with a maximum score of 68. The higher the score, the greater the level of kinesiophobia.	Clinical assessment at base line
Psychological Inflexibility in Pain	Psychological flexibility measures psychological functioning in phase (in fusion) with the pain or whether the patient has certain degrees of freedom from it. The investigators will use the Psychological Inflexibility in Pain Scale (PIPS) allowing to assess two factors: avoidance and cognitive fusion. This scale consists of 16 items with a scale of 1 (never true) to 7 (always true). The higher the score, the greater the level of psychological inflexibility.	Clinical assessment at base line
Fear Avoidance Beliefs	Fear and avoidance beliefs reflect patients' pain avoidance behaviors. The investigators will use the Fear Avoidance Beliefs Questionnaire (FABQ) to assess two subscales: beliefs about work and beliefs about physical activity. The questionnaire consists of 16 items scored from 0 (absolutely disagree with the sentence) to 6 (completely agree with the sentence). The maximum score for beliefs about work is 42 and the maximum score for beliefs about physical activity is 24. The higher the score, the greater the level of beliefs.	Clinical assessment at base line
Physical functioning	Physical functioning refers to the impact on the patient's ability to perform daily physical activities necessary to meet basic needs, ranging from self-care to more complex activities that require a combination of skills. The investigators will use the Roland Morris Disability Questionnaire (RMDQ). This questionnaire has 24 items with a maximum score of 24. The higher the score, the more functional disabilities the person has.	Clinical assessment at base line
Quality of life assessment	Quality of life refers to the impact on the physical, psychological, and social domains of health, considered as distinct domains that are influenced by a person's experiences, beliefs, expectations, and perceptions. The investigators will use the EuroQol 5 Dimension questionnaire (EQ-5D) allowing for the assessment of five dimensions: mobility, ability to care for oneself, usual work, home, and leisure activities, pain/discomfort, anxiety, and depression. Five degrees of severity in ascending order are used to assess each dimension: "no problems" to "total disability" for items that assess ability, and "no problem" to "extreme" for the other items. The higher the score, the lower the level of quality of life.	Clinical assessment at base line

Collaborators and Investigators

• Sponsor: University of Rennes 2
• Investigators: Principal Investigator: Olivier Roze, Clinique de la Sagesse, Rennes, France

Study record dates

Study Major Dates

• Study Start (Actual): March 1, 2023
• Primary Completion (Anticipated): May 1, 2024
• Study Completion (Anticipated): May 1, 2024

Study Registration Dates

• First Submitted: April 28, 2023
• First Submitted That Met QC Criteria: April 28, 2023
• First Posted (Actual): May 9, 2023

Study Record Updates

• Last Update Posted (Estimate): May 11, 2023
• Last Update Submitted That Met QC Criteria: May 9, 2023
• Last Verified: May 1, 2023

More Information

Terms related to this study

• Keywords: Humans; Low Back Pain; Adult; Psychomotor Performance / physiology; Walking / physiology*; Motion Perception / physiology*
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Back Pain; Low Back Pain
• Other Study ID Numbers: PERL2

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No