The association between pain-related psychological variables and postural control in low back pain: a systematic review and meta-analysis

Abstract

Introduction Individuals with low back pain (LBP) show impaired postural control, particularly during challenging postural tasks. Moreover, in individuals with LBP, higher levels of pain-related psychological variables are (weakly) associated with reduced spinal movement, increased trunk muscle activity, and worse maximal physical performance. It remains unknown whether pain-related psychological variables are related to postural control in this population.

Aim We aimed to evaluate the association between pain-related psychological variables and postural control in individuals with LBP.

Methods The study was registered at PROSPERO (CRD42021241739). Multiple databases were searched until November 2022. Studies were eligible for inclusion if they measured center of pressure (CoP) parameters during bipedal upright standing and reported at least one pain-related psychological factor (e.g., pain-related fear). Random-effect models were used to calculate pooled correlation coefficients between pain-related psychological variables and CoP parameters during different postural tasks with increasing difficulty. Certainty of evidence was assessed with an adapted version of the GRADE.

Results Seventeen studies (735 participants) were included. Pain-related fear (17 studies) and pain catastrophizing (3 studies) 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 parameters during different postural difficulties (e.g., vision occluded, unstable standing). For all associations, certainty of evidence was rated very low.

Relevance In line with earlier evidence of associations between pain-related psychological factors and spinal motor behavior in patients with LBP, only weak associations with postural control were found.

Conclusions There is very low certainty of evidence for weak associations between pain-related psychological variables and postural control during bipedal standing in individuals with LBP, regardless of the postural task difficulty.

Implications More high-quality research including more demanding and threatening postural tasks and task-specific psychological questionnaires should be conducted.