Analysis of Crepitus in Human Subjects
Condition: Low Back Pain; Healthy
MeSH terms: Low Back Pain
Study type: Observational

Summary: 
      Chiropractic adjustment has been shown to gap certain joints in the spine, thereby improving
      mobility in individuals with decreased movement capabilities. During normal motion, joints in
      the spine produce sounds and vibrations called crepitus. The purpose of this study is to
      assess how this crepitus may be used as an indicator for joint degeneration in healthy human
      subjects and those with low back pain, and if chiropractic adjusting causes change in this
      crepitus. We hypothesis that change in crepitus after adjustment may be a useful indication
      of changes in joint mobility and joint stiffness.
    

Detailed description: 
      Objective: This is a reliability study (n=12) comparing the results of a recently developed
      automated method (AM) with two human observers in the analysis of recordings of human lumbar
      zygapophyseal (Z) joint crepitus. The recordings will be taken during ranges of motion
      performed before and after lumbar side-posture spinal manipulation (SMT). Methods: Six (6)
      healthy and 6 low back pain subjects will participate in the study. Using clinical study
      procedures developed for our previous research, subjects will be given an initial phone
      screen before being scheduled for a clinical study appointment. At the appointment, subjects
      will undergo the informed consent process, and those consenting will be further screened and
      examined by the Research Clinician who will use the inclusion/exclusion criteria to determine
      eligibility for the study. Eligible subjects will be enrolled and scheduled for an
      accelerometry visit. At the accelerometry visit, 11 accelerometers will be applied to the
      lumbar region, allowing assessment of Z joint crepitus. Each subject will undergo full
      flexion and full extension (ROM) while recordings are made from the accelerometers. Subjects
      will then undergo bilateral lumbar SMT, and immediately thereafter will undergo repeated ROM
      while recordings are made. Two human observers and the AM, blinded to the results of one
      another, will then assess the recordings to identify Z joints from which crepitus originated.
      The primary outcomes will be: 1) weighted kappa inter-rater reliability statistic comparing
      AM and the 2 human observers in identifying Z joint crepitus, and 2) ANOVA test statistic
      comparing time to complete the crepitus analysis by the AM and human observers. Hypotheses:
      1) The automated method will be reliable, agreeing with the human observers' analysis. 2) The
      automated method will be significantly more time efficient than the analyses made by the
      human observers. Application: We believe that this program will improve the efficiency of
      identifying the site of Z joint crepitus, thereby advancing the line of investigation
      designed to use crepitus as a biomarker of spinal joint dysfunction.
    

Observational model: Case-Control
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Participants will be recruited from the faculty, student and staff population at National
        University Of Health Sciences, Lombard, IL. If unable to recruit sufficient number of
        participants, recruitment will be extended to the general population of the Chicago, IL
        metro area.
      
Keywords: crepitus; spine; noise; physiological; pathological