Patient-reported outcome measures for non-specific neck pain validated in the Italian-language: a systematic review

The effectiveness of cognitive behavioural therapy in chronic neck pain: A systematic review with meta-analysis

We evaluated the effects of Cognitive Behavioural Therapy (CBT) alone or with additional interventions on pain, disability, kinesiophobia, anxiety, stress, depression, quality of life, and catastrophizing of patients with chronic neck pain (CNP). Nineteen studies met the inclusion criteria, and fourteen studies were quantitatively analysed. Risk of bias was assessed using the PEDro scale and the certainty of evidence using the GRADE approach. Studies were pooled (where applicable) and subgroup analyses were performed for CNP, or whiplash associated disorders. Studies compared-directly or indirectly-CBT interventions to no treatment, conservative interventions such as exercise and/or physiotherapy, or multimodal interventions. We present effect estimates at 8-week, 12-week, 6-month, and 1-year follow-up. Low certainty evidence suggests a clinically significant pain reduction (short-term) favouring CBT with or without additional intervention compared to no intervention SMD = -0.73; 95%CI: -1.23 to -0.23). Very low and low certainty evidence suggest clinically significant improvements in kinesiophobia (very short-term SMD = -0.83; 95%CI: -1.28 to -0.39 and short-term SMD = -1.30, 95%CI: -1.60 to -0.99), depression SMD = -0.74, 95%CI: -1.35 to -0.14) and anxiety SMD = -0.76, 95%CI: -1.34 to -0.18) favouring a multimodal intervention with CBT (short-term) compared to other conservative interventions. Combining different types of CBT interventions resulted in potentially heterogeneous comparisons.

Are Patient-Reported Outcome Measures for Distal Radius Fractures Validated for Spanish and Culture? A Systematic Review

PURPOSE

Patient-reported outcome measures (PROMs) are used commonly to assess function to direct treatment and evaluate outcomes for patients with distal radius fractures. Most PROMs have been developed and validated in English with minimal report of the demographics of patients studied. The validity of applying these PROMs among Spanish-speaking patients is unknown. The purpose of this study was to evaluate the quality and psychometric properties of Spanish-language adaptations of PROMs for distal radius fractures.

METHODS

We conducted a systematic review to identify published studies of adaptations of Spanish-language PROMs evaluating patients with distal radius fractures. We evaluated the methodologic quality of the adaptation and validation using Guidelines for the Process of Cross-Cultural Adaptation of Self-Report Measures, Quality Criteria for Psychometric Properties of Health Status Questionnaire, and the Consensus-based Standards for the Selection of Health Measurement Instruments Checklist for Cross-Cultural Validity. The level of evidence was evaluated based upon prior methodology.

RESULTS

Five instruments reported in eight studies were included: the Patient-Rated Wrist Evaluation (PRWE), Disability of Arm Shoulder and Hand, Upper Limb Functional Index, Lawton Instrumental Activities of Daily Living Scale, and Short Musculoskeletal Function Assessment. The PRWE was the most frequently included PROM. No study followed all six processes for adaptation or assessed all measurement properties. No study demonstrated the completion of more than eight of the 14 aspects of cross-cultural validity. The PRWE had moderate evidence to support half of the domains of measurement properties evaluating the level of evidence.

CONCLUSIONS

None of the five instruments identified received a good rating on all three checklists. Only the PWRE demonstrated moderate evidence on half of the measurement domains.

CLINICAL RELEVANCE

Given the lack of strong evidence to support the quality of these instruments, we recommend adaptation and testing of PROMs for this population before use. Currently, PROMs in Spanish-speaking patients should be used with caution so as not to perpetuate health care disparities.

Effects of dry needling on pain, disability, kinesiophobia, pain catastrophizing and psychological distress in patients with chronic neck pain: A randomized controlled pilot study

BACKGROUND

Myofascial trigger points (MTrPs) in neck muscles seem to be related to the main symptoms of patients with chronic neck pain.

OBJECTIVE

The objective was to investigate the effects of dry needling (DN) on pain, disability, kinesiophobia, pain catastrophizing and psychological distress in patients with chronic neck pain.

METHODS

A double blind randomized controlled pilot trial was designed. Twenty-one patients with chronic neck pain were randomly allocated to the DN group (n= 7), Sham-DN group (n= 7) or Control group (n= 7). All groups received a Transcutaneous Electrical Nerve Stimulation and Therapeutic Ultrasound (TENS/US) protocol with patient education. The DN and Sham-DN groups received two sessions of DN and sham DN, respectively. The primary outcome was pain intensity. Secondary outcomes were disability, kinesiophobia, pain catastrophizing, psychological distress, self-reported improvement and success of blinding.

RESULTS

The DN group showed a greater decrease in pain intensity, disability and pain catastrophizing compared to the Sham-DN group (p< 0.05) and the Control group (p< 0.05). The DN group showed the highest self-reported improvement.

CONCLUSION

Adding two sessions of DN in active MTrPs in upper trapezius, levator scapulae and sternocleidomastoid muscles to a TENS/US protocol with patient education decreased pain intensity, disability and pain catastrophizing in patients with chronic neck pain.

Validation of the Nepali versions of the Neck Disability Index and the Numerical Rating Scale for Neck Pain

STUDY DESIGN

A cross-sectional study with a test-retest design.

OBJECTIVE

To translate and culturally adapt the numerical rating scale (NRS) for neck pain intensity and the Neck Disability Index (NDI), and asses their measurement properties in a Nepalese neck pain population.

SUMMARY OF BACKGROUND DATA

Neck pain is one of the most common musculoskeletal disorders in Nepal. Research on neck pain disorders has been hampered by lack of standardized patient-reported outcome measures (PROMs) in Nepali language. Therefore, we aimed at validating a Nepali version of the NDI and NRS neck pain.

METHODS

At Dhulikhel hospital in Nepal, 150 patients with neck pain and/or cervical radiculopathy completed the translated self-administered questionnaires. We had made one cultural adaption of the NDI driving item in the final Nepali version. Relative reliability was analyzed with intraclass correlation coefficient (ICC 2.1) and absolute reliability with the smallest detectable change (SDC). Internal consistency was assessed by Cronbach alpha. Construct and discriminative validity was assessed by Spearman correlation for a priori hypotheses, receiver-operating characteristics curves, and analysis of variance. Time spent and assistance needed to complete the questionnaires were used to assess feasibility.

RESULTS

Test-restest reliability was excellent with ICC (95% confidence intervals) of 0.87 (0.66, 0.94) for NDI and 0.97 (0.94, 0.99) for NRS neck pain. The absolute reliability was acceptable (a SDC of 1.6 for NRS and 9.3 for NDI) and a Cronbach alpha (internal consistency) of 0.70 for NDI, as well as acceptable construct validity, discriminative validity, and feasibility.

CONCLUSION

The Nepali versions of the NRS neck pain and NDI can be recommended for assessing pain and disability among patients with neck pain and cervical radiculopathy, but their responsiveness to change remains to be tested.Level of Evidence: 2.

Cross-cultural adaptation and validation of the Dutch language version of the Pictorial Fear of Activity Scale - Cervical

Background

The Pictorial Fear of Activity Scale-Cervical (PFActS-C) is a reliable and valid instrument to assess fear of movement in people with whiplash associated disorders. It is not available in Dutch and has not been evaluated in other neck pain populations. This study aimed to systematically translate the PFActS-C into Dutch and evaluate the psychometric properties of this Dutch Language Version (DLV) in people with non-specific neck pain.

Methods

The PFActS-C was translated according to international guidelines. Internal consistency, test-retest reliability, floor and ceiling effects, face validity and construct validity (convergent and discriminant validity by hypotheses testing and structural validity by confirmatory and exploratory factor-analyses) of the PFActS-C-DLV were tested in 125 people with non-specific neck pain.

Results

The PFActS-C-DLV showed good to excellent internal consistency (Cronbach’s alpha: 0.98) and stability over time (ICC: 0.90 [95%CI: 0.82–0.93). Four out of five a priori formulated hypotheses regarding related (convergent validity) and unrelated (discriminant validity) constructs were confirmed. However, the confirmatory factor analysis could not confirm the expected 1-factor solution. Furthermore, the exploratory factor analyses revealed that also a higher factor solution would not lead to a good fit of the model.

Conclusions

The PFActS-C-DLV is a reliable region-specific instrument for people with non-specific neck pain. The construct validity was supported, based on hypotheses testing. However, factor analyses could not confirm a 1-factor solution, so the underlying construct of the PFActS-C-DLV remains unclear. Given the PFActS-C’s photographic format, we believe these findings also have relevance for the original English version.

Supplementary information

Supplementary information accompanies this paper at 10.1186/s12891-020-03724-1.

Rasch analysis of the Neck Bournemouth Questionnaire: Turkish version, validity, and reliability study

Background/aim

The multidimensional evaluation of patients with chronic neck pain is important for planning the treatment program. The aim of this study was to investigate the validity and reliability of the Turkish version of the Neck Bournemouth Questionnaire (NBQ).

Materials and methods

The internal construct validity of the NBQ was examined by the fit of the data to the Rasch measurement model. External validity of the NBQ was evaluated by testing for expected associations of Rasch transformed NBQ score with the corresponding variables through the process of convergent validity. The reliability of the NBQ in terms of both internal consistency and test-retest reliability was assessed by the person separation index (PSI) and differential item functioning (DIF) by time effect.

Results

It was determined that the questionnaire has 2 factors. None of the items of Factor 1 (F1) and Factor 2 (F2) showed DIF. The reliability of F1 (Cronbach’s alpha = 0.89, PSI = 0.87) and F2 (Cronbach’s alpha = 0.77, PSI = 0.87) was good with Cronbach’s alpha and PSI. There was a good correlation between NBQ/F1 and the Neck Disability Index (NDI) (r = 0.673) and Neck Pain and Disability Scale (NPDS) (r = 0.709). Also, there was a correlation between NBQ/F2 and the Beck Depression Inventory (BDI) (r = 0.552) and Beck Anxiety Inventory (BAI) (r = 0.410).

Conclusion

The Turkish version of the Neck Bournemouth Questionnaire is valid and reliable.

Development, validity and reliability of the Italian version of the Copenhagen neck functional disability scale

BACKGROUND

Valid and reliable patient-reported outcome measures support health professionals in evaluating the results of clinical research and practice. The Copenhagen Neck Functional Disability Scale (CNFDS) has shown promising measurement properties to measure disability in patients with neck pain, but an Italian version of this questionnaire is not available. The objective of this study was to cross-culturally adapt the CNFDS into Italian (CNFDS-I), and to assess its validity and reliability in patients with neck pain.

METHODS

The CNFDS-I was developed according to well-established guidelines for cross-cultural adaptation of patient-reported outcome measures. A cross-sectional clinimetric study was conducted to evaluate its validity and reliability. Patients with chronic neck pain (pain > 3 months) participated in this study. The following measurement properties (defined by the COSMIN initiative) were assessed: structural validity (exploratory factor analysis), internal consistency (Cronbach's α), construct validity [by testing hypotheses on expected correlations with the Neck Disability Index (NDI), the Neck Bournemouth Questionnaire (NBQ), and pain Visual Analogue Scale (VAS)]. Test-retest reliability [Intraclass Correlation Coefficient for agreement (ICCagreement)], and measurement error [Smallest Detectable Change (SDC)] were also assessed in 50 clinically stable patients. Floor/ceiling effects and acceptability were calculated.

RESULTS

One-hundred and sixty-two patients (mean age = 47.9 ± 14.5 years, 70% female) were included. The CNFDS-I exhibited sufficient unidimensionality (one factor explained 83% of the variability) and internal consistency (α = 0.83). Construct validity was sufficient as all correlations with the other questionnaires were as expected (r = 0.846 with NDI, r = 0.708 with NBQ, r = 0.570 with VAS). Test-retest reliability was excellent (ICCagreement = 0.99, 95% CI from 0.995 to 0.999), while measurement error was equal to 8.31 scale points (27% scale range). No floor/ceiling effects were detected. The average time for filling the questionnaire was two minutes.

CONCLUSIONS

The CNFDS-I proved to be a valid and reliable outcome measure to assess disability in patients with chronic neck pain. Head-to-head comparison studies on the CNFDS-I measurement properties against other disability measures for neck pain (e.g. NDI and NBQ) are required to determine the relative merits of these different measures.

Patient-Reported Outcome Measures Used for Neck Disorders: An Overview of Systematic Reviews

BACKGROUND

The evaluation of patient-reported outcome measures for the neck from multiple systematic reviews will provide a broader view of, and may identify potential conflicting or consistent results for, their psychometric properties.

OBJECTIVES

The purpose of this study was to conduct an overview of systematic reviews and synthesize evidence to establish the current state of knowledge on psychometric properties of patient-reported outcome measures for patients with neck disorders.

METHODS

In this overview of systematic reviews, an electronic search of 6 databases (MEDLINE, Embase, CINAHL, ILC, the Cochrane Central Register of Controlled Trials, and LILACS) was conducted to identify reviews that addressed at least one measurement property of outcome measures for people with neck pain. Only systematic reviews with patient-reported outcome measures were included in the analysis. Risk of bias was assessed with A MeaSurement Tool to Assess systematic Reviews (AMSTAR). Data on measurement properties were extracted from each systematic review.

RESULTS

From 13 systematic reviews, 8 patient-reported outcome measures were evaluated in 2 or more reviews. Risk-of-bias scores ranged from moderate (5-7) to high (4 and lower). Findings on internal consistency, test-retest reliability, construct validity, responsiveness to change, and content and structural validity were synthesized for the Neck Disability Index (NDI) in 11 systematic reviews; the Northwick Park Neck Pain Questionnaire and Neck Pain and Disability scale (NPDS) in 6 systematic reviews; the Copenhagen Neck Functional Disability Scale in 5 systematic reviews; the Neck Bournemouth Questionnaire in 4 systematic reviews; the Core Neck Pain Questionnaire and Patient-Specific Functional Scale in 3 systematic reviews, and the Whiplash Disability Questionnaire in 2 systematic reviews.

CONCLUSION

High-quality evidence was found of good to excellent internal consistency and moderate to excellent test-retest reliability for the NDI. Moderate-quality evidence was found of good to excellent internal consistency and good test-retest reliability for the Northwick Park Neck Pain Questionnaire. High-quality evidence was found of excellent test-retest reliability and good to strong construct validity with pain scales for the Copenhagen Neck Functional Disability Scale. Moderate-quality evidence was found of unclear to excellent internal consistency and moderate to strong concurrent associations with the NDI and global assessment of change for the Neck Pain and Disability scale. Moderate-quality evidence was found of excellent internal consistency for the Whiplash Disability Questionnaire and of high test-retest reliability for the Patient-Specific Functional Scale. J Orthop Sports Phys Ther 2018;48(10):775-788. Epub 22 Jun 2018. doi:10.2519/jospt.2018.8131.