A systematic review of movement and muscular activity biomarkers to discriminate non-specific chronic low back pain patients from an asymptomatic population

Abstract

The identification of relevant and valid biomarkers to distinguish patients with non-specific chronic low back pain (NSCLBP) from an asymptomatic population in terms of musculoskeletal factors could contribute to patient follow-up and to evaluate therapeutic strategies. Several parameters related to movement and/or muscular activity impairments have been proposed in the literature in that respect. In this article, we propose a systematic and comprehensive review of these parameters (i.e. potential biomarkers) and related measurement properties. This systematic review (PROSPERO registration number: CRD42020144877) was conducted in Medline, Embase, and Web of Knowledge databases until July 2019. In the included studies, all movements or muscular activity parameters having demonstrated at least a moderate level of construct validity were defined as biomarkers, and their measurement properties were assessed. In total, 92 studies were included. This allowed to identify 121 movement and 150 muscular activity biomarkers. An extensive measurement properties assessment was found in 31 movement and 14 muscular activity biomarkers. On the whole, these biomarkers support the primary biomechanical concepts proposed for low back pain. However, a consensus concerning a robust and standardised biomechanical approach to assess low back pain is needed.

Figure 1

Flowchart of the search strategy conducted in this review (based on the PRISMA flowchart).

Figure 2

Labelled world map reporting the number of studies and the number of participants (NSCLBP and control) for each country of origin.

Figure 3

Circos plot linking the included studies to their selected parameter types, ICF 2nd level categories, variable categories and regions of interest. The number of studies linked to each item is also reported.

Figure 4

Circos plot synthesising the main characteristics and measurement properties of each movement biomarker. See Table 4 for measurement properties rating. Biomarkers are underlined in grey when at least 3 COSMIN items have been assessed, and dark grey when all these items reached at least a good level. Biomarker characteristics have been sorted by occurrence.

Figure 5

Circos plot synthesising the main characteristics and measurement properties of each muscular activity biomarker. See Table 4 for measurement properties rating. Biomarkers are underlined in grey when at least 3 COSMIN items have been assessed, and dark grey when all these items reached at least a good level. Biomarker characteristics have been sorted by occurrence.