Trunk postural control during unstable sitting among individuals with and without low back pain: A systematic review with an individual participant data meta-analysis
Authors: Alshehri Mansour Abdullah , Alzahrani Hosam , van den Hoorn Wolbert , Klyne David M. , Vette Albert H. , Hendershot Brad D. , Roberts Brad W. R. , Larivière Christian , Barbado David , Vera-Garcia Francisco J. , van Dieen Jaap H. , Cholewicki Jacek , Nussbaum Maury A. , Madigan Michael L. , Reeves Norman Peter , Silfies Sheri P. , Brown Stephen H. M. , Hodges Paul W. 
Published: January 2024

Introduction

Sitting on an unstable surface is a common paradigm to investigate trunk postural control among individuals with low back pain (LBP), by minimizing the influence lower extremities on balance control. Outcomes of many small studies are inconsistent (e.g., some find differences between groups while others do not), potentially due to confounding factors such as age, sex, body mass index [BMI], or clinical presentations. We conducted a systematic review with an individual participant data (IPD) meta-analysis to investigate whether trunk postural control differs between those with and without LBP, and whether the difference between groups is impacted by vision and potential confounding factors.

Methods

We completed this review according to PRISMA-IPD guidelines. The literature was screened (up to 7thSeptember 2023) from five electronic databases: MEDLINE, CINAHL, Embase, Scopus, and Web of Science Core Collection. Outcome measures were extracted that describe unstable seat movements, specifically centre of pressure or seat angle. Our main analyses included: 1) a two-stage IPD meta-analysis to assess the difference between groups and their interaction with age, sex, BMI, and vision on trunk postural control; 2) and a two-stage IPD meta-regression to determine the effects of LBP clinical features (pain intensity, disability, pain catastrophizing, and fear-avoidance beliefs) on trunk postural control.

Results

Forty studies (1,821 participants) were included for the descriptive analysis and 24 studies (1,050 participants) were included for the IPD analysis. IPD meta-analyses revealed three main findings: (a) trunk postural control was worse (higher root mean square displacement [RMSdispl], range, and long-term diffusion; lower mean power frequency) among individuals with than without LBP; (b) trunk postural control deteriorated more (higher RMSdispl, short- and long-term diffusion) among individuals with than without LBP when vision was removed; and (c) older age and higher BMI had greater adverse impacts on trunk postural control (higher short-term diffusion; longer time and distance coordinates of the critical point) among individuals with than without LBP. IPD meta-regressions indicated no associations between the limited LBP clinical features that could be considered and trunk postural control.

Conclusion

Trunk postural control appears to be inferior among individuals with LBP, which was indicated by increased seat movements and some evidence of trunk stiffening. These findings are likely explained by delayed or less accurate corrective responses.

Systematic review registration

This review has been registered in PROSPERO (registration number: CRD42021124658).