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Onan D, Ulger O, Martelletti P. Effects of spinal stabilization exercises delivered using telerehabilitation on outcomes in patients with chronic neck pain: a randomized controlled trial. Expert Rev Neurother 2023; 23:269-280. [PMID: 36927237 DOI: 10.1080/14737175.2023.2192870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
BACKGROUND When spinal stabilization exercises (SSE) are performed regularly, may provide benefits on outcome measures in chronic nonspecific neck pain (CNNP) patients. The pandemic has made it difficult for CNNP patients to access regular physiotherapy-exercise services. This study aims to compare telerehabilitation (TR) with face-to-face rehabilitation in CNNP. METHODS Neck Functional Capacity Evaluation Test (NFCET) results were the primary outcomes. Pain intensity (PI), disability, awareness, neck muscles architecture, andexercise satisfaction were the secondary outcomes. Patients were randomized into the TR group (TRG) (n = 15) and the control group (CG) (n = 16). Patients performed SSE 3 days a week, for 8 weeks. The TRG was instructed remotely while the CG was instructed in the clinic. RESULTS After 8 weeks in both groups, NFCET values and neck awareness increased (p < 0.05), PI and disability decreased (p < 0.05). Muscle architecture improved in both groups (p < 0.05), except for the Right Sternocleidomastoideus in both groups and the Right Upper-Trapezius in TRG (p > 0.05). There was no difference between the groups for all variables and exercise satisfaction(p > 0.05). CONCLUSION SSE for CNNP, whether supervised by therapists in the clinic or by telerehabilitation, was equally effective. THE CLINICAL TRIAL NUMBER NCT04691024.
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Affiliation(s)
- Dilara Onan
- Spine Health Unit, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Ozlem Ulger
- Spine Health Unit, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
- Regional Referral Headache Centre, Sant'Andrea Hospital, Sapienza University, Rome, Italy
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Habberfield J, Schneider G, Schneider K, Katuli S, Olson L. A clinical test to assess isometric cervical strength in chronic whiplash associated disorder (WAD): a reliability study. BMC Musculoskelet Disord 2022; 23:736. [PMID: 35915421 PMCID: PMC9341054 DOI: 10.1186/s12891-022-05703-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 07/07/2022] [Indexed: 11/23/2022] Open
Abstract
Background Cervical spine muscle weakness is well demonstrated in individuals with chronic neck pain. There is a lack of literature evaluating clinically applicable means of assessing isometric cervical strength in chronic whiplash associated disorder (WAD). This study assessed the reliability of self-resisted isometric cervical strength testing using a handheld dynamometer. The relationship between strength and neck pain-related disability and kinesiophobia was also investigated. Methods Twenty subjects with chronic WAD performed maximum-effort isometric cervical flexion, extension, side flexion, and rotation against a hand held dynamometer. The dynamometer was held by the subject, who provided self-resistance. Subjects completed two sessions of testing on one day with two different examiners, and one session on a subsequent day with one of the original examiners. Subjects completed the Neck Disability Index (NDI) and Tampa Scale for Kinesiophobia (TSK) prior to the first testing session. Results Intraclass correlation coefficients (ICC) for directional strength measures were fair to high (0.71–0.88 for intra-rater and 0.79–0.91 for inter-rater). Total strength (sum of all directional strengths) ICCs were high for both intra-rater (ICC = 0.91) and inter-rater (ICC = 0.94) measures. All statistical tests for ICCs demonstrated significance (α < 0.05). Agreement was assessed using Bland Altman (BA) analysis with 95% limits of agreement. BA analysis demonstrated difference scores between the two testing sessions that ranged from 3.0—17.3% and 4.5—28.5% of the mean score for intra and inter-rater measures, respectively. Most measures did not meet the a priori standard for agreement. A moderate to good inverse relationship was demonstrated between kinesiophobia (TSK score) and six out of seven strength measures (α < .05). No significant correlation was found between neck disability (NDI) and cervical strength in any direction. Conclusion This study demonstrated fair to high reliability of self resisted isometric cervical strength testing in the chronic WAD population. All directional strength measures except flexion demonstrated a significant inverse relationship with kinesiophobia. No cervical strength measures were correlated with neck disability. These results support testing cervical strength in this manner to reliably assess change over time within individual patients. The value of such measurement requires further consideration given the lack of correlation between cervical strength and disability. Further research is required to establish normative values and enhance clinical utility. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05703-0.
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Affiliation(s)
- Jeff Habberfield
- Evidence Sport and Spinal Therapy, 2000 Veterans Place NW, T3B 4N2, Calgary, AB, Canada. .,Andrews University School of Rehabilitation Sciences. School of Rehabilitation Sciences Building 131, 8515 East Campus Circle Drive, 49104-0420, Berrien Springs, MI, USA.
| | - Geoff Schneider
- Evidence Sport and Spinal Therapy, 2000 Veterans Place NW, T3B 4N2, Calgary, AB, Canada.,Andrews University School of Rehabilitation Sciences. School of Rehabilitation Sciences Building 131, 8515 East Campus Circle Drive, 49104-0420, Berrien Springs, MI, USA.,University of Calgary Cumming School of Medicine, 3330 Hospital Drive NW, T2N 4N1, Calgary, AB, Canada
| | - Kathryn Schneider
- Evidence Sport and Spinal Therapy, 2000 Veterans Place NW, T3B 4N2, Calgary, AB, Canada.,Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, 2500 University Drive NW, T2N 1N4, Calgary, AB, Canada.,Hotchkiss Brain Institute, University of Calgary, 2500 University Drive NW, T2N 1N4, Calgary, AB, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, 2500 University Drive NW, T2N 1N4, Calgary, AB, Canada
| | - Sozina Katuli
- Andrews University School of Rehabilitation Sciences. School of Rehabilitation Sciences Building 131, 8515 East Campus Circle Drive, 49104-0420, Berrien Springs, MI, USA
| | - Lee Olson
- Andrews University School of Rehabilitation Sciences. School of Rehabilitation Sciences Building 131, 8515 East Campus Circle Drive, 49104-0420, Berrien Springs, MI, USA
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Griffin AR, Leaver AM, Arora M, Walton DM, Peek A, Bandong AN, Sterling M, Rebbeck T. Clinimetric Properties of Self-reported Disability Scales for Whiplash: A Systematic Review for the Whiplash Core Outcome Set (CATWAD). Clin J Pain 2021; 37:766-787. [PMID: 34282060 DOI: 10.1097/ajp.0000000000000968] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 07/02/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVES A core outcomes set (COS) for whiplash-associated disorders (WADs) has been proposed to improve consistency of outcome reporting in clinical trials. Patient-reported disability was one outcome of interest within this COS. The aim of this review was to identify the most suitable tools for measuring self-reported disability in WAD based on clinimetric performance. METHODS Database searches took place in 2 stages. The first identified outcome measures used to assess self-reported disability in WAD, and the second identified studies assessing the clinimetric properties of these outcome measures in WAD. Data on the study, population and outcome measure characteristics were extracted, along with clinimetric data. Quality and clinimetric performance were assessed in accordance with the Consensus-based Standards for the Selection of Health Status Measurement Instruments (COSMIN). RESULTS Of 19,663 records identified in stage 1 searches, 32 were retained following stage 2 searches and screening. Both the Whiplash Disability Questionnaire and Neck Disability Index performed well in reliability (intraclass correlation coefficient=0.84 to 0.98), construct validity (74% to 82% of hypotheses accepted), and responsiveness (majority of correlations in accordance with hypotheses). Both received Category B recommendations due to a lack of evidence for content validity. DISCUSSION This review identified the Neck Disability Index and Whiplash Disability Questionnaire as the most appropriate patient-reported outcome measures (PROMs) for assessing self-reported disability in WAD based on moderate to high-quality evidence for sufficient reliability, construct validity and responsiveness. However, the content validity of these PROMs has yet to be established in WAD, and until this is undertaken, it is not possible to recommend 1 PROM over the other for inclusion in the WAD COS.
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Affiliation(s)
- Alexandra R Griffin
- Faculty of Medicine and Health, The University of Sydney, Camperdown
- John Walsh Centre for Rehabilitation Research, Level 12, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards
| | - Andrew M Leaver
- Faculty of Medicine and Health, The University of Sydney, Camperdown
| | - Mohit Arora
- John Walsh Centre for Rehabilitation Research, Level 12, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards
- Sydney Medical School-Northern, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW
| | - David M Walton
- School of Physical Therapy, Western University, London, ON, Canada
| | - Aimie Peek
- Faculty of Medicine and Health, The University of Sydney, Camperdown
- NHMRC Centre of Research Excellence in Road Traffic Injury, The University of Queensland
| | - Aila N Bandong
- Faculty of Medicine and Health, The University of Sydney, Camperdown
- College of Allied Medical Professions, The University of the Philippines Manila, Philippines
| | - Michele Sterling
- NHMRC Centre of Research Excellence in Road Traffic Injury, The University of Queensland
- Recover Injury Research Centre, Level 7, UQ Oral Health Centre, The University of Queensland, Herston, QLD, Australia
| | - Trudy Rebbeck
- Faculty of Medicine and Health, The University of Sydney, Camperdown
- John Walsh Centre for Rehabilitation Research, Level 12, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards
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Peterson G, Landén Ludvigsson M, Peolsson A. Neck-related function and its connection with disability in chronic whiplash-associated disorders: secondary analysis of a randomized controlled study. Eur J Phys Rehabil Med 2021; 57:607-619. [PMID: 34519194 DOI: 10.23736/s1973-9087.21.06518-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND More than 40% of individuals with whiplash injury experience persistent neck pain and disability years later, called whiplash-associated disorders (WAD). A randomized controlled trial evaluated three exercise interventions in WAD and found that neck-specific exercise (NSE) and NSE with a behavioral approach (NSEB) significantly improve disability compared to prescribed physical activity (PPA). However, the relationship between neck-related function and disability is inconclusive and needs to be further investigated. AIM The present study compares the effect of NSE, NSEB, and PPA on neck muscle endurance (NME), active cervical range of motion (AROM), grip strength, and pain intensity immediately before and after the physical tests, and neck disability in individuals who are below or above the cut-off for normative reference values regarding NME, AROM, and grip strength. DESIGN Follow-up to a multicenter randomized clinical trial. SETTING Primary healthcare centers and hospital outpatient services. POPULATION The selected population of this study included 216 patients with persistent WAD grades II and III. METHODS This is a secondary analysis including 12 months' follow-up. NME, AROM, grip strength, pain, and self-reported disability were recorded at baseline, 3, 6, and 12 months. Linear mixed models were used, and sub-group analyses evaluated by non-parametric tests. RESULTS NSE and NSEB resulted in greater improvements compared to PPA (P<0.01) in ventral (only males) and dorsal NME, AROM, and pain intensity during testing. We found no significant between-group differences in grip strength and no significant differences between the NSE and NSEB groups. Improvement in disability was seen at the 12-month follow-up of NSE and/or NSEB for individuals both below and above the cut-off reference values for NME and AROM. Individuals in the PPA group below the reference values for NME and AROM reported increasing disability at 12 months compared to baseline. CONCLUSIONS The results suggest that neck-specific exercises (i.e., NSE, NSEB) improve clinical function and decrease disability in chronic WAD compared to PPA, but PPA can increase disability for patients with low neck-related function. CLINICAL REHABILITATION IMPACT Higher neck-related function seems to be important for reduced disability in persistent WAD grades II and III. Neck-specific exercises could lead to higher neck-related function.
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Affiliation(s)
- Gunnel Peterson
- Center for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden - .,Department of Health, Medicine and Caring Sciences, Physiotherapy, Linköping University, Linköping, Sweden -
| | - Maria Landén Ludvigsson
- Department of Health, Medicine and Caring Sciences, Physiotherapy, Linköping University, Linköping, Sweden.,Department of Rehabilitation and Department of Health, Medicine and Caring Sciences, Linköping University, Rehab Väst, Region Council of Östergötland, Motala, Sweden
| | - Anneli Peolsson
- Department of Health, Medicine and Caring Sciences, Physiotherapy, Linköping University, Linköping, Sweden
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McGee S, Sipos T, Allin T, Chen C, Greco A, Bobos P, MacDermid J. Systematic review of the measurement properties of performance-based functional tests in patients with neck disorders. BMJ Open 2019; 9:e031242. [PMID: 31767589 PMCID: PMC6886974 DOI: 10.1136/bmjopen-2019-031242] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES The purpose of this systematic review is to identify and synthesise studies evaluating performance-based functional outcome measures designed to evaluate the functional abilities of patients with neck pain. DESIGN Systematic review. DATA SOURCES A literature search using PubMed, Scopus, CINAHL, EMBASE, COCHRANE, Google Scholar and a citation mapping strategy was conducted until July 2019. ELIGIBILITY CRITERIA More than half of the study's patient population had neck pain or a musculoskeletal neck disorder and completed a functional-based test. Clinimetric properties of at least one performance-based functional tests were reported. Both traumatic and non-traumatic origins of neck pain were considered. DATA EXTRACTION AND SYNTHESIS Relevant data were then extracted from selected articles using an extraction guide. Selected articles were appraised using the Quality Appraisal for Clinical Measurement Research Reports Evaluation Form (QACMRR). RESULTS The search obtained 12 articles which reported on four outcome measures (functional capacity evaluations (FCE), Baltimore Therapeutic Equipment Work Simulator II (BTEWS II), Functional Impairment Test-Hand and Neck/Shoulder/Arm (FIT-HaNSA)) and a physiotherapy test package, to assess the functional abilities in patients with mechanical neck pain. Of the selected papers: one reports content validity, five construct validity, four reliability, one sensitivity to change and one both reliability and construct validity. QACMRR scores ranged from 68% to 95%. CONCLUSIONS This review found very good quality evidence that the FIT-HaNSA has excellent inter and intra-rater reliability and very weak to weak convergent validity. Excellent quality evidence of fair test-retest reliability, weak convergent validity and very weak known groups validity for the BTEWS II test was found. Good to excellent quality evidence exists that an FCE battery has poor to excellent reliability and very weak to strong validity. Good to excellent quality of weak to strong validity and trivial to strong effect sizes were found for a physiotherapy test package. PROSPERO REGISTRATION NUMBER CRD42018112358.
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Affiliation(s)
- Steven McGee
- School of Physical Therapy, Health and Rehabilitation Sciences, Western University, London, Ontario, Canada
| | - Taylor Sipos
- School of Physical Therapy, Health and Rehabilitation Sciences, Western University, London, Ontario, Canada
| | - Thomas Allin
- School of Physical Therapy, Health and Rehabilitation Sciences, Western University, London, Ontario, Canada
| | - Celia Chen
- School of Physical Therapy, Health and Rehabilitation Sciences, Western University, London, Ontario, Canada
| | - Alexandra Greco
- School of Physical Therapy, Health and Rehabilitation Sciences, Western University, London, Ontario, Canada
| | - Pavlos Bobos
- School of Physical Therapy, Health and Rehabilitation Sciences, Western University, London, Ontario, Canada
- Western's Bone and Joint Intitute, Western University, London, Ontario, Canada
- Dalla Lana School of Public Health, Institute of Health Policy Management and Evaluation, Department of Clinical Epidemiology and Health Care Research, University of Toronto, Toronto, Ontario, Canada
| | - Joy MacDermid
- School of Physical Therapy, Health and Rehabilitation Sciences, Western University, London, Ontario, Canada
- Western's Bone and Joint Intitute, Western University, London, Ontario, Canada
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
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