Is there a relationship between lumbar proprioception and low back pain? A systematic review with meta-analysis

Objective To systematically review the relationship between lumbar proprioception and low back pain (LBP). Data Sources Four electronic databases (PubMed, EMBASE, CINAHL, SPORTDiscus) and reference lists of relevant articles were searched from inception to March-April 2014. Study Selection Studies compared lumbar proprioception in patients with LBP with controls or prospectively evaluated the relationship between proprioception and LBP. Two reviewers independently screened articles and determined inclusion through consensus. Data Extraction Data extraction and methodologic quality assessment were independently performed using standardized checklists. Data Synthesis Twenty-two studies (1203 participants) were included. Studies measured lumbar proprioception via active or passive joint repositioning sense (JRS) or threshold to detection of passive motion (TTDPM). Data from 17 studies were pooled for meta-analyses to compare patients with controls. Otherwise, descriptive syntheses were performed. Data were analyzed according to measurement method and LBP subgroup. Active JRS was worse in patients compared with controls when measured in sitting (standard mean difference, .97; 95% confidence interval [CI], .31–1.64). There were no differences between groups measured via active JRS in standing (standard mean difference, .41; 95% CI, −.07 to .89) or passive JRS in sitting (standard mean difference, .38; 95% CI, −.83 to 1.58). Patients in the O'Sullivan flexion impairment subgroup had worse proprioception than the total LBP cohort. The TTDPM was significantly worse in patients than controls. One prospective study found no link between lumbar proprioception and LBP. Conclusions Patients with LBP have impaired lumbar proprioception compared with controls when measured actively in sitting positions (particularly those in the O'Sullivan flexion impairment subgroup) or via TTDPM. Clinicians should consider the relationship between sitting and proprioception in LBP and subgroup patients to guide management. Further studies focusing on subgroups, longitudinal assessment, and improving proprioception measurement are needed.