To What Degree Does Active Cervical Range of Motion Differ Between Patients With Neck Pain, Patients With Whiplash, and Those Without Neck Pain? A Systematic Review and Meta-Analysis

Quantifying Cervical Rotation Smoothness: Exploring Various Jerk Metrics and Test-Retest Reliability of Jerk, Range of Motion, and Head Repositioning Accuracy

The assessment of smoothness, range of motion (ROM), and head repositioning accuracy (HRA) has gained attention in identifying sensorimotor impairments. Uncertainty persists on the approach for acquiring reliable measures, including choice of smoothness metric, normalization factors, and the required number of measurements for reliable results. This study aimed to address this uncertainty. Thirty healthy participants were included in this single-session randomized cross-over study. The experiment consisted of two parts. One focused on the test-retest assessment of head ROM into right rotation to the end of range from a neutral position using a self-selected movement speed and the HRA when returning to the start-position. In the other part, participants repeated the previous tasks and performed head rotations at slower and faster speeds than their self-selected pace and to the beat of a metronome. All tasks were repeated ten times. For the test-retest, the inter-class-correlation (ICC) values for ROM were between 0.84-0.91, 0.20-0.31 for HRA, and 0.65-0.90 for jerk for 1-10 repetitions. Normalizing jerk through vmean and vpeak had similar variability and appeared equally valid for our data. However, normalizing by vmax ensures desirable properties in the smoothness metric. Lower variability was observed when standardizing movements using a metronome. Based on test-retest findings, three repetitions are recommended, as ICC values show marginal improvement beyond 2-3 repetitions, providing limited additional value.

An overview of systematic reviews investigating clinical features for diagnosing neck pain and its associated disorders

BACKGROUND

Neck pain is a common condition that is often difficult to diagnose. Previous literature has investigated diagnostic accuracy of examination measures, but the strength and clinical applicability are limited. This overview of systematic reviews aimed to investigate clinical features for diagnosing neck pain and its associated disorders.

METHODS

An overview of systematic reviews was conducted searching four electronic databases for systematic reviews evaluating diagnostic criteria for neck pain. Quality and risk of bias were assessed using the AMSTAR 2 and ROBIS. Clinical features for neck pain were investigated for diagnostic utility.

RESULTS

Twenty-seven systematic reviews were included. Hand radiculopathy and numbness have good specificities (0.89-0.92) for facet and uncinate joint hypertrophy. For facet-related dysfunction, the extension rotation test (ERT) and manual assessment have good sensitivities and moderate-good specificities. Positive ERT combined with positive manual assessment findings (+LR = 4.71; Sp = 0.83) improves diagnostic accuracy compared to positive ERT alone (+LR = 2.01; Sp = 0.59). Canadian C-spine Rules and Nexus criteria have excellent validity in screening for cervical fracture or instability. Imaging appears to have validity in diagnosing ligamentous disruption or fractures but lacks clarity on predicting future neck pain. Increased fatty infiltrates have been found with whiplash-associated disorders and mechanical neck pain.

CONCLUSIONS

This review found limited indicators providing strong diagnostic utility for diagnosing neck pain. Strength of recommendations are limited by heterogeneous outcomes, methodology, and classification systems. Future research should investigate new differential diagnostic criteria for specific structures contributing to neck pain.

The CROM-VAS Test: A novel and reliable clinical test to assess immediate pain relief following treatment for movement-evoked neck pain

BACKGROUND

The CROM-VAS Test is a novel method to quantify immediate hypoalgesic treatment effects for neck pain by measuring the reduction in pain intensity (using a VAS) at the same (sub)maximal neck position (using a CROM device) before and after treatment. It is a novel test designed to quantify immediate pain relief following treatment, without the potentially confounding effects of simultaneous improvements in function.

OBJECTIVES

(1) To describe the CROM-VAS Test, (2) To assess reliability and absolute agreement of the CROM-VAS Test, and (3) To evaluate its distinctiveness by comparing it to changes in pressure pain threshold (PPT) and baseline pain scores.

DESIGN

Cross-sectional study.

METHODS

The CROM-VAS Test was assessed in 58 people with non-specific neck pain treated with cervical mobilisation and cervicothoracic manipulation. Inter-rater reliability (intraclass correlation coefficient (ICC1.1)) and absolute agreement (standard error of measurement (SEM), minimal detectable change (MDC) and Bland-Altman limits of agreement (LoA)) were determined.

RESULTS

Reliability was high (ICC1.1: 0.91 (95%CI: 0.85-0.95) for the CROM-VAS Test in the painful direction and 0.73 (95%CI: 0.54-0.85) in the non/least painful direction). Agreement was good (CROM-VAS Test (painful direction): SEM: 2.3 mm; MDC: 6.4 mm; LoA: 13.5 to 16.6 mm; CROM-VAS Test (non/least painful direction): SEM: 4.0 mm; MDC: 11.1 mm; LoA: 14.7 to 22.0 mm). Low or negative correlations were observed between CROM-VAS Test scores and changes in PPT and baseline neck pain scores.

CONCLUSION

The CROM-VAS Test has good clinimetric properties. It measures a distinct dimension of pain relief compared to PPTs and baseline pain scores.

Jaw-neck motor function 2 years after whiplash trauma

BACKGROUND

There is limited knowledge about the possible long-term effects on jaw motor function after whiplash trauma.

OBJECTIVES

The primary aim was to evaluate integrated jaw and head-neck movement amplitudes during jaw function in individuals 2 years after whiplash trauma, compared to controls. The secondary aim was to evaluate changes between the acute stage and a 2-year follow-up in terms of jaw and head-neck movement amplitudes during jaw function.

METHODS

This study included 28 cases exposed to a whiplash trauma 2 years earlier (13 women) and 28 controls (13 women) without previous neck trauma. Head and jaw movement amplitudes were recorded during maximal jaw opening-closing movements using an optoelectronic 3D recording system. For a subpopulation of 12 cases and 15 controls, recordings had also been performed in the acute stage after the whiplash trauma. Jaw and head movement amplitudes were analysed using linear regression with group and sex as independent variables. The subpopulation longitudinal analysis was adjusted for movement amplitudes at baseline.

RESULTS

Jaw movement amplitudes were significantly associated with group (coefficient: -0.359: 95% CI: -10.70 to -1.93, p = .006) with smaller amplitudes of jaw movements for whiplash cases. Head movement amplitudes were not associated with group (coefficient: -0.051, 95% CI: -4.81 to 3.20, p = .687). In the longitudinal analysis, both jaw and head movement amplitudes showed significant associations between baseline and the 2-year follow-up.

CONCLUSION

The present findings indicate that the effects on jaw function in terms of jaw opening capacity in the acute stage after whiplash trauma do not spontaneously recover.

Effects of a Guided Neck-Specific Exercise Therapy on Recovery After a Whiplash: A Systematic Review and Meta-analysis

OBJECTIVE

To analyze the effects on pain and disability recovery after a whiplash of a guided neck-specific exercise therapy, compared to a different or an unguided neck-specific exercise therapy.

DESIGN

A literature search was conducted from inception to May 31, 2023, in three electronic databases: PubMed, ScienceDirect, and Web of Science. Eleven randomized controlled trials were included. Meta-analyses were performed with Review Manager software. The standardized mean difference with a 95% confidence interval was used to measure the effect sizes and only short-term time points were considered.

RESULTS

Not all studies reported a significant decrease of pain and disability in the neck-specific exercise group compared to controls. However, meta-analyses demonstrated a significantly greater decrease in neck pain (standardized mean difference: -0.25; 95% confidence interval: [-0.38, -0.12]; P = 0.0002) and neck-disability index (standardized mean difference: -0.35; 95% confidence interval: [-0.54, -0.15]; P = 0.0005) in the neck-specific exercise group.

CONCLUSIONS

In addition to the benefits that a guided neck-specific exercise therapy has on motivation and program adherence, it provides greater benefits in pain and disability than a different or unguided neck-specific exercise therapy. Positive results are observed primarily with intervention periods of more than 6 wks and at least two sessions per week.

TO CLAIM CME CREDITS

Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME.

CME OBJECTIVES

Upon completion of this article, the reader should be able to: (1) Determine the impact that whiplash-associated disorders have on a patient's life; (2) Identify and recognize the greater benefits of a supervised exercise therapy on recovery after a whiplash injury; and (3) Differentiate between the different exercise protocols conducted (types of exercises and duration) and incorporate therapy appropriately as part of an effective treatment plan.

LEVEL

Advanced.

ACCREDITATION

The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s) ™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

More neck pain, less spinal mobility, altered sitting posture: Sagittal spinal alignment and mobility in women with chronic neck pain

BACKGROUND

Increasing evidence suggests that people with chronic neck pain (CNP) may display altered biomechanics beyond the cervical spine. However, whether spinal alignment and mobility are associated with neck pain is not clarified.

OBJECTIVES

To investigate whether there is a significant association between neck pain intensity and sagittal spinal alignment and mobility in people with CNP, and to examine whether sagittal spinal alignment and mobility differ according to pain intensity.

DESIGN

A cross-sectional study.

METHOD

Forty-four women with CNP were included. The neck pain intensity at rest and during neck movements was assessed with the visual analogue scale (VAS). A skin-surface measurement device was used to assess sagittal alignment and mobility while sitting and standing. Linear regression analysis was used to assess associations. Participants were divided into two groups according to the pain intensity as group with mild pain (VAS≤4.4 cm) and group with moderate to severe pain (VAS>4.4 cm) and compared using the analysis of covariance.

RESULTS

Greater resting pain was associated with a more forward trunk during sitting (Beta = 0.433, p < 0.05). Greater pain during neck movements was associated with increased lumbar lordosis during sitting (Beta = -0.376, p < 0.05). Classified by pain intensity at rest, trunk mobility while sitting was lower and forward trunk inclination and sacral kyphosis while sitting were higher in those with moderate/severe pain (η2p = 0.093-0.119, p < 0.05). By pain intensity during neck movements, women with moderate/severe pain exhibited lower sacral mobility while sitting (η2p = 0.129, p < 0.05).

CONCLUSIONS

Addressing the entire spine in the assessment and management of CNP may help reduce pain.

Immediate Effects of Kinesio Tape and Instrument-Assisted Soft Tissue Mobilization on Pain and Proprioception in Chronic Neck Pain: A Randomized Controlled Trial

Objective

The purpose of this study was to compare the immediate effects of single-session Kinesio Tape (KT) and instrument-assisted soft tissue mobilization (IASTM) interventions on pain and proprioception in patients with chronic neck pain (CNP).

Methods

Forty patients with CNP aged 21 to 44 years were included in this study. The participants were divided into 2 groups as the IASTM and KT groups. The participants in the KT group took part in one session of KT application to the trapezius and sternocleidomastoid muscles, while those in the IASTM group took part in one session of IASTM application to the same muscles. The pain levels of the participants during activity were recorded using the Visual Analog Scale (VAS), and their cervical region proprioception levels were assessed using the Cervical Range of Motion device. Pain severity and proprioception were assessed before and after the interventions.

Results

No statistically significant difference was found between the pretreatment pain and proprioception values of the 2 groups (P > .05). After the treatments, there was a significant improvement in proprioception in both groups (P ≤ .001). Similarly, there was a significant improvement in VAS values in both groups after the treatments (P ≤ .001). The VAS and proprioception values of the 2 groups were not significantly different in the post-treatment measurements (P > .05).

Conclusion

It was concluded that the IASTM and KT interventions had an immediate effect on pain and proprioception in the participants who had CNP, while neither intervention was superior to the other.

Neck muscle function improves after neck exercises in individuals with whiplash-associated disorders: a case-control ultrasound study with speckle-tracking analyses

A whiplash injury can alter neck muscle function, which remains years after the injury and may explain why symptoms such as persistent pain and disability occur. There is currently limited knowledge about dynamic neck muscle function in chronic whiplash-associated disorders (WAD), and about the extent to which altered muscle function can improve after rehabilitation. Ultrasound can detect mechanical neck muscle function by measuring real-time deformation and deformation rate in the muscles. This method was used for five dorsal neck muscles in participants with chronic WAD versus matched controls in resistant neck rotation. We obtained real-time, non-invasive ultrasound measurements using speckle tracking, multivariate analyses, and mixed-design ANOVA analyses. The results showed altered deformation in the three deepest neck muscle layers, with less deformation area in the WAD group compared to controls in rotation to the most painful side at baseline. Participants in the WAD group performed three months of neck-specific exercises, resulting in improved deformation in the deep neck muscles in WAD and with a similar deformation pattern to controls, and the significant group differences ceased. We reveal new and important insights into the capability of ultrasound to diagnose altered neck muscle function and evaluate an exercise intervention.

Effect of neck-specific exercises with and without internet support on cervical range of motion and neck muscle endurance in chronic whiplash-associated disorders: analysis of functional outcomes of a randomized controlled trial

OBJECTIVE

To compare the effects of a neck-specific exercise programme with internet support and 4 physiotherapist sessions (NSEIT) and the same neck-specific exercises supervised by a physiotherapist (NSE) on neck muscle endurance and cervical range of motion.

DESIGN

Randomized controlled trial.

PATIENTS

A total of 140 participants with chronic whiplash-associated disorders grade II or grade III were randomly assigned to the NSEIT or NSE groups.

METHODS

Outcomes were changes in active cervical range of motion, cranio-cervical flexion test, neck muscle endurance, and neck pain, at 3- and 15-month follow-ups.

RESULTS

There were no significant differences between the NSEIT and NSE groups. There was a significant group-by-time inter-action effect in active cervical range of motion flexion/extension where the NSEIT group improved to 3-month follow-up, but the NSE group did not. Both groups were significantly improved over time in all other outcomes (p < 0.001) at 3- and 15-month follow-ups, with effect size between 0.64 and 1.35 in active cervical range of motion, cranio-cervical flexion test, dorsal neck muscle endurance, and neck pain, and effect size between 0.22 and 0.42 in ventral neck muscle endurance.

CONCLUSION

Both NSE and NSEIT led to improved neck function. Depending on the patients' needs, either NSE or NSEIT could be used as treatment for patients with chronic whiplash-associated disorders.

Global trends and hotspots related to whiplash injury: A visualization study

Whiplash injury, commonly occurring as a result of car accidents, represents a significant public health concern. However, to date, no comprehensive study has utilized bibliometric approaches to analyze all published research on whiplash injury. Therefore, our study aims to provide an overview of current trends and the global research landscape using bibliometrics and visualization software. We performed a bibliometric analysis of the data retrieved and extracted from the Web of Science Core Collection database in whiplash injury research up to December 31, 2022. Research articles were assessed for specific characteristics, such as year of publication, country/region, institution, author, journal, field of study, references, and keywords. We identified 1751 research articles in the analysis and observed a gradual growth in the number of publications and references. The United States (379 articles, 21.64%), Canada (309 articles, 17.65%), and Australia (280 articles, 16.00%) emerged as the top-contributing countries/regions. Among institutions, the University of Queensland (169 articles, 9.65%) and the University of Alberta (106 articles, 6.05%) demonstrated the highest productivity. "Whiplash," "Neck Pain," "Cervical Spine Disease," and "Whiplash-associated Disorders" are high-frequency keywords. Furthermore, emerging areas of research interest included traumatic brain injury and mental health issues following whiplash injury. The number of papers and citations has increased significantly over the past 2 decades. Whiplash injury research is characteristically multidisciplinary in approach, involving the fields of rehabilitation, neuroscience, and spinal disciplines. By identifying current research trends, our study offers valuable insights to guide future research endeavors in this field.

Does having an external focus in immersive virtual reality increase range of motion in people with neck pain?

BACKGROUND

When instructing exercises to improve Range of Motion (ROM), clinicians often create an internal focus of attention, while motor performance may improve more when using an external focus.

OBJECTIVES

Using Virtual Reality (VR), we investigated the effect of tasks with an internal and external focus on maximal ROM in people with neck pain and explored whether this effect was associated with fear of movement.

METHOD

In this cross-over experimental design study, the cervical ROM of 54 participants was measured while performing a target-seeking exercise in a VR-environment (external focus task) and during three maximal rotation and flexion-extension movements with the VR-headset on, without signal (internal focus task). The main statistical analysis included two dependent T-tests. Pearson correlation coefficients were calculated to investigate whether the differences in ROM in both conditions were correlated to fear of movement.

RESULTS

Maximal neck rotation was larger in the external focus condition than in the internal focus condition (mean difference: 26.4°, 95% CI [20.6, 32.3]; p < 0.001, d = 1.24). However, there was a difference favouring the internal focus condition for flexion-extension (mean difference: 8.2°, 95% CI [-14.9, -1.5]; p = 0.018, d = 0.33). The variability in ROM was not explained by variability in fear of movement (for all correlations p ≥ 0.197).

CONCLUSION

An external focus resulted in a larger range of rotation, but our flexion-extension findings suggest that the task has to be specific to elicit such an effect. Further research, using a task that sufficiently elicits movement in all directions, is needed to determine the value of an external focus during exercise.

Association between clinical biomechanical metrics of cervical spine function and pain or disability in people with neuromusculoskeletal neck pain: Protocol for a systematic review and planned meta-analysis

INTRODUCTION/BACKGROUND

Neck pain is a burdensome condition associated with pain, disability, and economic cost. Neck pain has been associated with observable changes in neuromuscular function and biomechanics. Prior research shows impairments in kinematic control, including reduced mobility, velocity, and smoothness of cervical motion. However, the strength of association between these impairments and patient-reported pain and disability is unclear rendering development of novel and relevant rehabilitation strategies difficult. The aim of this systematic review is to synthesize existing evidence on the strength of association between clinical biomechanical metrics of neck function (ROM, strength, acceleration, accuracy, smoothness, etc.) and patient-reported neck pain and disability.

METHODS/ANALYSIS

This protocol follows Cochrane guidelines and adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P). MEDLINE, EMBASE, CINAHL, SPORTDiscus, Web of Science and Scopus will be searched, along with the gray literature, up to 20 November 2023, using terms and keywords derived from initial scoping searches. Observational studies, including cohorts and cross-sectional studies, that explore associations between clinical biomechanics of the neck and patient-reported outcomes of neck pain or disability will be included. Two reviewers will independently perform study selection, data extraction, and risk of bias assessment (National Institute of Health tool). Data will be synthesized using either a random effects meta-analytic approach or qualitatively using a modified Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach, dependent on the homogeneity of data available.

DISCUSSION AND RELEVANCE

This review addresses a gap in the literature by systematically synthesizing findings on the relationship between neck function impairments and patient-reported outcomes. It will identify priorities for neck pain rehabilitation and gaps in current knowledge.

DISSEMINATION

The results of this review will be disseminated through a peer-reviewed publication, conference presentation, and lay language summaries posted on an open-access website.

TRIAL REGISTRATION

PROSPERO Registration number: CRD42023417317. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023417317.

Relationship between neck kinematics and neck dissability index. An approach based on functional regression

Numerous studies use numerical variables of neck movement to predict the level of severity of a pathology. However, the correlation between these numerical variables and disability levels is low, less than 0.4 in the best cases, even less in subjects with nonspecific neck pain. This work aims to use Functional Data Analysis (FDA), in particular scalar-on-function regression, to predict the Neck Disability Index (NDI) of subjects with nonspecific neck pain using the complete movement as predictors. Several functional regression models have been implemented, doubling the multiple correlation coefficient obtained when only scalar predictors are used. The best predictive model considers the angular velocity curves as a predictor, obtaining a multiple correlation coefficient of 0.64. In addition, functional models facilitate the interpretation of the relationship between the kinematic curves and the NDI since they allow identifying which parts of the curves most influence the differences in the predicted variable. In this case, the movement's braking phases contribute to a greater or lesser NDI. So, it is concluded that functional regression models have greater predictive capacity than usual ones by considering practically all the information in the curve while allowing a physical interpretation of the results.

The effects of conventional treatment in addition to Pilates on biopsychosocial status in chronic neck pain: A randomized clinical trial

BACKGROUND

Although guidelines and systematic reviews recommend the use of exercise in the treatment of chronic pain and neck pain, there are no clear recommendations for conservative treatments frequently used in clinics. The effect of supporting clinical Pilates exercises with passive physiotherapy methods on biopsychosocial status is still unknown.

OBJECTIVE

The objective was to investigate the effects of conventional treatment (CT) in addition to clinical Pilates on pain levels, physical condition, functional status, and psychosocial status in individuals with chronic neck pain.

METHODS

Fifty women were randomly divided into 2 groups, the clinical Pilates group (Pilates, n= 25), and the group receiving CT in addition to clinical Pilates (Pilates-CT, n= 25). Both groups received treatment 3 days a week for 6 weeks. The CT program involved the implementation of hot pack (HP) application, Transcutaneous Electrical Nerve Stimulation (TENS), and therapeutic ultrasound (US) to the cervical area.

RESULTS

CT in addition to Pilates was more effective in reducing the Visual Analog Scale (at rest and during activity), Neck Disability Index, Fear-Avoidance Beliefs Questionnaire, NeckPix Scale, Hospital Anxiety and Depression Scale-depression, and Cognitive Exercise Therapy Approach-Biopsychosocial questionnaire scores (p< 0.05) and in increasing the degree of change in the extension range of motion (ROM) and cervical flexor endurance values and scores in the energy parameter of Short Form-36 (p< 0.05).

CONCLUSION

CT provided in addition to Pilates was more effective in reducing pain levels, disability, fear of movement, depression levels, and negative biopsychosocial status and improving extension ROM and cervical flexor endurance, neck awareness, and the energy/vitality parameter of quality of life in individuals with chronic neck pain.

Concurrent Validity of Cervical Movement Tests Using VR Technology-Taking the Lab to the Clinic

Reduced cervical range of motion (ROM) and movement velocity are often seen in people with neck pain. Objective assessment of movement characteristics is important to identify dysfunction, to inform tailored interventions, and for the evaluation of the treatment effect. The purpose of this study was to investigate the concurrent validity of a newly developed VR technology for the assessment of cervical ROM and movement velocity. VR technology was compared against a gold-standard three-dimensional optical motion capture system. Consequently, 20 people, 13 without and 7 with neck pain, participated in this quantitative cross-sectional study. ROM was assessed according to right/left rotation, flexion, extension, right/left lateral flexion, and four diagonal directions. Velocity was assessed according to fast cervical rotation to the right and left. The correlations between VR and the optical system for cervical ROM and velocity were excellent, with intraclass correlation coefficient (ICC) values > 0.95. The mean biases between VR and the optical system were ≤ 2.1° for the ROM variables, <12°/s for maximum velocity, and ≤3.0°/s for mean velocity. In conclusion, VR is a useful assessment device for ROM and velocity measurements with clinically acceptable biases. It is a feasible tool for the objective measurement of cervical kinematics in the clinic.

Elastic Taping Application on the Neck: Immediate and Short-Term Impacts on Pain and Mobility of Cervical Spine

The aim of this study was to measure the effects on three-planar active cervical range of motion (ACROM) and self-perceived pain of elastic taping (ET) application in the cervical area. Thirty participants (n: 22-M and 8-F, age 35.4 ± 4.4 years; body height 173.1 ± 8.4 cm; body mass 73.5 ± 12.8 kg) in the study group (SG) and twenty participants (n: 11-M and 9-F, age 32.6 ± 3.9 years; body height 174.9 ± 10.9 cm; body mass 71.2 ± 12.9 kg) in the control group (CG) were recruited. All subjects had neck and cervical pain in baseline condition. Each group performed an ACROM test and measured the perceived pain in the neck based on the Numerical Rating Scale (NRS 0--10, a.u.) at the baseline (T0), after 20' from the ET application (T1), and after three days of wearing the ET application (T2). Between T0 and T1, an ET was applied to the cervical area of the SG participants. Statistical analysis did not show any significant change in CG in any measurement session for ACROM and neck pain parameters. Conversely, the SG showed significant improvements for ACROM rotation to the left (T0 64.8 ± 7.7°-T2 76.0 ± 11.1° p < 0.000) and right (T0 66.0 ± 11.9°-T2 74.2 ± 9.6° p < 0.000), lateral inclination to the left (T0 37.5 ± 6.9°-T2 40.6 ± 10.8° p < 0.000) and right (T0 36.5 ± 7.9°-T2 40.9 ± 5.2° p < 0.000), extension (T0 47.0 ± 12.9°-T2 55.1 ± 12.3° p < 0.001), and flexion (T0 55.0 ± 3.6°-T2 62.9 ± 12.0° p < 0.006). A significant decrease was also measured in SG for pain NRS between T0 and T2 (T0 7.5 ± 1.0°-T1 5.5 ± 1.4-T2 1.4 ± 1.5° p < 0.000). In conclusion, a bilateral and symmetrical ET cervical application is useful to enhance multiplanar ACROM and reduce subjective self-perceived cervical pain when it is needed. Based on the evidence, the use of ET on the neck is recommended for managing neck motion restrictions and pain in adult individuals.

Positive Outcomes Following Cervical Acceleration-Deceleration (CAD) Injury Using Chiropractic BioPhysics® Methods: A Pre-Auto Injury and Post-Auto Injury Case Series

This series illustrates how rear-end impact motor vehicle collisions (MVCs) alter the cervical spine's alignment and demonstrates therapeutic use of cervical extension traction to improve lordotic alignment and other outcomes. This is a retrospective reporting of 7 adult patients (4 males and 3 females, 28-42 years) treated for cervical hypolordosis. These subjects received Chiropractic BioPhysics® (CBP®) rehabilitation and then were involved in a rear-end MVC. All cases had radiographic assessment that quantified the buckling of the cervical spine, presumably resulting directly from the CAD trauma. After an average of 3 years and 9 months (range: 1-7.6 years) following their initial program of care, the 7 patients sought care for a second time after the MVC. At this time, compared with their previously recorded post-treatment spine radiographs, there was an average 18.7° (range: 7.6-35.4°) reduction in cervical lordosis, a 9.2 mm (range: 3.6-19.8 mm) increase in anterior head translation (AHT), an 11.3° (range: 0.2-19.9°) decrease in the atlas plane line (APL), as well as a 35.7% (range: 22-52%) average neck disability index score (NDI) measured after the MVC. After the crash, a second round of CBP rehabilitation was administered, resulting in an average 15.1° improvement in cervical lordosis, 10.9 mm reduction in AHT, 10.4° increase in APL, and a 23.7% drop in NDI after an average of 35 treatments over 9 weeks. Treatment was universally successful, as an average 80% re-establishment of the lordosis toward its pre-injury state was found. There were no adverse events reported. This case series demonstrates that motor vehicle collisions may alter the alignment of the cervical spine. Rehabilitation of the cervical curve using extension traction improved the patients' initial pre-crash alignments toward their pre-injury alignments and was likely responsible for improvement in the patients' conditions. Clinical trials are needed to confirm these findings.

The validity of a single inertial sensor to assess cervical active range of motion

Cervical active range of motion (AROM) is an important outcome measure for clinicians working with a range of patient populations, especially people with neck pain. Multi-sensor inertial measurement unit (IMU) devices demonstrate good validity in the research laboratory but are expensive and not easily accessible in clinical settings. The use of single-IMU devices has been proposed but their validity for measuring cervical AROM is unknown. A concurrent and content validity study was conducted, comparing accuracy of single-IMU NeckCare Pro™ with multi-IMU Xsens™ for measuring cervical AROM in healthy adults (8 males, 7 females, mean age 30.6 years [SD 10.4]). Cervical AROM was assessed for flexion, extension, rotation (right and left), and lateral flexion (right and left), whereby six repetitions were performed for each movement with the subjects strapped to a high-back chair. Regarding content validity, Xsens™ detected a small amount of thoracic movement that could not be detected by the NeckCare Pro™ during cervical AROM testing, with means ranging from 1.5° to 4.1°. However, this did not significantly impact concurrent validity, which was good for all movements (ICC 0.764 - 0.966). This paper found that single-IMU technology (NeckCare Pro™) had good validity for measuring cervical AROM in healthy adults when subjects were strapped to a chair to limit trunk movement.

Validity of an inertial measurement unit for the assessment of range and quality of movement during head and thoracic spine movements

BACKGROUND

Patients with spinal pain often exhibit movement limitations and altered motor control, which can be challenging to measure accurately in clinical practice. Inertial measurement sensors present a promising new opportunity to develop valid, low-cost, and easy-to-use methods for assessing and monitoring spinal motion in a clinical setting.

AIM

This study aimed to investigate the agreement of an inertial sensor and a 3D camera system for assessing the range of motion (ROM) and quality of movement (QOM) in head and trunk single-plane movements.

METHODS

Thirty-three healthy, pain-free volunteers were included. Each participant performed movements of the head (cervical flexion, extension, and lateral flexion) and trunk (trunk flexion, extension, rotation, and lateral flexion), which were simultaneously recorded by a 3D camera system and an inertial measurement unit (MOTI, Aalborg, Denmark). Agreement and consistency were analyzed for ROM and QOM by determining intraclass correlation coefficients (ICC), mean bias, and with Bland-Altman plots.

RESULTS

The agreement between systems was excellent for all movements (ICC between 0.91 and 1.00) for ROM and good to excellent for the QOM (ICC between 0.84 and 0.95). The mean bias for all movements (0.1-0.8°) was below the minimum acceptable difference between devices. The Bland-Altman plot indicated that MOTI systematically measured a slightly greater ROM and QOM than the 3D camera system for all neck and trunk movements.

CONCLUSION

This study showed that MOTI is a feasible and potentially applicable option to assess ROM and QOM for head and trunk movements in experimental and clinical settings.

Immediate Effects of a Single Session of Cervical Spine Manipulation on Cervical Movement Patterns in People With Nonspecific Neck Pain: A Randomized Controlled Trial

OBJECTIVE

The aim of the present study was to assess the immediate effects of a single session of cervical spine manipulation on cervical movement patterns, disability, and the patient's perceived improvement in people with nonspecific neck pain.

METHODS

A single-blinded, randomized, sham-controlled trial was carried out at a biomechanics institute. Fifty participants diagnosed with acute and chronic nonspecific neck pain (minimum duration of the symptoms being 1 month) were randomized to an experimental group (EG, n = 25) or a sham-control group (CG, n = 25, 23 of whom completed the study). EG received a single cervical spine manipulation session; CG received a single placebo intervention. Both groups received manipulation or sham from the same physiotherapist. Main outcome measures were neck kinematics (ie, range of motion and movement harmony) during cyclic movements, self-reported neck disability, and impression of change assessed before and 5 minutes after treatment.

RESULTS

The EG showed no significant improvements (P > .05) in any of the studied biomechanical variables, except for right-side bending and left rotation, in which we found a range of motion significant mean difference of 1.97° and 1.95°, respectively (P < .05). The CG showed enhanced harmonic motion during flexion (P < .05). Both groups showed a significant decrease in self-reported neck disability after treatment (P < .05), and EG participants perceived a significantly larger improvement after manipulation compared with the CG (P < .05).

CONCLUSIONS

A single session of cervical manipulation provided by a physiotherapist had no impact on cervical motion during cyclic movements, but rather induced self-reported perceived improvement in neck disability and impression of change after treatment in people with nonspecific neck pain.

The reliability and validity of the Turkish version of the self-administered neck mobility assessment tool (s-rom-neck) in patients with chronic neck pain

BACKGROUND

The self-administered neck mobility assessment tool (S-ROM-Neck) is the subjective cervical region range of motion (S-ROM) assessment scale. The study aimed to demonstrate the reliability and validity of the Turkish version of the S-ROM-Neck in patients with chronic neck pain.

METHODS

: A cross-sectional study was conducted with a total of 60 chronic neck pain patients in the Physical Therapy and Rehabilitation Clinic of Pamukkale University Hospital between January and August 2021. The mean age of the individuals was 34.1 ± 9.9 years. Patients were assessed with S-ROM-Neck twice to prove the test-retest reliability. In addition, Visual Analogue Scale (VAS), Neck Disability Index (NDI) and bubble inclinometer measurement were used to analyze the construct validity of S-ROM-Neck.

RESULTS

The intraclass correlation coefficients of the S-ROM-Neck were higher than 0.80 (ICC > 80, CI: 0.90-98). The internal consistency of the S-ROM-Neck total score was within the acceptable limits (α = 0.754). Construct validity was high regarding the correlation analysis (r > 0.05, p < 0.01).

DISCUSSION

Turkish S-ROM-Neck is a valid and reliable tool to assess the S-ROM of individuals with chronic neck pain.

Variability of Active Cervical Range of Motion Within and Between Days in Healthy Participants: A Prospective Observational Study

OBJECTIVE

The purpose of this study was to determine the intraday and interday variability and systematic change over the day of active cervical range of motion (aCROM) measurements in asymptomatic persons using a clinically applicable measurement device.

METHODS

A prospective observational study was performed. Sixteen adults (8 men and 8 women, median age 51 years) without neck pain in the last 3 months were recruited in 2 physiotherapy practices. Active cervical range of motion was estimated using the Apple iPhone application "3D Range of Motion." Measurements were performed 3 times a day for 7 days and spread over a period of 3 weeks. Mean values of aCROM were calculated. Intraday and interday variability was estimated by calculating limits of agreement.

RESULTS

The limits of agreement for intraday variability ranged from ±12.1° for left rotation to ±15.5° for total rotation. For interday variability, the limits of agreement ranged from ±14.2° for right rotation to ±20.1° for total rotation. No systematic change over the day was found.

CONCLUSION

This study showed substantial intraday and interday variability of aCROM measurements in asymptomatic people. No trend toward an increased or decreased aCROM was observed during the course of the day. When interpreting aCROM values, clinicians should consider the degree of variation in aCROM measurements over time.

Kinematic analysis of sensorimotor control during the craniocervical flexion movement in patients with neck pain and asymptomatic individuals: a cross-sectional study

BACKGROUND

Patients with craniocervical pain have shown reduced performance in the craniocervical flexion test (CCFT). However, there is limited evidence of other possible kinematic alterations not assessed in the context of the CCFT. Previous studies on other functional or planar movements have reported alterations in sensorimotor control (e.g., range of motion [ROM], velocity, or smoothness) in subjects with neck pain. The objective of this study was to explore the association between sensorimotor control variables associated with craniocervical flexion movement and different characteristics related to pain, age, disability, and fear of movement in individuals with non-traumatic chronic neck pain and asymptomatic controls.

METHODS

This was an observational, cross-sectional study in patients with non-traumatic neck pain and asymptomatic participants. Regression models were used to assess whether descriptive characteristics of the sample, including: (a) age, (b) intensity of pain, (c) neck disability, (d) chronicity of pain, and (e) fear of movement could explain sensorimotor control variables such as ROM, velocity, jerk, head repositioning accuracy, and conjunct motion. All these variables were recorded by means of light inertial measurement unit sensors during the performance of three maximal repetitions of full range craniocervical flexion in the supine position.

RESULTS

A total of 211 individuals were screened and 192 participants finished the protocol and were included in the analyses. Participants had an average age of 34.55 ± 13.93 years and included 124 patients with non-traumatic neck pain and 68 asymptomatic subjects. Kinesiophobia partially explained lower craniocervical flexion ROM (p = .01) and lower peak velocity in flexion (P < .001). Age partially explained increased craniocervical extension ROM (P < .001) and lower peak velocity in flexion (P = .03). Chronicity partially explained increased lateral flexion conjunct motion (P = .008). All models showed low values of explained variance (< 32%) and low absolute values of regression coefficients.

CONCLUSIONS

This study did not find a clear relationship between population characteristics and sensorimotor control variables associated with the craniocervical flexion movement. Kinesiophobia might have some association with reduced ROM in craniocervical flexion, but further research in this field is needed in large samples of patients with higher levels of kinesiophobia pain or disability.

A study protocol for the validation of a prognostic model with an emphasis on modifiable factors to predict chronic pain after a new episode of acute- or subacute nonspecific idiopathic, non-traumatic neck pain presenting in primary care

BACKGROUND

The primary objective of this study is to identify which modifiable and non-modifiable factors are independent predictors of the development of chronic pain in patients with acute- or subacute nonspecific idiopathic, non-traumatic neck pain, and secondly, to combine these to develop and internally validate a prognostic prediction model.

METHODS

A prospective cohort study will be conducted by physiotherapists in 30 primary physiotherapy practices between January 26, 2020, and August 31, 2022, with a 6-month follow-up until March 17, 2023. Patients who consult a physiotherapist with a new episode of acute- (0 to 3 weeks) or subacute neck pain (4 to 12 weeks) will complete a baseline questionnaire. After their first appointment, candidate prognostic variables will be collected from participants regarding their neck pain symptoms, prior conditions, work-related factors, general factors, psychological and behavioral factors. Follow-up assessments will be conducted at six weeks, three months, and six months after the initial assessment. The primary outcome measure is the Numeric Pain Rating Scale (NPRS) to examine the presence of chronic pain. If the pain is present at six weeks, three months, and six months with a score of NPRS ≥3, it is classified as chronic pain. An initial exploratory analysis will use univariate logistic regression to assess the relationship between candidate prognostic factors at baseline and outcome. Multiple logistic regression analyses will be conducted. The discriminative ability of the prognostic model will be determined based on the Area Under the receiver operating characteristic Curve (AUC), calibration will be assessed using a calibration plot and formally tested using the Hosmer and Lemeshow goodness-of-fit test, and model fit will be quantified as Nagelkerke's R2. Internal validation will be performed using bootstrapping-resampling to yield a measure of overfitting and the optimism-corrected AUC.

DISCUSSION

The results of this study will improve the understanding of prognostic and potential protective factors, which will help clinicians guide their clinical decision making, develop an individualized treatment approach, and predict chronic neck pain more accurately.

Baduanjin improves neck pain and functional movement in middle-aged and elderly people: A systematic review and meta-analysis of randomized controlled trials

Background

Neck pain (NP), one of the most common musculoskeletal diseases, exercises a great influence on the daily life of individuals, especially the elderly. Baduanjin is a traditional Qigong therapy from China, but there is no evidence for its use in the treatment of neck pain in middle-aged and elderly people.

Objective

We hope to summarize the efficacy evidence of Baduanjin in the treatment of middle-aged and elderly patients with neck pain (NP) for the first time, conduct a systematic review and meta-analysis, and provide basic evidence-based evidence for clinical practice.

Methods

Two researchers collectively searched PubMed, Web of Science, Embase, Cochrane Library, China Biology Medicine disk (Sino-Med), China National Knowledge Infrastructure (CNKI), Wanfang database, and China Science and Technology Journal Database (VIP). The search time is set from initial to 27 September 2022, to find out RCT articles that may meet the criteria. The risk bias assessment tool Cochrane was applied to assess the methodological quality of involved studies. RevMan 5.3 was used for the meta-analysis with a mean difference (MD) and 95% confidence interval (CI), and the model type was a random effects model. The VAS scores of the intervention and control groups were extracted and the results of the meta-analysis were presented using a forest plot.

Results

In total, 13 randomized controlled trials were meta-analyzed, including 840 patients. The results turned out that the VAS score in the intervention group was below the control group, which was statistically significant [MD = -1.15, 95% CI (-1.39, -0.92) and P < 0. 001]. The result of general efficiency suggests that the Baduanjin group was better than the control group [RR = 1.19, 95% CI (1.10, 1.29), P < 0.001].

Conclusion

The existing results seem to show that Baduanjin is safe and has a trend of positive benefits in the treatment of neck pain in middle-aged and elderly people. However, considering the limitations of this study, we need to be cautious in our conclusions, and more studies are needed to verify it in future.

Association between age, sex and cervical and upper cervical rotation tests. Descriptive and correlational study in healthy volunteers

Background

Active cervical spine rotation (ACROM Rot) shows cervical rotation and flexion rotation test (FRT); side-bending rotation test (SBRT) and upper cervical axial rotation test (C0-C2ART) are described to measure upper cervical rotation. The objectives of this study are (1) to describe the normal range of motion (ROM) of ACROM Rot, and the ROM in FRT, SBRT and C0-C2ART tests; (2) to explore the correlation among the four tests and (3) to investigate the influence of age and sex in their ROM.

Methods

A cross-sectional study was carried out with healthy volunteers from 18 to 75 years of age. Tests were measured using a CROM device and a bubble inclinometer. Descriptive analysis was performed to establish normative data for the ROM tests. Correlation analysis was conducted to understand the relation between upper and global cervical rotation ROM and among the three upper cervical rotation tests. Linear regression models were developed to understand the influence of age and sex in the ROM of all tests.

Results

Normative values were obtained from 122 healthy volunteers (50% male), by sex and age strata. The degree of correlation ranged between 0.582 (p < 0.01) for FRT and ACROM Rot left and 0.217 (p < 0.05) for SBRT and C0-C2ART left. Linear regression models showed the influence of sex for ACROM Rot right (men -4.64° less than women), SBRT (men -4.1° less than women) left and C0-C2ART right and left (men -2.24° and -1.78° less than women). The age influenced rotation ROM with a decrease for every 10 years of -2.11° and -1.96° for ACROM Rot right and left, of -1.72° and -1.26° for FRT right and left and -0.58° and -0.41° for C0-C2ART right and left in the linear regression models. No association was found between age and SBRT (p = 0.63 for right SBRT and p = 0.49 for left SBRT).

Conclusion

Weak-to-moderate correlation was found between the upper cervical spine rotation tests and with the ACROM. Women had a larger ROM in ACROM Rot right, SBRT left and C0-C2ART. Decreases in ROM related with age were observed for ACROM Rot, FRT and C0-C2ART but not for SBRT.

Musculoskeletal disorders and functional characteristics of the neck and shoulder: Comparison between office workers using a laptop or desktop computer

BACKGROUND

Using a laptop for work is gaining rapid popularity, but there is little evidence of how it influences musculoskeletal disorders (MSDs) and functional characteristics of the neck and shoulder area.

OBJECTIVE

This study aimed to compare the prevalence of upper body MSDs and functional characteristics of the neck between office workers using a laptop or desktop computer.

METHODS

A total of 110 office workers with a mean age of 41±10 years participated. 45 office workers (73% female) used a laptop and 65 office workers (86% female) used desktop computers. The prevalence of MSDs was recorded using the Nordic Musculoskeletal Questionnaire. Active range of motion (AROM), maximal voluntary isometric contraction (MVC) force, joint position error (JPE), and pain-pressure threshold (PPT) of the neck and shoulder area were measured.

RESULTS

Laptop users experienced significantly more MSDs in the right shoulder area on the day of participation (p < 0.001, OR = 4.47), during the previous 7 days (p < 0.01, OR = 3.74), and at 6 months (p < 0.01, OR = 3.57). Laptop users also experienced significantly more MSDs in the left shoulder during the previous 7 days (p < 0.05, OR = 2.44). There were no statistically significant differences in any of the functional characteristics of the neck and shoulder area between the groups.

CONCLUSION

Using the laptop computer for office work may pose a higher risk of developing MSDs in the right shoulder area, but might not have long-term effects on the functional characteristics of the neck and shoulder area.

Flexion-rotation test and C0-C2 axial rotation test. Are they equally reliable for novice clinicians?

OBJECTIVE

To analyse the inter- and intra-examiner reliability for the neck flexion-rotation test and the C0-C2 axial rotation test when applied in asymptomatic subjects by two novice physiotherapists.

DESIGN

Repeated measures reliability study design. The study was approved by the Research Ethics Committee of [X], in compliance with the Declaration of Helsinki (CSEULS-PI: 004/2020).

METHODS

32 asymptomatic adults were included, recruited by convenience sampling. Two sessions were scheduled for each subject, with an intersession break of 30 min. Two inexperienced raters blinded to their own previous and peer results performed three movements to both sides using the flexion-rotation test and the C0-C2 axial rotation test in randomised order of rater, test and direction. A third researcher collected the data measured by inertial sensors and displayed to the Pro Motion Capture software.

RESULTS

Both raters showed good-excellent intra-examiner reliability (ICC_(2,3) ranging from 0.88 to 0.94) and moderate to good inter-examiner reliability (ICC_(2,3) ranging from 0.58 to 0.86) to measure the rotation ROM with the FRT. The C0-C2 axial rotation test resulted in poor to moderate intra-examiner reliability (ICC_(2,3) ranging from 0.33 to 0.74) and poor inter-examiner reliability using (ICC_(2,3) ranging from 0.16 to 0.37).

CONCLUSION

Although performed by novice raters, the FRT showed good to excellent intra and inter-examiner reliability. Results for the C0-C2 axial rotation test were less reliable. We suggest that novice physiotherapists use the FRT instead of the C0-C2 axial rotation test in order to determine C1-C2 dysfunction.

Sagittal intervertebral rotational motion: a deep learning-based measurement on flexion–neutral–extension cervical lateral radiographs

Background

The analysis of sagittal intervertebral rotational motion (SIRM) can provide important information for the evaluation of cervical diseases. Deep learning has been widely used in spinal parameter measurements, however, there are few investigations on spinal motion analysis. The purpose of this study is to develop a deep learning-based model for fully automated measurement of SIRM based on flexion–neutral–extension cervical lateral radiographs and to evaluate its applicability for the flexion–extension (F/E), flexion–neutral (F/N), and neutral–extension (N/E) motion analysis.

Methods

A total of 2796 flexion, neutral, and extension cervical lateral radiographs from 932 patients were analyzed. Radiographs from 100 patients were randomly selected as the test set, and those from the remaining 832 patients were used for training and validation. Landmarks were annotated for measuring SIRM at five segments from C2/3 to C6/7 on F/E, F/N, and N/E motion. High-Resolution Net (HRNet) was used as the main structure to train the landmark detection network. Landmark performance was assessed according to the percentage of correct key points (PCK) and mean of the percentage of correct key points (MPCK). Measurement performance was evaluated by intra-class correlation coefficient (ICC), Pearson correlation coefficient, mean absolute error (MAE), root mean square error (RMSE), and Bland-Altman plots.

Results

At a 2-mm distance threshold, the PCK for the model ranged from 94 to 100%. Compared with the reference standards, the model showed high accuracy for SIRM measurements for all segments on F/E and F/N motion. On N/E motion, the model provided reliable measurements from C3/4 to C6/7, but not C2/3. Compared with the radiologists’ measurements, the model showed similar performance to the radiologists.

Conclusions

The developed model can automatically measure SIRM on flexion–neutral–extension cervical lateral radiographs and showed comparable performance with radiologists. It may provide rapid, accurate, and comprehensive information for cervical motion analysis.

Cervical spine characteristics differ in competitive combat athletes compared with active control participants

BACKGROUND

Injury to the head and neck are common in combat sport athletes. Impairments of the cervical spine have been found in some athletes who participate in sports with high forces and collisions. There is a lack of research on the effects of combat sports on the cervical spine.

OBJECTIVE

The primary study aim was to investigate differences in cervical spine characteristics between combat athletes and a similarly aged active control group. The secondary aim was to investigate the relationship between symptom-based outcome measures and characteristics of the cervical spine.

DESIGN

Cross-sectional.

METHOD

40 male adult combat sport athletes and 40 male adult control participants were recruited from 4 combat sport clubs and a university campus, Australia. Cervical spine assessments were conducted at a private physiotherapy clinic. The Neck Disability Index and the Post-Concussion Symptom Scale were used as symptom-based outcome measures.

RESULTS

Combat sport athletes had a reduced range of cervical motion, but greater isometric strength and endurance compared with a control group (p < 0.05). The Neck Disability Index and Post-Concussion Symptom Scale were negatively correlated with cervical spine range of motion and isometric strength, meaning that higher scores correlated with a reduction in function.

CONCLUSIONS

Differences were observed in characteristics of the cervical spine in combat sport athletes compared with a control group. Higher symptom-based outcome scores correlated with reduced range of motion and strength of cervical spine muscles. Further investigation to establish clinical cut-off scores for functional impairment may be warranted.

Lack of Objective Measurement in the Initial Screening and Follow-Up of Patients Who Report Whiplash Injury—Is Elastography of the Trapezius Muscle an Answer?

Background: Painfully decreased cervical range of motion accompanied by muscle spasm is a common presentation of whiplash injury of the neck. Stiffness of the cervical muscles can be assessed by ultrasound shear wave elastography (SWE), expressed in kilopascals (kPa). The hypothesis: SWE of the trapezius muscle is an objective measurement suitable for the initial screening and follow-up of patients who report whiplash injury. Methods and results: A total of 99 patients after whiplash injury were compared to 75 control participants. Mean trapezius stiffness was 82.24 ± 21.11 vs. 57.47 ± 13.82 for whiplash patients and controls, respectively. The cut-off value of SWE of 75.8 kPa showed 77% accuracy in correctly assigning patients to the whiplash or control group. To evaluate whether SWE can be used as a follow-up method of recovery after a whiplash injury, initial and endpoint SWE (after six months, n = 24) was carried out. Patients reporting no recovery showed similar SWE values as completely recovered patients. This finding refutes the second part of our hypothesis. Conclusions: SWE is a method that can be used for the initial screening of patients with whiplash injury, but we are still searching for an objective measurement that can be used in the follow-up of recovery.

Neck Strength in Coronal and Sagittal Head Movement in Military Pilots and Aircrew With Chronic Neck Pain: A Systematic Review With Meta-Analysis

OBJECTIVE

This systematic review aimed to assess whether there is a difference in neck strength between military pilots and aircrew with and without chronic neck pain.

METHODS

The PubMed, Embase, and Scopus databases were searched. Two independent reviewers selected relevant full articles comparing neck strength between military pilots and aircrew with and without chronic neck pain. Two independent reviewers extracted the data from the full articles selected. A meta-analysis was used to assess standardized mean differences in neck strength based on a random-effects model.

RESULTS

The search returned 3554 results; 5 articles were included in the study. Military pilots and aircrew with chronic neck pain showed no difference in neck strength from military pilots and aircrew without chronic neck pain for flexion and extension, but did show a neck strength reduction for right and left lateral flexion -0.29 (95% confidence interval, -0.52 to -0.06; I² = 3%) and -0.23 (95% confidence interval, -0.45 to 0.00; I² = 0%), respectively.

CONCLUSION

Based on this meta-analysis with a 3a level of evidence, military pilots and aircrew with chronic neck pain have reduced neck strength for coronal head movement, but not sagittal movement compared with military pilots and aircrew without chronic neck pain.

Posttraumatic Stress Symptoms and Pain Sensitization After Whiplash Injury: A Longitudinal Cohort Study With Quantitative Sensory Testing

Posttraumatic stress symptoms (PTSS) are common after whiplash injury and are associated with poor recovery. The acute stress response may lead to pain sensitization and widespread pain, thereby compromising recovery. To our knowledge, no longitudinal study has assessed the associations between early PTSS and pain sensitization over time using quantitative sensory testing (QST). The aim of this study was to compare participants with different levels of PTSS, as measured by the impact of event scale (IES; subclinical 0–8, mild 9–25, and clinical ≥ 26) at baseline (<10-day post-injury) and at a follow-up of 1, 3, 6, and 12-month post-injury on pain sensitivity, neck mobility, pain distribution, and pain intensity. In total, 740 participants were recruited from emergency units or general practitioners with acute neck pain after a whiplash injury. The clinical PTSS group showed increased pain sensitivity on all QSTs at all time points compared to the subclinical PTSS group. Also, the clinical PTSS group showed significantly lower neck mobility at all time points except for a 3-month follow-up compared to the subclinical PTSS group. Moreover, the clinical PTSS group showed more widespread pain and self-reported headache and neck pain intensity at all time points compared to the subclinical PTSS group. This study emphasizes that participants with clinical levels of PTSS constitute a high-risk group that is sensitized to pain early after the injury. Hence, screening for PTSS within the 1st week after whiplash injury for those who experience high levels of pain intensity and distress may be an important clinical procedure in the assessment and treatment of whiplash-associated disorders (WAD).

Analysis of sensorimotor control in people with and without neck pain using inertial sensor technology: study protocol for a 1-year longitudinal prospective observational study

INTRODUCTION

Neck pain is a very common musculoskeletal disorder associated with high socioeconomic costs derived from work absenteeism and medical expenses. Previous studies have suggested that patients with neck pain of different origins present sensorimotor control impairments compared with the asymptomatic population. However, there is a small number of published studies focusing on these with conflicting results. In addition, the existing methodological limitations highlight the need for more and better quality studies. Moreover, longitudinal studies are necessary to investigate whether changes in pain or disability in individuals with chronic neck pain over time associate with changes in cervical sensorimotor control.

METHODS AND ANALYSIS

This is a descriptive, observational, longitudinal, prospective study consecutively enrolling 52 patients with non-specific neck pain and 52 age-matched asymptomatic participants.Intensity of pain, neck disability, duration of symptoms, topography of pain and comorbidities will be registered at baseline. Sensorimotor control variables including active range of motion, movement speed, acceleration, smoothness of motion, head repositioning accuracy and motion coupling patterns will be recorded as primary outcomes by means of inertial sensors during the following tests consecutively performed in two sessions separated by 12 months: (1) kinematics of planar movements, (2) kinematics of the craniocervical flexion movement, (3) kinematics during functional tasks and (4) kinematics of task-oriented neck movements in response to visual targets.Secondary outcomes will include: (1) Regular physical activity levels, (2) Kinesiophobia, (3) Symptoms related to central sensitisation and (4) The usability of the inertial measurement unit sensor technology.

ETHICS AND DISSEMINATION

This study was approved by the Research Ethics Committee of CEU San Pablo University (495/21/39). Patients will be recruited after providing written informed consent and they will be able to withdraw their consent at any time. Only the study investigators will have access to the study data. The results will be disseminated through scientific publications, conferences and media.

TRIAL REGISTRATION NUMBER

NCT05032911.

Comparison of the effectiveness of a structured exercise program on nonspecific neck pain in string and woodwind players

To investigate the effect of a structured exercise training program on pain, functional status, physical function and quality of life (QoL) in string and woodwind players with nonspecific cervical pain. This study had a prospective cohort design and conducted on 40 musicians (26 male, 14 female) aged between 18 and 65 years with persistent nonspecific neck pain in the previous 3 months. Forty musicians were assigned to either violin (n = 20, median age; 26.5 year, height; 1.67 m, body mass; 65 kg, BMI; 23.04 kg/m²) or ney group (n = 20, median age; 27.5 year, height; 1.81 m, body mass; 75 kg, BMI; 23.35 kg/m²) and followed the same structured exercise program (3 days/per week for 8 weeks). The primary outcome was neck pain intensity and assessed on a visual analog scale (VAS). Secondary outcomes; cervical range of motion (ROM) was measured using a goniometer, the jaw-to-sternum and jaw-to-wall distances were used for the assessment of cervical mobility, neck, shoulder and back muscles strength were assessed with a hand-held dynamometer, the Northwick Park Neck Pain and Short Form 36 (SF-36) questionnaires were also used. Normality of data distribution was checked using the Kolmogorov-Smirnov test. For evaluating the training effectiveness on outcome measures, Mann-Whitney U and Wilcoxon test were used compare pre-test and post-test values with/within groups, respectively. The primary outcome (pain intensity) was lowered %33 in both groups. However, the mean change was found similar (median mean changes; -2 for both groups) (p > 0.05). The secondary outcomes; cervical mobility, cervical flexion ROM, disability and muscle strength of the left middle trapezius, left hand grip, anterior and middle parts of the right deltoid, and cervical flexors also significantly improved in both groups (p < 0.05). Only the mean changes of right serratus anterior, middle trapezius and cervical flexor muscles were higher in violin group than ney group (p < 0.05). There was no significant difference in the cervical extension, right rotation, left rotation, right lateral flexion and left lateral flexion after the treatment in both groups (p > 0.05). There was no significant difference between the groups after the exercise program in terms of pain, mobility, range of motion and SF-36 subdomains (p > 0.05). Specific exercise program had similar positive effects on pain, cervical mobility, cervical fexion ROM and disability in string and woodwind players. Although several muscles showed similar improvements in strength, some muscle groups recovered differently. Physical needs specific to the instrument and performance should be taken into account when prescribing exercises to musicians having the same problem, but playing different instruments.

Associations of neck muscle strength and cervical spine mobility with future neck pain and disability: a prospective 16-year study

Background

Neck pain has been associated with weaker neck muscle strength and decreased cervical spine range of motion. However, whether neck muscle strength or cervical spine mobility predict later neck disability has not been demonstrated. In this 16-year prospective study, we investigated whether neck muscle strength and cervical spine mobility are associated with future neck pain and related disability in women pain-free at baseline.

Methods

Maximal isometric neck muscle strength and passive range of motion (PROM) of the cervical spine of 220 women (mean age 40, standard deviation (SD) 12 years) were measured at baseline between 2000 and 2002. We conducted a postal survey 16 years later to determine whether any subjects had experienced neck pain and related disability. Linear regression analysis adjusted for age and body mass index was used to determine to what extent baseline neck strength and PROM values were associated with future neck pain and related disability assessed using the Neck Disability Index (NDI).

Results

The regression analysis Beta coefficient remained below 0.1 for all the neck strength and PROM values, indicating no association between neck pain and related disability. Of the 149 (68%) responders, mean NDI was lowest (3.3, SD 3.8) in participants who had experienced no neck pain (n = 50), second lowest (7.7, SD 7.1) in those who had experienced occasional neck pain (n = 94), and highest (19.6, SD 22.0) in those who had experienced chronic neck pain (n = 5).

Conclusions

This 16-year prospective study found no evidence for an association between either neck muscle strength or mobility and the occurrence in later life of neck pain and disability. Therefore, screening healthy subjects for weaker neck muscle strength or poorer cervical spine mobility cannot be recommended for preventive purposes.

Traditional Chinese Mind and Body Exercises for Neck Pain: A Meta-Analysis of Randomized Controlled Trials

BACKGROUND

Neck pain is common and can have a significant impact on patients' physical functionality, mobility, and quality of life (QOL). In clinical practice, traditional Chinese mind and body exercise (TCMBE) is a combination of different types of exercise based on traditional Chinese medicine, including qigong, tai chi, the 12-words-for-life-nurturing exercise, and so on, and many studies have found that it is safe and effective at helping patients with neck pain.

OBJECTIVE

The aim of this study was to investigate the effectiveness of TCMBE on pain intensity, functional mobility, and QOL in individuals with neck pain.

METHODS

The PubMed, MEDLINE, PEDro, and Embase databases were systematically searched for relevant studies. Randomized controlled trials reporting the effects of TCMBE on pain intensity, functional mobility, and QOL in individuals with neck pain were included. Screening, data extraction, and literature quality assessments were performed independently by two reviewers. RevMan5.4 software was used for data analysis.

RESULTS

Six studies with 716 participants met the inclusion criteria. Compared with the control groups, TCMBE had no therapeutic advantage in improving pain intensity (visual analogue scale: mean difference (MD) = 1.8, 95% confidence interval (CI): -7.70 to 11.46, and P = 0.70); functional mobility (neck disability index: MD = 0.15, 95% CI: -6.37 to 6.66, and P = 0.96; neck pain and disability scale: MD = 1.31, 95% CI: -4.10 to 6.71, and P = 0.64); or 36-item short-form health survey (SF-36) scores for physical function (MD = 5.58, 95% CI: -8.03 to 19.18, and P = 0.42), general health (MD = 1.87, 95% CI: -4.99 to 8.72, and P = 0.59), body pain (MD = 2.26, 95% CI: -3.80 to 8.32, and P = 0.46), vitality (MD = 6.24, 95% CI: -1.49 to 13.98, and P = 0.11), social function (MD = 8.06, 95% CI: -4.85 to 20.98, and P = 0.22), role physical (MD = -1.46, 95% CI: -8.54 to 5.62, and P = 0.69), or role emotional (MD = 6.5, 95% CI: -3.45 to 16.45, and P = 0.2). However, TCMBE was less effective at improving mental health results based on the SF-36 survey (MD = 3.37, 95% CI: 0.5 to 6.24, and P = 0.02).

CONCLUSIONS

Based on the meta-analysis, there is insufficient evidence to support the clinical use of TCMBE in improving pain intensity and enhancing functional mobility and QOL in individuals with neck pain.

Neck-related function and its connection with disability in chronic whiplash-associated disorders: secondary analysis of a randomized controlled study

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.

Clinical characteristics differ between patients with non-traumatic neck pain, patients with whiplash-associated disorders, and pain-free individuals

BackgroundEvidence is lacking to what extent patients with Whiplash-Associated Disorders (WAD), those with non-traumatic neck pain (NTNP), and pain-free individuals differ regarding type and severity of impairments, disability, and psychological factors.Objective To compare clinical characteristics between patients with WAD, with NTNP, and pain-free individuals in primary care physiotherapy. Additionally, differences between patient groups for both acute and chronic symptoms were assessed.MethodA cross-sectional study was conducted including 168 patients with WAD, 336 matched patients with NTNP, and 336 pain-free individuals. Differences and prevalence rates were calculated for pain intensity, pain distribution, cervical range of motion, neck flexor muscle endurance, self-reported disability, and psychological factors.Results Patients with WAD had higher pain intensity (median 6/10 vs. 5/10 p<.01), had a wider distribution of their neck pain (p=.02), more restricted cervical flexion-extension (-11.9°) and rotation (-12.4°), less muscle endurance (-5.5 seconds), and more disability (+14.0%), compared to patients with NTNP. More patients with WAD reported low back pain (+9.5%) and headache (+12.2%) as musculoskeletal comorbidities. Regarding anxiety, depression, and stress, most patients (>83%) scored in the normal range. No significant differences between the patient groups were observed (p>.16). Both patient groups scored significantly worse than pain-free individuals on all characteristics. Patients with WAD and NTNP experienced different types of activity limitations and participation restrictions.ConclusionWAD is a more severe condition than NTNP and should be considered a separate subgroup. A different approach in clinical practice and research is required for WAD and NTNP.

Test - re-test reliability and concurrent validity of cervical active range of motion in young asymptomatic adults using a new inertial measurement unit device

OBJECTIVES

Cervical range of motion (CROM) is one of the first things evaluated in cervical disorders. DyCare-Lynx is an inertial measurement unit device that was recently designed to measure CROM. Therefore, the objectives of the present study were to test the reliability and validity of the DyCare-Lynx device for active CROM.

MATERIALS AND METHODS

This study included 36 healthy individuals for the reliability study and 31 individuals for the validity study. Test-retest reliability was examined in three different days, by the same examiner with a 4 ± 1-day interval between them in all cervical movements in random order. For validity, the CROM was tested with the Zebris Motion Analysis system and DyCare-Lynx simultaneously.

RESULTS

The interclass correlation coefficient (ICC) of the DyCare-Lynx ranged from 0.54 to 0.90. The standard error of measurement (SEM) ranged from 2.12°-7.65°. The smallest detectable change (SDD) ranged from 11.25% to 29.75%. The Pearson's r correlation of DyCare-Lynx with Zebris ranged from 0.655 to 0.957.

CONCLUSION

DyCare-Lynx showed moderate to excellent reliability and moderate-to-high validity. Moreover, SEM was low with acceptable SDD values for all movements. Overall, it can be suggested that DyCare-Lynx is a reliable and valid tool to evaluate active CROM.

Validity and reliability of Veloflex to measure active cervical range of motion in asymptomatic and symptomatic subjects

BACKGROUND

Neck pain has a high annual incidence and decreases the cervical active range of motion (ROM). Clinicians use various methods to evaluate cervical range of motion (CROM) that some of them have also been proposed to give instant feedback. Accordingly, this study aimed to examine the validity and reliability of Veloflex (VF) to measure the CROM by comparison with the cervical range of motion (CROM) device, and to examine their test-retest reliability.

METHODS

Thirty-eight healthy and 20 symptomatic participants were evaluated. Cervical flexion-extension, side bending, and rotations were tested in two sessions, first by the CROM and VF and in the second only with the VF. To evaluate the concurrent validity and agreement between CROM and VF, Pearson correlation coefficient (r) and Bland-Altmann plots were used. Reliability were evaluated using intra-class correlation (ICC), standard error of measurement (SEM) and minimal detectable change (MDC).

RESULTS

CROM and VF showed excellent correlation for all movements (r > 0.960). Both devices provided small mean 'bias' (≤1.29%) in all movements regarding CROM measures. The intra-rater and inter-rater reliability of the VF was excellent (ICC > 0.98). SEMs ranging from 0.72% to 2.38% and the MDC ranging from 1.22° to 2.60° in all participants. The results support the validity and reliability of VF to measure CROM. For its use, with a basic training is enough to get reliable measurements.

Prognostic factors for the improvement of pain and disability following multidisciplinary rehabilitation in patients with chronic neck pain

Background

Recent clinical studies have demonstrated the effectiveness of specific, multidisciplinary, bio-psychosocial, rehabilitation programmes for chronic neck pain. However, prognostic factors for the improvement of pain and disability are mostly unknown. Therefore, the aim of this study was to explore prognostic factors associated with improvements in chronic neck pain following participation in a three-week, multidisciplinary, bio-psychosocial, rehabilitation programme.

Methods

In this observational, prospective cohort study, a total of 112 patients were assessed at the beginning, end, and 6 months following the completion of a multidisciplinary, bio-psychosocial, rehabilitation programme. Inclusion for participation in the rehabilitation programme depended upon an interdisciplinary pain assessment. The primary outcome was neck pain and disability, which was measured using the Northern American Spine Society questionnaire for pain+disability and was quantified with effect sizes (ES). Multivariable linear regression analyses were used to explore potential prognostic factors associated with improvements in pain and disability scores at discharge and at the 6-month follow-up period.

Results

The mean age of the patients was 59.7 years (standard deviation = 10.8), and 70.5% were female. Patients showed improvement in pain+disability at discharge (ES = 0.56; p < 0.001), which was sustained at the 6-month follow-up (ES = 0.56; p < 0.001). Prognostic factors associated with improvement in pain+disability scores at discharge included poor pain+disability baseline scores (partial, adjusted correlation r = 0.414, p < 0.001), older age (r = 0.223, p = 0.024), a good baseline cervical active range-of-motion (ROM) (r = 0.210, p < 0.033), and improvements in the Short-form 36 mental health scale (r = 0.197; p = 0.047) and cervical ROMs (r = 0.195, p = 0.048) from baseline values. Prognostic factors associated with improvements in pain+disability at the 6-month follow-up were similar and included poor pain+disability baseline scores (partial, adjusted correlation r = 0.364, p < 0.001), improvements in the Short-form 36 mental health scale (r = 0.232; p = 0.002), cervical ROMs (r = 0.247, p = 0.011), and better cervical ROM baseline scores. However, older age was not a factor (r = 0.134, p = 0.172).

Conclusions

Future prognostic models for treatment outcomes in chronic neck pain patients should consider cervical ROM and mental health status. Knowledge of prognostic factors may help in the adoption of individualized treatment for patients who are less likely to respond to multidisciplinary rehabilitation.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-021-04194-9.

Sensory, Motor, and Psychosocial Characteristics of Individuals With Chronic Neck Pain: A Case-Control Study

OBJECTIVE

Given the complex and unclear etiology of neck pain, it is important to understand the differences in central sensitization as well as psychosocial factors in individuals with chronic neck pain and healthy controls. The purpose of this study was to benchmark differences in central sensitization, psychosocial factors, and range of motion between people with nonspecific chronic neck pain and healthy controls and to analyze the correlation between pain intensity, neck disability, and psychosocial factors in people with chronic neck pain.

METHODS

Thirty individuals with chronic neck pain and 30 healthy controls were included in this case-control study. Outcome measures were as follows: central sensitization (pressure pain threshold, temporal summation, and conditioned pain modulation), psychosocial factors (depressive symptoms, pain catastrophizing, and quality of life), and active cervical range of motion.

RESULTS

People with neck pain had lower local pressure pain threshold, a decrease in conditioned pain modulation, more depressive symptoms, greater pain catastrophizing, lower quality of life, and reduced range of motion for neck rotation when compared with healthy controls. In people with neck pain, moderate correlations were observed between pain intensity and quality of life (ρ = -0.479), disability and pain catastrophizing (ρ = 0.379), and disability and quality of life (ρ = -0.456).

CONCLUSIONS

People with neck pain have local hyperalgesia, impaired conditioning pain modulation, depressive symptoms, pain catastrophizing, low quality of life, and reduced active range of motion during neck rotation, which should be taken into account during assessment and treatment.

IMPACT

This study shows that important outcomes, such as central sensitization and psychosocial factors, should be considered during assessment and treatment of individuals with nonspecific chronic neck pain. In addition, pain intensity and neck disability are correlated with psychosocial factors.

Artificial intelligence prediction of the effect of rehabilitation in whiplash associated disorder

The active cervical range of motion (aROM) is assessed by clinicians to inform their decision-making. Even with the ability of neck motion to discriminate injured from non-injured subjects, the mechanisms to explain recovery or persistence of WAD remain unclear. There are few studies of ROM examinations with precision tools using kinematics as predictive factors of recovery rate. The present paper will evaluate the performance of an artificial neural network (ANN) using kinematic variables to predict the overall change of aROM after a period of rehabilitation in WAD patients. To achieve this goal the neck kinematics of a cohort of 1082 WAD patients (55.1% females), with mean age 37.68 (SD 12.88) years old, from across Spain were used. Prediction variables were the kinematics recorded by the EBI^® 5 in routine biomechanical assessments of these patients. These include normalized ROM, speed to peak and ROM coefficient of variation. The improvement of aROM was represented by the Neck Functional Holistic Analysis Score (NFHAS). A supervised multi-layer feed-forward ANN was created to predict the change in NFHAS. The selected architecture of the ANN showed a mean squared error of 308.07–272.75 confidence interval for a 95% in the Monte Carlo cross validation. The performance of the ANN was tested with a subsample of patients not used in the training. This comparison resulted in a medium correlation with R = 0.5. The trained neural network to predict the expected difference in NFHAS between baseline and follow up showed modest results. While the overall performance is moderately correlated, the error of this prediction is still too large to use the method in clinical practice. The addition of other clinically relevant factors could further improve prediction performance.

Does the patient and clinician perception of restricted range of cervical movement agree with the objective quantification of movement in people with neck pain? And do clinicians agree in their interpretation?

BACKGROUND

Measurement of cervical range of motion (ROM) is recommended when physically examining people with neck pain. However, little is known about the clinician's perception of "normal" versus restricted movement. Additionally, it is unknown if an objective measure of restricted movement correlates with the patient's perception of movement restriction.

METHODS

One hundred patients with neck pain were asked to rate their total amount of restriction, using a movement restriction scale. Two physical therapists (PTs) measured cervical ROM using a CROM device. Assessors independently rated whether the patient was restricted in their cervical ROM for each movement direction ("yes" or "no"). Cohen's kappa was used to assess reliability between both assessor's interpretation for all movement directions. Correlations between the perception of 'normal' versus 'restricted' movement according to both the assessor and patient was compared with an objective classification of movement restriction using normative data.

RESULTS

The agreement between PTs was high, ranging from substantial (K: 0.74) to almost perfect (K: 0.94). The correlation between the self-reported restriction scale and objective restriction was 0.44, indicating moderate correlation. The correlation between the PT's interpretation and objective restriction ranged from 0.55 to 0.66 depending on the direction of movement.

CONCLUSION

A large proportion (85%) of the patients with neck pain exhibited restricted cervical ROM, relative to normative data. The agreement between PTs was high in judging whether a patient had restricted cervical ROM. However, the judgement of both the patient and the PT was not always in accordance with the objective measure of movement.

Patient characteristics associated with a poor response to non-surgical multidisciplinary management of knee osteoarthritis: a multisite prospective longitudinal study in an advanced practice physiotherapist-led tertiary service

OBJECTIVES

To explore patient characteristics recorded at the initial consultation associated with a poor response to non-surgical multidisciplinary management of knee osteoarthritis (KOA) in tertiary care.

DESIGN

Prospective multisite longitudinal study.

SETTING

Advanced practice physiotherapist-led multidisciplinary orthopaedic service within eight tertiary hospitals.

PARTICIPANTS

238 patients with KOA.

PRIMARY AND SECONDARY OUTCOME MEASURES

Standardised measures were recorded in all patients prior to them receiving non-surgical multidisciplinary management in a tertiary hospital service across multiple sites. These measures were examined for their relationship with a poor response to management 6 months after the initial consultation using a 15-point Global Rating of Change measure (poor response (scores -7 to +1)/positive response (scores+2 to+7)). Generalised linear models with binomial family and logit link were used to examine which patient characteristics yielded the strongest relationship with a poor response to management as estimated by the OR (95% CI).

RESULTS

Overall, 114 out of 238 (47.9%) participants recorded a poor response. The odds of a poor response decreased with higher patient expectations of benefit (OR 0.74 (0.63 to 0.87) per 1/10 point score increase) and higher self-reported knee function (OR 0.67 (0.51 to 0.89) per 10/100 point score increase) (p<0.01). The odds of a poor response increased with a greater degree of varus frontal knee alignment (OR 1.35 (1.03 to 1.78) per 5° increase in varus angle) and a severe (compared with mild) radiological rating of medial compartment degenerative change (OR 3.11 (1.04 to 9.3)) (p<0.05).

CONCLUSIONS

These characteristics may need to be considered in patients presenting for non-surgical multidisciplinary management of KOA in tertiary care. Measurement of these patient characteristics may potentially better inform patient-centred management and flag the need for judicious monitoring of outcome for some patients to avoid unproductive care.

Normative values of cervical range of motion for both children and adults: A systematic review

STUDY DESIGN

Systematic review.

OBJECTIVE

To synthesize studies reporting normative values of active cervical range of motion (ROM) in healthy children and adults.

SUMMARY OF BACKGROUND DATA

Evaluating active cervical ROM is part of routine assessment of patients with neck pain. Interpretation of outcomes necessitates having normative data per age category. Currently available normative values differ across studies, perhaps due to (the measurement properties of) the devices used.

METHODS

A systematic review according to PRISMA guidelines was conducted. Electronic searches included EMBASE, MEDLINE, Web of Science, Cochrane, CINAHL and Google Scholar databases from inception to August 2018. Included studies had to involve healthy subjects in which active cervical ROM was assessed or when determining normative values was the aim of the study. Methodological quality of the included studies was assessed using an adapted version of the QUADAS. A mean value was re-calculated for the total group in case data were presented per gender per age-category only. When possible, data were pooled.

RESULTS

From 2151 unique hits, 217 articles were selected for full text assessment, after which 162 articles were excluded. Data were extracted from 55 articles using 16 different measurement devices. Twenty-five studies were rated as being of "low risk of bias". Only data from studies evaluating the CROM device and Zebris could be pooled.

CONCLUSIONS

This systematic review revealed that although a large number of studies assessed normative data for active cervical ROM, the methodological quality of most studies was low and the heterogeneity between studies was high. Only the normative data for active cervical ROM using the CROM device seems to be useful. Overall, reference values for measuring active cervical ROM is unclear for most measurement devices. Normative values of cervical range of motion for both children and adults: a systematic review.