The influence of attention on movement-related outcomes in non-specific low back pain: a systematic review.

BACKGROUND: Cognitive affective factors have been proposed to influence movement performance in non-specific low back pain. However, the specific influence of attention on movement performance remains an underexplored domain. Therefore, this systematic review evaluated the current knowledge concerning the influence of attention on movement-related outcomes in non-specific low back pain. METHODS: Five electronic databases were systematically searched (Medline, Web of Science, Embase, CINAHL and PsycArticles) and methodological quality was assessed using the adjusted Newcastle-Ottawa Scale. Level of evidence and strength of conclusion were assigned following guidelines of the Dutch Institute for Healthcare Improvement. RESULTS: Twenty-eight studies were included and categorized into three clusters: 19 studies employed dual-task paradigms to implicitly divide attention between a motor and concurrent cognitive task, 6 explicitly manipulated attention and 3 used self-reported measures of attention. Findings were grouped by movement-related outcomes (muscle activity, muscle timing, gait parameters, balance parameters, trunk flexibility, muscle strength, functional performance and kinematics) and by low back pain group (acute, recurrent and chronic low back pain). DISCUSSION: Overall, the available evidence was highly heterogeneous, and most conclusions regarding a specific motor outcome were supported by only limited evidence, often based on only a single study. Even when multiple studies were available within an outcome domain, substantial methodological variability hindered direct comparisons. As a result, it was challenging to draw definite conclusions regarding the specific influence of attention on movement-related outcomes in low back pain. Furthermore, notable evidence gaps remain for acute and recurrent low back pain populations. [PROSPERO registration number: CRD42022207174].