Archives of Physical Medicine and Rehabilitation
Volume 89, Issue 8 , Pages 1542-1549 , August 2008

Classifying Subgroups of Chronic Low Back Pain Patients Based on Lifting Patterns

Presented to the Institute of Electrical and Electronics Engineers Engineering in Medicine and Biology Society, August 28–September 3, 2006, New York, NY; and at the Institute of Electrical and Electronics Engineers Statistical Signal Processing Workshop, August 26–28, 2007, Madison, WI.

  • Jill C. Slaboda, PhD

      Affiliations

    • Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA
    • Pain Evaluation and Treatment Institute, University of Pittsburgh, Pittsburgh, PA.
    • Corresponding Author InformationReprint requests to Jill C. Slaboda, PhD, Temple University, 40 Pearson Hall, 1800 N Broad St, Philadelphia, PA 19122
  • ,
  • J. Robert Boston, PhD

      Affiliations

    • Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA
    • Department of Electrical Engineering, University of Pittsburgh, Pittsburgh, PA
    • Pain Evaluation and Treatment Institute, University of Pittsburgh, Pittsburgh, PA.
  • ,
  • Thomas E. Rudy, PhD

      Affiliations

    • Department of Anesthesiology, University of Pittsburgh, Pittsburgh, PA
    • Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA
    • Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
    • Pain Evaluation and Treatment Institute, University of Pittsburgh, Pittsburgh, PA.
  • ,
  • Susan J. Lieber, MS, OTR/L

      Affiliations

    • Pain Evaluation and Treatment Institute, University of Pittsburgh, Pittsburgh, PA.

References 

  1. Delitto A, Erhard RE, Bowling RW, DeRosa CP, Greathouse DG. A treatment-based classification approach to low back syndrome: identifying and staging patients for conservative treatment. Phys Ther. 1994;75:470–489
  2. Fritz JM, Delitto A, Erhard RE. Comparison of classification-based physical therapy with therapy based on clinical practice guidelines for patients with acute low back pain: a randomized clinical trial. Spine. 2003;28:1363–1372
  3. Turk DC, Rudy TE. Towards a comprehensive assessment of chronic pain patients. Behav Res Ther. 1987;25:237–249
  4. Turk DC, Rudy TE. Toward an empirically derived taxonomy of chronic pain patients: integration of psychological assessment of data. J Consult Clin Psychol. 1989;56:233–238
  5. Rudy TE, Turk DC, Kubinski JA, Zaki HS. Differential treatment response of TMD patients as a function of psychological characteristics. Pain. 1995;61:103–112
  6. Dunn KM, Jordan K, Croft PR. Characterizing the course of low back pain: a latent class analysis. Am J Epidemiol. 2006;163:754–761
  7. Denison E, Asenlof P, Sandborgh M, Lindberg P. Musculoskeletal pain in primary health care: sub-groups based on pain intensity, disability, self-efficacy, and fear-avoidance variables. J Pain. 2007;8:67–74
  8. O'Sullivan PB. Clinical instability of the lumbar spine: its pathological basis, diagnosis and conservative management. In:  Boyling JD,  Jull G editor. Grieve's modern manual therapy. 3rd ed. Philadelphia: Elsevier; 2004;p. 311–331
  9. Dankaerts W, O'Sullivan P, Burnett A, Straker L. Differences in sitting postures are associated with nonspecific chronic low back pain disorders when patients are subclassified. Spine. 2006;31:698–704
  10. Wittink H, Rogers W, Sukiennik A, Carr DB. Physical functioning: self-report and performance measures are related but distinct. Spine. 2003;28:2407–2413
  11. Larivière C, Gagnon D, Loisel P. The effect of load on coordination of the trunk for subjects with and without chronic low back pain during flexion-extension and lateral bending. Clin Biomech (Bristol, Avon). 2000;15:407–416
  12. Marras WS, Davis KG, Ferguson SA, Lucas BR, Gupta P. Spine loading characteristics of patients with low back pain compared with asymptomatic individuals. Spine. 2001;26:2566–2574
  13. Oddsson LI, DeLuca CJ. Activation imbalances in lumbar spine muscles in the presence of chronic low back pain. J Appl Physiol. 2003;94:1410–1420
  14. Kankaanpaa M, Taimela S, Laaksonen D, Hanninen O, Airaksinen O. Back and hip extensor fatigability in chronic low back pain patients and controls. Arch Phys Med Rehabil. 1998;79:412–417
  15. Boston JR, Rudy TE, Mercer SR, Kubinski JA. A measure of body coordination during repetitive dynamic lifting. IEEE Trans Rehabil Eng. 1993;1:137–144
  16. Slaboda JC, Boston JR, Rudy TE, Lieber SJ, Rasetshwane DM. The use of splines to calculate jerk for a repetitive lifting task involving chronic lower back patients. IEEE Trans Neural Syst Rehabil Eng. 2005;13:406–414
  17. Rudy TE, Boston JR, Lieber SJ, Kubinski JA, Stacey BR. Body motion during repetitive isodynamic lifting: a comparative study of normal subjects and low-back pain patients. Pain. 2003;105:319–326
  18. Slaboda JC. Classifying chronic lower back pain groups using a time series model of lifting. [dissertation] Pittsburgh: Univ Pittsburgh; 2007;
  19. Slaboda JC, Boston JR, Rudy TE. Evaluating the reliability of hidden Markov models that describe the lifting patterns of chronic lower back pain patients and controls. Conf Proc IEEE Eng Med Biol Soc. 2006;1:3238–3241
  20. Slaboda JC, Boston JR, Rudy TE. Using HMMs to identify groups in patient population: a simulation. Presented to: IEEE 14th Workshop on Statistical Signal Processing; 2007 Aug 26-28; Madison (WI). p 355-7.
  21. Rabiner LR, Juang BH. An introduction to the Hidden Markov models. IEEE ASSP Magazine. 1986;Jan:4–16
  22. Rudy TE, Turk DC, Brena SF, Stieg RL, Brody MC. Quantification of biomedical findings of chronic pain patients: development of an index of pathology. Pain. 1990;42:167–182
  23. Lankhorst GJ, van de Stadt RJ, Vodeelaar TW, van der Korst JK, Prevo AJ. Objectivity and repeatability of measurements in low back pain. Scand J Rehabil Med. 1982;14:21–26
  24. Rudy TE. Multidimensional Pain Inventory, version 3.0 user's guide. University of Pittsburgh http://www.pain.pitt.edu/mpiAccessed May 6, 2008
  25. Turk DC, Rudy TE. Pain experience: assessing the cognitive component. Paper presented to: 5th Annual Meeting of the American Pain Society; 1985; Dallas (TX).
  26. Fairbank JC, Mbaot JC, Davis JB, O'Brien JP. The Oswestry low back pain disability questionnaire. Psychotherapy. 1980;66:271–273
  27. Turk DC, Wack JT, Kerns RD. An empirical examination of the “pain behavior” construct. J Behav Med. 1985;8:119–130
  28. Genaidy AM, Asfour SS. Effects of frequency and load of lift on endurance time. Ergonomics. 1989;23:51–56
  29. Marras M, Rangarajulu SL. Trunk force development during static and dynamic lifts. Hum Factors. 1989;29:19–29
  30. Milligan GW, Cooper MC. An examination of procedures for determining the number of clusters in a data set. Psychometrika. 1980;50:159–179
  31. Milligan GW, Cooper MC. Methodology review: clustering methods. Appl Psychol Meas. 1987;11:329–354
  32. Lipsey MW. Design sensitivity: statistical power for experimental research. Newbury Park: Sage; 1990;
  33. Simmons DG, Statham-Simons L. Chronic myofascial pain syndrome. In:  Tollison CD editors. Handbook of chronic pain management. Baltimore: Williams & Wilkins; 1989;p. 509–529
  34. Rudy TE, Lieber SJ, Boston JR, Gourley LM, Baysal E. Psychosocial predictors of physical performance in disabled individuals with chronic pain. Clin J Pain. 2003;19:18–30
  35. Vlaeyen JW, Kole-Snijders AM, Boeren RG, van Eek H. Fear of movement/(re)injury in chronic pain and its relation to behavioral performance. Pain. 1995;62:363–372
  36. Lackner JM, Carosella AM. The relative influence of perceived pain control, anxiety, and functional self-efficacy on spinal function among patients with chronic lower back pain. Spine. 1999;24:2254–2261
  37. Verbunt JA, Seelen HA, Vlaeyen JW, et al. Pain-related factors contributing to muscle inhibition in patients with chronic lower back pain. Clin J Pain. 2005;21:232–240

 Supported by the National Institutes of Health (grant nos. 1R01 AR38698, 1R01 AG18299) and the University of Pittsburgh (Provost Development Fund).No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

PII: S0003-9993(08)00351-1

doi: 10.1016/j.apmr.2008.01.016

Archives of Physical Medicine and Rehabilitation
Volume 89, Issue 8 , Pages 1542-1549 , August 2008