Neck motion kinematics: an inter-tester reliability study using an interactive neck VR assessment in asymptomatic individuals

Cervical Sensorimotor Function Tests Using a VR Headset-An Evaluation of Concurrent Validity

Sensorimotor disturbances such as disturbed cervical joint position sense (JPS) and reduced reaction time and velocity in fast cervical movements have been demonstrated in people with neck pain. While these sensorimotor functions have been assessed mainly in movement science laboratories, new sensor technology enables objective assessments in the clinic. The aim was to investigate concurrent validity of a VR-based JPS test and a new cervical reaction acuity (CRA) test. Twenty participants, thirteen asymptomatic and seven with neck pain, participated in this cross-sectional study. The JPS test, including outcome measures of absolute error (AE), constant error (CE), and variable error (VE), and the CRA test, including outcome measures of reaction time and maximum velocity, were performed using a VR headset and compared to a gold standard optical motion capture system. The mean bias (assessed with the Bland-Altman method) between VR and the gold standard system ranged from 0.0° to 2.4° for the JPS test variables. For the CRA test, reaction times demonstrated a mean bias of -19.9 milliseconds (ms), and maximum velocity a mean bias of -6.5 degrees per seconds (°/s). The intraclass correlation coefficients (ICCs) between VR and gold standard were good to excellent (ICC 0.835-0.998) for the JPS test, and excellent (ICC 0.931-0.954) for reaction time and maximum velocity for the CRA test. The results show acceptable concurrent validity for the VR technology for assessment of JPS and CRA. A slightly larger bias was observed in JPS left rotation which should be considered in future research.

Sensory-motor training with virtual reality as a complementary intervention to manual therapy for persistent non-specific neck pain: a randomized controlled trial

BACKGROUND

Persistent non-specific neck pain (NP) is a widespread condition described as a complex biopsychosocial disorder, characterized by physical and psychological symptoms. Virtual reality (VR) shows promise in NP treatment, potentially reducing pain, kinesiophobia, and improving range of motion (ROM) and motor control.

AIM

The primary aim of the study was to assess the effectiveness of VR sensorimotor training, combined with manual therapy, in reducing the level of disability in persistent non-specific NP individuals. The secondary aim was to determine if this VR-enhanced approach also contributes to improvement in overall function, pain perception and kinesiophobia.

DESIGN

Monocentric, single-blind, randomized controlled trial.

SETTING

We conducted this trial at San Raffaele Scientific Institute, Department of Rehabilitation and Functional Recovery, Milan, Italy.

POPULATION

Forty NP participants were enrolled in the study and randomly allocated into two groups.

METHODS

The study involved a 6-week rehabilitation program, comprising 12 sessions of 45 minutes each, twice weekly. Both intervention groups underwent manual therapy as a consistent component of their treatment. The Experimental Group (VRT) was additionally engaged in sensorimotor rehabilitation exercises using Virtual Reality, whereas the Control Group (CT) performed the same exercises without VR. We assessed subjects at baseline (T0) and after six weeks of rehabilitation (T1). The primary outcome was the disability (Neck Disability Index) while the secondary outcomes were: pain perception (Numeric Rating Scale, NP and Disability Scale, Central Sensitization Inventory) function (Cervical Kinematics) and kinesiophobia (Tampa Scale of Kinesiophobia).

RESULTS

Both groups demonstrated significant reduction in level of disability, pain perception, and kinesiophobia. Significant advancements in kinematics were observed: VRT group showed enhanced ROM during craniocervical rotation (P=0.039), lateral bending (P=0.001), flexion-extension (P=0.009), and mean velocity across movements (P<0.001), whereas CT group improved in maximal ROM during lateral bending rotation (P=0.001). Between-group analysis, after Bonferroni's correction for multiple comparisons, revealed that VRT group had significantly better outcomes in ROM during rotation (P=0.040), ratio of the primary over the secondary movement while performing rotation (P=0.021), and mean velocity during lateral bending (P=0.031).

CONCLUSIONS

Sensorimotor training, combined with manual therapy, could enhance kinematic outcomes for NP patients, supporting the potential of VR in rehabilitation.

CLINICAL REHABILITATION IMPACT

This study highlighted that both groups demonstrated significant reduction in level of disability, pain perception, and kinesiophobia after sensorimotor training combined with manual therapy. It is important to underscore that in terms of reducing the level of neck disability, both interventions proved to be equally effective. This parity in efficacy is a critical finding, reaffirming the robustness of our therapeutic approaches for this specific outcome.

Effects of Virtual Reality Therapy Combined With Conventional Rehabilitation on Pain, Kinematic Function, and Disability in Patients With Chronic Neck Pain: Randomized Controlled Trial

BACKGROUND

Neck pain is a common condition that leads to neck motor dysfunction and subsequent disability, with a significant global health care burden. As a newly emerging tool, virtual reality (VR) technology has been employed to address pain and reduce disability among patients with neck pain. However, there is still a lack of high-quality studies evaluating the efficacy of VR therapy combined with conventional rehabilitation for patients with chronic neck pain, particularly in terms of kinematic function.

OBJECTIVE

This study aims to investigate the effect of VR therapy combined with conventional rehabilitation on pain, kinematic function, and disability in patients with chronic neck pain.

METHODS

We conducted an assessor-blinded, allocation-concealed randomized controlled trial. Sixty-four participants experiencing chronic neck pain were randomly allocated into the experimental group that underwent VR rehabilitation plus conventional rehabilitation or the control group receiving the same amount of conventional rehabilitation alone for 10 sessions over 4 weeks. Pain intensity, disability, kinematic function (cervical range of motion, proprioception, and mean and peak velocity), degree of satisfaction, and relief of symptoms were evaluated at 3 timepoints (baseline, postintervention, and at 3 months follow-up). A 2*3 mixed repeated measures analysis of variance was utilized for analyzing the difference across indicators, with a significant difference level of .05.

RESULTS

Both groups demonstrated significant improvements in pain, disability, and kinematic functions (P<.05) at postintervention and at 3-month follow-up. The experimental group showed superior therapeutic outcomes compared to the control group in pain reduction (mean difference from the baseline: 5.50 vs 1.81 at posttreatment; 5.21 vs 1.91 at the 3-month follow-up, respectively; P<.001), disability improvement (mean difference from baseline: 3.04 vs 0.50 at posttreatment; 3.20 vs 0.85 at the 3-month follow-up, respectively; P<.001), and enhanced kinematic functions (P<.05). Moreover, participants in the experimental group reported better satisfaction and relief of symptoms than the control group (P<.05), with better initiative for exercising during the follow-up period. However, there was no between-group difference of improvement in proprioception. No adverse events were reported or observed in our research.

CONCLUSIONS

The findings of our study support the efficacy of combining VR therapy with conventional rehabilitation in alleviating pain, enhancing kinematic function, and reducing disability of patients with chronic neck pain. Future research should focus on refining the therapeutic protocols and dosages for VR therapy as well as on optimizing its application in clinical settings for improved convenience and effectiveness.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR2000040132; http://www.chictr.org.cn/showproj.aspx?proj=64346.

Analysis of time-space variations during dynamic cervical spine motion in cervical spondylosis myelopathy patients

BACKGROUND CONTEXT

Decreased cervical range of motion (ROM) is a common symptom of myelopathy patients. Many previous studies have relied on a variety of experimental approaches for quantifying static cervical range of motion. However, the change rules of time-space variation during dynamic cervical spine motion remains unknown.

PURPOSE

To develop and validate the effectiveness of a novel wearable robot-based sensor system, Analysis of Dynamic Cervical spine Motion (ADCM), in evaluating the dynamic cervical spine motion dysfunction of patients with cervical spondylotic myelopathy (CSM).

STUDY DESIGN/SETTING

A cross-sectional study.

PATIENT SAMPLE

One hundred forty consecutive healthy individuals (70 men and 70 women) and 120 CSM patients (60 men and 60 women) were enrolled in the present study.

OUTCOME MEASURES

The cervical motion process parameters, including the flexion and extension ROM, the flexion and extension time, and the Japanese Orthopedic Association scores (JOA) for cervical spine were measured.

METHODS

Two hundred and sixty consecutive participants were asked to wear ADCM system and then fully flex and extend their neck rapidly and evenly at tolerable maximum speed. The cervical motion process was recorded and converted into waveforms. Relevant waveform parameters were measured and analyzed. The number of complete flexion-extension motions in 10 seconds has been defined as 10s F-E cycles. The Japanese Orthopedics Association (JOA) scores of CSM patients were marked.

RESULTS

CSM patients had a lower number of 10s F-E cycles than healthy subjects. There were significant differences in flexion and extension time and ROM between two groups. The waveforms of myelopathy patients were wider and lower than those in healthy individuals. The average ratio value (defined as F) of wave height to wave width (a+b/c+d) could quantitatively reflect such differences of waveforms. The average F value was correlated with the JOA scores of the cervical motion function (r=0.7538), and F value declined as JOA scores decreased. According to receiver operating characteristic curve analysis, the optimal threshold value of the normal average ratio was more than 34.7.

CONCLUSIONS

ADCM appears to be an objective and quantitative severity assessment tool for confirmed CSM patients by evaluating dynamic cervical spine motion dysfunction.

Reliability of Cervicocephalic Proprioception Assessment: A Systematic Review

OBJECTIVE

The purpose of this systematic review was to determine the reliability and, where possible, the validity of cervicocephalic proprioceptive (CCP) tests in healthy adults and clinical populations.

METHODS

A systematic search, utilizing 7 databases from the earliest possible date to April 14, 2021, identified studies that measured reliability of CCP tests. Studies were screened for eligibility, and included studies were appraised using Quality Appraisal Tool for Studies of Diagnostic Reliability (QAREL) and Quality Assessment and Diagnostic Accuracy Studies-2 Tool (QUADAS-2) tools. Validity outcomes were assessed for included studies.

RESULTS

Of 34 included studies, 29 investigated reliability for sense of position tests, 10 involved sense of movement tests, and 1 used a sense of force test. The head to neutral test was reliable and valid when 6 or more repetitions were performed within the test, discriminating between those with and without neck pain. Head tracking tests were reliable with 6 repetitions, and 1 study found discriminative validity in a whiplash population. Studies that found discriminative validity in sense of position reported mean joint position error generally >4.5° in the neck pain group and <4.5° in the asymptomatic group. No sense of force test was applied to a clinical population. Convergent validity analysis showed that these proprioceptive tests have low correlations with each other.

CONCLUSION

The reliability and validity of CCP tests for sense of position and movement are dependent upon equipment and repetitions. Six repetitions are generally required for good reliability, and joint position error >4.5° is likely to indicate impairment in sense of position.

Assessment of Neuromuscular and Psychological Function in People with Recurrent Neck Pain during a Period of Remission: Cross-Sectional and Longitudinal Analyses

The aim of this study was to examine for the presence of differences in neuromuscular and psychological function in individuals with recurrent neck pain (RNP) or chronic neck pain (CNP) following a whiplash trauma compared to healthy controls. A secondary aim was to examine whether neuromuscular characteristics together with psychological features in people with RNP were predictive of future painful episodes. Multiple features were assessed including neck disability, kinesiophobia, quality of life, cervical kinematics, proprioception, activity of superficial neck flexor muscles, maximum neck flexion and extension strength, and perceived exertion during submaximal contractions. Overall, those with RNP (n = 22) and CNP (n = 8) presented with higher neck disability, greater kinesiophobia, lower quality of life, slower and irregular neck movements, and less neck strength compared to controls (n = 15). Prediction analysis in the RNP group revealed that a higher number of previous pain episodes within the last 12 months along with lower neck flexion strength were predictors of higher neck disability at a 6-month follow-up. This preliminary study shows that participants with RNP presented with some degree of altered neuromuscular features and poorer psychological function with respect to healthy controls and these features were similar to those with CNP. Neck flexor weakness was predictive of future neck disability.

The association between forward head posture and non-specific neck pain: A cross-sectional study

BACKGROUND

Poor posture is traditionally associated with various musculoskeletal disorders. Consequently, educators in the musculoskeletal field have been teaching postural observation as part of the physical assessment. Forward head posture (FHP) is hypothesized to be associated with neck pain; however, evidence in this topic remains inconclusive.

PURPOSE

To investigate the association between FHP and neck pain intensity, disability, and cervical kinematics in individuals with neck pain compared to asymptomatic individuals. A secondary aim of this study was to explore the possible effect of a head-mounted display (HMD) used in a virtual reality (VR) assessment on FHP.

METHODS

The study was conducted with 43 volunteers (20 asymptomatic individuals, 23 individuals with neck pain) aged 19 to 62. FHP was assessed by measuring craniovertebral angle on profile photographs. Secondary outcome measures included pain intensity, the neck disability index (NDI) questionnaire, and neck kinematics using specialized VR software.

RESULTS

There were no significant differences between individuals with neck pain and asymptomatic individuals in FHP (craniovertebral angle = 48.24°±7.29; 48.90°±5.89, respectively, p > .05). The neck pain group demonstrated a restricted range of motion and slower neck movements (p < .05). We found no significant correlation between FHP and visual analog scale, NDI, and most neck kinematic measures.

CONCLUSIONS

Our findings cannot support a clinically applicable association between FHP and neck pain. Additionally, individuals with neck pain had a lower range of motion and slower neck movements.

Head kinematics in patients with neck pain compared to asymptomatic controls: a systematic review

BACKGROUND

Neck pain is one of the most common musculoskeletal disorders encountered by healthcare providers. A precise assessment of functional deficits, including sensorimotor control impairment, is regarded necessary for tailored exercise programmes. Sensorimotor control can be measured by kinematic characteristics, such as velocity, acceleration, smoothness, and temporal measures, or by assessing movement accuracy. This systematic review aims to identify movement tasks and distinct outcome variables used to measure kinematics and movement accuracy in patients with neck pain and present their results in comparison to asymptomatic controls.

METHODS

Electronic searches were conducted in MEDLINE, PEDro, Cochrane Library and CINAHL databases from inception to August 2020. Risk of bias of included studies was assessed. Movement tasks and specific outcome parameters used were collated. The level of evidence for potential group differences in each outcome variable between patients with neck pain and controls was evaluated.

RESULTS

Twenty-seven studies examining head kinematics and movement accuracy during head-aiming, functional and unconstrained movement tasks of the head were included. Average Risk of Bias of included studies was moderate. In total, 23 different outcome variables were assessed. A strong level of evidence for an increased movement time and for an increased number of errors during head aiming tasks was found. Moderate evidence was found in traumatic neck pain for a decreased mean velocity, peak acceleration, and reaction time, and for point deviation and time on target during head aiming tasks. Moderate evidence was found for decreased acceleration during unconstrained movements, too. Results on the remaining movement task and outcome variables showed only limited, very limited or even conflicting level of evidence for patients with neck pain to differ from controls.

CONCLUSIONS

Sensorimotor control in NP in the way of kinematic and movement accuracy characteristics of head motion was examined in head aiming, functional or unconstrained movement tasks. The results from this review indicate that for some characteristics that describe sensorimotor control, patients with NP differ from healthy controls.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration number: CRD42020139083.

XR (Extended Reality: Virtual Reality, Augmented Reality, Mixed Reality) Technology in Spine Medicine: Status Quo and Quo Vadis

In recent years, with the rapid advancement and consumerization of virtual reality, augmented reality, mixed reality, and extended reality (XR) technology, the use of XR technology in spine medicine has also become increasingly popular. The rising use of XR technology in spine medicine has also been accelerated by the recent wave of digital transformation (i.e., case-specific three-dimensional medical images and holograms, wearable sensors, video cameras, fifth generation, artificial intelligence, and head-mounted displays), and further accelerated by the COVID-19 pandemic and the increase in minimally invasive spine surgery. The COVID-19 pandemic has a negative impact on society, but positive impacts can also be expected, including the continued spread and adoption of telemedicine services (i.e., tele-education, tele-surgery, tele-rehabilitation) that promote digital transformation. The purpose of this narrative review is to describe the accelerators of XR (VR, AR, MR) technology in spine medicine and then to provide a comprehensive review of the use of XR technology in spine medicine, including surgery, consultation, education, and rehabilitation, as well as to identify its limitations and future perspectives (status quo and quo vadis).

The Analgesic Effects of Virtual Reality for People with Chronic Pain: A Scoping Review

OBJECTIVE

Although virtual reality is shown to have short-term analgesic effects in acute pain settings, its long-term efficacy in chronic pain conditions has not been established. This scoping review aims to provide a summary of virtual reality approaches explored in chronic primary and secondary pain conditions as defined by the International Association for the Study of Pain.

METHODS

A systematic literature search in Ovid PubMed and Ovid Embase was conducted between January 5 and January 10, 2021, with the use of the Arksey and O'Malley six-step scoping review criteria. Articles were searched via search terms and keywords relating to International Classification of Diseases-defined primary and secondary chronic pain conditions, virtual reality, virtual illusion, distraction, and effects on levels of pain.

RESULTS

Of the 2,118 articles located, 44 were included, which covered a range of primary and secondary chronic pain conditions and used a variety of different computer screen and headset protocols, including gaming, mindfulness, exercise, relaxation, and proprioceptive skills.

CONCLUSIONS

Studies show virtual reality to be an effective analgesic intervention for people with chronic pain. Given user satisfaction, a lack of side effects such as cybersickness, and relief of comorbid symptoms, virtual reality has potential as a worthwhile adjunct to chronic pain management programs, thus enabling patients to take control of their symptoms.

Sensorimotor performance in acute-subacute non-specific neck pain: a non-randomized prospective clinical trial with intervention

Background

The assessment of cervical spine kinematic axial rotation performance is of great importance in the context of the study of neck sensorimotor control. However, studies addressing the influence of the level of provocation of spinal pain and the potential benefit of passive manual therapy mobilizations in patients with acute-subacute non-specific neck pain are lacking.

Methods

A non-randomized prospective clinical trial with an intervention design was conducted. We investigated: (1) the test-retest reliability of kinematic variables during a fast axial head rotation task standardized with the DidRen laser test device in 42 Healthy pain-free Control Participants (HCP) (24.3 years ±6.8); (2) the differences in kinematic variables between HCP and 38 patients with Acute-subacute Non-Specific neck Pain (ANSP) assigned to two different groups according to whether their pain was localized in the upper or lower spine (46.2 years ±16.3); and (3) the effect of passive manual therapy mobilizations on kinematic variables of the neck during fast axial head rotation.

Results

(1) Intra-class correlation coefficients ranged from moderate (0.57 (0.06-0.80)) to excellent (0.96 (0.91-0.98)). (2) Kinematic performance during fast axial rotations of the head was significantly altered in ANSP compared to HCP (age-adjusted) for one variable: the time between peaks of acceleration and deceleration (p<0.019). No significant difference was observed between ANSP with upper vs lower spinal pain localization. (3) After the intervention, there was a significant effect on several kinematic variables, e.g., ANSP improved peak speed (p<0.007) and performance of the DidRen laser test (p<0.001), with effect sizes ranging from small to medium.

Conclusion

(1) The DidRen laser test is reliable. (2) A significant reduction in time between acceleration and deceleration peaks was observed in ANSP compared to HCP, but with no significant effect of spinal pain location on kinematic variables was found. (3) We found that neck pain decreased after passive manual therapy mobilizations with improvements of several kinematic variables.

Trial registration

Registration Number: NCT 04407637

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-021-04876-4.

Validity and Reliability of Interactive Virtual Reality in Assessing the Musculoskeletal System: a Systematic Review

PURPOSE OF REVIEW

Assessment of the musculoskeletal system requires consideration of its integrated function with the nervous system. This may be assisted by using valid and reliable methods that simulate real-life situations. Interactive virtual reality (VR) technology may introduce various auditory and visual inputs that mimic real-life scenarios. However, evidence supporting the quality and strength of evidence regarding the adequacy of its psychometric properties in assessing the musculoskeletal function has not been evaluated yet. Therefore, this study reviewed the validity and reliability of VR games and real-time feedback in assessing the musculoskeletal system.

RECENT FINDINGS

Nine studies were included in quality assessment. Based on outcome measures, studies were categorized into range of motion (ROM), balance, reaction time, and cervical motion velocity and accuracy. The majority of the studies were of moderate quality and provided evidence of VR adequate concurrent and, in some cases, known-groups validity. Also, VR showed high intra-rater reliability for most of the measured outcomes. Based on the included studies, there is a limited promising evidence that interactive VR using games or real-time feedback is highly valid and reliable in assessing ROM in asymptomatic participants and patients with chronic neck pain and radial fracture. For the remaining outcomes, evidence is limited to draw a robust conclusion. Future studies are recommended to test VR psychometric properties in different patients' population using a rigor research methodology.

The Application of Virtual Reality in Cervical Spinal Surgery: A Review

In recent years, clinicians have used virtual reality (VR) to simulate real-world environments for medical purposes. The use of VR systems in the field of cervical spine surgery can lead to effective surgical training programs without causing harm to patients. Moreover, both imaging and VR can be used before surgery to assist preoperative surgical planning. VR devices have a variety of built-in motion sensors, therefore kinematic data can be recorded while users are wearing VR devices and performing some actions for the evaluation of cervical spine activity and exercise ability. Therapists have also applied VR to cervical spine rehabilitation and showed good results. At present, the application of VR systems in cervical spine surgery has great potential, but current research is insufficient. Here, we review the latest advancements in VR technology used in cervical spine surgery and discuss potential directions for future work.

Predictors for Positive Response to Home Kinematic Training in Chronic Neck Pain

OBJECTIVES

There is strong evidence for exercise therapy in neck pain, but a wide variety of protocols. Predictors for outcome are unknown and current practice is based on trial and error. The objective of this study was to identify predictors for response to home kinematic training (KT) considering improvement in both self-reported and kinematic measures.

METHODS

A continuing analysis of data from the second phase of a randomized controlled trial, which included 4 weeks of KT using laser or virtual reality, with baseline, postintervention, and 3-month follow-up measures. Positive self-reported response was defined as a ≥50% pain reduction, ≥7% reduction in neck disability index (NDI), or a global perceived effect of 3 to 5 of 5. A second model defined improvement by ≥40% increase in cervical velocity.

RESULTS

Data were retrieved from 79 participants with chronic neck pain who completed the postintervention evaluation and 52 who completed the 3-month follow-up. Self-reported response was 71% to 73% and kinematic response was 41% to 46%. Prediction models indicated an immediate increase in self-reported measures in men with NDI ≥ 20% slower (≤65°/s), and less accurate (≥16° error) cervical motion at baseline. In the longer term, older patients with higher NDI seemed to benefit more. In the second model, no factors significantly predicted improvement in kinematic measures at either time point.

CONCLUSION

A high positive response rate to home KT was found by self-reported criteria. Males with poorer clinical and kinematic presentation at baseline, that is greater disability and slower neck motion, were more likely to respond.

Paths of the cervical instantaneous axis of rotation during active movements-patterns and reliability

The instantaneous helical axis (IHA) is a characteristic of neck movement that is very sensitive to changes in coordination and that has potential in the assessment of functional alterations. For its application in the clinical setting, normative patterns must be available, and its reliability must be established. The purpose of this work is to describe the continuous paths of the IHA during cyclic movements of flexion-extension (FE), lateral bending (LB), and axial rotation (AR) and to quantify their reliability. Fifteen healthy volunteers participated in the study; two repetitions were made on the same day (by different operators) and over an 8-day interval (by the same operator) to evaluate the inter-operator and inter-session reliability, respectively. The paths described by the IHA suggest a sequential movement of the vertebrae in the FE movement, with a large vertical displacement (mean, 10 cm). The IHA displacement in LB and AR movements are smaller. The paths described by the IHAs have a very high reliability for FE movement, although it is somewhat lower for LB and RA movements. The standard error of measurement (SEM) is less than 0.5 cm. These results show that the paths of the IHA are reliable enough to evaluate changes in the coordination of intervertebral movement. Graphical abstract A video photogrammetry system is used to record the cyclic movements of the neck, from which the continuous trajectories of the associated instantaneous helical axis (IHA) are calculated. We have analyzed the movements of flexion-extension (FE), lateral flexion (LB), and axial rotation (AR) for a sample of 15 healthy subjects. The measurements have been repeated with two different operators (in the same session) and in two separate sessions (same operator). IHA displacement patterns have been obtained in each movement, and the reliability of the measurement of such IHA trajectories has been estimated.

Intra-rater and inter-rater reliability of cervical active range of movement in young asymptomatic adults using inertial sensors

Objectives: Current literature is scarce about the use of an inertial sensor to measure cervical active range of motion (aROM). The objective of the present study is to determine inter- and intra-reliability in the measurement of cervical aROM using inertial sensors in asymptomatic individuals.Materials and methods: Twenty asymptomatic individuals participated in the study. Two different physiotherapists measured each participant for cervical aROM (6 movements). The sequence of movements and the explanations given were standardized. The rater's order of measurement was randomized.Results: For the intra-rater results, the intraclass correlation coefficient (ICC) values for all cervical movements were good for Rater A (ICC >0.90) and Rater B (ICC >0.90). For the inter-rater results, the ICC values were above 0.75 for all movements, indicating a good level of reliability. Also, values obtained in SEM, MDC₉₀ and LOA indicate good agreement.Conclusion: The data obtained in this study suggest that inertial sensors can be used in clinics due to their high intra- and inter-rater ICC (>0.80). Also, its low economic cost, easy handling, and various utilities make this tool a useful alternative in the measurement of cervical aROM.

Is Virtual Reality Effective in Orthopedic Rehabilitation? A Systematic Review and Meta-Analysis

BACKGROUND

Virtual reality (VR) is an interactive technology that allows customized treatment and may help in delivering effective person-centered rehabilitation.

PURPOSE

The purpose of this review was to systematically review and critically appraise the controlled clinical trials that investigated VR effectiveness in orthopedic rehabilitation.

DATA SOURCES

Pubmed, CINAHL, Embase, PEDro, REHABDATA, and Sage publications were searched up to September 2018. In addition, manual searching and snowballing using Scopus and Web of Science were done.

STUDY SELECTION

Two reviewers screened studies for eligibility first by title and abstract and then full text.

DATA EXTRACTION

Articles were categorized into general or region-specific (upper limbs, lower limbs, and spine) orthopedic disorders. Study quality was assessed using the Evaluation Guidelines for Rating the Quality of an Intervention Study scoring. Meta-analysis quantified VR effectiveness, compared with no treatment, in back pain.

DATA SYNTHESIS

Nineteen studies were included in the quality assessment. The majority of the studies were of moderate quality. Fourteen studies showed that VR did not differ compared with exercises. Compared with the no-treatment control, 5 studies favored VR and 3 other studies showed no differences. For low back pain, the meta-analysis revealed no significant difference between VR and no-treatment control (n = 116; standardized mean difference = -0.21; 95% confidence interval = -0.58 to 0.15).

LIMITATIONS

Limitations included heterogeneity in interventions and the outcome measures of reviewed studies. Only articles in English were included.

CONCLUSION

The evidence of VR effectiveness is promising in chronic neck pain and shoulder impingement syndrome. VR and exercises have similar effects in rheumatoid arthritis, knee arthritis, ankle instability, and post-anterior cruciate reconstruction. For fibromyalgia and back pain, as well as after knee arthroplasty, the evidence of VR effectiveness compared with exercise is absent or inconclusive.

Age-related kinematic performance should be considered during fast head-neck rotation target task in individuals aged from 8 to 85 years old

Kinematic behavior during fast cervical rotations is a useful parameter for assessing sensorimotor control performances in neck-pain patients. However, the influence of age in asymptomatic individuals from children to older people still needs to be explored. Our aim was to assess the impact of age on sensorimotor control performance of the head-neck with execution time and kinematic variables (time of task, mean speed/acceleration/deceleration, overshoots (OSs), minimum/maximum speed) during standardized fast rotation target task using the DidRen Laser test. A total of 80 volunteers were stratified in four different age-groups: Children (8–14 years): n = 16; Young Adults (18–35 years): n = 29; Old Adults (36–64 years): n = 18; Seniors (65–85 years): n = 17. Results showed that to perform the test, Children were slower (69.0 (60.6–87.3)s) compared to Young Adults (49.6 (45.6–55.6)s) with p < 0.001, and Old Adults (51.7 (48.4–55.8)s) with p < 0.001. It was also slower in Seniors (57 (52.3–67.6)s) compared to Young Adults with p < 0.013. Mean speed was slower in Children (9.4 ± 2.3 °s⁻¹) and Seniors (10.6 ± 2.4 °s⁻¹) compared to Young Adults (13.7 ± 1.9 °s⁻¹) with p < 0.001 and Old Adults (13.3 ± 2.4 °s⁻¹) with p < 0.001. Mean acceleration was slower for Children (8.4(7.6–10.2) °s⁻²) compared to Young Adults (11.1 (8.8–15.3) °s⁻²) with p < 0.016, and Old Adults (12.0(8.4–15.3) °s⁻²) with p < 0.015. Mean deceleration was slower for Children (−1.9(−2.6–1.4) °s⁻²) compared to Young Adults (−2.9(−3.7–2.5) °s⁻²) with p < 0.001 and Old Adults (−3.2(−3.7–2.3) °s⁻²) with p < 0.003. The DidRen Laser test allows us to discriminate age-specific performances for mean speed, acceleration and deceleration. Seniors and Children needed to be slower to become as precise as Young Adults and Old Adults. No difference was observed for OSs which assesses accuracy of movement. Age should therefore be considered as a key parameter when analyzing execution time and kinematic results during DidRen Laser test. These normative data can therefore guide clinicians in the assessment of subjects with neck pain.

Relationship between neck motion and self-reported pain in patients with whiplash associated disorders during the acute phase

BACKGROUND

Biomechanical measures quantify motor control and functional deficits in Whiplash Associated Disorders (WAD), but few studies relate those measures to the clinical scales that are routinely used to assess patients. Most studies are limited to chronic neck pain, and report poor to moderate correlations.

OBJECTIVE

To define a statistical model that relates measures of neck kinematics with clinical scales of neck pain, in WAD patients during the rehabilitation process in the acute phase (less than 3 months since the accident).

METHODS

96 WAD patients self-assessed their pain using VAS and NPQ, and passed neck motion tests as part of their rehabilitation program. Four regression models were fitted to analyze the effects of the measured kinematic parameters and subject-specific characteristics on VAS and NPQ. Model errors were compared to minimal clinically significant differences.

RESULTS

Multiple correlation coefficients of the models were between 0.74 and 0.90. More than 66% of that correlation was accounted for by subject-specific factors, and most of the other half by the measured kinematic parameters. Range of motion of flexion-extension and axial rotation, and harmonicity of flexion-extension, where the variables most consistently related to the decrease of pain. The error of the models was within the MCSD in more than 50% of the observations.

CONCLUSIONS

Part of the individual progression of pain and pain-related disability in acute WAD patients, as rated by NPQ and VAS, can be mapped to objective kinematic parameters of neck mobility tests, like ranges of motion, velocities, repeatability and harmonicity of movements.

Cervical kinematics in patients with vestibular pathology vs. patients with neck pain: A pilot study

OBJECTIVE

Research has consistently shown cervical kinematic impairments in subjects with persistent neck pain (NP). It could be reasoned that those with vestibular pathology (VP) may also have altered kinematics since vestibular stimulation via head movement can cause dizziness and visual disturbances. However, this has not been examined to date. This pilot study investigated changes in cervical kinematics between asymptomatic control, NP and VP subjects using a Virtual Reality (VR) system. It was hypothesised that there would be altered kinematics in VP subjects, which might be associated with dizziness and visual symptoms.

DESIGN

Pilot cross sectional observational study.

PARTICIPANTS

Twenty control, 14 VP and 20 NP subjects.

INTERVENTION

Not applicable.

MAIN OUTCOME MEASURES

Measures included questionnaires (neck disability index, pain on movement, dizziness and pain intensity, visual disturbances) and cervical kinematics (range, peak and mean velocity, smoothness, symmetry, and accuracy of cervical motion) using a virtual reality system.

RESULTS

Results revealed significantly decreased mean velocity and symmetry of motion in both planes in those with NP but no differences in accuracy or range of motion. No significant differences were seen between VP subjects and asymptomatic controls. However, correlation analysis showed some moderate correlations between dizziness to selected kinematics in both the NP and the VP groups.

CONCLUSIONS

These results support that cervical kinematics are altered in NP patients, with velocity most affected. There is potential for VP subjects to also have altered kinematics, especially those who experience dizziness. More research is required.