Are pain-related psychological variables associated with postural control in individuals with low back pain? A systematic review and meta-analysis

Abstract

Background and Aims: Altered postural control can contribute to low back pain (LBP), particularly during challenging postural tasks. Moreover, higher levels of pain-related fear and pain catastrophizing are (weakly) associated with protective spinal movement behaviour in individuals with LBP. However, it remains unknown whether pain-related psychological variables are associated with postural control, measured by center of pressure (CoP) variables, in individuals with LBP.

Methods: A systematic review and meta-analysis was conducted (PROSPERO CRD42021241739). Pubmed, Web of Science and PsycInfo were searched until November 2022. Studies were eligible for inclusion if they measured CoP variables during static bipedal standing and if they reported at least one pain-related psychological variable. Random-effect models were used to calculate pooled correlation coefficients between pain-related psychological variables and CoP variables during different postural tasks with increasing difficulty. An adapted version of the GRADE was used to determine the certainty of evidence.

Results: Sixteen studies (n= 723 participants) were included. Pain-related fear and pain catastrophizing were the only reported pain-related psychological variables. Results indicated that both pain-related fear (-0.04 < pooled r < 0.15) and pain catastrophizing (0.28 < pooled r < 0.29) were weakly associated with CoP variables. For all associations, the certainty of evidence was rated as very low.

Conclusion: In the majority of the findings, higher levels of pain-related psychological variables are weakly associated with an increase in CoP motion and velocity in individuals with LBP, regardless of the postural task difficulty. The certainty of evidence is very low.