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      The effect of chronic, non-specific low back pain on superficial lumbar muscle activity: a protocol for a systematic review and meta-analysis

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          Abstract

          Introduction

          Chronic, non-specific low back pain is a major global cause of disability. One factor which might potentially contribute to ongoing pain is maladaptive variation in the level of activity in the lumbar musculature. Several studies have investigated this activity using surface electromyography, in varied muscles and during a number of functional activities. Due to differences in the applied methodology, the results have been difficult to compare, and previous reviews have been limited in scope. In this protocol, we aim to perform a comprehensive review of the effect of chronic low back pain on lumbar muscle activity.

          Methods and analysis

          This protocol was informed by the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) and results will be reported in line with the PRISMA. Searches will be conducted on the Web of Science, PubMed, MEDLINE, EMBASE, ZETOC and CINAHL databases, along with a comprehensive review of grey literature and key journals. One reviewer will conduct the searches, but two independent reviewers will screen potential studies and assess the risk of bias within studies which meet the inclusion criteria. The Newcastle-Ottawa risk of bias tool, and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) guidelines will be used to assess the quality of the data. Meta-analysis will be conducted where appropriate on groups of studies with homogenous methodology. Where studies are too heterogeneous to allow for meta-analysis, meta-synthesis will instead be completed, comparing results in terms of net increases or decreases of activity.

          Ethics and dissemination

          This review aims to identify common adaptations of muscle activity in people with low back pain and it is expected that the results will influence future research directions and future rehabilitation approaches. The results will be submitted for publication in a peer-reviewed journal and presented at conferences.

          Prospero registration number

          CRD42019125156

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          Most cited references24

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          A consensus approach toward the standardization of back pain definitions for use in prevalence studies.

          A modified Delphi study conducted with 28 experts in back pain research from 12 countries. To identify standardized definitions of low back pain that could be consistently used by investigators in prevalence studies to provide comparable data. Differences in the definition of back pain prevalence in population studies lead to heterogeneity in study findings, and limitations or impossibilities in comparing or summarizing prevalence figures from different studies. Back pain definitions were identified from 51 articles reporting population-based prevalence studies, and dissected into 77 items documenting 7 elements. These items were submitted to a panel of experts for rating and reduction, in 3 rounds (participation: 76%). Preliminary results were presented and discussed during the Amsterdam Forum VIII for Primary Care Research on Low Back Pain, compared with scientific evidence and confirmed and fine-tuned by the panel in a fourth round and the preparation of the current article. Two definitions were agreed on a minimal definition (with 1 question covering site of low back pain, symptoms observed, and time frame of the measure, and a second question on severity of low back pain) and an optimal definition that is made from the minimal definition and add-ons (covering frequency and duration of symptoms, an additional measure of severity, sciatica, and exclusions) that can be adapted to different needs. These definitions provide standards that may improve future comparisons of low back pain prevalence figures by person, place and time characteristics, and offer opportunities for statistical summaries.
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            Understanding GRADE: an introduction.

            Grading of recommendations, assessment, development, and evaluations (GRADE) is arguably the most widely used method for appraising studies to be included in systematic reviews and guidelines. In order to use the GRADE system or know how to interpret it when reading reviews, reading several articles and attending a workshop are required. Moreover, the GRADE system is not covered in standard medical textbooks. Here, we explain GRADE concisely with the use of examples so that students and other researchers can understand it. In order to use or interpret the GRADE system, reading several articles and attending a workshop is currently required. Moreover, the GRADE system is not covered in standard medical textbooks. We read, synthesized, and digested the GRADE publications and contacted GRADE contributors for explanations where required. We composed a digested version of the system in a concise way a general medical audience could understand. We were able to explain the GRADE basics clearly and completely in under 1500 words. While advanced critical appraisal requires judgment, training, and practice, it is possible for a non-specialist to grasp GRADE basics very quickly. © 2013 Wiley Publishing Asia Pty Ltd and Chinese Cochrane Center, West China Hospital of Sichuan University.
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              Trunk muscle activation in low-back pain patients, an analysis of the literature.

              This paper provides an analysis of the literature on trunk muscle recruitment in low-back pain patients. Two models proposed in the literature, the pain-spasm-pain model and the pain adaptation model, yield conflicting predictions on how low- back pain would affect trunk muscle recruitment in various activities. The two models are outlined and evidence for the two from neurophsysiological studies is reviewed. Subsequently, specific predictions with respect to changes in activation of the lumbar extensor musculature are derived from both models. These predictions are compared to the results from 30 clinical studies and three induced pain studies retrieved in a comprehensive literature search. Neither of the two models is unequivocally supported by the literature. These data and further data on timing of muscle activity and load sharing between muscles suggest an alternative model to explain the alterations of trunk muscle recruitment due to low-back pain. It is proposed that motor control changes in patients are functional in that they enhance spinal stability.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2019
                31 October 2019
                : 9
                : 10
                : e029850
                Affiliations
                [1] departmentCentre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences , University of Birmingham , Birmingham, UK
                Author notes
                [Correspondence to ] Professor Deborah Falla; d.falla@ 123456bham.ac.uk
                Author information
                http://orcid.org/0000-0002-7892-1067
                http://orcid.org/0000-0001-8114-7669
                http://orcid.org/0000-0001-7599-3674
                http://orcid.org/0000-0003-1689-6190
                Article
                bmjopen-2019-029850
                10.1136/bmjopen-2019-029850
                6830713
                31676646
                f824c25e-0058-4c76-a37e-02595ad8d0bf
                © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 14 February 2019
                : 09 September 2019
                : 15 October 2019
                Categories
                Rehabilitation Medicine
                Protocol
                1506
                1727
                Custom metadata
                unlocked

                Medicine
                low back pain,electromyography,muscle activity,emg,motor control
                Medicine
                low back pain, electromyography, muscle activity, emg, motor control

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