Journal of Nonverbal Behavior

, Volume 41, Issue 3, pp 289–304 | Cite as

Estimating Pain and Disability in Virtual Patients with Low Back Pain: The Contribution of Nonverbal Behaviors

  • Anne Courbalay
  • Thomas Deroche
  • Martin Descarreaux
Original Paper


It is well recognized that chronic low back pain (cLBP) can be estimated from nonverbal pain behaviors. However, only a few studies examined how clinicians rely on those when estimating specific outcomes, such as pain intensity and pain disability. Therefore, the present study examines (1) if facial expressions and guarding behaviors (including speed of the movement and lifting strategy) contribute to the prediction of pain intensity and disability in patients with cLBP; and (2) if these pain behaviors have been given the same importance according to the outcome. Twenty-five experienced clinicians and thirty-one novice clinicians were asked to estimate low back pain intensity and disability from a realistic virtual character performing a lifting lowering task. The studied pain behaviors were manipulated across different conditions. Pain intensity and disability were judged higher when the character moved more slowly and displayed painful facial expression. Speed of the movement and facial expressions explained a greater portion of variance when related to pain intensity assessment than to pain disability assessment. Results also showed a significant interaction between the lifting strategy, the speed of the movement and facial expressions, but only when estimating the character’s pain-related intensity. Novice clinicians rated pain disability higher than experienced clinicians did. Although pain-related concepts, pain intensity and related disability are not estimated through the same pain behaviors by clinicians. Clinical experience does not contribute to clinical judgments through the use of nonverbal pain behaviors when estimating pain outcomes but contributes to pain disability rating overall.


Clinical judgment Low back pain Nonverbal behaviors Medical expertise 



The authors thank Pierre Black for his assistance in creating the 3D realistic characters, and Geneviève Côté for her help in preparing the manuscript.


The authors received no financial support for the research, authorship, and/or publication of this article.

Compliance with Ethical Standards

Conflict of interest

The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.


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Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Anne Courbalay
    • 1
  • Thomas Deroche
    • 2
    • 3
  • Martin Descarreaux
    • 1
  1. 1.Département des Sciences de l’activité physiqueUniversité du Québec à Trois-RivièresTrois-RivièresCanada
  2. 2.CIAMSUniv. Paris-Sud, Université Paris-SaclayOrsay CedexFrance
  3. 3.CIAMSUniversité d’OrléansOrléansFrance

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