Regional musculoskeletal conditions: neck pain

Is adding dry needling to a standard care protocol beneficial in patients with chronic neck pain? A randomized placebo-controlled trial

PURPOSE

To evaluate the short-term effects of adding a dry needling therapy to a standard care protocol based on education, exercise and electrotherapy, compared to a sham procedure and to a standard care protocol in isolation in patients with chronic neck pain.

MATERIAL AND METHODS

A randomized placebo-controlled trial was performed. The participants in the dry needling group received a standard care protocol based on patient education, therapeutic exercise and electrotherapy, as well as two sessions of dry needling in the upper trapezius, levator scapulae, and/or sternocleidomastoid muscles. The participants in the sham dry needling group received the same standard care protocol and two sessions of sham dry needling. The participants in the control group received the same standard care protocol. The outcomes measured were pain intensity, pressure pain threshold, neck disability, range of movement, activation of deep cervical flexor muscles, kinesiophobia, pain catastrophizing, anxiety, and depression.

RESULTS

No significant group by time interactions were found for any of the outcome variables except for lower cervical spine range of movement (F = 3.79; p = 0.030).

CONCLUSION

The addition of two sessions of dry needling in the superficial neck muscles to a standard protocol did not yield superior results compared to either the standard care alone or the standard care plus sham dry needling in patients with chronic neck pain in any outcome except for cervical range of movement.

Spinal displacement during thoracic manipulative therapy in mechanical neck pain patients: an observational study

INTRODUCTION

Thoracic manipulative therapy (TMT) is recommended for treating patients with mechanical neck pain (MNP). However, there are multiple proposed recommendations for the mechanism for neck pain reduction.

OBJECTIVE

To investigate displacement of the cervicothoracic spine during the application of TMT in patients with MNP.

METHODS

Thirty-five male patients with MNP were recruited. Displacements of C3, C5, C7, T2, T4 and T6 were measured using a motion capture system while a therapist applied a grade III central posteroanterior TMT (cpa-TMT) to T6.

RESULTS

Mean (SD) displacement ranged from 2.2 (0.62) to 5.5 (1.1) mm. A significant decrease in neck pain intensity at rest was found after the application of the cpa-TMT (mean difference 17 mm, p < 0.001). A downward trend in spinal displacement was noted, with the largest and smallest displacement occurring at T6 and C3, respectively. Correlations between the displacement of T6 and adjacent spinal levels were moderate to high (Pearson's r range 0.70-0.90, p < 0.001). It was showed that cpa-TMT applied to T6 produced the PA displacement toward the upper cervical spine.

CONCLUSION

TMT produces spinal segmental displacements toward the upper cervical spine in MNP patients. These segmental displacements would activate the alleviation effect at both the spinal and supraspinal levels resulting in neck pain reduction. These findings would provide supporting evidence for the use of TMT in neck pain reduction.

Efficacy of telerehabilitation in patients with nonspecific neck pain: A meta-analysis

INTRODUCTION

At a rate of more than 30% annually, neck pain is a very prevalent musculoskeletal ailment that is second only to low back pain as the most common cause of disability. Most occurrences of neck pain are nonspecific. Telerehabilitation is regarded as a potentially effective healthcare approach in this setting. This review aims to evaluate how a telerehabilitation-based intervention affected individuals with nonspecific neck pain (NNP) in terms of pain and disability.

METHODS

PubMed, Web of Science, Scopus, Embase, MEDLINE, Cochrane library, ClinicalTrials.gov, CNKI, and WanFang were consulted from inception to September 2023, with the inclusion of randomized controlled trials only. The experimental data were meta-analyzed using RevMan 5.3.

RESULTS

The meta-analysis contained eight studies; there was no significant difference in pain improvement in patients with NNP by telerehabilitation compared to conventional care (SMD = -0.10, 95% CI: -0.48 to 0.28), but there was a significant effect on disability improvement (SMD = -0.41, 95% CI: -0.78 to -0.03). Telerehabilitation demonstrated more significant improvements in pain (SMD = -1.16, 95% CI: -1.99 to -0.32) and disability (MD = -3.78, 95% CI: -5.29 to -2.27) compared to minimal or no intervention.

DISCUSSION

This study emphasizes the potential benefits of employing telerehabilitation in patients with NNP, especially in reducing pain intensity and improving disability. But additional study is required to fully grasp the potential of telerehabilitation in this field.

Simplified Chinese version of the core outcome measures index (COMI) for patients with neck pain: cross-cultural adaptation and validation

PURPOSE

The aim of this study was to translate and cross-culturally adapt the Core Outcome Measures Index for (COMI) into a Simplified Chinese version (COMI-SC) and to evaluate the reliability and validity of COMI-SC in patients with neck pain.

METHODS

The COMI-neck was translated into Chinese according to established methods. The COMI-neck questionnaire was then completed by 122 patients with a hospital diagnosis of neck pain. Reliability was assessed by calculating Cronbach's alpha and intraclass correlation coefficient (ICC). Construct validity was assessed by correlating the COMI-neck with the Neck Pain and Disability Scale (NPDS), the Neck Disability Index (NDI), the VAS and the Short Form (36) Health Survey (SF-36). Using confirmatory factor analysis to validate the structural, convergent and discriminant validity of the questionnaire.

RESULTS

The COMI-neck total scores were well distributed, with no floor or ceiling effects. Internal consistency was excellent (Cronbach's alpha = 0.861). Moderate to substantial correlations were found between COMI-neck and NPDS (r = 0.420/0.416/0.437, P < 0.001), NDI (r = 0.890, P < 0.001), VAS (r = 0.845, P < 0.001), as well as physical function (r = - 0.989, P < 0.001), physical role (r = - 0.597, P < 0.001), bodily pain (r = - 0. 639, P < 0.001), general health (r = - 0.563, P < 0.001), vitality (r = - 0.702, P < 0.001), social functioning (r = - 0.764, P < 0.001), role emotional (r = - 0.675, P < 0.001) and mental health (r = - 0.507, P < 0.001) subscales of the SF-36. An exploratory factor analysis revealed that the 3-factor loading explained 71.558% of the total variance [Kaiser-Mayer-Olkin (KMO) = 0.780, C2 = 502.82, P < 0.001]. CMIN/DF = 1.813, Tucker-Lewis index (TLI) = 0.966 (> 0.9), Comparative Fit Index (CFI) = 0.982 (> 0.9), Normed Fit Index (NFI) = 0.961 (> 0.9), RMSEA = 0.082 (< 0.5) indicating that the model fits well.

CONCLUSION

COMI-neck was shown to have acceptable reliability and validity in patients with non-specific chronic neck pain and could be recommended for patients in mainland China.

LEVEL OF EVIDENCE

Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.

The Use of Virtual Reality in the Rehabilitation of Chronic Nonspecific Neck Pain: A Systematic Review and Meta-Analysis

OBJECTIVES

There has been a major interest in using virtual reality (VR) as a pain-management tool. This systematic review evaluated the literature on the use of VR in the treatment of chronic nonspecific neck pain (CNNP).

METHODS

Electronic database searches were conducted in Cochrane, Medline, PubMed, Web of Science, Embase, and Scopus between inception and November 22, 2022. Search terms used were synonyms of "chronic neck pain" and "virtual reality." Inclusion criteria were as follows: chronic neck pain patients or pain lasting longer than 3 months; nonspecific neck pain; adult population; VR intervention; and functional and/or psychological outcomes. Study characteristics, quality, participant demographics, and results were independently extracted by 2 reviewers.

RESULTS

VR interventions demonstrated significant improvement in patients experiencing CNNP. Scores in the visual analogue scale, the Neck Disability Index, and range of motion were significantly improved compared with baseline but not better than gold standard kinematic treatments.

DISCUSSION

Our results suggest that VR is a promising tool for chronic pain management; however, there is a lack of VR intervention design consistency, objective outcome measures, follow-up reporting, and large sample sizes. Future research should focus on designing VR interventions to serve specific, individualized movement goals as well as combining quantifiable outcomes with existing self-report measures.

Benefits and Harms of Spinal Manipulative Therapy for Treating Recent and Persistent Nonspecific Neck Pain: A Systematic Review With Meta-analysis

OBJECTIVE: We aimed to estimate the benefits and harms of cervical spinal manipulative therapy (SMT) for treating neck pain. DESIGN: Intervention systematic review with meta-analysis of randomized controlled trials (RCTs). LITERATURE SEARCH: We searched the MEDLINE, Cochrane CENTRAL, Embase, CINAHL, PEDro, Chiropractic Literature Index bibliographic databases, and grey literature sources, up to June 6, 2022. STUDY SELECTION CRITERIA: RCTs evaluating SMT compared to guideline-recommended and nonrecommended interventions, sham SMT, and no intervention for adults with neck pain were eligible for our systematic review. Prespecified outcomes included pain, range of motion, disability, health-related quality of life. DATA SYNTHESIS: Random-effects meta-analysis for clinically homogenous RCTs at short-term and long-term outcomes. Risk of bias was assessed using the Cochrane Risk of Bias 2.0 Tool. We used the Grading of Recommendations, Assessment, Development, and Evaluations approach to judge the certainty of evidence. RESULTS: We included 28 RCTs. There was very low to low certainty evidence that SMT was more effective than recommended interventions for improving pain at short term (standardized mean difference [SMD], 0.66; 95% confidence interval [CI]: 0.35, 0.97) and long term (SMD, 0.73; 95% CI: 0.31, 1.16), and for reducing disability at short-term (SMD, 0.95; 95% CI: 0.48, 1.42) and long term (SMD, 0.65; 95% CI: 0.23, 1.06). Transient side effects only were found (eg, muscle soreness). CONCLUSION: There was very low certainty evidence supporting cervical SMT as an intervention to reduce pain and improve disability in people with neck pain. J Orthop Sports Phys Ther 2023;53(9):510-528. Epub: 10 August 2023. doi:10.2519/jospt.2023.11708.

Association of Cervical Spine Magnetic Resonance Imaging Abnormalities with Chronic Neck Pain in Southern Nigeria

Objective

This study was done to evaluate the relationship between cervical spine magnetic resonance imaging (MRI) findings and clinical features in adults with chronic neck pain (NP) at our tertiary hospital.

Materials and Methods

This was a prospective cross-sectional study of the cervical spine MRI of 90 adult patients with chronic NP. The clinical history, biodata, and cervical spine MRI findings were analysed. Statistical tests were considered significant at P ≤ 0.05.

Results

The mean age of the participants was 54.72 (13.51) years (range = 28-79 years). There were 52 (58%) males and 38 (42%) females. Cervical disc desiccation and disc herniation were the most prevalent MRI findings. C4/C5 and C5/C6 disc levels were most commonly affected. Disc height reduction correlated with shoulder pain (r = 0.23, P = 0.030), unsteady gait (r = 0.27, P = 0.010), and lower limb weakness (r = 0.23, P = 0.029). Vertebral collapse correlated with shoulder pain (r = 0.22, P = 0.036), upper limbs burning sensation (r = 0.33, P = 0.001), and loss of dexterity (r = 0.22, P = 0.037). Spondylolisthesis correlated significantly with unsteady gait (r = 0.34, P = 0.001), dizziness/vertigo (r = 0.29, P = 0.005), painful neck movement (r = 0.32, P = 0.002), loss of dexterity (r = 0.37, P < 0.001) and sphincteric dysfunction (r = 0.23, P = 0.031). Modic changes correlated with loss of dexterity (r = 0.39, P < 0.001) and upper limbs burning sensation (r = 0.21, P = 0.048). Cervical canal stenosis did not correlate significantly with any symptom.

Conclusion

Cervical disc disease (C4/C5 and C5/C6 levels) was the most prevalent finding on MRI. Disc height reduction, vertebral collapse, spondylolisthesis, and Modic changes correlated with various clinical symptoms.

Neck pain clinical practice guidelines: a systematic review of the quality and quantity of complementary and alternative medicine recommendations

BACKGROUND

Individuals with neck pain frequently turn to complementary and alternative medicine (CAM) to seek relief. However, conventional healthcare providers often lack adequate CAM therapy knowledge to deliver informed recommendations to patients. The purpose of this study was to identify mention of CAM in neck pain clinical practice guidelines (CPG) and assess the quality of CAM recommendations using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument.

METHODS

MEDLINE, EMBASE and CINAHL were systematically searched from 2009 to 2020 in addition to the Guidelines International Network and National Center for Complementary and Integrative Health websites. Eligible CPGs providing CAM recommendations were assessed twice with the AGREE II instrument, once to assess the overall CPG and then once to assess the CAM sections specifically.

RESULTS

From 643 unique search results, 15 CPGs on the treatment and/or management of neck pain were identified, and 8 made recommendations on CAM therapy. Regarding scaled domain percentages, the overall CPG scored higher than the CAM section for 5 of 6 domains (overall, CAM): (1) scope and purpose (93.4%, 93.1%), (2) stakeholder involvement (81.6%, 81.9%), (3) rigour of development (70.8%, 66.3%), (4) clarity of presentation (64.9%, 60.8%), (5) applicability (39.3%, 33.6%), and (6) editorial independence (47.9%, 45.3%).

CONCLUSIONS

Most neck pain CPGs made CAM recommendations. The quality of CAM recommendations is lower than overall recommendations across all domains with the exception of stakeholder involvement. This disparity highlights the need for CAM recommendations quality improvement. Although many patients with neck pain seek CAM therapies, few CPGs are available for healthcare providers and patients.

Effect of a Posture-Cueing Shirt on Sitting Posture During a Functional Task in Healthy Participants: A Randomized Cross-Over Study

OBJECTIVES

The purpose of this study was to investigate the effect of a posture-cueing shirt on sitting posture during a functional task.

METHODS

Thirty healthy male participants were seated at a standardized workstation while completing 3 laptop writing tasks of 15-minute duration wearing either a posture-cueing shirt, a compression shirt, or no shirt. Posture was assessed based on photos taken at minutes 1 and 15 into the writing task from which the head and shoulder angles were measured and extracted for analysis. After each task, participants rated any potential pain they felt during the task on an 11-point numeric rating scale (NRS).

RESULTS

The results showed that none of the shirts significantly affected the head or shoulder angles at any time point. Participants reported lower pain levels after using the posture-cueing shirt (NRS 0 [0-1]) compared with no shirt (NRS 1 [0-2]; P = .012). No significant difference in pain levels was observed between shirts.

CONCLUSION

Although posture did not change in any conditions for these healthy male subjects, the posture-cueing shirt resulted in a lower pain intensity compared with no shirt but not with a compression shirt. Although a significant difference was found for pain intensity favoring the posture-cueing shirt, this difference was negligible, and thus its value to reduce pain or improve posture in healthy subjects remains in question.

Visual, Vestibular, and Proprioceptive Dependency of the Control of Posture in Chronic Neck Pain Patients

Sensory reweighting of postural control was compared in participants with and without neck pain. Center of pressure variables of 60 volunteers, the same in each group, were calculated under four standing conditions: (a) eyes open, neutral head posture; (b) foam interface, eyes open; (c) cervical extension, eyes open; and (d) cervical extension, eyes closed. All center of pressure variables except anterior posterior range/velocity increased significantly in Condition 2 compared with Conditions 1 and 3 (p < .001) and in Condition 4 compared with Conditions 1 and 3. The mediolateral range/velocity and path length in both groups, anterior posterior range in patients, and center of pressure area in the control group were significantly different between Conditions 2 and 4 (p < .001). No overweighting was observed on the vestibular or visual afferents in patients. Compensatory strategies seem to lie within the proprioceptive system.

Comparison of kinematic similarity index during gait between adults with and without nonspecific chronic neck pain

BACKGROUND

Individuals with nonspecific chronic neck pain (NP) walk with a stiffer spine. However, there is a lack of understanding on kinematic similarities on the limbs during gait between individuals with and without NP.

RESEARCH QUESTION

Are there differences in gait parameters and the kinematic similarity index (SI) between individuals with and without NP?

METHODS

Eighteen individuals with NP and 17 controls participated in this study. A three-dimensional motion capture system and two force plates were utilized to measure kinematic changes of the upper and lower limbs during gait. The gait parameters included cadence, speed, stride length, and step width. The SI calculations were compared based on the response vectors from the NP group and the prototype response vectors from the control participants. The SI values at 5% intervals of the entire gait cycle were compared between groups.

RESULTS

Although the gait parameters were not significantly different between groups, the SI values of the control group were significantly higher than the NP group during gait (0.98 ± 0.02 vs. 0.95 ± 0.03), especially at the midstance (10-30 %) and swing (80-90 %) phases. Also, the standard deviation of the SI decreased in the control group when compared to the NP group (0.02 ± 0.01 vs. 0.04 ± 0.02).

SIGNIFICANCE

The SI was a useful measure to differentiate similarities between groups in the gait cycle at specific phases. These results indicated that the NP group demonstrated a greater variation of walking patterns during the midstance and swing phases and displayed altered compensatory gait. Clinicians need to consider the similarities of the kinematic changes for the NP group to aid in detection of limb motion differences and the resulting gait dysfunction.

Specific versus Non-Specific Exercises for Chronic Neck or Shoulder Pain: A Systematic Review

The current systematic review aimed to compare the effect of injury-focused (specific) exercises versus more general (non-specific) exercises on pain in patients with chronic neck or shoulder pain. We searched PubMed, EMBASE, and Web of Science. Two reviewers screened and selected studies, extracted outcomes, assessed risk of bias, and rated the quality of evidence. A total of nine eligible studies, represented in 13 articles, were identified, with a considerable risk of bias. One article investigated the acute effect of single bouts of exercise on pain and reported an immediate pain reduction after non-specific exercise. Regarding short-term effects, seven out of the nine studies found no differences in pain between interventions, with inconsistent results among two other studies. Concerning the long-term effects, while pain reduction seems to be favored by specific exercises (two out of four articles), the best format is still unclear. Based on the acute effects, a single bout of non-specific exercise seems to be a better option for pain-relief for patients with chronic neck or shoulder pain. For short-term effects, there are no differences in pain between specific and non-specific exercises. Regarding long-term effects, specific exercises seem to be the best option. Nevertheless, more studies are warranted.

Thread Embedded Acupuncture for Non-Specific Posterior Neck Pain: A PRISMA-Compliant Protocol for Systematic Review and Meta-Analysis

Purpose

The prevalence of non-specific posterior neck pain (NPNP) has been increasing yearly. There are several treatments for NPNP, but in this review, we will focus on thread-embedded acupuncture (TEA). TEA is used in the Republic of Korea, Taiwan, and China for managing musculoskeletal diseases, obesity, and sequelae of facial palsy. However, there is insufficient evidence on its effectiveness and safety. This study aims to assess the efficacy and safety of TEA for NPNP.

Methods

We will search the following nine electronic databases, from their inception to May 2020: MEDLINE, Embase, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, Citation Information by the National Information infrastructure, Korean Studies Information Service System, National Digital Science Library, Oriental Medicine Advanced Searching Integrated System, and Research Information Service System. Only randomized controlled trials of TEA for NPNP will be included. The methodological quality of the included trials will be assessed using the Cochrane risk-of bias tool. To conduct the meta-analysis, the risk ratio and mean difference with the 95% confidence interval will be used. Sensitivity analyses will be conducted based on this protocol.

Results

The results of this study will be submitted to a peer-reviewed journal for publication.

Conclusion

The results of this study would provide the evidence of whether TEA can be effective for treating NPNP.

Registration Number

PROSPERO CRD42020188346.

Chuna Manual Therapy vs Usual Care for Patients With Nonspecific Chronic Neck Pain: A Randomized Clinical Trial

IMPORTANCE

The incidence rate of neck pain is increasing worldwide, and the disease is associated with a high social burden. Manual therapy has been widely applied in the treatment of neck pain, but a high-quality, pragmatic randomized clinical trial for this treatment has not been conducted to date.

OBJECTIVE

This study aimed to compare the effectiveness of Chuna manual therapy with that of usual care for patients with chronic neck pain.

DESIGN, SETTING, AND PARTICIPANTS

A multicenter, assessor-blinded, pragmatic, randomized clinical trial was conducted between October 18, 2017, and June 28, 2019. This intention-to-treat analysis included 108 patients with chronic neck pain persisting for at least 3 months; patients were recruited from 5 hospitals in Korea.

INTERVENTIONS

Ten sessions (2 sessions per week for 5 weeks) of Chuna manual therapy or usual care (electrotherapy and oral medication) were conducted.

MAIN OUTCOMES AND MEASURES

The main outcome was the difference in visual analog scale (VAS) score for chronic neck pain between baseline and 5 weeks after randomization.

RESULTS

This randomized clinical trial recruited 108 patients (mean [SD] age, 38.4 [9.3] years; 73 women [67.6%]). Fifty-four patients were allocated to the Chuna therapy group, and 54 received usual care. At 5 weeks after randomization, manual therapy showed statistically superior results compared with usual care in terms of pain (difference in chronic neck pain VAS, 16.8 mm; 95% CI, 10.1-23.5 mm), function (difference in Neck Disability Index, 8.6%; 95% CI, 4.2%-13.1%), and quality of life (difference in the European Quality of Life-5 Dimension 5 Levels (EQ-5D-5L) scores, -0.07 points; 95% CI, -0.11 to -0.02 points). Regarding the 1-year cumulative values measured using area under the curve analyses, superior outcomes were attained in the manual therapy group in terms of the numerical rating scale for chronic neck pain (1.3 points; 95% CI, 0.5-2.0 points), Neck Disability Index (6.7%; 95% CI, 2.5%-10.9%), Neck Pain Questionnaire (7.4%; 95% CI, 2.3%-12.6%), and EQ-5D-5L scores (-0.03 points; -0.07 to 0.00 points).

CONCLUSIONS AND RELEVANCE

In this randomized clinical trial, for patients with chronic neck pain, Chuna manual therapy was more effective than usual care in terms of pain and functional recovery at 5 weeks and 1 year after randomization. These results support the need to consider recommending manual therapies as primary care treatments for chronic neck pain.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT03294785.

Bone morphogenic protein-2 signaling in human disc degeneration and correlation to the Pfirrmann MRI grading system

BACKGROUND CONTEXT

Back and neck pain secondary to disc degeneration is a major public health burden. There is a need for therapeutic treatments to restore intervertebral disc (IVD) composition and function.

PURPOSE

To quantify ALK3, BMP-2, pSMAD1/5/8 and MMP-13 expression in IVD specimens collected from patients undergoing surgery for disc degeneration, to correlate ALK3, BMP-2, pSMAD1/5/8 and MMP-13 expression in IVD specimens to the 5-level Pfirrmann MRI grading system, and to compare ALK3, BMP-2, pSMAD1/5/8 and MMP-13 expression between cervical and lumbar degenerative disc specimens.

STUDY DESIGN

An immunohistochemical study assessing ALK3, BMP-2, pSMAD1/5/8, and MMP-13 expression levels in human control and degenerative IVD specimens.

METHODS

Human IVD specimens were collected from surgical patients who underwent discectomy and interbody fusion at our institution between 1/2015 and 8/2017. Each patient underwent MRI prior to surgery. The degree of disc degeneration was measured according to the 5-level Pfirrmann MRI grading system. Patients were categorized into either the 1) control group (Pfirrmann grades I-II) or 2) degenerative group (Pfirrmann grades III-V). Histology slides of the collected IVD specimens were prepared and immunohistochemical staining was performed to assess ALK3, BMP-2, pSMAD1/5/8, and MMP-13 expression levels in the control and degenerative specimens. Expression levels were also correlated to the Pfirrmann criteria. Lastly, the degenerative specimens were stratified according to their vertebral level and expression levels between the degenerative lumbar and cervical discs were compared.

RESULTS

Fifty-two patients were enrolled; however, 2 control and 2 degenerative patients were excluded due to incomplete data sets. Of the remaining 48 patients, there were 12 control and 36 degenerative specimens. Degenerative specimens had increased expression levels of BMP-2 (p=.0006) and pSMAD1/5/8 (p<.0001). Pfirrmann grade 3 (p=.0365) and grade 4 (p=.0008) discs had significantly higher BMP-2 expression as compared to grade 2 discs. Pfirrmann grade 4 discs had higher pSMAD1/5/8 expression as compared to grade 2 discs (p<.0001). There were no differences in ALK3 or MMP-13 expression between the control and degenerative discs (p>.05). Stratifying the degenerative specimens according to their vertebral level showed no significant differences in expression levels between the lumbar and cervical discs (p>.05).

CONCLUSIONS

BMP-2 and pSMAD1/5/8 signaling activity was significantly upregulated in the human degenerative specimens, while ALK3 and MMP-13 expression were not significantly changed. The expression levels of BMP-2 and pSMAD1/5/8 correlate positively with the degree of disc degeneration measured according to the Pfirrmann MRI grading system.

CLINICAL SIGNIFICANCE

BMP-SMAD signaling represents a promising therapeutic target to restore IVD composition and function in the setting of disc degeneration.

Cross-cultural Adaptation, Reliability, Validity, and Responsiveness of the Simplified-Chinese Version of Neck Disability Index

STUDY DESIGN

Cross-cultural adaptation and psychometric evaluation.

OBJECTIVE

The aim of this study was to translate the Neck Disability Index (NDI) into the simplified-Chinese language and to evaluate the reliability, validity, and responsiveness of the new questionnaire.

SUMMARY OF BACKGROUND DATA

Neck pain is a major health problem resulting in major disability. NDI is the most frequently used scale for self-rating of disability due to neck pain. At present, there is no simplified-Chinese version of the NDI. The aims of this study were to culturally adapt and translate the NDI into the simplified-Chinese language (NDI-SC) and to evaluate its psychometric properties in patients with neck pain.

METHODS

The NDI was translated into simplified-Chinese version based on established guidelines. A total of 70 patients participated in this study. Patients were asked to complete a set of questionnaires comprising of their demographic information, the NDI-SC, and a visual analog scale (VAS) of pain. Fifty-six patients returned after 1 to 2 weeks to complete the same set of questionnaires and the global rating of change (GROC) scale. Then, the NDI-SC was evaluated for content validity, construct validity, internal consistency, test-retest reliability, and responsiveness.

RESULTS

The NDI-SC demonstrated excellent internal consistency (Cronbach α = 0.92) and good test-retest reliability (ICC2,1 = 0.85). Content validity was confirmed as no floor or ceiling effects were detected for the NDI-SC total score. Construct validity was established with factor analysis revealing two-factor subscales explaining 66% of the variance. The NDI-SC showed a strong correlation with VAS (Rp = 0.61, P < 0.001) and a moderate correlation with GROC (Rs = 0.46, P < 0.001). The correlation between NDI-SC change scores and VAS change scores was also moderate (Rp = 0.59, P < 0.001).

CONCLUSION

The results showed that the NDI-SC is a reliable, valid, and responsive instrument to measure functional limitations in patients with neck pain.

LEVEL OF EVIDENCE

3.

Efficacy and Safety of Diclofenac + Capsaicin Gel in Patients with Acute Back/Neck Pain: A Multicenter Randomized Controlled Study

Introduction

Back and neck pain are common musculoskeletal disorders. Topical non-steroidal anti-inflammatory drugs (NSAIDs) are frequently used to reduce pain and inflammation with fewer systemic side effects and drug interactions compared with oral NSAIDs. This study assessed efficacy and tolerability of a topical combination of capsaicin + diclofenac to treat acute back/neck pain.

Methods

In a randomized, double-blind, controlled, multicenter, parallel group trial, 746 patients were treated twice-daily for 5 days with diclofenac 2% + capsaicin 0.075%, diclofenac 2%, capsaicin 0.075% or placebo. Efficacy assessments included change and area under the curve in pain on movement for the worst procedure (POM_WP), change in pressure algometry, and number of patients with decrease in POM_WP of ≥ 30% and ≥ 50%. Adverse events (AEs) were recorded.

Results

Change in POM_WP between baseline and day 2 evening, 1 h after drug application, demonstrates superiority of the combination (− 3.05 cm) versus diclofenac alone (− 2.33 cm) and placebo (− 2.45 cm), but not capsaicin alone (− 3.26 cm). AEs were consistent with known safety profiles.

Conclusion

Capsaicin alone and capsaicin + diclofenac showed superior benefit compared with placebo. However, diclofenac alone demonstrated efficacy comparable with placebo, and therefore its addition to capsaicin added no increased pain relief over capsaicin alone.

Trial registration

ClinicalTrials.gov identifier; NCT02700815.

Electronic supplementary material

The online version of this article (10.1007/s40122-020-00161-9) contains supplementary material, which is available to authorized users.

Comparison of CPG's for the diagnosis, prognosis and management of non-specific neck pain: a systematic review

BACKGROUND

Neck pain (NP) is a very common musculoskeletal condition with potential for a high burden in disability and length of disorder. Clinical practice guidelines (CPG) give recommendations to clinicians for providing optimal care for patients however best practice recommendations are often contradictory. The purpose for this review was to conduct a SR of CPGs to assess the management recommendations for NP (diagnosis, treatment, prognosis, imaging).

METHODS

Standard SR methodology was employed including a grey literature search (including the National Guideline Clearing House). Medline, Cinahl, Embase, ILC, Cochrane, Central, and Lilacs were searched from 1995-to March 2018. Two raters evaluated all citations and a third rater resolved any disagreements. The AGREE II was used to assess risk of bias of each CPG. Data was extracted and included CPG purpose, type of NP problem and clinical recommendations. The AGREE II critical appraisal tool was used to assess risk of bias of each CPG.

RESULTS

From 640 articles, 241 were available for screening. A total of 46 guidelines were selected. CPG's were categorized by the NP population (General NP, whiplash, interventional, headache and risk for vertebral insufficiency) and type of clinical aim (diagnosis, prognosis, treatment, imaging). Each clinical NP population had a large overlap of clinical aims presented. The CPGs were directed to a variety of clinicians that included physicians, physiotherapists and chiropractors. Results suggest heterogeneity in CPG recommendations within each clinical aim. CPG characteristics accounting for these differences are outlined.

CONCLUSION

The majority of CPGs were developed for general NP that focused on treatment recommendations, with fewer number aimed at recommendations for diagnosis, prognosis, and outcomes. Heterogeneity of recommendations within the categories were noted as were potential factors associated with these differences, including CPG quality as assessed by the AGREE II.

Symptom severity and quality of life in patients with concurrent neck pain and dizziness

Purpose: There is little knowledge on how neck pain impacts dizzy patients, and if different diagnoses of dizziness associate with neck pain. The aim was to examine differences in dizziness severity, quality of life and demographics in dizzy patients with and without neck pain. Additionally, we examined if neck pain was associated with a non-vestibular or vestibular diagnosis.Methods: We included 236 consecutive patients referred to an otorhinolaryngological university clinic for vertigo and balance problems. The patients were divided in two groups: Patients with and without neck pain. Patient-reported outcomes measures were the Dizziness Handicap Inventory, RAND-12, neck pain and symptom duration.Results: A total of 59% of the patients reported neck pain. Patients with neck pain reported poorer quality of life (p < .001) and worse handicap due to dizziness (p < .001). There were no associations between reported neck pain and dizziness of non-vestibular or vestibular origin (p = .29).Conclusion: Neck pain is a common complaint among dizzy patients. Patients with concurrent dizziness and neck pain should warrant attention due to poorer general and dizziness-related quality of life. This finding appears unrelated to whether or not they receive a peripheral vestibular diagnosis.IMPLICATION FOR REHABILITATIONNeck pain is common in patients with dizziness and associated with higher dizziness handicap and lower quality of life.Neck pain should be addressed specifically in patients assessed for dizziness, irrespective of diagnosis.Further research is needed to better understand the interactions between neck pain and dizziness.

Recovery from nonspecific neck pain in office workers

BACKGROUND

Neck pain has an episodic course with varying time for recovery and identification of individuals likely to recover is important.

OBJECTIVE

The aim of this study was twofold: 1a) to explore the duration of recovery from nonspecific neck pain, and 1b) to investigate the relation between recovery duration and age, and 2) to evaluate whether the NHBOW can predict duration of recovery from non-specific neck pain.

METHODS

One hundred and three from 342 office workers reported non-specific neck pain, with information collected on pain intensity and disability every month for 12 months. The time to recovery was measured from the onset of neck pain to full recovery. The 103 office workers were divided into two groups using the NHBOW score. Kaplan-Meier survival curves were used to describe the median time to recovery. The survival curves of the two NHBOW groups were compared using Cox regression analysis.

RESULTS

The median time to recovery from neck pain was 2 months. The duration of recovery was not significantly related with age of participants. There was no significant difference in time to recovery from neck pain between the NHBOW low-score group and the high-score group.

CONCLUSION

This study showed that the NHBOW was unable to predict duration of recovery from nonspecific neck pain in office workers.

Cervical Spine Disability in Correlation with Subjective Voice Handicap in Patients With Voice Disorders: A Retrospective Analysis

OBJECTIVE

Neck muscle dysfunction has been considered as risk factor or consequence of voice disorders. This study investigates the correlation between neck and voice-related subjective symptoms in patients with voice disorders.

STUDY DESIGN

Retrospective case-control study.

METHODS

100 adult patients (59 female and 41 male) over 18 years with a mean age of 50.01 years (SD 16, range 24-87), of which 68 were under 60 years, were included. 50 patients had organic voice pathologies and 50 functional dysphonia. Outcome measures were the Voice Handicap Index 9 international (VHI-9i) and the Neck Disability Index (NDI-G). Spearman rank order coefficient was applied to determine the correlation between overall and single item VHI and NDI results. Subanalyses were done for functional vs. organic disorder, gender and age ± 60 years.

RESULTS

Mean overall VHI-9i (13.93, SD = 7.81, range = 0-31) and mean NDI-G (6.07, SD = 7.71, range = 0-43) showed a significant mild correlation (r_s = 0.220, P = 0.02). Split into subgroups the relation was stronger in patients with organic pathologies (r_s = 0.297, P = 0.03), but not significant in functional disorders (r = 0.148, P = 0.30). There was a moderate relation in men (r_s = 0.317, P = 0.04). Single item correlation was highest between VHI-9i item P4 (physiological) and NDI-G item reading (cognitive functioning) (r_s = 0.480, P = 0.002).

CONCLUSION

Specifically patients with organic voice disorders showed increased voice symptoms with the presence of neck dysfunction. This indicates a risk for a functional imbalance of the muscles surrounding the larynx, which in extreme cases may hinder functional voice rehabilitation even after phonosurgery. Therefore, neck dysfunction should be considered in voice diagnostics.

A Comparison of Narcotic Consumption Between Hospital and Ambulatory-Based Surgery Centers Following Anterior Cervical Discectomy and Fusion

Background

Several studies have compared outcomes between hospital-based (HBCs) and ambulatory surgery centers (ASCs) following anterior cervical discectomy and fusion (ACDF). However, the association between narcotic consumption and pain in the early postoperative period has not been well characterized. As such, the purpose of this study is to compare pain, narcotic consumption, and length of stay (LOS) between HBC and ASC patients undergoing same-day-discharge following ACDF.

Methods

A surgical registry of patients who underwent a primary, 1- or 2-level ACDF during 2013-2015 was reviewed. Patients were stratified by operative location. Differences in demographics were assessed using independent-sample t tests and chi-square analysis. The presence of an association between operative location and outcomes was analyzed using Poisson regression with robust error variance or linear regression adjusted for preoperative characteristics.

Results

A total of 76 patients were identified, of which 42 and 34 underwent surgery at an HBC or ASC, respectively. The HBC cohort had greater total (P < .001) and hourly (P = .034) narcotic consumption and prolonged LOS (P < .001). Over 90% of ASC patients consumed less than or equal to the 30th percentile (32.0 mg) of oral morphine equivalents (OME), whereas over 57% of HBC patients consumed greater than 32.0 mg OME. The HBC cohort consumed greater average doses of fentanyl and oxycodone (P < .001 for each).

Conclusions

This study demonstrates that patients undergoing same-day surgery for primary 1- or 2-level ACDF received more narcotics at HBCs compared to at ASCs. The increased narcotic consumption at HBCs may have resulted in longer LOS; however, this did not impact long-term pain, complications, or clinical outcomes.

Clinical Relevance

Patients scheduled to be discharged on postoperative day 0 following ACDF at HBCs may be able to receive fewer narcotics and be discharged sooner without compromising pain control or increasing their risk for complications.

Reliability of skin impedance in subjects with chronic neck pain

BACKGROUND

Skin impedance is a biological signal that has been employed in the measurement of pain. However, there are few scientific data on skin impedance, with a great variety of assessment methods and controversial results.

OBJECTIVE

To examine the intra- and inter-rater reliability of skin impedance measurement in individuals with chronic neck pain.

METHODS

This is a blind cross-sectional study. Thirty individuals of both genders, aged between 18 and 45 years and with chronic neck pain were included in the study. Two examiners assessed skin impedance of the upper and lower limbs and torso at two intervals separated by one week. For statistical analysis, we used the intraclass correlation coefficient (ICC2,3) to determine the intra- and inter-rater reliability of skin impedance, with its respective confidence interval of 95%, standard error of measurement (SEM) and minimum detectable change (MDC).

RESULTS

The intra-rater reliability was considered substantial to excellent, with ICC values ranging between 0.843 and 0.978, SEM between 0.58 and 15.26 Ω, and MDC between 1.61 and 42.31 Ω. The inter-rater reliability was moderate to excellent, with ICC values ranging between 0.761 and 0.997, SEM ranging between 0.22 and 16.72 Ω, and MDC ranging between 0.63 and 46.35 Ω.

CONCLUSION

The measurement of skin impedance of the upper and lower limbs and torso in individuals with chronic neck pain has acceptable reliability values when considered at different times and by different examiners.

Inactive individuals with chronic neck pain have changes in range of motion and functional performance of the shoulder

OBJECTIVE

To correlate the range of movement and functional performance of the shoulder with pain measures in inactive individuals with and without neck pain. In addition, comparisons were made between the groups.

METHODS

The sample comprised two groups of inactive adults, aged 18-45 years: chronic neck pain (n = 30) and healthy subjects (n = 30). All participants had no clinical dysfunction in the shoulder joint. Aspects related to neck pain were evaluated with the Numerical Rating Scale, Neck Disability Index, and the Catastrophic Thoughts about Pain Scale. Range of motion and shoulder functionality was evaluated by means of goniometry and the Closed Kinetic Chain Upper Extremity Stability (CKCUES) test, respectively.

RESULTS

Individuals with neck pain presented reduction in CKCUES test (absolute score, mean difference [MD] = -1.50, 95% confidence interval [CI] [-2.87, -0.12]) and in abduction (MD = -7.36°, 95% CI [-13.84, -0.89]) and lateral rotation (MD = -8.61°, CI [-15.94, -1.28]) range of motion. Moreover, weak, significant, and negative association (p < 0.05, r = -0.262 to -0.384) was observed between the CKCUES test and pain intensity at rest and during active cervical movements, as well as catastrophizing. A weak, significant, and negative association (p < 0.05, r = -0.256 to -0.389) was also observed between the lateral rotation range of motion and catastrophizing, as well as pain intensity both at rest and during active movements.

CONCLUSION

The greater the neck pain intensity and catastrophizing, the lower the functional performance and lateral rotation range of motion of the shoulder.

Adoption and use of guidelines for whiplash: an audit of insurer and health professional practice in New South Wales, Australia

BACKGROUND

In Australia, the New South Wales (NSW) State Insurance Regulatory Authority has been continuously developing and implementing clinical practice guidelines to address the health and economic burden from whiplash associated disorders (WAD). Despite this, it is uncertain the extent to which the guidelines are followed. This study aimed to determine insurer and health professional compliance with recommendations of the 2014 NSW clinical practice guidelines for the management of acute WAD; and explore factors related to adherence.

METHODS

This was an observational study involving an audit of 288 randomly-selected claimant files from 4 insurance providers in NSW, Australia between March and October 2016. Data extracted included demographic, claim and injury details, use of health services, and insurer and health professional practices related to the guidelines. Analyses involved descriptive statistics and correlation analysis.

RESULTS

Median time for general practitioner medical consultation was 4 days post-injury and 25 days for physical treatment (e.g. physiotherapy). Rates of x-ray investigations were low (21.5%) and most patients (90%) were given active treatments in line with the guideline recommendations. The frequency of other practices recommended by the guidelines suggested lower guideline adherence in some areas such as; using the Quebec Task Force classification (19.9%); not using specialised imaging for WAD grades I and II (e.g. MRI, 45.8%); not using routine passive treatments (e.g. manual therapy, 94.0%); and assessing risk of non-recovery using relevant prognostic tools (e.g. Neck Disability Index, 12.8%). Over half of the claimants (59.0%) were referred to other professionals at 9-12 weeks post-injury, among which 31.2% were to psychologists and 68.8% to specialists (surgical specialists, 43.6%; WAD specialists, 20.5%). Legal representation and lodgment of full claim were associated with increased number of medical visits and imaging (ρ 0.23 to 0.3; p < 0.01).

CONCLUSION

There is evidence of positive uptake of some guideline recommendations by insurers and health professionals; however, there are practices that are not compliant and might lead to poor health outcomes and greater treatment cost. Organisational, regulatory and professional implementation strategies may be considered to change practice, improve scheme performance and ultimately improve outcomes for people with WAD.

Alleviation of pain and disability in a post-surgical C4-C7 total fusion patient after reducing a lateral head translation (side shift) posture: a CBP® case report with a 14 year follow-up

[Purpose] This case describes the long-term successful outcome in a chronic neck pain patient given Chiropractic Biophysics® treatment 14 years previously, and following surgical fusion of C4-C7 as performed 6.5 years prior to initial presentation. [Participant and Methods] The 56-year-old female had a severe right head translation (side shift) posture and surgical fusion of C4-7 with concomitant head and neck symptoms, high pain and neck disability scores, and low health-related quality of life scores. The patient was treated by Chiropractic BioPhysics methods in an attempt to restore the head and neck posture back towards vertical alignment by mirror image® (opposite posture positioning) exercises, adjustments and traction. [Results] The patient received 25 treatments over the course of 11 days due to special circumstances. Initial treatment resulted in a 50% improvement of posture, a marked improvement in health status and a near complete resolution of pain. Follow-up examinations at 7.5 years, 11.5 years, and 14 years, revealed the patient had lived a virtual pain-free life since those initial treatments. [Conclusion] This case illustrates what has previously been suggested in the literature, that lateral head translation postures can be overlooked and undiagnosed and these postures may play a significant role in the production of neck pain, headaches, and related disability.

A health behavior screening tool for non-specific neck pain in office workers: a 1-year prospective cohort study

Objective:

One effective strategy for management of musculoskeletal disorders is self-management based on the biopsychosocial model. Self-management requires patients to have adequate health literacy, defined as the individual's ability to seek, understand, and utilize health information. Recently, the neck pain-specific health behavior for office workers (NHBOW) questionnaire was developed based upon a conceptual framework of health literacy. The content in the NHBOW relates to the work and exercise behaviors of office workers. The primary aim of this study was to evaluate the predictive validity of the NHBOW.

Methods:

At baseline, 342 healthy participants filled out a series of questionnaires, including the NHBOW. The incidence of neck pain was prospectively recorded every month over a 12-month period. Sensitivity, specificity, positive predictive value, negative predictive value, and the area under the receiver operating characteristics curve (AUC) were calculated.

Results:

There were 103 (30.7%) incidents of non-specific neck pain among 335 office workers during the 12-month period, and seven participants were lost to follow-up. For the NHBOW, a cut-off score of less than or equal to 8 points (lower scores indicate poorer health behavior) had a sensitivity of 57.3% and a specificity of 96.6%. The positive and negative predictive values were 88.1% and 83.6%, respectively. The AUC was 0.769 (95% CI: 0.706 to 0.832).

Conclusion:

The NHBOW was an acceptable screening tool for predicting non-specific neck pain in office workers during the 1-year follow-up period, and can be used in occupational and primary care settings.

Do findings identified on magnetic resonance imaging predict future neck pain? A systematic review

BACKGROUND CONTEXT

Magnetic resonance imaging (MRI) has the potential to identify pathology contributing to neck pain. However, the importance of findings on MRI remains unclear.

PURPOSE

We aimed to investigate whether findings on cervical spine MRI predict future neck pain.

STUDY DESIGN

A systematic review was carried out.

PATIENT SAMPLE

People with or without neck pain comprised the study sample.

OUTCOME MEASURES

Clinically important neck pain outcomes such as pain and disability.

METHODS

The review protocol was registered on PROSPERO [CRD42016049228]. MEDLINE, CINAHL, and EMBASE databases were searched. Prospective cohort studies investigating the association between baseline MRI findings and clinical outcome were included. Cohorts with serious underlying diseases as the cause of their neck pain were excluded. Associations between MRI findings and neck pain outcomes were extracted from the included studies.

RESULTS

A total of 12 studies met all inclusion criteria. Eight studies presented data on participants with current neck pain, two studies included a mixed sample, and two studies included a sample of participants with no current neck pain. Because of the heterogeneity between the studies in terms of MRI findings, populations, and clinical outcomes investigated, it was not possible to pool the results. No consistent associations between MRI findings and future outcomes were identified. Single studies of populations with neck pain reported significant associations for neck muscle fatty infiltrate (risk ratio [RR]: 21.00, 95% confidence interval [CI]: 2.97-148.31) with persistent neck disability; disc protrusion (mean difference ranged from -1.83 to -2.88 on a 10-point pain scale), and disc degeneration (RR: 0.59; 95% CI: 0.36-0.98) with neck pain. In a population without pain, the development of foraminal stenosis over a 10-year period was associated with development of neck pain (RR: 2.99; 95% CI: 1.23-7.23).

CONCLUSION

The limited number, heterogeneity, and small sample size of the included studies do not permit definitive conclusions on the association between MRI findings of the cervical spine with future neck pain.

Analysis of peak plantar pressure and center of pressure oscillation in individuals with chronic neck pain: A cross-sectional study

BACKGROUND

Baropodometric evaluation has been used in research and clinical environments by professionals who are working on the physical rehabilitation of patients. However, to date, there is no published data on the use of baropodometry in patients with chronic neck pain.

OBJECTIVE

To analyze peak plantar pressure and center of pressure oscillation in individuals with chronic neck pain compared to a control group.

METHODS

This was a blind cross-sectional study. It included 44 participants of both genders, between 18 and 45 years old, distributed into a chronic neck pain group (n= 22) and a control group (n= 22). Participants were assessed by means of baropodometry, the Numeric Rating Scale, the Neck Disability Index, and the Pain-Related Self Statement Scale. The Mann-Whitney test was used for comparison of baropodometric variables between the two groups, and the Spearman correlation coefficient was used to check possible associations between the variables.

RESULTS

No significant differences (p> 0.05) in peak plantar pressure or center of pressure oscillation were detected in the comparisons between the chronic neck pain and control groups. In addition, no significant correlation was observed (p> 0.05) between baropodometric variables and neck pain.

CONCLUSION

Individuals with chronic neck pain with mild disability did not differ from a control group in terms of peak plantar pressure or center of pressure oscillation.

Long-term effect of direction-movement control training on female patients with chronic neck pain

BACKGROUND

Treatment of movement faults in the neck is known as an important factor in treatment of chronic neck pain. Along with the identification of site and direction of the faults, direction-movement control intervention retrains the control of the movement faults.

PURPOSE

This study was designed to investigate long-term effects of a direction-movement control training on pain, disability, head repositioning accuracy, function, cervical flexor endurance, and range of motion in female patients with chronic nonspecific neck pain.

MATERIAL AND METHODS

Thirty women (36.5 ± 5.7 years) with chronic nonspecific neck pain were randomly allocated into two groups, i.e., an experimental group (n = 15) and a control group (n = 15). The experimental group performed the direction-movement control training for 30 min/day, three days per week for six months. All subjects were evaluated using the visual analog scale (VAS), range of motion (TOM), progressive iso-inertial lifting evaluation (PILE), neck disability Index (NDI), helmet attached with laser pointer using for head repositioning accuracy (HRA), and Trott's test (deep neck flexor endurance), in pre- and six-months post-treatment intervention.

RESULTS

Significant differences were observed for the pain, neck disability Index, function endurance, head repositioning accuracy, range of motion, and cervical flexor endurance in the experimental group compared to that of control group.

CONCLUSION

Direction-movement control training is likely to be an effective training program to enhance body functionality through improvement of pain, function, endurance, head repositioning accuracy, range of motion, and cervical flexor endurance. Due to the high reported effect size for direction-movement control exercises, the application of the training is suggested as a supplementary method to improve chronic nonspecific neck pain in females.

Clinical effectiveness of a Pilates treatment for forward head posture

[Purpose] This study compared the effects of pilates and an exercise program on the craniovertebral angle, cervical range of motion, pain, and muscle fatigue in subjects with a forward head posture (FHP). [Subjects and Methods] A total of 28 sedentary females (age 20 to 39 years) with FHP were randomly assigned to pilates (n=14) and combined (n=14) exercise groups. The study was a randomized, controlled, double-blind study with the two groups performing exercise 50 min/day, 3 days/week, with an intensity of 11–15 rating of perceived exertion (RPE) for ten weeks. The main outcome measures were craniovertebral angle, cervical range of motion (ROM), pain levels assessed by visual analog scale (VAS), and neck disability index (NDI). Surface electromyography was also used to measure muscle fatigue. [Results] There were significant increases in craniovertebral angle and cervical ROM in the pilates group, but none in the control group. The only significant differences in muscle activity were recorded in the sternocleidomastoid muscle in the pilates group. Both exercise programs had positive effects on pain measures, as VAS and NDI were significantly decreased. [Conclusion] The results suggest that pilates could be recommended as an appropriate exercise for treatment of FHP in sedentary individuals.

A value proposition for early physical therapist management of neck pain: a retrospective cohort analysis

BACKGROUND

Neck pain is one of the most common reasons for entry into the healthcare system. Recent increases in healthcare utilization and medical costs have not correlated with improvements in health. Therefore there is a need to identify management strategies for neck pain that are effective for the patient, cost efficient for the payer and provided at the optimal time during an episode of neck pain.

METHODS

One thousand five hundred thirty-one patients who underwent physical therapist management with a primary complaint of non-specific neck pain from January 1, 2008 to December 31, 2012 were identified from the Rehabilitation Outcomes Management System (ROMS) database at Intermountain Healthcare. Patients reporting duration of symptoms less than 4 weeks were designated as undergoing "early" management and patients with duration of symptoms greater than 4 weeks were designated as receiving "delayed" management. These groups were compared using binary logistic regression to examine odds of achieving Minimal Clinically Important Difference (MCID) on the Neck Disability Index (NDI) and Numerical Pain Rating Scale (NPRS). Separate generalized linear modeling examined the effect of timing of physical therapist management on the metrics of value and efficiency.

RESULTS

Patients who received early physical therapist management had increased odds of achieving MCID on the NDI (aOR = 2.01, 95 % CI 1.57, 2.56) and MCID on the NPRS (aOR = 1.82, 95 % CI 1.42, 2.38), when compared to patients receiving delayed management. Patients who received early management demonstrated the greatest value in decreasing disability with a 2.27 percentage point change in NDI score per 100 dollars, best value in decreasing pain with a 0.38 point change on the NPRS per 100 dollars. Finally, patients receiving early management were managed more efficiently with a 3.44 percentage point change in NDI score per visit and 0.57 point change in NPRS score per visit.

CONCLUSIONS

These findings suggest that healthcare systems that provide pathways for patients to receive early physical therapist management of neck pain may realize improved patient outcomes, greater value and higher efficiency in decreasing disability and pain compared to delayed management. Further research is needed to confirm this assertion.

Predictors for persistent neck/shoulder pain, medical care-seeking due to neck/shoulder pain and sickness absence

Objective: To determine whether symptoms and clinical signs can predict persistent neck/shoulder pain, future medical care-seeking and sickness absence.

Design: A population-based cohort was followed prospectively over a 5—6 year period.

Setting: Subjects from the district of Norrtälje (Sweden).

Subjects: Subjects with self-rated neck/shoulder pain were included ( n = 1471).

Main measures: Cox regression analyses were used to test the predictive value of single and combinations of symptoms and clinical signs obtained with questionnaires and simple tests concerning persistent neck/shoulder pain, future medical care-seeking and sickness absence.

Results: Several symptoms and clinical signs were associated with the outcomes of interest: the relative risk (RR) for persistent neck/shoulder pain was 1.38 (95% confidence interval (CI) 1.14—1.52) for subjects with pain for over three months at baseline and concerning future medical care-seeking RR was 2.10 (95% CI 1.73—2.54) for subjects who had previously sought medical care. An episode of sickness absence during the year of enrolment increased the risk for future sickness absence (RR = 2.42, 95% CI 1.95—3.00). Having five or seven concurrent symptoms and clinical signs was common and more strongly associated with persistent pain (RR = 1.77, 95% CI 1.39 — 2.27) and future medical care-seeking (RR = 4.51, 95% CI 2.54—9.94), respectively, but not concerning sickness absence.

Conclusion: By simply counting the number of concurrent symptoms and clinical signs, it is possible to predict persistent neck/shoulder pain and future medical care-seeking, but not sickness absence.

Association between psychosocial, organizational and personal factors and prevalence of musculoskeletal disorders in office workers

The purpose of this study was to investigate the relationship between organizational and personal (individual) factors with the prevalence of musculoskeletal disorders (MSDs) in office workers of the Iranian Gas Transmission Company. The participants rated two questionnaires - the standardized Nordic Musculoskeletal Questionnaire to measure the prevalence of MSDs, and the Veterans Healthcare Administration All Employee Survey questionnaire (2004 version) - to measure psychosocial, organizational and individual aspects of job satisfaction and workplace climate. The highest prevalence of MSDs was found in the lower back (49.7%) and neck (49.0%) regions. Results of the logistic regression models showed that some psychosocial and organizational factors and also some individual factors were associated with prevalence of MSDs (p < 0.05).These findings illustrate the need to consider all elements of the work system as a whole in future studies and in organizational planning.

Alexander Technique Lessons or Acupuncture Sessions for Persons With Chronic Neck Pain: A Randomized Trial

BACKGROUND

Management of chronic neck pain may benefit from additional active self-care-oriented approaches.

OBJECTIVE

To evaluate clinical effectiveness of Alexander Technique lessons or acupuncture versus usual care for persons with chronic, nonspecific neck pain.

DESIGN

Three-group randomized, controlled trial. (Current Controlled Trials: ISRCTN15186354).

SETTING

U.K. primary care.

PARTICIPANTS

Persons with neck pain lasting at least 3 months, a score of at least 28% on the Northwick Park Questionnaire (NPQ) for neck pain and associated disability, and no serious underlying pathology.

INTERVENTION

12 acupuncture sessions or 20 one-to-one Alexander lessons (both 600 minutes total) plus usual care versus usual care alone.

MEASUREMENTS

NPQ score (primary outcome) at 0, 3, 6, and 12 months (primary end point) and Chronic Pain Self-Efficacy Scale score, quality of life, and adverse events (secondary outcomes).

RESULTS

517 patients were recruited, and the median duration of neck pain was 6 years. Mean attendance was 10 acupuncture sessions and 14 Alexander lessons. Between-group reductions in NPQ score at 12 months versus usual care were 3.92 percentage points for acupuncture (95% CI, 0.97 to 6.87 percentage points) (P = 0.009) and 3.79 percentage points for Alexander lessons (CI, 0.91 to 6.66 percentage points) (P = 0.010). The 12-month reductions in NPQ score from baseline were 32% for acupuncture and 31% for Alexander lessons. Participant self-efficacy improved for both interventions versus usual care at 6 months (P < 0.001) and was significantly associated (P < 0.001) with 12-month NPQ score reductions (acupuncture, 3.34 percentage points [CI, 2.31 to 4.38 percentage points]; Alexander lessons, 3.33 percentage points [CI, 2.22 to 4.44 percentage points]). No reported serious adverse events were considered probably or definitely related to either intervention.

LIMITATION

Practitioners belonged to the 2 main U.K.-based professional associations, which may limit generalizability of the findings.

CONCLUSION

Acupuncture sessions and Alexander Technique lessons both led to significant reductions in neck pain and associated disability compared with usual care at 12 months. Enhanced self-efficacy may partially explain why longer-term benefits were sustained.

PRIMARY FUNDING SOURCE

Arthritis Research UK.

The effect of a knowledge-based ergonomic intervention amongst administrators at Aga Khan University Hospital, Nairobi

BACKGROUND

Low back pain (LBP) and neck pain are part of the common work-related musculoskeletal disorders with a large impact on the affected person. Despite having a multifactorial aetiology, ergonomic factors play a major role thus necessitating workers' education.

OBJECTIVE

To determine the prevalence of ergonomic-related LBP and neck pain, and describe the effect of a knowledge-based ergonomic intervention amongst administrators in Aga Khan University Hospital, Nairobi.

METHODS

This study applied a mixed method design utilizing a survey and two focus group discussions (FGD). A self-administered questionnaire was distributed to 208 participants through systematic sampling. A one hour knowledge-based ergonomic session founded on the survey results was thereafter administered to interested participants, followed by two FGDs a month later with purposive selection of eight participants to explore their experience of the ergonomic intervention. Quantitative data was captured and analyzed using SPSS by means of descriptive and inferential statistics, whereas thematic content analysis was used for qualitative data.

RESULTS

Most participants were knowledgeable about ergonomic-related LBP and neck pain with a twelve month prevalence of 75.5% and 67.8% respectively.

CONCLUSION

Continual ergonomic education is necessary for adherence to health-related behaviours that will preventwork-related LBP and neck pain.

Description of Common Clinical Presentations and Associated Short-Term Physical Therapy Clinical Outcomes in Patients With Neck Pain

OBJECTIVE

To determine the effect of clinical presentations of neck pain on short-term physical therapy outcomes.

DESIGN

Retrospective analysis of pair-matched groups from a clinical cohort.

SETTING

Thirteen outpatient physical therapy clinics in 1 health care system.

PARTICIPANTS

Patients (N=1069) grouped by common clinical presentations of neck pain: nonspecific neck pain (NSNP) with duration <4 weeks; NSNP with duration >4 weeks; neck pain with arm pain; neck pain with headache; and neck pain from whiplash.

INTERVENTION

Conservative interventions provided by physical therapists.

MAIN OUTCOME MEASURES

Neck Disability Index (NDI) and numerical pain rating scale (NPRS) recorded at the initial and last visits. The main outcome of interest was achieving recovery status on the NDI. Changes in NDI and NPRS were compared between clinical presentation groups.

RESULTS

Compared with patients presenting with NSNP >4 weeks, patients with NSNP <4 weeks had increased odds of achieving recovery status on the NDI (P<.0001) and demonstrated the greatest changes in clinical outcomes of pain (P≤.0001) and disability (P≤.0001). Patients with neck pain and arm pain demonstrated an increased odds of achieving recovery status on the NDI (P=.04) compared with patients presenting with NSNP >4 weeks.

CONCLUSIONS

Treating patients with NSNP within <4 weeks of onset of symptoms may lead to improved clinical outcomes from physical therapy compared with other common clinical presentations.

Cardiovascular responses to an acute psychological stressor are associated with the cortisol awakening response in individuals with chronic neck pain

INTRODUCTION

Dysregulation of the hypothalamic-pituitary-adrenal axis (HPA-axis) is common in individuals who experience chronic psychological stress, as well as individuals with chronic pain. Changes in cortisol availability in the presence of a chronic stressor such as pain may influence the sympathetic-adrenal-medullary (SAM) system, which contributes to cardiovascular responses to stress and also exhibits altered responsiveness in the presence of pain. The purpose of this study was to investigate the relationship between HPA activity during the cortisol awakening response and cardiovascular reactivity during exposure to an acute psychological stressor in individuals with chronic neck pain.

METHODS

Area under the curve (AUC) of the salivary cortisol awakening response was assessed in 41 individuals with chronic neck pain aged 19-80 years (22 men, 23 women). Slopes representing the change in mean arterial pressure and heart rate during a baseline quiet sitting condition, a low stress condition with mental concentration, and a high stress condition combining mental concentration with social evaluative threat were calculated for each individual as an index of cardiovascular responsiveness to the acute stressor. Cardiovascular responses were regressed on cortisol awakening AUC and pain duration, adjusting for age and sex.

RESULTS

Greater mean arterial pressure (β = -0.33, p = 0.02) and heart rate responses (β = -0.41, p = 0.007) to the acute psychological stressor were associated with lower cortisol awakening responses after adjusting for age and sex. Individuals with a shorter duration of chronic pain also demonstrated a larger increase in mean arterial pressure during the laboratory stressor (β = -0.39, p = 0.01), but there was no relationship between pain duration and changes in heart rate (p = 0.25).

CONCLUSIONS

Individuals with a shorter duration of chronic neck pain who demonstrate heightened cardiovascular responsiveness to an acute psychological stressor also exhibit lower cortisol awakening response. These results are consistent with time-dependent adaptations across the two major stress systems in the presence of chronic pain.

Influence of altered visual feedback on neck movement for a virtual reality rehabilitative system

This paper investigates altering visual feedback during neck movement through control-display (C-D) gain for a head-mounted display, for the purpose of determining the just noticeable difference (JND) for encouraging individuals with kinesiophobia (i.e. fear avoidance of movement due to chronic pain) to effectively perform therapeutic neck exercises. The JND was defined as .25 probability of detecting a difference from unity C-D gain (gain=1). A target-aiming task with two consecutive neck moves per trial was presented; one neck move had varying C-D gain and the other had unity gain. The VR system was able to influence neck moves without changing locations of the target. Participants indicated whether the two neck movements were the same or different. Logistic regression revealed that the JND gains were 0.903 (lower bound) and 1.159 (upper bound) as the participants could not discriminate a 55° turn, ranging from 49.7° to 63.7°. This preliminary study shows that immersive VR with altered visual feedback influenced movement. The feasibility for rehabilitation of individuals with kinesiophobia will next be assessed.

The effect of pressure pain sensitivity and patient factors on self-reported pain-disability in patients with chronic neck pain

The study was conducted to estimate the extent to which pressure pain sensitivity (PPS) and patient factors predict pain-related disability in patients with neck pain (NP), and to determine if PPS differs by gender. Forty-four participants with a moderate level of chronic NP were recruited for this cross sectional study. All participants were asked to complete self-reported assessments of pain, disability and comorbidity and then underwent PPS testing at 4-selected body locations. Pearson`s r w was computed to explore relationships between the PPS measures and the self-reported assessments. Regression models were built to identify predictors of pain and disability. An independent sample t-test was done to identify gender-related differences in PPS, pain-disability and comorbidity. In this study, greater PPS (threshold and tolerance) was significantly correlated to lower pain-disability (r = -.30 to -.53, p≤0.05). Age was not correlated with pain or disability but comorbidity was (r= 0.42-.43, p≤0.01). PPS at the 4-selected body locations was able to explain neck disability (R²=25-28%). Comorbidity was the strongest predictor of neck disability (R² =30%) and pain (R²=25%). Significant mean differences for gender were found in PPS, disability and comorbidity, but not in pain intensity or rating. This study suggests that PPS may play a role in outcome measures of pain and disability but between-subject comparisons should consider gender and comorbidity issues.

The current perception threshold test differentiates categories of mechanical neck disorder

STUDY DESIGN

Cross-sectional discriminative analysis.

OBJECTIVE

To determine whether current perception threshold (CPT) can differentiate between categories of patients with mechanical neck disorders (MNDs).

BACKGROUND

Neck pain is the third most common musculoskeletal disorder and affects a third of all adults each year. It can present as neck pain without musculoskeletal signs, neck pain with musculoskeletal signs but no neurological signs, or neck pain with neurological signs. CPT testing can assess altered sensory perception that may reflect neurological changes.

METHODS

Patients with MNDs (n = 106) were classified into 3 groups, based on a standardized musculoskeletal examination process performed by an experienced physiotherapist who was blinded to CPT scores. The 3 groups were defined as neck pain without musculoskeletal signs (MND I) (n = 60), neck pain with musculoskeletal signs (MND II) (n = 29), and neck pain with neurological signs (MND III) (n = 17). A rapid protocol of CPT testing was performed at 3 frequencies (5, 250, and 2000 Hz), using 3 dermatomal locations on the hand. A 1-way analysis of variance with post hoc comparison and effect sizes was calculated to compare the mean CPT scores between the groups. A binary logistic-regression model was used to predict probability of higher CPT in MND III and to create a receiver-operating-characteristic curve.

RESULTS

Mean CPT differed significantly across the 3 MND groups (MND I, 9.7; MND II, 10.6; and MND III, 11.8; P<.001; η(2) = 0.6). Post hoc comparisons indicated differences between MND I and MND II (P = .05) and between MND II and MND III (P = .01) that had large effect sizes (MND I versus II, d = 1 and MND II versus III, d = 2.2). CPT testing was able to distinguish between MND II and III when a threshold value of greater than 11 was used to indicate MND III. The predicted probability of abnormal CPT in MND III had an estimated 73% sensitivity and 81% specificity; the odds ratio was 11.5 (P = .001) for the differentiation capacity of CPT between MND II and III, with a cutoff of 11. The area under the receiver-operating-characteristic curve was 0.84 (95% confidence interval: 0.72, 0.96; P<.001).

CONCLUSION

CPT testing has moderate discriminatory accuracy, specificity, and sensitivity for classification of MND categories into neck pain with or without neurological signs. J Orthop Sports Phys Ther 2014;44(7):532-540. Epub 10 May 2014. doi:10.2519/jospt.2014.4691.