Deep Core Muscles and Biopsychosocial in Asymptomatic Adults and NSCLBP

Assessment of Deep Core Muscles, Postural Analysis, Functional and Mental Performance in Different Age Group of Asymptomatic Participants and Patients With Non-specific Low Back Pain

The goal of this observational study is to (1) investigate age effects on core muscles, sensorimotor system, psychosocial factors in asymptomatic adults across years of age; (2) explore the differences in biopsychosocial factors between asymptomatic adults and people with non-specific chronic low back pain (NSCLBP); (3) study the correlations between biopsychosocial factors in people with NSCLBP.

The main questions it aims to answer :

1. Are the core muscles, lumbar propriocpetion, and psychological measures altered as age increases?
2. Do the core muscles, lumbar propriocpetion, functional performance, psychological measures, disability, and quality of life affected by NSCLBP?
3. following (2), if so, are there correlations between the measured biopsychosocial factors, disability, and quality of life in people with NSCLBP?

Researchers will compare between people with NSCLBP and age-matched asymptomatic participants across years of age to see if the effect of age and effect of NSCLBP existed in biopsychosocial factors.

Participants will

1. be observed by ultrasound image at the low back and abdominal areas to collect parameters related to trunk deep core muscles, such as changes in muscle thickness from resting state to contraction;
2. ungergo MRI examination to acquire image of deep core muscles;
3. perform lumbar repositioning test which quantifies the lumbar proprioception;
4. perform Timed Up-and-Go Test and Five-Times Sit-to-Stand test, which are used as a measurement of physically functional performance;
5. fill out the psychosocial questionnaires including: Patient-Reported Outcomes Measurement Information System Short Form Depression 4a and Anxiety 4a, Pittsburgh Sleep Quality Index, Pain Catastrophizing Scale, Fear-Avoidance Belief Questionnaire, Oswestry Disability Index, and Heath Survey Short Form-36.

Study Overview

• Status: Completed
• Conditions: Aged; Non-Spesific Chronic Low Back Pain

• Study Type: Observational
• Enrollment (Actual): 57

Contacts and Locations

Study Locations

• Taiwan
  • Taipei City, Taiwan, 110
    • School and Graduate Institute of Physical Therapy, National Taiwan University

Participation Criteria

Eligibility Criteria

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

• Sampling Method: Non-Probability Sample

Study Population

Taiwanese people

Description

Inclusion Criteria:

• aged above 20 years old
• Non-specific chronic low back defined as discomfort in the low back area, which persisted over a day during the past three months and was diagnosed as non-specific low back pain.

Exclusion Criteria:

• history of surgery at the low back or lower extremity
• neurological symptoms, such as numbness or tingling
• not able to walk or stand independently
• cancer
• systemic inflammation, such as ankylosing spondylitis, rheumatoid arthritis, and systemic lupus erythematosus
• in pregnancy

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort
non-specific chronic low back pain; Participants with non-specific chronic low back pain (CLBP) aged 20-65 years old were recruited from the community by posters. Non-specific chronic low back was defined as discomfort in the low back area, which persisted over a day during the past three months and was diagnosed as non-specific low back pain. Participants who 1) had gone through surgery at the low back or lower extremity; 2) presented neurological symptoms, such as numbness or tingling; 3) could not walk or stand independently; 4) had cancer; 5) had systemic inflammation, such as ankylosing spondylitis, rheumatoid arthritis, and systemic lupus erythematosus; 6) were in pregnancy were excluded from the study.
Asymptomatic; Asymptomatic participants aged 20-65 years old were recruited from the community by posters. Participants who 1) had gone through surgery at the low back or lower extremity; 2) presented neurological symptoms, such as numbness or tingling; 3) could not walk or stand independently; 4) had cancer; 5) had systemic inflammation, such as ankylosing spondylitis, rheumatoid arthritis, and systemic lupus erythematosus; 6) were in pregnancy were excluded from the study.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Deep core muscles thickness by USI	The deep core muscles, including transversus abdominis, psoas major, and multifidus, are observed by USI. During USI measurements, participants are instructed to perform specific movement within normal range of motion to activate muscles.	On the 1 day of data collection for all parameters.
Deep core muscles thickness by MRI	The deep core muscles, including transversus abdominis, psoas major, and multifidus, are observed by MRI. Data collected by MRI is analyzed through ImageJ.	On the 1 day of data collection for all parameters or the day arranged specifically for MRI.
Deep core muscles cross-sectional area	The deep core muscles, including transversus abdominis, psoas major, and multifidus, are observed by MRI. Data collected by MRI is analyzed through ImageJ with threshold method, to acquire funcitonal cross-sectional area of core muscles.	On the 1 day of data collection for all parameters or the day arranged specifically for MRI.
Lumbar proprioception	Proprioception was evaluated by lumbar repositioning error with the Zebris motion analysis system (Zebris Medizintechnik GmbH, Isny, Germany). The smaller the error suggests the better proprioception. Repositioning test was performed in a standing position. Participants were first instructed and practiced anterior and posterior pelvic tilting with minimal paraspinal muscle activation, and the neutral position of the lumbar spine was identified. Then, anterior and posterior pelvis tilting to the half and maximal range were practiced with eyes closed. For the actual tests, participants performed 5 repetitions of half range of anterior tilt, back to neutral spine, half range of posterior tilt, and back to neutral spine position. The performance of the first repetition served as the reference for the repositioning test. The error between the reference and the following 4 repetitions indicated the proprioception of the lumbar spine.	On the 1 day of data collection for all parameters.
Functional performance-Timed Up-and-Go	Timed-Up-and-Go (TUG) was adopted to test functional performance. A 10-foot walkway was set with a chair at one end and a mark on the other. Trunk muscle activation for stabilization, lower limb strength, and mobility were required to complete the test.	On the 1 day of data collection for all parameters.
Functional performance-Five-Times Sit-to-Stnad	Five-Times Sit-To-Stand (5-STS) was adopted to test functional performance. Participants were asked to perform sit to stand for consecutive 5 repetitions as fast as possible. Trunk muscle activation for stabilization, lower limb strength, and mobility were required to complete 5-STS.	On the 1 day of data collection for all parameters.
Psychological Distress	Psychological distress were evaluated with the Patient-Reported Outcomes Measurement Information System (PROMIS) Short Form Depression 4a and Anxiety 4a, which included 4 questions for each domain. Raw scores of PROMIS Short Form Depression 4a and Anxiety 4a were transformed into T scores according to the scoring manual (HealthMeasures; HealthMeasures). Higher scores of PROMIS indicated a higher degree of depression or anxiety.	On the 1 day of data collection for all parameters.
Sleep Quality	Sleep quality was examined with the Pittsburgh Sleep Quality Index (PSQI), a self-report questionnaire that assesses sleep quality over a 1-month time interval.	On the 1 day of data collection for all parameters.
Cognition toward pain	Fear-Avoidance Beliefs Questionnaire (FABQ) and Pain Catastrophizing Scale (PCS) were filled out to quantify the cognition and behaviors toward pain. Higher scores on both questionnaires indicated greater fear or tendency to catastrophize.	On the 1 day of data collection for all parameters.
Disability	Oswestry Disability Index (ODI) was used to measure the disability, which included 10 questions. The total scores of ODI ranged from 0 to 50 and higher scores indicated a higher extent of disability.	On the 1 day of data collection for all parameters.
Quality of life	Short Form-36 (SF-36) questionnaire was used to assess physical, psychological, and social factors, whose dimensions include physical functioning (PF), role physical (RP), bodily pain (BP), general health (GH), vitality (VT), social function (SF), role emotional (RE), and mental health (MH). Standardized scores of each domain in SF-36 ranged from 0 to 100 and higher scores referred to higher satisfaction. Raw scores of each domain in SF-36 were standardized according to the SF-36 Health Survey Manual.	On the 1 day of data collection for all parameters.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
VAS	Pain intensity is measured by Visual Analog Scale in which the 10 indicates the most severe pain participants can imagine.	On the 1 day of data collection for all parameters.
Hip range of motion	Hip joint range of motion was measured, including extension, internal rotation, and external rotation.	On the 1 day of data collection for all parameters.
Stability test	Stability was examined by Shraman's test. There were five levels of movement tasks. Completing the tasks meanwhile maintaining spine stability was the required. The higher level completed indicates better stability.	On the day of data collection for all parameters.

Collaborators and Investigators

• Sponsor: National Taiwan University Hospital
• Collaborators: National Science and Technology Council; National Taiwan University, Taiwan

Study record dates

Study Major Dates

• Study Start (Actual): August 1, 2022
• Primary Completion (Actual): August 30, 2024
• Study Completion (Actual): August 30, 2024

Study Registration Dates

• First Submitted: January 10, 2025
• First Submitted That Met QC Criteria: January 17, 2025
• First Posted (Actual): March 25, 2025

Study Record Updates

• Last Update Posted (Actual): March 25, 2025
• Last Update Submitted That Met QC Criteria: January 17, 2025
• Last Verified: January 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Back Pain; Low Back Pain
• Other Study ID Numbers: 202012268RIND; MOST 111-2221-E-002-059 (Other Grant/Funding Number: National Science and Technology Council, Taiwan); MOST 112-2221-E-002-092 (Other Grant/Funding Number: National Science and Technology Council, Taiwan)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

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