Relationship between physical activity and central sensitization in chronic low back pain: Insights from machine learning

卷:232

Article

关键词: CHRONIC MUSCULOSKELETAL PAIN;    FEAR-AVOIDANCE;    VALIDATION;    CONSEQUENCES;    CALIBRATION;    VALUES;    SCALE;   

DOI  :  10.1016/j.cmpb.2023.107432

来源: SCIE

【 摘 要 】

Background and objectives: Chronic low back pain (CLBP) is a leading cause of disability. The management guidelines for the management of CLBP often recommend optimizing physical activity (PA). Among a subsample of patients with CLBP, central sensitization (CS) is present. However, knowledge about the association between PA intensity patterns, CLBP, and CS is limited. The objective PA computed by conventional approaches (e.g. cut-points) may not be sensitive enough to explore this association. This study aimed to investigate PA intensity patterns in patients with CLBP and low or high CS (CLBP-, CLBP + , respectively) by using advanced unsupervised machine learning approach, Hidden semi-Markov model (HSMM).Methods: Forty-two patients were included (23 CLBP-, 19 CLBP + ). CS-related symptoms (e.g. fatigue, sensitivity to light, psychological features) were assessed by a CS Inventory. Patients wore a standard 3Daccelerometer for one week and PA was recorded. The conventional cut-points approach was used to compute the time accumulation and distribution of PA intensity levels in a day. For the two groups, two HSMMs were developed to measure the temporal organization of and transition between hidden states (PA intensity levels), based on the accelerometer vector magnitude.Results: Based on the conventional cut-points approach, no significant differences were found between CLBP- and CLBP + groups ( p = 0.87). In contrast, HSMMs revealed significant differences between the two groups. For the 5 identified hidden states (rest, sedentary, light PA, light locomotion, and moderatevigorous PA), the CLBP- group had a higher transition probability from rest, light PA, and moderatevigorous PA states to the sedentary state ( p < 0.001). In addition, the CBLP- group had a significantly shorter bout duration of the sedentary state ( p < 0.001). The CLBP + group exhibited longer durations of active ( p < 0.001) and inactive states ( p = 0.037) and had higher transition probabilities between active states ( p < 0.001).Conclusions: HSMM discloses the temporal organization and transitions of PA intensity levels based on accelerometer data, yielding valuable and detailed clinical information. The results imply that patients with CLBP- and CLBP + have different PA intensity patterns. CLBP + patients may adopt the distressendurance response pattern with a prolonged bout duration of activity engagement.(c) 2023 The Author(s). Published by Elsevier B.V. This is an open access article under the CC BY license ( http://creativecommons.org/licenses/by/4.0/ )

【 授权许可】

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