Defining “Postural Control” in Interventions for Musculoskeletal Pain

Objective(s): To identify and describe how “postural control” is measured in therapeutic interventions for musculoskeletal pain, and to provide recommendations on assessment methods when “postural control” is a primary outcome measure.

Data Sources: PubMed and CINAHL were searched using terms encompassing concepts “postural control”, “intervention”, and “musculoskeletal pain” including MeSH terms and truncations. Limits were applied for human studies published in English.

Study Selection: 1,553 results were screened by title, then abstract to include only those studies providing an intervention to a human population experiencing musculoskeletal pain. Studies were included if they described a specific intervention or protocol, and identified a relevant keyword that could be related to “postural control.” 136 articles were full-text reviewed to identify if a study had specific outcome measures for measuring postural control. Consensus was achieved between the first and last authors identifying a final list of 20 studies meeting inclusion criteria.

Data Extraction: Specific measurement tools for postural control and their methods of use were extracted from each study. Agreement on how “postural control” was measured in a study was achieved between at least two staff for each study.

Data Synthesis: Frequency counts were used to identify 3 measurement categories for “postural control”: trunk sway or center of pressure during static standing, muscle activation or body position in response to or anticipating perturbation, and segmental coordination during movement. The most frequently used assessment was center of pressure during static standing, then velocity and amplitude of trunk sway, then relative joint angles.

Conclusions: Results indicate “postural control” is defined in multiple ways in musculoskeletal interventions for pain. Three broad concepts were identified as being measures of “postural control:” body position during static standing, anticipatory & reactive movements, and relative joint positions. Measures traditionally associated with “balance” were the most frequent measures of “postural control.” Given the theoretical importance of postural control in musculoskeletal pain and it's multifaceted nature, we recommend including outcome measures that encompass reactive and dynamic activities to differentiate “postural control” from “balance.”

Author(s) Disclosures: None to disclose.