Articles
Physical activity in daily life in patients with chronic low back pain,☆☆,,★★

Presented in part at the International Association for the Study of Pain's 9th World Congress on Pain, Vienna, 1999.
https://doi.org/10.1053/apmr.2001.23182Get rights and content

Abstract

Verbunt JA, Westerterp KR, van der Heijden GJ, Seelen HA, Vlaeyen JW, Knottnerus JA. Physical activity in daily life in patients with chronic low back pain. Arch Phys Med Rehabil 2001;82:726-30. Objectives: To evaluate disuse (ie, a decreased daily physical activity level) in patients with chronic low back pain (LBP) and to evaluate the construct validity of accelerometry for measuring physical activity in daily life. Design: Case-control study in a cross-sectional design; comparison of accelerometry to the criterion standard (doubly labeled water technique). Setting: Normal daily living (unrestricted by the measurement devices). Patients: Thirteen patients with chronic nonspecific LBP and 13 age- and gender-matched healthy controls. Main Outcome Measures: Physical activity in daily life, expressed as whole-body acceleration measured with a triaxial accelerometer (Tracmor), and as the ratio between average daily metabolic rate (ADMR), measured by the doubly labeled water technique, and resting metabolic rate (RMR), measured by the ventilated hood. Both techniques were used simultaneously for 14 days. Results: Mean physical activity level in patients and controls did not differ significantly. The correlation between the Tracmor and ADMR and RMR was.72 (p <.01). Conclusions: Decreased physical activity levels in this sample of chronic LBP patients was not confirmed. The Tracmor is a valid instrument for measuring daily activity in LBP patients.

Section snippets

Subjects

Thirteen patients (9 men, 4 women) participated in the study. The mean age ± standard deviation (SD) was 45 ± 3 years. All patients had nonspecific LBP with a mean duration of 12 ± 7 years, 77% were employed, and 15% of the employed were on sick leave because of their back pain. Fifteen percent received disability payments because of back pain problems. Inclusion criteria were: nonspecific LBP for at least 3 months and age between 18 and 60 years. Exclusion criteria were lumbar disc herniation

Results

The test result of the doubly labeled water technique of 1 patient showed an inconsistency between the first and the second week and was therefore excluded from further analysis according to the criteria presented in the Method section.

Discussion

We used the nonparametric Mann-Whitney U test, a nonparametric statistical test, for statistical analysis, because the data were clearly skewed. They did not satisfy the gaussian distribution assumptions, which is likely the result of the criteria and procedure of patient selection, combined with the small number of patients. Bivariate correlations between the doubly labeled water technique and the accelerometer were also performed by a nonparametric statistical test (Spearman's rank-order

Conclusion

The triaxial accelerometer is a valid instrument for measuring daily activity in patients with chronic LBP. The mean level of physical activity did not differ in chronic LBP patients when compared with a healthy population, and the presence of disuse in chronic LBP was not confirmed. The discrepancy between measured physical activity and patient reports gives emphasis to the need to use an objective measurement if physiologic factors are of interest.

Acknowledgements

The authors thank Peter Heuts and Kees Pons for their contributions to the study.

References (30)

  • BE Ainsworth et al.

    Compendium of physical activities: classification of energy costs of human physical activities

    Med Sci Sports Exerc

    (1993)
  • CV Bouten et al.

    Daily physical activity assessment: comparison between movement registration and doubly labeled water

    J Appl Physiol

    (1996)
  • DA Schoeller et al.

    Reliability of the doubly labeled water method for the measurement of daily energy expenditure in free living subjects

    J Nutr

    (1996)
  • JE Cotes et al.

    The energy expenditure and mechanical energy demand of walking

    Ergonomics

    (1960)
  • KY Chen et al.

    Improving energy expenditure estimation by using a triaxial accelerometer

    J Appl Physiol

    (1997)
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    Supported by the Foundation De Drie Lichten in the Netherlands, the Council for Medical and Health Research of the Netherlands (grant no. 904-65-090), and Zorgonderzoek Nederland (grant no. 96-06-006).

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    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.

    Reprint requests to Jeanine A. Verbunt, MSc, MD, Institute for Rehabilitation Research, PO Box 192, 6430 AD Hoensbroek, The Netherlands, e-mail: [email protected].

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