The reliability of the cervical relocation test on people with and without a history of neck pain

Measurement properties of cervical joint position error in people with and without neck pain: a systematic review and narrative synthesis

INTRODUCTION

Proprioception can be impaired in people with neck pain. The cervical joint position sense test, which measures joint position error (JPE), is the most common test used to assess neck proprioception. The aim of this systematic review was to assess the measurement properties of this test for the assessment of people with and without neck pain.

METHODS

This systematic review was registered prospectively on Prospero (CRD42020188715). It was designed using the COSMIN guidelines and reported in line with the PRISMA checklist. Two reviewers independently searched Medline, Embase, SportDiscus, and CINAHL Plus databases from inception to the 24th July 2022 with an update of the search conducted until 14th of October 2023. The COSMIN risk of bias checklist was used to assess the risk of bias in each study. The updated criteria for good measurement properties were used to rate individual studies and then the overall pooled results. The level of evidence was rated by two reviewers independently using a modified GRADE approach.

RESULTS

Fifteen studies were included in this review, 13 reporting absolute JPE and 2 reporting constant JPE. The measurement properties assessed were reliability, measurement error, and validity. The measurement of JPE showed sufficient reliability and validity, however, the level of evidence was low/very low for both measurement properties, apart from convergent validity of the constant JPE, which was high.

CONCLUSION

The measure of cervical JPE showed sufficient reliability and validity but with low/very low levels of evidence. Further studies are required to investigate the reliability and validity of this test as well as the responsiveness of the measure.

Concurrent validity and reliability of a smartphone-based application for the head repositioning and cervical range of motion

Objectives

To evaluate the validity and reliability of a smartphone-based application against inertial sensors to measure head repositioning (by using joint position sense –JPS) and cervical range of motion (ROM).

Methods

JPS and cervical ROM were evaluated for neck flexion, extension and both-sides lateral flexion in thirty-one volunteers. Participants were simultaneously evaluated with inertial sensors and the smartphone application. A total of 248 angles were compared for concurrent validity. Inter-tester and intra-tester reliability were evaluated through scoring of images with the smartphone application by two testers, and re-scoring images by the same tester.

Results

Very high correlation was observed between both methods for ROM in all neck movements and JPS in left-side lateral flexion (r>0.9), and high for JPS in the rest of movements (r>0.8). Bland-Altman plots always demonstrated absolute agreement. Inter-and intra-tester reliability was perfect for JPS and ROM in all the neck movements (ICC>0.81).

Conclusions

This smartphone-based application is valid and reliable for evaluating head repositioning and cervical ROM compared with inertial sensors in healthy and young adults. Health professionals could use it in an easier and portable way in field conditions.

Prevalence of Static Balance Impairment and Associated Factors of University Student Smartphone Users with Subclinical Neck Pain: Cross-Sectional Study

The aim of this study was to assess the prevalence of static balance impairment in university student smartphone users with subclinical neck pain and identify the associated risk factors. Because of rapid and widespread smartphones use, and the subsequent effect on neck pain in university students, it is essential to determine the prevalence of balance impairment and associated factors in this population. Simple random sampling was completed among eighty-one participants in this cross-sectional study. A self-reported questionnaire, fitted precisely for smartphone users, was used prior to clinical assessment by the Balance Error Scoring System. Both simple and multiple logistic regressions were used to analyze the prevalence of static balance impairment and associated factors. The prevalence of static balance impairment in university student smartphone users with subclinical neck pain was 74.07% (95% CI: 64.32 to 83.82). The significant risk factors were "daily smartphone use ≥ 4 h'' (AOR: 19.24 (95% CI 4.72 to 78.48) p = 0.000), "≥4 years of smartphone use" (AOR: 5.01 (95% CI 1.12 to 22.38) p = 0.035), and "≥7 neck disability index score'' (AOR: 12.91 (95% CI 2.24 to 74.45) p = 0.004). There was a high prevalence of static balance impairment in university smartphone users with subclinical neck pain. University student smartphone users with subclinical neck pain who met at least one of the risk factors should realize their static balance impairment.

Reliability of Cervicocephalic Proprioception Assessment: A Systematic Review

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Effects of Proprioceptive and Craniocervical Flexor Training on Static Balance in University Student Smartphone Users with Balance Impairment: A Randomized Controlled Trial

Purpose

University student smartphone users adopt flexed neck postures during smartphone use, creating an increased compressive load on their neck structures. This study was conducted to compare the effects of proprioceptive and craniocervical flexor training with a control group on static balance in a group of university student smartphone users with balance impairment.

Methods

A double-blinded, randomized controlled trial was conducted involving 42 university students (19.67±1.68 years old) with balance impairment. Participants were randomized into a proprioceptive training (ProT) group (n=14), a craniocervical flexor training (CCFT) group (n=14), and a control group (CG; n=14) for a 6-week intervention. The balance error scoring system (BESS), cervical joint position sense (CJPS), craniocervical flexion (CCF) test, and visual analog scale (VAS) for neck pain were evaluated using univariate analysis of covariance (ANCOVA).

Results

After 6 weeks of intervention, the ProT group showed significantly greater improvement of CJPS than the CG (p=0.000) and the CCFT group significantly improved of CCF test than CG (p=0.002). Findings, at 4 weeks after intervention, were (i) the ProT group had significantly more improvement in BESS than the CCFT group (p=0.014) and CG (p=0.003), (ii) the ProT group had significantly more improvement of CJPS than the CG (right and left rotate) (p=0.001, p=0.016, respectively) and CCFT group (right rotate) (p=0.004), (iii) the CCFT group had significantly more improvement of craniocervical flexor strength than CG (p=0.004), and (iv) the ProT group and CCFT group had significantly more decreased pain than CG (p=0.015, p=0.033, respectively). No adverse effects occurred during or after training in any group.

Conclusion

ProT is important for regaining static balance and CJPS, while CCFT improved craniocervical flexor strength. Moreover, both ProT and CCFT can reduce neck pain. We recommend performing ProT to improve static balance, CJPS and to reduce neck pain in smartphone users with static balance impairment.

Clinical Trail Registration Number

TCTR20190909003.

Medial Branch Blocks for Diagnosis of Facet Joint Pain Etiology and Use in Chronic Pain Litigation

A commonly disputed medicolegal issue is the documentation of the location, degree, and anatomical source of an injured plaintiff’s ongoing pain, particularly when the painful region is in or near the spine, and when the symptoms have arisen as result of a relatively low speed traffic crash. The purpose of our paper is to provide health and legal practitioners with strategies to identify the source of cervical pain and to aid triers of fact (decision makers) in reaching better informed conclusions. We review the medical evidence for the applications and reliability of cervical medial branch nerve blocks as an indication of painful spinal facets. We also present legal precedents for the legal admissibility of the results of such diagnostic testing as evidence of chronic spine pain after a traffic crash. Part of the reason for the dispute is the subjective nature of pain, and the fact that medical documentation of pain complaints relies primarily on the history given by the patient. A condition that can be documented objectively is chronic cervical spine facet joint pain, as demonstrated by medial branch block (injection). The diagnostic accuracy of medial branch blocks has been extensively described in the scientific medical literature, and evidence of facet blocks to objectively document chronic post-traumatic neck pain has been accepted as scientifically reliable in courts and tribunals in the USA, Canada and the United Kingdom. We conclude that there is convincing scientific medical evidence that the results of cervical facet blocks provide reliable objective evidence of chronic post-traumatic spine pain, suitable for presentation to an adjudicative decision maker.