Introduction A traditional problem faced by clinicians attempting to objectively measure musculoskeletal disorders such as low back pain,
where there is often primarily soft tissue involvement, is that psychosocial factors (e.g., fear-avoidance, secondary gain)
frequently influence the experience/reporting of pain. Nevertheless, there is still a great need for the quantification of
physical function, with appropriate criteria in place, in order to help assess both physical impairment and therapeutic endpoint
following treatment. One such potentially objective measure is surface electromyographic (sEMG) recordings during purposeful
muscular activity and resting states. The present randomized controlled study assessed the potential validity of a new sEMG
approach—the comprehensive muscular activity profile (CMAP)—by addressing the following question: can the CMAP accurately
document whether a subject is exerting appropriate muscular effort during range-of-motion and lifting testing, or is submaximum
effort being exerted?
Methods Eighty healthy volunteers were randomly assigned to either: (1) an instruction group encouraging maximum effort on the tests;
or (2) an instruction group encouraging “faking” and not putting in maximum effort on the tests. Therapists, who then administered
the CMAP protocol (range-of-motion and lifting tests), were kept blind to subject group assignment. They were also asked to
complete a rating scale evaluating whether subjects were exerting maximum effort after all the tests were completed.
Results In differentiating between the two instruction groups, the CMAP demonstrated high levels of sensitivity [predicting maximum
effort on all tests (ranging from 84.6 to 94.9%)]. In contrast, the sensitivity of the therapists’ ratings was much lower
(ranging from only 72.5 to 80.0%). Most importantly, when the CMAP data and therapists’ ratings were combined, logistic regression
analyses revealed high rates of sensitivity (94.4–97.2%), specificity (84.6–92.3%), and overall classification (90.7–93.3%).
Conclusion The results of this study demonstrate the potential utility of the CMAP, combined with therapist ratings, as a valid method
of objectively quantifying subject muscular performance and effort during lumbar range-of-motion and lifting tasks.
Keywords Lumbar spine - sEMG - Comprehensive muscular activity profile - Quantification of function