COSMIN database

Validity and everyday clinical applicability of lumbar muscle fatigue assessment methods in patients with chronic non-specific low back pain: a systematic review

Villafane, J. H., Gobbo, M., Peranzoni, M., Naik, G., Imperio, G., Cleland, J. A., and Negrini, S.
PURPOSE: This systematic literature review aimed at examining the validity and applicability in everyday clinical rehabilitation practise of methods for the assessment of back muscle fatiguability in patients with chronic non-specific low back pain (CNSLBP).

METHODS: Extensive research was performed in MEDLINE, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Embase, Physiotherapy Evidence Database (PEDro) and Cochrane Central Register of Controlled Trials (CENTRAL) databases from their inception to September 2014. Potentially relevant articles were also manually looked for in the reference lists of the identified publications. Studies examining lumbar muscle fatigue in people with CNSLBP were selected. Two reviewers independently selected the articles, carried out the study quality assessment and extracted the results. A modified Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) scale was used to evaluate the scientific rigour of the selected works.

RESULTS: Twenty-four studies fulfilled the selection criteria and were included in the systematic review. We found conflicting data regarding the validity of methods used to examine back muscle fatigue. The Biering-Sorensen test, performed in conjunction with surface electromyography spectral analysis, turned out to be the most widely used and comparatively, the most optimal modality currently available to assess objective back muscle fatigue in daily clinical practise, even though critical limitations are discussed.

CONCLUSIONS: Future research should address the identification of an advanced method for lower back fatigue assessment in patients with CNSLBP which, eventually, might provide physical therapists with an objective and reliable test usable in everyday clinical practise. Implications for Rehabilitation Despite its limitations, the Biering-Sorensen test is currently the most used, convenient and easily available fatiguing test for lumbar muscles. To increase validity and reliability of the Biering-Sorensen test, concomitant activation of synergistic muscles should be taken into account. Pooled mean frequency and half-width of the spectrum are currently the most valid electromyographic parameters to assess fatigue in chronic non-specific low back pain. Body mass index, grading of pain and level of disability of the study population should be reported to enhance research quality.
Disabil Rehabil
Publication year:
Biological and physiological variables:
Biological and physiological variables
Functional status:
Physical functioning
Adults (18-65)
Diseases of and symptoms related to the musculoskeletal system and connective tissue
PRO / non-PRO:
Non-patient Reported Outcome
Type of measurement instrument:
4 - Performance-based tests
6 - Clinical rating scales
9 - Laboratory tests
Biering-Sorensen test
Biodex - trunk flexion/extension cycles on Biodex dynamometer
DBC - isometric back extension on David Back Clinic rig
LIFext - isometric lumbar extension by lifting with knee extended combined with pelvic stabilisation
LIFflex - isometric lumbar extension by lifting in semicrounched position without pelvic stabilisation
RC - trunk flexion/extension cycles on the roman chair
SEMG - surface electromyography
UPPflex - back extension on a static dynamometer in upright position with knee flexed/extended