Special Poster Session 51st International Society for the Study of the Lumbar Spine Annual Meeting 2025

In-field assessment of pain and physical activities of individuals with chronic low back pain using ecological momentary assessment and wearable sensors (115733)

Zakiy F Alfikri 1 , Carol M Greco 2 , John M Jakicic 3 , Rachel Roos 1 , Harold A Cook 1 , Jordan Hoydick 1 , William W Clark 4 , Bambang Parmanto 5 , Brad E Dicianno 1 6 , Leming Zhou 5 , Sara R Piva 7 , Michael J Schneider 7 , Meenakshi Sundaram 7 , Jessa Darwin 6 , Charity G Patterson 7 , Gina P McKernan 6 , Gwendolyn A Sowa 6 8 , Kevin M Bell 1
  1. Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States
  2. Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
  3. Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, United States
  4. Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, PA, United States
  5. Department of Health Information Management, University of Pittsburgh, Pittsburgh, PA, United States
  6. Department of Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA, United States
  7. Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, United States
  8. Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, United States

INTRODUCTION: Chronic low back pain (cLBP) is a prevalent and debilitating condition[1]. Understanding the daily experiences of individuals with cLBP is crucial for developing effective interventions. Traditional methods of assessing pain and activity are typically collected at a single time point and often rely on retrospective self-reports, which can be subject to recall bias and may not capture the variability of these experiences. To address these limitations, this study utilized ecological momentary assessment (EMA)[2] and wearable devices to collect real-time data in a large cohort of adults with cLBP[3]. The primary aims were to collect and characterize pain and activity profiles of individuals with cLBP.


METHODS: This study enrolled 1007 adults with cLBP who met NIH criteria[4]. Over seven days, participants underwent an unstructured assessment in their own environment. EMA gathered real-time data via a custom mobile app, prompting participants three times daily. Data included pain intensity (0-10), pain interference (0-10), and activity levels (very light, light, moderate, moderate-to-vigorous, or vigorous).
Two custom back sensors at T12/L1 and L5/S1 captured accelerometer data. Activity counts, wear time, and step counts were calculated, utilizing algorithms provided by ActiGraph™[5]. Participants also wore ActiGraph™ GT9X devices on wrist and waist. Activity counts, wear time, and step counts were exported from ActiGraph™ CentrePoint. Sensor data were filtered to include at least four days of 10+ hours each. Activity counts were categorized into sedentary, light, and moderate-to-very-vigorous based on Freedson Adult cutpoints[6].


RESULTS: Out of 1007 participants, 989 submitted EMA data (58.8 ± 16.5 years old; 40.2% male and 59.7% female). The median pain intensity was 1 (IQR=3), while pain interference was 3 (IQR=3). The median activity level was light. Most participants reported their activity levels as moderate (36%) or light (33%). Based on the trend of their pain during each day, most participants had their pain intensity (30%) and pain interference (40%) peaking in the evening.
Data from 592 T12/L1 and 586 L5/S1 sensors were analyzed T12/L1 showed a median of 418,103 (IQR=262,743) activity counts/day and 3,987 (IQR=2,851) steps/day. L5/S1 showed 340,345 (IQR=223,399) activity counts/day and 3,695 (IQR=2,743) steps/day. The percentage of daily sedentary activity was 82.7% for T12/L1 and 82.6% for L5/S1.
ActiGraph data from 886 wrist-worn and 784 waist-worn devices were analyzed. Wrist data showed a median of 922,587 (IQR=435,586) activity counts/day and 1,803 (IQR=1,953) steps/day. Waist data showed 209,094 (IQR=134,657) activity counts/day and 3,409 (IQR=3,353) steps/day. The percentage of daily sedentary activity was 49.2% for wrist and 72.6% for waist.


DISCUSSION: Participants reported low pain intensity and interference levels. More than half of the participants reported pain intensity between 0 and 1 (54.0%) and pain interference between 0 and 3 (57.4%). EMA-reported activity levels differed from sensor data. Participants reported median of light activity, while sensors indicated sedentary activity. This suggests cutpoint adjustments may be needed for the cLBP population, or that participants overestimated their activity levels on EMA. Sensors on different body locations showed varying activity and step counts. Further research is needed to better quantify these differences for people with cLBP.

 

  1. Lucas, et al., NCHS Data Brief, 2019.
  2. Shiffman, S., et al., Annu. Rev. Clin. Psychol., 2008.
  3. Vo N V, et al., Pain Med. 2023.
  4. Deyo R A, et al., Phys Ther. 2015.
  5. Neishabouri A, et al., Sci Reports 2022 121. 2022.
  6. Freedson P S,. et al., Med Sci Sports Exerc. 1998.