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      Functional movement analysis in patients with chronic nonspecific low back pain: a reliability and validity study

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          Abstract

          Background

          Individuals afflicted with nonspecific chronic low back pain (CLBP) exhibit altered fundamental movement patterns. However, there is a lack of validated analysis tools. The present study aimed to elucidate the measurement properties of a functional movement analysis (FMA) in patients with CLBP.

          Methods

          In this validation (cross-sectional) study, patients with CLPB completed the FMA. The FMA consists of 11 standardised motor tasks mimicking activities of daily living. Four investigators (two experts and two novices) evaluated each item using an ordinal scale (0–5 points, one live and three video ratings). Interrater reliability was computed for the total score (maximum 55 points) using intra class correlation and for the individual items using Cohen’s weighted Kappa and free-marginal Kappa. Validity was estimated by calculating Spearman’s Rho correlations to compare the results of the movement analysis and the participants’ self-reported disability, and fear of movement.

          Results

          Twenty-one participants (12 females, 9 males; 42.7 ± 14.3 years) were included. The reliability analysis for the sum score yielded ICC values between .92 and.94 ( p < .05). The classification of individual scores are categorised ‘slight’ to ‘almost perfect’ agreement (.10–.91). No significant associations between disability or fear of movement with the overall score were found ( p > .05). The study population showed comparably low pain levels, low scores of kinesiophobia and disability.

          Conclusion

          The functional movement analysis displays excellent reliability for both, live and video rating. Due to the low levels of disability and pain in the present sample, further research is necessary to conclusively judge validity.

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          Most cited references21

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          Coefficient Kappa: Some Uses, Misuses, and Alternatives

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            Interrater reliability of the functional movement screen.

            The Functional Movement Screen (FMS) is a series of 7 tests that categorize fundamental movement. Each test is scored on an ordinal scale with 4 categories. The purpose of this study was to determine the interrater reliability of the FMS. Forty healthy subjects were videotaped while performing the FMS. The videos were independently scored by 4 raters, including 2 experts who instruct FMS training courses and 2 novices who completed a standardized training course on the FMS. Interrater reliability was analyzed using the weighted kappa statistic. The novice raters demonstrated excellent or substantial agreement on 14 of the 17 tests, whereas the expert raters did the same on 13 of the 17 tests. When the novice raters were paired with the expert raters, all 17 components demonstrated excellent or substantial agreement. These data indicate that the FMS can confidently be applied by trained individuals. This would suggest that the FMS can be confidently used to assess the movement patterns of athletes and to make decisions related to interventions for performance enhancement, and the FMS may assist in identifying athletes at risk for injury.
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              A Systematic Review of the Effects of Exercise and Physical Activity on Non-Specific Chronic Low Back Pain

              Back pain is a major health issue in Western countries and 60%–80% of adults are likely to experience low back pain. This paper explores the impact of back pain on society and the role of physical activity for treatment of non-specific low back pain. A review of the literature was carried out using the databases SPORTDiscuss, Medline and Google Scholar. A general exercise programme that combines muscular strength, flexibility and aerobic fitness is beneficial for rehabilitation of non-specific chronic low back pain. Increasing core muscular strength can assist in supporting the lumbar spine. Improving the flexibility of the muscle-tendons and ligaments in the back increases the range of motion and assists with the patient’s functional movement. Aerobic exercise increases the blood flow and nutrients to the soft tissues in the back, improving the healing process and reducing stiffness that can result in back pain.
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                Author and article information

                Contributors
                +49(0)69 798 244 , johvogel@em.uni-frankfurt.de
                wilke@sport.uni-frankfurt.de
                krause@sport.uni-frankfurt.de
                l.vogt@sport.uni-frankfurt.de
                niederer@sport.uni-frankfurt.de
                banzer@med.uni-frankfurt.de
                Journal
                BMC Musculoskelet Disord
                BMC Musculoskelet Disord
                BMC Musculoskeletal Disorders
                BioMed Central (London )
                1471-2474
                31 August 2019
                31 August 2019
                2019
                : 20
                : 395
                Affiliations
                [1 ]ISNI 0000 0004 1936 9721, GRID grid.7839.5, Department of Sports Medicine, , Goethe University Frankfurt/Main, ; Ginnheimer Landstraße 39, 60487 Frankfurt, Germany
                [2 ]ISNI 0000 0004 0578 8220, GRID grid.411088.4, Institute for Occupational Medicine, Social Medicine and Environmental Medicine, , University Hospital Frankfurt, ; Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
                Author information
                http://orcid.org/0000-0001-7477-0970
                Article
                2779
                10.1186/s12891-019-2779-6
                6717644
                31472693
                445ee294-5b0c-436c-9918-27e36fad4439
                © The Author(s). 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 4 July 2019
                : 22 August 2019
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2019

                Orthopedics
                low back pain,unspecific pain,idiopathic pain,movement patterns,kinematic analysis,disability,pain intensity

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