Evidence of Impaired Proprioception in Chronic, Idiopathic Neck Pain: Systematic Review and Meta-Analysis

Good vibes for the brain - Placebo versus real vibration in patients with chronic neck pain: A randomized cross-over study

BACKGROUND

Neck muscle vibration decreases pain and improves sensorimotor impairments in patients with chronic neck pain. However, the impact of placebo on these effects are still unclear.

OBJECTIVE

The aim was to evaluate the effect of neck muscle vibration compared to placebo neck muscle vibration in patients with chronic neck pain.

METHODS

Twenty-three people with chronic neck pain participated in this double-blinded, randomized crossover study. After baseline assessment at day 1, patients received either neck muscle vibration or placebo neck muscle vibration at day 2. At day 3, patients underwent the other treatment. The primary outcomes assessed at each day were active cervical joint position sense acuity, resting pain, and pressure pain threshold.

RESULTS

Cervical joint position sense revealed a significant time effect (F1, 22 = 4.366, p = 0.016, η2 = 0.902). Post-hoc testing revealed significant increases in cervical joint position sense after neck muscle vibration (p = 0.023; d = 0.602) but not after placebo vibration. Resting pain (F1, 22 = 7.550, p = 0.003, η2 = 0.418) displayed significant time effects for neck muscle vibration and placebo vibration. Pressure pain threshold demonstrated a significant time to condition effect (F1, 22 = 6.146; p = 0.008, η2 = 0.369). Post-hoc tests revealed that only neck muscle vibration significantly increased pressure pain threshold (p = 0.043, d = 0.516).

CONCLUSION

The study demonstrates the efficacy of neck muscle vibration to decrease neck pain and improve cervical joint position sense in patients with chronic neck pain. Nevertheless, the influence of placebo effects should not be underestimated as they may contribute to these effects, indicated by similar decreases in resting pain.

Differentiating the Structural and Functional Instability of the Craniocervical Junction

This paper presents the anatomical and biomechanical aspects of chronic instability of the craniocervical junction (CCJ) with a discussion on clinical diagnostics based on mobility tests and provocative tests related to ligamentous system injuries, as well as radiological criteria for CCJ instability. In addition to the structural instability of the CCJ, the hypothesis of its functional form resulting from cervical proprioceptive system (CPS) damage is discussed. Clinical and neurophysiological studies have shown that functional disorders or organic changes in the CPS cause symptoms similar to those of vestibular system diseases: dizziness, nystagmus, and balance disorders. The underlying cause of the functional form of CCJ instability may be the increased activity of mechanoreceptors, leading to "informational noise" which causes vestibular system disorientation. Due to the disharmony of mutual stimulation and the inhibition of impulses between the centers controlling eye movements, the cerebellum, spinal motoneurons, and the vestibular system, inadequate vestibulospinal and vestibulo-ocular reactions occur, manifesting as postural instability, dizziness, and nystagmus. The hyperactivity of craniocervical mechanoreceptors also leads to disturbances in the reflex regulation of postural muscle tone, manifesting as "general instability". Understanding this form of CCJ instability as a distinct clinical entity is important both diagnostically and therapeutically as it requires different management strategies compared to true instability. Chronic CCJ instability significantly impacts the quality of life (QOL) of affected patients, contributing to chronic pain, psychological distress, and functional impairments. Addressing both structural and functional instability is essential for improving patient outcomes and enhancing their overall QOL.

Reliability and usability of a novel inertial sensor-based system to test craniocervical flexion movement control

BACKGROUND

Neck pain has a significant global impact, ranking as the fourth leading cause of disability. Recurrent neck pain often leads to impaired sensorimotor control, particularly in craniocervical flexion (CFF). The Craniocervical Flexion Test (CCFT) has been widely investigated to assess the performance of deep cervical flexor muscles. However, its use requires skilled assessors who need to subjectively detect compensations, progressive increases in range of motion (ROM) or excessive superficial flexor activation during the test. The aim of this study was to design and develop a novel Craniocervical Flexion Movement Control Test (CFMCT) based on inertial sensor technology and real-time computer feedback and to evaluate its safety and usability, as well as inter and intra-rater reliability in both healthy individuals and patients with neck pain.

METHODS

We used inertial sensor technology associated with new software that provides real-time computer feedback to assess CCF movement control through two independent test protocols, the progressive consecutive stages protocol (including progressive incremental stages of ROM) and the random stages protocol (providing dynamic and less predictable movement patterns). We determined intra and inter-rater reliability and standard error of the measurement for both protocols. The participants rated their usability was analysed through the System Usability Scale (SUS) and possible secondary effects associated with the tests were registered.

RESULTS

The progressive consecutive stages protocol and the random stages protocol were safe and easy to use (SUS scores of 82.00 ± 11.55 in the pain group and 79.56 ± 13.36 in the asymptomatic group). The progressive consecutive stages protocol demonstrated good inter-rater reliability (intraclass correlation coefficient [ICC] ≥ 0.75) and moderate to good intra-rater reliability (ICC 0.62-0.80). However, the random stages protocol exhibited lower intra-rater reliability, especially in the neck pain group, where the reliability values were poor in some cases (ICC 0.48-0.72).

CONCLUSION

The CFMCT (progressive consecutive stages protocol) is a promising instrument to evaluate CCF motor control in patients with chronic neck pain. It has potential for telehealth assessment and easy adherence for exercise prescription and seems to be a safe and usable tool for patients with pain and asymptomatic individuals. Its use as a test or for exercise needs to be further investigated to facilitate its transfer to clinical practice.

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

BACKGROUND

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

OBJECTIVES

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

DESIGN

Cross-sectional study.

METHODS

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

RESULTS

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

CONCLUSION

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

Cervical Sensorimotor Function Tests Using a VR Headset-An Evaluation of Concurrent Validity

Sensorimotor disturbances such as disturbed cervical joint position sense (JPS) and reduced reaction time and velocity in fast cervical movements have been demonstrated in people with neck pain. While these sensorimotor functions have been assessed mainly in movement science laboratories, new sensor technology enables objective assessments in the clinic. The aim was to investigate concurrent validity of a VR-based JPS test and a new cervical reaction acuity (CRA) test. Twenty participants, thirteen asymptomatic and seven with neck pain, participated in this cross-sectional study. The JPS test, including outcome measures of absolute error (AE), constant error (CE), and variable error (VE), and the CRA test, including outcome measures of reaction time and maximum velocity, were performed using a VR headset and compared to a gold standard optical motion capture system. The mean bias (assessed with the Bland-Altman method) between VR and the gold standard system ranged from 0.0° to 2.4° for the JPS test variables. For the CRA test, reaction times demonstrated a mean bias of -19.9 milliseconds (ms), and maximum velocity a mean bias of -6.5 degrees per seconds (°/s). The intraclass correlation coefficients (ICCs) between VR and gold standard were good to excellent (ICC 0.835-0.998) for the JPS test, and excellent (ICC 0.931-0.954) for reaction time and maximum velocity for the CRA test. The results show acceptable concurrent validity for the VR technology for assessment of JPS and CRA. A slightly larger bias was observed in JPS left rotation which should be considered in future research.

Reliability of cervicocephalic sense of force

Cervicocephalic proprioception (CCP) is an important assessment item for people with a range of clinical conditions, where reduced CCP is associated with neck pain and imbalance. Reliability has been established for a range of positional and movements tests, but there is limited data regarding sense of force, particularly across three planes of movement. The current test-retest study assessed reliability when evaluating sense of force in healthy adults (8 males, 6 females, mean age 31.50 years [SD 10.14]) over two sessions, 4-7 days apart. A force matching protocol was used to evaluate reliability of absolute error (AE), constant error (CE), and variable error (VE) for 10 % and 25 % maximal voluntary contraction (MVC) target forces for flexion, extension, lateral flexion, and rotation. Participants were strapped to a chair to limit trunk movement and data was captured using a compressive force transducer fixed to an adjustable wall mount. Six trials were performed for each contraction-type, totaling 72 submaximal MVCs per session. ICC estimates for AE (0.15-0.77), CE (0.01-0.85), and VE (0.00-0.83) were varied and confidence intervals were mostly wide. Considering lower limits of confidence intervals, CE had best reliability values generally, but more specifically the most reliable contraction type and movement was 25 % MVC flexion (ICC 0.85, confidence interval 0.54-0.95). This study found that reliability for sense of force testing was dependent upon contraction, type of error, and target force utilized. Further reliability analysis should be performed when applying this test to measure validity outcomes in clinical populations.

A cluster analysis of cervicocephalic kinesthetic sensibility in persons with nonspecific neck pain

INTRODUCTION

Inter-individual variability may contribute to impaired cervicocephalic kinesthetic sensibility (CKS) in patients with nonspecific neck pain.

OBJECTIVES

To identify subgroups of participants with nonspecific neck pain based on cervical joint position errors (JPEs) and to determine potential factors associated with identified subgroups.

METHODS

One hundred participants with nonspecific neck pain (unidentified pathoanatomical cause) and 50 controls were recruited. JPEs were measured in cervical extension and rotation, using a laser pointer. JPEs were expressed as absolute (AEs), constant (CEs), and variable (VEs) errors. Clinical characteristics were pain intensity, duration, disability, side of pain, dizziness, psychological features, and range of motion. All tests were performed within 1 day. A cluster analysis was conducted based on AEs. A logistic regression was used to identify factors associated with the cluster groups.

RESULTS

Analysis divided neck pain participants into two groups: cluster 1 with greater impaired CKS (n = 36) and cluster 2 with lesser impaired CKS (n = 64). The AEs (all cervical movements) and CE (left rotation) were larger in cluster 1 than 2 (p ≤ .002). Overall, participants in clusters 1 and 2 had larger AEs, CEs, and VEs than controls (p ≤ .04). The presence of dizziness was a risk factor associated with cluster 1 (OR=2.5, p = .04). The other characteristics were not associated with the cluster groups (p ≥ .09).

CONCLUSION

The AEs identified two subgroups of patients with nonspecific neck pain. Participants in subgroup 1 had greater impaired CKS, and participants in subgroup 2 had lesser impaired CKS. Dizziness was a potential risk factor associated with greater impaired CKS.

In Myotonic Dystrophy Type 1 Head Repositioning Errors Suggest Impaired Cervical Proprioception

Background: Myotonic dystrophy type 1 (DM1) is a rare multisystemic genetic disorder with motor hallmarks of myotonia, muscle weakness and wasting. DM1 patients have an increased risk of falling of multifactorial origin, and proprioceptive and vestibular deficits can contribute to this risk. Abnormalities of muscle spindles in DM1 have been known for years. This observational cross-sectional study was based on the hypothesis of impaired cervical proprioception caused by alterations in the neck spindles. Methods: Head position sense was measured in 16 DM1 patients and 16 age- and gender-matched controls. A head-to-target repositioning test was requested from blindfolded participants. Their head was passively rotated approximately 30° leftward or rightward and flexed or extended approximately 25°. Participants had to replicate the imposed positions. An optoelectronic system was adopted to measure the angular differences between the reproduced and the imposed positions (joint position error, JPE, °) concerning the intended (sagittal, horizontal) and unintended (including the frontal) planar projections. In DM1 patients, JPEs were correlated with clinical and balance measures. Static balance in DM1 patients was assessed through dynamic posturography. Results: The accuracy and precision of head repositioning in the intended sagittal and horizontal error components did not differ between DM1 and controls. On the contrary, DM1 patients showed unintended side-bending to the left and the right: the mean [95%CI] of frontal JPE was -1.29° [-1.99°, -0.60°] for left rotation and 0.98° [0.28°, 1.67°] for right rotation. The frontal JPE of controls did not differ significantly from 0° (left rotation: 0.17° [-0.53°, 0.87°]; right rotation: -0.22° [-0.91°, 0.48°]). Frontal JPE differed between left and right rotation trials (p < 0.001) only in DM1 patients. No correlation was found between JPEs and measures from dynamic posturography and clinical scales. Conclusions: Lateral head bending associated with head rotation may reflect a latent impairment of neck proprioception in DM1 patients.

Efficacy Comparison of Osteopathic Muscle Energy Techniques and Cervical Mobilization on Pain, Disability, and Proprioception in Cervical Spondylosis Patients

BACKGROUND Cervical spondylosis (CS) is a degenerative disease of the cervical spine characterized by persistent neck pain. Cervical facet joint mobilization (CM) and the osteopathic muscle energy technique (MET) are effective manual procedures for the treatment of neck pain. In this study, we compared the efficacy of the MET and CM techniques on pain, disability, and proprioception in 76 patients with CS. MATERIAL AND METHODS A total of 96 participants with a diagnosis of CS were randomized into an electro-thermal therapy (ET) group (control group, n=32), ET+MET group (experiment I, n=32), and ET+CM group (experiment II, n=32). All patients received 3 treatment sessions per week for 4 consecutive weeks. Pain intensity, functional disability and cervical position sense were measured using the visual analog scale (VAS), Copenhagen Neck Functional Disability Scale (CNFDS), and cervical range of motion (CROM) device. RESULTS The study was completed by 76 participants. VAS and CNFDS scores decreased significantly after treatment in all 3 groups (P<0.001); however, there was no significant difference between the groups (P>0.05). Between-group analysis showed a significant difference in extension joint position error in favor of MET (P<0.001), while there was no significant difference between the groups in other movement directions (P>0.05). CONCLUSIONS MET and CM have similar effects on improving pain and disability in individuals with CS and chronic neck pain. However, the results of this study show that MET combined with ET is a more effective method for improving cervical position sense.

The relationship between sustained hamstring pain and reorganisation of somatosensory representations: a randomised, controlled study

ABSTRACT

Recurrent hamstring injuries are highly prevalent amongst sporting populations. It has been hypothesised that pain from an initial hamstring injury may induce reorganisation of somatosensory representations that could contribute to reinjury. However, because of the cross-sectional nature of existing research, it remains unknown whether somatosensory changes are a cause or effect of pain or if they are driven by other potentially confounding factors. Here, we explored the effect of experimentally induced sustained hamstring pain on tasks that interrogate somatosensory and spatial representations. Fifty healthy participants were randomly allocated to an experimental group that performed an eccentric exercise protocol on the right hamstring to induce delayed onset muscle soreness or a control group performing a repetition-matched concentric exercise protocol. The tactile cortical representation was assessed using two-point discrimination and tactile localisation, whereas the proprioceptive representation was assessed using a left-right judgement task. Peripersonal spatial representations were assessed using an auditory localisation task. Assessments were performed at baseline and day 2. No between-group differences in tactile acuity were observed. However, improvements in left-right judgments and worsening of auditory localisation occurred in the experimental group compared with the control group. This study provides preliminary evidence showing that somatosensory changes occur in response to sustained hamstring pain. Experimentally induced, sustained hamstring pain elicited enhancements in proprioceptive processing and deficits in peripersonal spatial processing, suggesting a shift in the allocation of attentional resources from the external (peripersonal) to internal (body) environment. These findings may hold important implications for reinjury risk and rehabilitation following hamstring pain.

The Relationship Between Pain and Interoception: A Systematic Review and Meta-Analysis

Interoception refers to the ability to sense internal bodily sensations. Research suggests that dysfunctions in interoception may be implicated in the transition to chronic pain, however, little work has examined interoceptive ability in pain states. Therefore, this systematic review aimed to assess whether interoception is altered in individuals experiencing pain. Following a systematic search of 4 electronic databases from inception to February 2023, 28 studies were included. Outcomes of interoceptive accuracy, interoceptive sensibility, and interoceptive awareness were meta-analysed. The risk of bias was assessed, and the certainty of the evidence was evaluated. Meta-analyses indicated that those with chronic pain display reduced interoceptive accuracy and increased interoceptive sensibility. Subgroup analyses indicated that the change in interoceptive sensibility is dependent on the measure used, with those with chronic pain scoring higher on measures focusing on attention to bodily sensations, while also scoring lower on emotional reactivity. No difference in interoceptive awareness was observed between individuals with chronic pain and pain-free controls. Only one study was found that measured interoception in those experiencing acute pain, while another study recruited those experiencing recurrent pain. These findings suggest that while those with chronic pain self-report as more interoceptively aware, they are less accurate at detecting internal bodily signals. Further research investigating domains of interoception in those experiencing acute and recurrent pain is needed. Data should be interpreted with caution as the certainty of evidence was very low for all completed analyses. This review was registered on the PROSPERO International Prospective Register of Systematic Reviews (Registration ID = CRD42022318843). PERSPECTIVE: This review considered the relationship between interoception and pain and found that an individual's ability to accurately sense internal signals is decreased in those with chronic pain, despite them reporting being more aware of internal sensations. However, there remains little research examining interoception in non-chronic pain states.

Analysis of posture and balance impairments in individuals with chronic nonspecific neck pain-an observational study

Background

Neck pain is one of the most burdensome chronic musculoskeletal problems globally. Impaired proprioception is associated with Chronic Nonspecific neck pain as the structures of the cervical spine are crucial for proprioception and balance. There is a paucity of literature examining objective measures of balance and postural sway in patients with Nonspecific neck pain.

Methods

This study was observational and consisted of 126 samples (63 cases and 63 controls who were recruited using convenience sampling. The demographics of the samples were collected and the postural and balance impairment was assessed using Biodex Balance SD. Mean, Median, and SD were obtained and the inferential analysis was done using the Whitney U Test and the level of significance was accepted at p < 0.05.

Results

The subjects with neck pain showed had a lower static stability index, static sway index, static stability index- forward backward and static sway index lateral scores than the normal counterparts. There are significant differences in the overall static stability index, (p < 0.001). There was a significant difference in static sway index(p = 0.003), and static stability index lateral (p = 0.004). There was no significant difference for static sway index forward and backward (p = 0.550) and lateral sway index (p = 0.711).

Conclusion

Subjects with neck pain showed had a lower static stability index, static sway index, static stability index- forward backward and static sway index lateral scores than the normal counterparts and there was a significant difference between the static sway and static stability index in forward and backward directions as well as in lateral direction. These findings may help to assess the specific balance parameters and address the underlying causes of balance issues in patients with neck pain and also provide a comprehensive care to the patients.

Clinical Trial Registration

The trial was registered with CTRI India with registration number: CTRI/2022/07/044222.

Sensorimotor tests in patients with neck pain and its associated disorders: a systematic review and meta-analysis

This systematic review aimed to synthesize the current evidence regarding neck sensorimotor testing in individuals with neck pain, assess the differences between neck pain groups and healthy controls, and recognize factors that might affect test results. We performed the data search using PubMed, Embase, PsycINFO, CINAHL, and Scopus databases. We used a two-step screening process to identify studies. Furthermore, we screened the reference lists for additional studies. Hedges g was used to present the difference between neck pain groups and asymptomatic individuals. We assessed the quality of the studies using the QUADAS tool. The final review included 34 studies, of which 25 were related to the joint position error test, four to the smooth pursuit neck torsion test and six to the balance test. Our meta-analysis showed poorer joint-position sense, oculomotor function, and wider postural sway in individuals with neck pain than healthy controls. The size of the difference between the groups seemed to be influenced by the intensity of the pain and the presence of dizziness. Therefore, it might be helpful in future studies to differentiate patients with neck pain into subgroups based on their symptom and demographic profiles to assess other factors that significantly affect cervical sensorimotor control.

Effects of Virtual Reality Therapy Combined With Conventional Rehabilitation on Pain, Kinematic Function, and Disability in Patients With Chronic Neck Pain: Randomized Controlled Trial

BACKGROUND

Neck pain is a common condition that leads to neck motor dysfunction and subsequent disability, with a significant global health care burden. As a newly emerging tool, virtual reality (VR) technology has been employed to address pain and reduce disability among patients with neck pain. However, there is still a lack of high-quality studies evaluating the efficacy of VR therapy combined with conventional rehabilitation for patients with chronic neck pain, particularly in terms of kinematic function.

OBJECTIVE

This study aims to investigate the effect of VR therapy combined with conventional rehabilitation on pain, kinematic function, and disability in patients with chronic neck pain.

METHODS

We conducted an assessor-blinded, allocation-concealed randomized controlled trial. Sixty-four participants experiencing chronic neck pain were randomly allocated into the experimental group that underwent VR rehabilitation plus conventional rehabilitation or the control group receiving the same amount of conventional rehabilitation alone for 10 sessions over 4 weeks. Pain intensity, disability, kinematic function (cervical range of motion, proprioception, and mean and peak velocity), degree of satisfaction, and relief of symptoms were evaluated at 3 timepoints (baseline, postintervention, and at 3 months follow-up). A 2*3 mixed repeated measures analysis of variance was utilized for analyzing the difference across indicators, with a significant difference level of .05.

RESULTS

Both groups demonstrated significant improvements in pain, disability, and kinematic functions (P<.05) at postintervention and at 3-month follow-up. The experimental group showed superior therapeutic outcomes compared to the control group in pain reduction (mean difference from the baseline: 5.50 vs 1.81 at posttreatment; 5.21 vs 1.91 at the 3-month follow-up, respectively; P<.001), disability improvement (mean difference from baseline: 3.04 vs 0.50 at posttreatment; 3.20 vs 0.85 at the 3-month follow-up, respectively; P<.001), and enhanced kinematic functions (P<.05). Moreover, participants in the experimental group reported better satisfaction and relief of symptoms than the control group (P<.05), with better initiative for exercising during the follow-up period. However, there was no between-group difference of improvement in proprioception. No adverse events were reported or observed in our research.

CONCLUSIONS

The findings of our study support the efficacy of combining VR therapy with conventional rehabilitation in alleviating pain, enhancing kinematic function, and reducing disability of patients with chronic neck pain. Future research should focus on refining the therapeutic protocols and dosages for VR therapy as well as on optimizing its application in clinical settings for improved convenience and effectiveness.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR2000040132; http://www.chictr.org.cn/showproj.aspx?proj=64346.

Cervicocephalic kinaesthesia reveals novel subgroups of motor control impairments in patients with neck pain

Cervical-spine sensorimotor control is associated with chronicity and recurrence of neck pain (NP). Tests used to measure sensorimotor impairments lack consistency in studied parameters. Interpretation is often based on either a handful or numerous parameters, without considering their possible interrelation. Different aspects of motor-control could be studied with different parameters, but this has not yet been addressed. The aim of this study was to determine if different parameters of cervical position (JPE) and movement (Butterfly) sense tests represent distinct components of motor-control strategies in patients with chronic NP. Principal component analysis performed on 135 patients revealed three direction-specific (repositioning from flexion, extension or rotations) and one parameter-specific (variability of repositioning) component for JPE, two difficulty-specific (easy or medium and difficult trajectory) and one movement-specific (undershooting a target) component for Butterfly test. Here we report that these components could be related to central (neck repositioning and control of cervical movement) and peripheral sensorimotor adaptations (variability of repositioning) present in NP. New technologies allow extraction of greater number of parameters of which hand-picking could lead to information loss. This study adds towards better identification of diverse groups of parameters offering potentially clinically relevant information and improved functional diagnostics for patients with NP.

The reliability and validity of a novel wearable inertial sensor to measure the cervical proprioception

BACKGROUND

Proprioceptive function assessment is crucial in clinical practice for patients with chronic non-specific neck pain (CNNP) as it is a major issue affecting their condition.

PURPOSE

To verify the reliability and validity of baiobit sensor in measuring the neck proprioceptive function of CNNP patients.

METHODS

Fifty-three CNNP patients were recruited (36 females, 17 males; age range 21-60 years) and were assessed for cervical joint position error by two blinded raters using the Baiobit sensor and laser pointer devices. The second measurement was conducted by the same rater 48 h later. Intra and inter-rater reliability of the Baiobit sensor was evaluated using the intra-class correlation coefficient (ICC), while the validity of the Baiobit sensor was established using the Spearman correlation coefficient.

RESULTS

The Baiobit sensor demonstrated moderate to excellent intra-rater reliability in flexion, extension, left lateral flexion, right lateral flexion, and right rotation (ICCs=0.71∼0.85, 95 %CIs: 0.50∼0.91), left-rotation shows poor to good intra-rater reliability (ICC=0.56, 95 %CI: 0.25∼0.75). The Baiobit sensor also demonstrated moderate to excellent inter-rater reliability in flexion, extension, left lateral flexion, right lateral flexion, and right rotation (ICCs=0.80∼0.88, 95 %CIs: 0.65∼0.91), left-rotation shows poor to good intra-rater reliability (ICC=0.59, 95 %CI: 0.29∼0.76). Validity analysis showed that the Baiobit sensor had a range of low to high validity (r = 0.46∼0.88) for measuring cervical proprioception function, with lower validity observed in the left flexion direction. The Baiobit showed good absolute reliability with low SEM and MDC90 values (0.35°∼2.42°).

CONCLUSION

The new device could be used as an alternative tool to evaluate neck proprioception.

Immediate effects of visuomotor tracking with the head on cervical sensorimotor function and pain in chronic neck pain patients

BACKGROUND

Working in awkward and sustained postures is, besides psychosocial risk factors, the most reported physical risk factor for neck pain. Accurate proprioception is fundamental to correcting awkward head-to-trunk positions, but impaired proprioceptive performance has been found in patients with chronic neck pain.

OBJECTIVE

The aim was to compare the effectiveness of two different interventions in a workplace set-up on sensorimotor performance and pain sensitivity in people with chronic neck pain.

METHODS

A total of 25 patients with chronic neck pain participated in this double-blind study. Patients were randomly allocated to the visuomotor tracking task group or the video group (watching a massage video, imagining themselves being massaged). The primary outcomes were cervical joint position sense acuity and pressure pain threshold of the cervical spine, evaluated by a blinded assessor.

RESULTS

There were significant time by group interactions for cervical joint position sense acuity (F1;23: 4.38; p= 0.048) and pressure pain threshold (F1;23: 5.78; p= 0.025), with the tracking task group being more accurate in cervical joint position sense testing and less pain sensitive for pressure pain threshold.

CONCLUSIONS

The visuomotor tracking task improves cervical joint position sense acuity and reduces pressure pain threshold immediately after intervention in people with chronic neck pain.

Investigating the Effect of Addition of Cervical Proprioceptive Training to Conventional Physiotherapy on Visual, Vestibular and Proprioceptive Dependency of Postural Control in Patients with Chronic Non-Specific Neck Pain: A Randomized Controlled Clinical Trial

Objectives

While cervical proprioception deficit has been suggested as a contributing factor to clinical consequences of chronic non-specific neck pain (CNSNP), the effect of addressing such impairments on postural control strategies has remained unexplored. The aim of this study was to compare the response of the postural control system to alteration of sensory afferents in CNSNP with asymptomatic individuals. Furthermore, we examined whether proprioceptive training would yield superior outcomes to routine physiotherapy for improvement of postural control, pain and disability.

Methods

Center of pressure (CoP) variables of sixty CNSNP patients equally distributed in any of the proprioception-specific or conventional physiotherapy groups and 30 asymptomatic participants were evaluated under four standing conditions:1) normal, 2) foam, 3) cervical extension/eyes open and 4) cervical extension/eyes closed standing.

Results

CoP anteroposterior range and anteroposterior and mediolateral velocity in patients were significantly higher than the control group under condition 2 (P<0.05). Patients also demonstrated lower anteroposterior lyapunov exponent under conditions 2 and 4 (P<0.05). Both interventions significantly decreased anteroposterior range and anteroposterior velocity(P<0.05). Anteroposterior lyapunov exponent also increased under condition 2 (P<0.05).. After the interventions, CoP anteroposterior range and anteroposterior velocity were significantly lower in the proprioceptive exercise group than the conventional physiotherapy group (P<0.05). Anteroposterior lyapunov exponent was also significantly higher in the proprioceptive exercise group (P<0.05).This while there was no significant difference between these patients and control group participants in any of the CoP variables after intervention.

Conclusion

Our results rejected the hypothesis that impaired neck proprioception in the presence of CNSNP is compensated by overweighting other sources of sensory afferent information. The findings also revealed that while proprioceptive exercises successfully returned postural strategies of CNSNP patients to those in asymptomatic participants, they do not add to clinical recovery of these patients.

Comparison of head posture and neck proprioceptive sense of individuals with chronic neck pain and healthy controls: A cross-sectional study

BACKGROUND

Chronic pain can affect body perception at the central level by causing the somatosensory cortex to rearrange. Additionally, cervical afferent abnormalities in individuals with neck pain can impair proprioceptive sensitivity, potentially leading to alterations in body alignment and biomechanics. Nevertheless, there are insufficient studies exploring these notions.

OBJECTIVE

The main objective of this study was to compare the head posture and neck proprioceptive sense of individuals with chronic neck pain and healthy controls.

METHODS

Utilizing a cross-sectional study, a total of 76 volunteers comprising 38 individuals with neck pain and 38 matched healthy controls participated in the study. Head posture and cervical joint position sense were measured using a Cervical Range of Motion Deluxe (CROM) device. Firstly, the deviation angles of the head in three planes were evaluated, then the Head Repositioning Accuracy (HRA) test was performed to determine the joint position error. Visual Analogue Scale (VAS) was used to determine the severity of pain in individuals with neck pain.

RESULTS

The deviation angles of the head in all three planes were significantly lower in the healthy control group (p< 0.05). Joint position error values were significantly higher in all directions (flexion-extension, right-left lateral flexion, and rotation) in the neck pain group (p< 0.001).

CONCLUSION

The findings show that the proprioceptive sensation of the cervical region in individuals with neck pain was adversely affected, with changes were observed in the head posture.

NOTE

The abstract of this study was presented as a verbal declaration at the International Congress of Health Sciences-ICHES-IDU 2020 that was held in İzmir on 20-21 June 2020.

Effect of sit-stand workstation position and computer task on head and trunk postural sway and discomfort

Adjustable-height desks may provide musculoskeletal health benefits to offset the effects of prolonged sitting. One mechanism may be increased postural variability, here characterized by head and trunk postural sway. Linear acceleration of the head and trunk were measured while participants used computer workstations in seated and standing positions during keyboard and mouse tasks; secondary measures were discomfort and proprioception (head and neck repositioning error). Median accelerations of the head and trunk were 20-26% lower in mouse tasks compared to keyboard tasks (p < 0.01). There were no significant differences in sway parameters between seated and standing positions. Discomfort and proprioception were correlated; subjects who experienced increased neck discomfort after 1.5 h of computer work had almost twice the head and neck repositioning error. The results suggest that postural sway is more affected by different tasks (keyboard vs. mouse) than by different workstation configurations and that low proprioception acuity may relate to the development of discomfort.

The efficacy of manual therapy on HRV in those with long-standing neck pain: a systematic review

OBJECTIVES

Long-standing neck pain (LNP) is a clinical condition frequently encountered in the physical therapy clinic. LNP is a complex, multifactorial condition affecting multiple body systems including the autonomic nervous system (ANS). Traditionally, research on the impact of physical therapy on LNP has focused on self-report measures and pain scales. Heart rate variability (HRV) is an objective measure of the ANS, allowing for quantification of effects of treatment. This systematic review is intended to evaluate if manual therapy acutely affects heart rate variability in adults with long-standing neck pain.

METHODS

Pubmed, Medline, CINAHL, Google Scholar, Web of Science, and Cochrane library were used to retrieve the randomized controlled trials for this review between the years 2010-2021. Search terms included: chronic neck pain, neck pain, cervical pain, manual therapy, mobilization, manipulation, osteopathy, osteopathic or chiropractic. Heart rate variability, HRV, heart rate variation, effects, outcomes, benefits, impacts or effectiveness.

RESULTS

Of 139 articles located and screened, three full-text articles were selected for full qualitative synthesis, with a combined population of 112 subjects, 91 of which were female, with an average age of 33.7 ± 6.8 years for all subjects. MT techniques in three studies were statistically significant in improving HRV in people with LNP; however, techniques were differed across studies, while one study showed no benefit. The studies were found to be of high quality with PEDro scores ≥6.

CONCLUSIONS

Although no clear cause and effect relationship can be established between improvement in HRV with manual therapy, results supported the use of MT for an acute reduction in HRV. No one particular method of MT has proven superior, MT has been found to produce a statistically significant change in HRV. These HRV changes are consistent with decreased sympathetic tone and subjective pain.

Neck Muscle Vibration Alters Cerebellar Processing Associated with Motor Skill Acquisition of a Proprioceptive-Based Task

Experimentally induced neck fatigue and neck pain have been shown to impact cortico-cerebellar processing and sensorimotor integration, assessed using a motor learning paradigm. Vibration specifically impacts muscle spindle feedback, yet it is unknown whether transient alterations in neck sensory input from vibration impact these neural processing changes following the acquisition of a proprioceptive-based task. Twenty-five right-handed participants had electrical stimulation over the right median nerve to elicit short- and middle-latency somatosensory evoked potentials (SEPs) pre- and post-acquisition of a force matching tracking task. Following the pre-acquisition phase, controls (CONT, n = 13, 6 F) received 10 min of rest and the vibration group (VIB, n = 12, 6 F) received 10 min of 60 Hz vibration on the right sternocleidomastoid and left cervical extensors. Task performance was measured 24 h later to assess retention. Significant time by group interactions occurred for the N18 SEP peak, 21.77% decrease in VIB compared to 58.74% increase in CONT (F(1,23) = 6.475, p = 0.018, np2 = 0.220), and the N24 SEP peak, 16.31% increase in VIB compared to 14.05% decrease in CONT (F(1,23) = 5.787, p = 0.025, np2 = 0.201). Both groups demonstrated improvements in motor performance post-acquisition (F(1,23) = 52.812, p < 0.001, np2 = 0.697) and at retention (F(1,23) = 35.546, p < 0.001, np2 = 0.607). Group-dependent changes in the SEP peaks associated with cerebellar input (N18) and cerebellar processing (N24) suggests that an altered proprioceptive input from neck vibration impacts cerebellar pathways.

Widespread Proprioceptive Acuity Impairment in Chronic Back Pain: A Cross-sectional Study

OBJECTIVE

To investigate whether proprioceptive accuracy measured with the Joint Position Sense (JPS) in patients with chronic neck and low back pain is impaired exclusively in affected areas or also in distant areas, not affected by pain.

DESIGN

Cross-sectional study.

SETTING

Interdisciplinary outpatient rehabilitation clinic for back and neck pain.

PARTICIPANTS

Patients with chronic neck pain (n=30), patients with chronic low back pain (n=30), and age- and sex-matched asymptomatic control subjects (n=30; N=90).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Patients and asymptomatic control subjects completed a test procedure for the JPS of the cervical spine, lumbar spine, and ankle in a randomized order. Between group differences were analyzed with the univariate analysis of variance and associations of the JPS with clinical features using the Pearson's correlation coefficient.

RESULTS

Both patients with chronic neck pain (P<.001) and patients with chronic low back pain (P<.01) differed significantly from asymptomatic controls in the JPS of the cervical spine, lumbar spine and ankle joint, regardless of the painful area. No difference was shown between patient groups (P>.05). An association of the JPS with clinical characteristics, however, could not be shown.

CONCLUSION

These results suggest widespread impairment of proprioceptive accuracy in patients with chronic and low back pain and a role for central sensorimotor processes in musculoskeletal pain conditions.

The importance of myofascial trigger points in chronic neck pain: An ultrasonography preliminary study

BACKGROUND

Ultrasonographic evaluation of trigger points detected by physical examination in patients with myofascial pain syndrome is being used more frequently in clinical care. However, the sonographic appearance of trigger points, in association with pain and disability, has not been adequately described.

OBJECTIVE

To reveal the presence of trigger points with ultrasonography in those with myofascial pain syndrome and to determine if ultrasound images can help discriminate between demographic and disease characteristics.

METHODS

Fifty-two participants with chronic neck pain (NP) were in this cross-sectional study. The pain intensity was evaluated using a 0-10 cm visual analog scale (VAS). The neck disability index measured the NP-induced disability status of the participants. Ultrasonography was used to measure the thicknesses of the paraspinal muscles and the presence of hypoechoic areas within these muscles.

RESULTS

There was a positive correlation between the VAS scores of the participants and the ultrasonographic detection of myofascial trigger points (MTPs) in the multifidus and middle trapezius muscles (right/left r = .30, p = .027; r = .29, p = .029; r = .32, p = .009, r = .30, p = .011, respectively). These features correlated with the disability levels of the participants and the MTPs on both the right and left sides of the splenius, multifidus, upper trapezius, and middle trapezius (r = .32, p = .028; r = .38, p = .013, r = .25, p = .027; r = .33, p = .016; r = .25, p = .025, r = .32, p = .018, r = .28, p = .013, r = .29, p = .016, respectively). A significant correlation was present between the detection of MTP at ultrasonography and decreased muscle thickness in the relevant muscles (between p = .001 and p = .034).

CONCLUSION

The detection of MTPs with ultrasonography is associated with the severity of pain and disability in those with chronic NP. Features on ultrasound include hypoechoic changes within muscle and reduced muscle thickness associated with MTPs.

Age-Related Decline in Cervical Proprioception and Its Correlation with Functional Mobility and Limits of Stability Assessed Using Computerized Posturography: A Cross-Sectional Study Comparing Older (65+ Years) and Younger Adults

Cervical proprioception and its implications on postural stability are crucial in older adults. Understanding their relationship is important in understanding and preventing falls in older adults. This research aims to evaluate the proprioceptive, functional mobility, and limits of stability (LOS) variables among two age groups: individuals aged 65 and above and those below 65. A secondary goal of the study is to analyze the relationship between cervical proprioception, functional mobility, and the LOS.

METHODS

In this cross-sectional study, 100 participants each were included in the older and younger groups. Researchers employed the target reposition technique to assess cervical proprioception and measured the joint position error (JPE) in degrees. Functional mobility was estimated using the Berg balance scale (BBS) and timed up-and-go test (TUG). In addition, dynamic posturography was utilized to evaluate variables related to the LOS, including reaction time, maximum excursion, and directional control.

RESULTS

The magnitudes of the mean cervical JPE are larger (p < 0.001), and functional mobility (p < 0.001) and the LOS (p < 0.001) are impaired in older individuals compared to the younger ones. The cervical proprioception is significantly associated with functional mobility (p < 0.001), and the LOS (p < 0.001).

CONCLUSION

In older adults aged above 65 years, cervical proprioception, functional mobility, and the LOS are impaired. Older adults with greater cervical JPE had more impaired functional mobility and LOS parameters. When evaluating or treating older adults with problems with their balance or falls, these factors should be considered.

Is Thoracic Kyphosis Relevant to Pain, Autonomic Nervous System Function, Disability, and Cervical Sensorimotor Control in Patients with Chronic Nonspecific Neck Pain?

There is great interest in thoracic kyphosis, as it is thought to be a contributor to neck pain, neck disability, and sensorimotor control measures; however, this has not been completely investigated in treatment or case control studies. This case control design investigated participants with non-specific chronic neck pain. Eighty participants with a defined hyper-kyphosis (>55°) were compared to eighty matched participants with normal thoracic kyphosis (<55°). Participants were matched for age and neck pain duration. Hyper-kyphosis was further categorized into two distinct types: postural kyphosis (PK) and Scheuermann's kyphosis (SK). Posture measures included formetric thoracic kyphosis and the craniovertebral angle (CVA) to assess forward head posture. Sensorimotor control was assessed by the following measures: smooth pursuit neck torsion test (SPNT), overall stability index (OSI), and left and right rotation repositioning accuracy. A measure of autonomic nervous system function included the amplitude and latency of skin sympathetic response (SSR). Differences in variable measures were examined using the Student's t-test to compare the means of continuous variables between the two groups. One-way ANOVA was used to compare mean values in the three groups: postural kyphosis, Scheuermann's kyphosis, and normal kyphosis group. Pearson correlation was used to evaluate the relationship between participant's thoracic kyphosis magnitude (in each group separately and as an entire population) and their CVA, SPNT, OSI, head repositioning accuracy, and SSR latency and amplitude. Hyper-kyphosis participants had a significantly greater neck disability index compared to the normal kyphosis group (p < 0.001) with the SK group having greatest disability (p < 0.001). Statistically significant differences between the two kyphosis groups and the normal kyphosis group for all the sensorimotor measured variables were identified with the SK group having the most decreased efficiency of the measures in the hyper-kyphosis group, including: SPNT, OSI, and left and right rotation repositioning accuracy. In addition, there was a significant difference in neurophysiological findings for SSR amplitude (entire sample of kyphosis vs. normal kyphosis, p < 0.001), but there was no significant difference for SSR latency (p = 0.07). The CVA was significantly greater in the hyper-kyphosis group (p < 0.001). The magnitude of the thoracic kyphosis correlated with worsening CVA (with the SK group having the smallest CVA; p < 0.001) and the magnitude of the decreased efficiency of the sensorimotor control measures and the amplitude and latency of the SSR. The PK group, overall, showed the greatest correlations between thoracic kyphosis and measured variables. Participants with hyper-thoracic kyphosis exhibited abnormal sensorimotor control and autonomic nervous system dysfunction compared to those with normal thoracic kyphosis.

A Cross-Sectional Study on Mediating Effect of Chronic Pain on the Relationship between Cervical Proprioception and Functional Balance in Elderly Individuals with Chronic Neck Pain: Mediation Analysis Study

(1) Background: Cervical proprioception maintains head orientation in space and contributes to maintaining bodily balance. Evaluating cervical proprioception in elderly individuals with chronic neck pain (CNP) and understanding how pain intensity mediates the relationship between proprioception and functional balance helps formulate treatment strategies for this population. The objectives of this study are to (a) compare the cervical proprioception and functional balance between CNP and asymptomatic, (b) investigate the relationship between cervical proprioception and functional balance ability in CNP individuals and (c) mediation effect of chronic pain on the relationship between cervical proprioception and functional balance tests (2) Methods: This cross-sectional comparative study recruited 60 elderly individuals with a diagnosis of CNP (mean age: 66.40 years) and 60 asymptomatic (mean age: 66.42 years). The cervical proprioception is measured using the target head repositing technique. The subjects were asked to close their eyes and reposition their head actively to the target position from the neutral position, and the reposition accuracy is estimated as joint position errors (JPE) in degrees. The cervical proprioception was measured in the directions of flexion, extension, and left and right rotation. The functional balance was assessed using the berg balance test (BBS) score and timed-up-and-go (TUG) test in seconds. (3) Results: The elderly individuals with CNP had increased cervical JPE compared to the asymptomatic group (p < 0.001) in all the directions tested, indicating that cervical proprioception is impaired in CNP patients. Moreover, the CNP individual functional balance is significantly impaired (p < 0.001) compared to asymptomatic. The BBS test scores were lower, and the TUG scores were higher in the CNP group. In CNP individuals, the cervical JPE showed a significant correlation with the BBS test scores (r = -0.672 to -0.732, p < 0.001) and TUG scores (r = 0.328 to -0.414, p < 0.001). (4) Conclusions: Cervical proprioception and functional balance are impaired in elderly individuals with CNP. Physical therapists and rehabilitation professionals may consider these factors during the evaluation and development of treatment strategies in elderly adults with CNP.

Potential Use of Wearable Inertial Sensors to Assess and Train Deep Cervical Flexors: A Feasibility Study with Real Time Synchronization of Kinematic and Pressure Data during the Craniocervical Flexion Test

The aim of the study was to develop a novel real-time, computer-based synchronization system to continuously record pressure and craniocervical flexion ROM (range of motion) during the CCFT (craniocervical flexion test) in order to assess its feasibility for measuring and discriminating the values of ROM between different pressure levels. This was a descriptive, observational, cross-sectional, feasibility study. Participants performed a full-range craniocervical flexion and the CCFT. During the CCFT, a pressure sensor and a wireless inertial sensor simultaneously registered data of pressure and ROM. A web application was developed using HTML and NodeJS technologies. Forty-five participants successfully finished the study protocol (20 males, 25 females; 32 (11.48) years). ANOVAs showed large effect significant interactions between pressure levels and the percentage of full craniocervical flexion ROM when considering the 6 pressure reference levels of the CCFT (p < 0.001; η² = 0.697), 11 pressure levels separated by 1 mmHg (p < 0.001; η² = 0.683), and 21 pressure levels separated by 0.5 mmHg (p < 0.001; η² = 0.671). The novel time synchronizing system seems a feasible option to provide real-time monitoring of both pressure and ROM, which could serve as reference targets to further investigate the potential use of inertial sensor technology to assess or train deep cervical flexors.

Virtual Reality Intervention for Patients With Neck Pain: Systematic Review and Meta-analysis of Randomized Controlled Trials

BACKGROUND

Neck pain is a prevalent condition that causes an enormous health care burden due to the lack of efficient therapies. As a promising technology, virtual reality (VR) has shown advantages in orthopedic rehabilitation. However, there is no meta-analysis evaluating the effectiveness of VR in neck pain management.

OBJECTIVE

This study aims to review original randomized controlled trials (RCTs) evaluating the effectiveness of VR for neck pain and to provide evidence for the clinical application of a new alternative approach for pain management.

METHODS

A total of 9 electronic databases were systematically searched for relevant articles published from inception to October 2022. RCTs in English or Chinese that investigated VR therapy for participants with neck pain were included. The methodological quality and the evidence level were assessed using the Cochrane Back and Neck Risk of Bias tool and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) guideline, respectively.

RESULTS

A total of 8 studies with 382 participants were included for the final analysis. For the pain intensity, the overall pooled effect size was 0.51, with a standardized mean difference (SMD) of -0.51 (95% CI -0.91 to -0.11; GRADE: moderate), favoring VR therapy compared with controls. Subgroups analyses revealed that significant differences in pain intensity were found in the multimodal intervention (VR in combination with other therapies) than in other interventions (SMD -0.45, 95% CI -0.78 to -0.13; GRADE: moderate), and better analgesic effects were also observed in patients with chronic neck pain receiving VR intervention (SMD -0.70, 95% CI -1.08 to -0.32; GRADE: moderate) and patients treated in the clinic or research unit (SMD -0.52, 95% CI -0.99 to -0.05; GRADE: moderate) than controls. Regarding other health outcomes, the VR experienced less disability, lower kinesiophobia, and greater kinematic function (cervical range of motion, mean and peak velocity). Nevertheless, the follow-up effects of VR therapy on pain intensity and disability were not found.

CONCLUSIONS

Existing moderate evidence support VR as a beneficial nonpharmacological approach to improve pain intensity in patients with neck pain, with advantages to multimodal intervention, people with chronic neck pain, and clinic or research unit-based VR therapy. However, the limited quantity and high heterogeneity of the articles limit our findings.

TRIAL REGISTRATION

PROSPERO CRD42020188635; https://tinyurl.com/2839jh8w.

Dizziness and balance outcomes after two different postoperative rehabilitation approaches following neck surgery: analyses of a multicenter randomized controlled trial

BACKGROUND

Dizziness and balance problems are common symptoms in patients with cervical radiculopathy.

OBJECTIVE

To evaluate the effect of neck surgery postoperatively combined with either structured rehabilitation or standard approach in patients with cervical radiculopathy and dizziness and/or balance problems, and investigate factors influencing dizziness and balance at 6-month follow-up.

METHODS

Individuals (n = 149) with cervical radiculopathy and dizziness and/or balance problems were randomized preoperatively to structured postoperative rehabilitation or standard postoperative approach. Outcomes were intensity of dizziness and subjective balance, and clinical measures of balance.

RESULTS

Self-reported measures improved at three months (p ˂ 0.001 to p = .007) and the standing balance at six months (p = .008). No between-group differences. Baseline values, neck pain, and physical activity level explained 23-39% of the variance in 6-month outcomes for self-reported measures. Baseline values and physical activity level explained 71% of the variance in walking balance, and lower baseline scores were significantly associated with standing balance impairments (OR 0.876).

CONCLUSION

Patients improved significantly in dizziness and subjective balance intensity shortly after surgery, and in standing balance at 6 months, independent of postoperative rehabilitation. Neck pain, physical activity, and neck muscle function influenced dizziness and balance, although preoperative values and neck pain were of most importance for 6-month outcomes.

Reliability and Validity of A Novel Device for Evaluating the Cervical Proprioception

INTRODUCTION

In clinical practice, cervical proprioception is usually evaluated by calculating the cervical joint position error (JPE) with laser pointer devices (LPD) or cervical range-of-motion (CROM) instruments. As technology continues to improve, more and more advanced tools are used to evaluate cervical proprioception. The purpose of this study was to analyze the reliability and validity of the WitMotion sensor (WS) device in evaluating cervical proprioception, and to explore a cheaper, more convenient, and more practical testing tool.

METHODS

Twenty-eight healthy participants (16 women, 12 men; age 25-66 years) were recruited and evaluated for cervical joint position error with a WS and LPD by two independent observers. All participants repositioned their head to the target position and the deviation of repositioning was calculated using these two instruments. The intra- and inter-rater reliability of the instrument were determined by calculating the intraclass correlation coefficients (ICC), and the validity was analyzed by calculating the ICC and the Spearman's correlation.

RESULTS

The intra-rater reliability of the WS (ICCs = 0.682-0.774) was higher than that of the LPD (ICCs = 0.512-0.719) for measuring JPE of cervical flexion, right lateral flexion, and left rotation. However, the LPD (ICCs = 0.767-0.796) outperformed the WS (ICCs = 0.507-0.661) in cervical extension, left lateral flexion, and right rotation. For the inter-rater reliability, the ICC values obtained by the WS and the LPD were above 0.70 for all cervical movements except cervical extension and left lateral flexion (ICCs = 0.580-0.679). For the validity, the ICC values were moderate to good (ICCs > 0.614) for measuring JPE in all movements with the WS and the LPD.

CONCLUSIONS

Based on the high ICC values of reliability and validity, the novel device can be an alternative tool to evaluate cervical proprioception in clinical practice.

TRIAL REGISTRATION

This study was registered in the Chinese Clinical Trial Registry (ChiCTR2100047228).

How well can we detect cervical driven sensorimotor dysfunction in concussion patients? An observational study comparing patients with idiopathic neck pain, whiplash associated disorders and concussion

BACKGROUND

Patients with mild traumatic brain injury (mTBI) suffer from sensorimotor impairments. Evidence is emerging that cervical spine plays an important role in mTBI, but it is not known how cervicocephalic kinaesthetic sensibility measured during dynamic unpredictable head movements and measures of position sense, cervical induced postural balance and eye movement control differ between mTBI, whiplash associated disorders (WAD) patients, idiopathic neck pain patients and healthy controls.

RESEARCH QUESTION

Are cervical sensorimotor deficits present in mTBI patients and do they differ from sensorimotor deficits found in traumatic and nontraumatic neck pain patients and whether they differ from healthy controls.

METHODS

Twenty idiopathic neck pain patients, 18 WAD, 17 mTBI and 20 healthy controls were enroled in the study. Frequency and velocity of centre of pressure movements were measured during parallel stance in the neutral and neck torsion positions, gain and smooth pursuit neck torsion difference of eye movements during smooth pursuit neck torsion test (SPNTT) and cervicocephalic kinaesthesia using Butterfly and head-to-neutral relocation test.

RESULTS

Statistically significant differences in postural balance, both tests of cervicocephalic kinaesthesia and SPNTT were observed between healthy controls and all patient groups. No differences were observed between patient groups for SPNTT, Butterfly and head-to-neutral relocation test, but differences were present in postural balance between mTBI and both groups of patients with neck pain disorders. Differences were found in the ML direction for mTBI, but not differences were found for AP direction.

SIGNIFICANCE

Results of our study show that mTBI present with similar impairment in cervical driven sensorimotor deficits as patients with neck pain disorders, but they differ from healthy individuals. Clinical practice would benefit from identifying cervical spine related sensorimotor impairments in patients with mTBI. This could enable to design more targeted prevention and rehabilitation programs to minimise cervical spine related disorders in concussion patients.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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.

Reference values, minimum repetitions for stable measures, and test-retest reliability in the torsion and conventional cervical joint position sense tests in asymptomatic individuals

OBJECTIVE

To determine reference values, including the appropriate number of repetitions, and test-retest reliability of the torsion and conventional cervical joint position sense (JPS) tests.

METHODS

Phase 1) Cross-sectional design to determine reference values and the appropriate number of repetitions; Phase 2) repeated-measures concordance design (test-retest reliability). Sixty-eight healthy participants performed 10 repetitions of randomized rotation left and right for both cervical JPS tests using a laser projected onto a target. Thirty participants returned for the same evaluation process one week later.

RESULTS

The age-stratified reference values for the torsion JPS test showed greater absolute error as age increased. Stable levels of performance were obtained with 6-7 repetitions for both tests. Moderate to good reliability was found with 7 or more repetitions for left rotation [Torsion JPS test, Intraclass Correlation Coefficient (ICC; 95% CI) = 0.85 (0.68-0.93); Conventional JPS test, ICC = 0.78 (0.53-0.89)], and 6-7 or more repetitions for right rotation [Torsion JPS test, 6 repetitions, ICC = 0.79 (0.56-0.90); Conventional JPS test, 7 repetitions, ICC = 0.82 (0.61-0.91)]. Standard Error of Measurement (SEM) and Minimal Detectable Change (MDC) stabilized at 7 repetitions in both tests [Torsion JPS test (SEM ≤ 1.0°; MDC₉₀ ≤ 2.4°; MDC₉₅ ≤ 2.9°); Conventional JPS test (SEM ≤ 1.2°; MDC₉₀ ≤ 2.8°; MDC₉₅ ≤ 3.3°)].

CONCLUSIONS

The reference values generated for the torsion JPS test may help identify the presence of impairments cervical proprioception. At least 7 repetitions optimize stability, reliability and responsiveness in the torsion and conventional cervical JPS tests.

Home exercises for neck pain: A Delphi survey

PURPOSE

The current context of the COVID-19 pandemic has demonstrated the need for home exercise strategies for the relief of neck pain, which, in recent times, has increased. However, there is a gap regarding home exercises that are aimed at reducing neck pain. Therefore, the aim of this study was to develop, validate and culturally adapt a home exercise protocol for neck pain.

METHODS

This was an observational study conducted in three stages: (1) Developing an online search of databases for articles on neck pain exercises. (2) Validating a panel of 12 physical therapists, using the Delphi technique, and (3) Cultural adaptation, through face-to-face assessment with individuals aged 18-30 years with neck pain (n = 15). This resulted in the production of a final version of the protocol. Consensus on the protocol items (using the five-point Likert scale) was considered when the percent agreement was equal to or greater than 75%. Individuals were also asked about pain intensity during the last week before and after performing the protocol.

RESULTS

A protocol was developed with the principles of neck and scapular stabilization and upper limb movements, for a period of 4 weeks. Nine physical therapists completed two rounds online, and all items in the second version of the protocol presented an agreement of over 75%. The protocol was culturally adapted by the target population, in which 73% of individuals presented pain reduction with a minimally clinically important difference.

CONCLUSION

A 4-week home exercise protocol was created based on the best evidence in the literature, was validated by physical therapists and adapted for the population with neck pain. It proved to be an understandable, useful, practical and convenient tool in the treatment of this disorder and demonstrated an improvement in neck pain.

CLINICALTRIALS

GOV: (NCT04187001).

Neck Muscle Vibration Alters Upper Limb Proprioception as Demonstrated by Changes in Accuracy and Precision during an Elbow Repositioning Task

Upper limb control depends on accurate internal models of limb position relative to the head and neck, accurate sensory inputs, and accurate cortical processing. Transient alterations in neck afferent feedback induced by muscle vibration may impact upper limb proprioception. This research aimed to determine the effects of neck muscle vibration on upper limb proprioception using a novel elbow repositioning task (ERT). 26 right-handed participants aged 22.21 ± 2.64 performed the ERT consisting of three target angles between 80−90° (T1), 90−100° (T2) and 100−110° (T3). Controls (CONT) (n = 13, 6F) received 10 min of rest and the vibration group (VIB) (n = 13, 6F) received 10 min of 60 Hz vibration over the right sternocleidomastoid and left cervical extensor muscles. Task performance was reassessed following experimental manipulation. Significant time by group interactions occurred for T1: (F1,24 = 25.330, p < 0.001, ηp2 = 0.513) where CONT improved by 26.08% and VIB worsened by 134.27%, T2: (F1,24 = 16.157, p < 0.001, ηp2 = 0.402) where CONT improved by 20.39% and VIB worsened by 109.54%, and T3: (F1,24 = 21.923, p < 0.001, ηp2 = 0.447) where CONT improved by 37.11% and VIB worsened by 54.39%. Improvements in repositioning accuracy indicates improved proprioceptive ability with practice in controls. Decreased accuracy following vibration suggests that vibration altered proprioceptive inputs used to construct body schema, leading to inaccurate joint position sense and the observed changes in elbow repositioning accuracy.

Can the balance evaluation systems test be used to identify system-specific postural control impairments in older adults with chronic neck pain?

BACKGROUND

Older adults with chronic neck pain (CNP) demonstrate impaired postural control. The Balance Evaluation Systems Test (BESTest) is used to assess systems underlying postural control impairments, but its use in CNP has not been reported. This study assessed whether the BESTest can identify postural control impairments in CNP as well as the level of BESTest item difficulty by Rasch analysis.

MATERIALS AND METHODS

This cross-sectional study recruited thirty young adults (YOUNG) aged 20-40 years and eighty older adults aged 60 years or older [without neck pain (OLD) = 60, with chronic neck pain (CNP) = 20]. Questionnaires were administered to collect demographic data, intensity of neck pain (VAS), patient's self-rated neck pain and disability (NDI), and balance confidence in daily activities (ABC). The BESTest was used to assess postural control.

RESULTS

The CNP group showed the lowest ABC scores. Compared to the YOUNG group, the BESTest score was significantly lower in the OLD group, while the CNP group showed the lowest score, suggesting that balance control deteriorated from the normal aging process and further declined in the CNP group, especially in biomechanical constraints, transitions-anticipatory postural adjustment, and reactive postural response (p < 0.05). Using scores from these three sections, the BESTest was accurate at the cutoff score of 48.5 out of 51 for differentiating the older adults whose daily life are affected by neck problems (using the NDI as a reference) with a high AUC (0.79), sensitivity (72%), and specificity (69%). The Rasch analysis revealed that the Timed Up and Go with dual task test was the most difficult BESTest item for all groups, whereas 14 items showed more difficulty for the CNP group.

CONCLUSION

The BESTest can be used to identify postural control impairments in CNP patients, even those with moderate pain and mild disability with a high level of physical functioning. The combined score of biomechanical constraints, transitions-anticipatory postural adjustment, and reactive postural response domains was suggested for the detection of older adults whose daily lives are affected by neck problems. This will also help clinicians consider the management of neck pain to prevent falls in CNP.

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

BACKGROUND

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

OBJECTIVE

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

DESIGN

Cross-sectional.

METHOD

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

RESULTS

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

CONCLUSIONS

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

Clinical characteristics and diagnostic aspects of cervicogenic dizziness in patients with chronic dizziness: A cross-sectional study

BACKGROUND AND OBJECTIVES

Chronic dizziness can significantly affect quality of life, but identifying the underlying cause remains challenging. This study focuses on proprioceptive cervicogenic dizziness (CGD) and aims: (1) to compare clinical test results between patients with CGD, dizzy patients without CGD, and healthy controls; and (2) to evaluate the diagnostic value of the clinical tests for CGD in patients with chronic dizziness.

METHODS

Sixty patients with chronic dizziness (18 with CGD and 42 without CGD), and 43 healthy controls underwent clinical tests evaluating neck function (mobility, proprioception, muscle function and disability), balance control, and the presence of visually induced dizziness. Data were analysed through one-way ANOVA, chi-square, independent samples t-test, and logistic regression analyses.

RESULTS

Patients with CGD had significantly more neck pain-related disability (Neck Bournemouth questionnaire (NBQ), p = 0.006), but better static (Static Balance, p = 0.001) and dynamic balance (Tandem Gait, p = 0.049), compared to dizzy patients without CGD. Univariable analyses revealed that increased NBQ (OR 1.05 [1.01; 1.09], p = 0.017), Joint Position Error (JPE) _{after extension} (OR 1.52 [1.00; 2.32], p = 0.050), and Tandem Gait scores (OR 1.09 [1.01; 1.18], p = 0.046) were individually associated with higher odds of having CGD. Their optimal cut-off level (based on the maximum Youden index) had high sensitivity but low specificity for CGD. The multivariable model, including NBQ and Tandem Gait, had fair discriminative ability (AUC = 0.74, 95% CI [0.61; 0.87]).

CONCLUSION

The combined use of the NBQ and Tandem Gait tests had the highest discriminative ability to detect CGD in patients with chronic dizziness.

Know Your Movements: Poorer Proprioceptive Accuracy is Associated With Overprotective Avoidance Behavior

Pain-related avoidance of movements that are actually safe (ie, overprotective behavior) plays a key role in chronic pain disability. Avoidance is reinforced through operant learning: after learning that a certain movement elicits pain, movements that prevent pain are more likely to be performed. Proprioceptive accuracy importantly contributes to motor learning and memory. Interestingly, reduced accuracy has been documented in various chronic pain conditions, prompting the question whether this relates to avoidance becoming excessive. Using robotic arm-reaching movements, we tested the hypothesis that poor proprioceptive accuracy is associated with excessive pain-related avoidance in pain-free participants. Participants first performed a task to assess proprioceptive accuracy, followed by an operant avoidance training during which a pain stimulus was presented when they performed one movement trajectory, but not when they performed another trajectory. During a test phase, movements were no longer restricted to 2 trajectories, but participants were instructed to avoid pain. Unbeknownst to the participants, the pain stimulus was never presented during this phase. Results supported our hypothesis. Furthermore, exploratory analyses indicated a reduction in proprioceptive accuracy after avoidance learning, which was associated with excessive avoidance and higher trait fear of pain. PERSPECTIVE: This study is the first to show that poorer proprioceptive accuracy is associated with excessive pain-related avoidance. This finding is especially relevant for chronic pain conditions, as reduced accuracy has been documented in these populations, and points toward the need for research on training accuracy to tackle excessive avoidance.

Investigation of Joint Position Sense and Balance in Individuals With Chronic Idiopathic Neck Pain: A Cross-Sectional Study

OBJECTIVE

The aim of this study was to determine the relationship between joint position sense and static and dynamic balance in female patients with chronic neck pain compared with healthy controls.

METHODS

The study sample comprised 25 female patients with chronic neck pain and 25 healthy (asymptomatic) female controls. Pain severity with the visual analog scale, joint position sense with the laser pointer method, static balance with the Single-Leg Balance Test, and dynamic balance with the Y Balance Test were assessed.

RESULTS

The deviation in cervical joint position sense was greater in extension (P < .001), right rotation (P < .001), and left lateral rotation (P < .05) in the patients with chronic neck pain compared with the healthy controls. The results of the patients with chronic neck pain were worse than the healthy controls in the Single-Leg Balance Test with both eyes open (P < .05) and eyes closed (P < .05). The patients with chronic neck pain had worse dynamic balance only in the anterior direction reach of the left leg (P < .05).

CONCLUSION

Cervical joint position sense and static balance were worse in female patients with chronic idiopathic neck pain when compared with asymptomatic controls. Dynamic balance in all other directions except for the anterior direction was not negatively affected in individuals with chronic idiopathic neck pain.

Effects of clinical pilates exercises in patients with chronic nonspecific neck pain: a randomized clinical trial

BACKGROUND

Neck pain is a common musculoskeletal problem in adults. Clinical pilates exercises can be beneficial managing the pain and improving the risk factors.

AIMS

The aim of this study was to investigate the effects of clinical pilates exercises on pain and disability, deep neck flexor endurance (DNFE), posture, cervical range of motion (CROM), and proprioception in patients with chronic nonspecific neck pain.

METHODS

Fifty patients with chronic nonspecific neck pain were randomized into two groups. The clinical pilates exercise group (CPEG) received clinical pilates exercises for 6 weeks. The control group (CG) received posture education. Pain and disability, DNFE, forward head angle (FHA) and forward shoulder angle (FSA) degrees, CROM, and joint position error (JPE) were measured before and after 6 weeks.

RESULTS

Clinical pilates exercises improved pain, Neck Disability Index (NDI), DNFE, posture, CROM (except extension), and JPE (p < 0.05). We found significant differences between CPEG and CG in the comparisons for the change of pain, NDI, DNFE, FSA, CROM (except extension), and JPE (except left rotation) (p < 0.05). NDI, FSA, and rotational JPE also improved in CG (p < 0.05). However, these improvements were significantly better in CPEG than CG (p < 0.05) except JPE in left rotation (p = 0.118).

CONCLUSION

In patients with chronic nonspecific neck pain, clinical pilates exercise is a safe and effective method to improve pain and disability, DNFE, posture, ROM, and proprioception.

CLINICAL TRIAL REGISTRATION

NCT03782584 retrospectively registered December 20 2018.

Neck Pain: Do We Know Enough About the Sensorimotor Control System?

Neck pain is a worldwide health problem. Clarifying the etiology and providing effective interventions are challenging for the multifactorial nature of neck pain. As an essential component of cervical spine function, the sensorimotor control system has been extensively studied in both healthy and pathological conditions. Proprioceptive signals generated from cervical structures are crucial to normal cervical functions, and abnormal proprioception caused by neck pain leads to alterations in neural plasticity, cervical muscle recruitment and cervical kinematics. The long-term sensorimotor disturbance and maladaptive neural plasticity are supposed to contribute to the recurrence and chronicity of neck pain. Therefore, multiple clinical evaluations and treatments aiming at restoring the sensorimotor control system and neural plasticity have been proposed. This paper provides a short review on neck pain from perspectives of proprioception, sensorimotor control system, neural plasticity and potential interventions. Future research may need to clarify the molecular mechanism underlying proprioception and pain. The existing assessment methods of cervical proprioceptive impairment and corresponding treatments may need to be systematically reevaluated and standardized. Additionally, new precise motor parameters reflecting sensorimotor deficit and more effective interventions targeting the sensorimotor control system or neural plasticity are encouraged to be proposed.

Relationship between Cervicocephalic Kinesthetic Sensibility Measured during Dynamic Unpredictable Head Movements and Eye Movement Control or Postural Balance in Neck Pain Patients

Cervical afferent input is believed to affect postural balance and oculomotor control in neck pain patients, but its relationship to cervicocephalic kinesthesia, describing movement sense, has not yet been studied. The aim of this study was to analyze the relationship of two aspects of cervicocephalic kinesthesia to postural balance and oculomotor control in neck torsion positions. Forty-three idiopathic neck pain patients referred from orthopedic outpatient clinics and forty-two asymptomatic controls were enrolled in the study. A force plate was used to measure center-of-pressure movements during parallel stances under neutral and neck torsion maneuvers. Video-oculography was used to assess eye movements during smooth pursuit neck torsion test (SPNTT), while kinesthetic awareness was measured using the Butterfly test and head-to-neutral relocation test. Multiple regression was used to describe relationships between tests. Body sway in the anterior-posterior direction was related to Butterfly parameters but less to the head-to-neutral test. A medium relationship between Butterfly parameters and gain during SPNTT, with less SPNT-difference, was observed, but not for the head-to-neutral test. It can be concluded that specific aspect of neck kinesthetic functions (i.e., movement sense) importantly contributes towards oculomotor and balance control, which is more evident under neck torsion positions in neck pain patients, but is less pronounced in asymptomatic individuals.

Respiratory dysfunction in patients with chronic neck pain: systematic review and meta-analysis

PURPOSE

To determine the differences in respiratory muscle strength and pulmonary function between patients with chronic neck pain (CNP) and asymptomatic individuals.

METHODS

Databases were MEDLINE, CINAHL, Scopus, Web of Science and EMBASE up to the end of September 2021. Studies with cross-sectional and longitudinal design were selected, with adult patients with CNP and asymptomatic individuals with reports respiratory function.

RESULTS

11 studies met the inclusion criteria and 10 were included in the meta-analysis showing a statistically significant reduction in inspiratory/expiratory muscle strength (MIP/MEP) in the patients with CNP compared with the asymptomatic individuals (mean difference (MD) for MIP, -11.67 [-14.57 to -8.77]; MD for MEP, -11.80 [-14.99 to -8.60]) and pulmonary function: vital capacity (standardized mean difference (SMD), -0.31 [-0.56 to -0.06]); maximum voluntary ventilation (SMD, -0.36 [-0.59 to -0.14]); forced vital capacity (SMD, -0.53 [-0.99 to -0.06]); peak expiratory flow (SMD, -0.58 [-1.03 to -0.12]); and forced expiratory volume in the first second (SMD, -0.28 [-0.51 to -0.05]).

CONCLUSIONS

Patients with CNP have reduced respiratory muscle strength and pulmonary function compared with asymptomatic individuals, and this difference could be clinically meaningful. However, more studies of high methodological quality and longitudinal studies are needed to strengthen the results of this meta-analysis. IMPLICATIONS FOR REHABILITATIONRespiratory dysfunction has been observed in patients with chronic neck pain.Patients with chronic neck pain present a decrease in respiratory muscle strength and pulmonary function compared with asymptomatic individuals.Respiratory pattern disorders should be considered in the clinical context of chronic neck pain.Interventions focused on respiratory muscle training could be helpful for this population.

A network analysis reveals the interaction between fear and physical features in people with neck pain

Although neck pain is known to be a complex and multifactorial condition characterised by the interplay between physical and psychological domains, a comprehensive investigation examining the interactions across multiple features is still lacking. In this study, we aimed to unravel the structure of associations between physical measures of neuromuscular function and fear of movement in people with a history of neck pain. One hundred participants (mean age 33.3 ± 9.4) were assessed for this cross-sectional study, and the neuromuscular and kinematic features investigated were the range of motion, velocity of neck movement, smoothness of neck movement, neck proprioception (measured as the joint reposition error), and neck flexion and extension strength. The Tampa Scale for Kinesiophobia was used to assess fear of movement. A network analysis was conducted to estimate the associations across features, as well as the role of each feature in the network. The estimated network revealed that fear of movement and neuromuscular/kinematic features were conditionally dependent. Higher fear of movement was associated with a lower range of motion, velocity, smoothness of neck movement, neck muscle strength, and proprioception (partial correlations between − 0.05 and − 0.12). Strong interactions were also found between kinematics features, with partial correlations of 0.39 and 0.58 between the range of motion and velocity, and between velocity and smoothness, respectively. The velocity of neck movement was the most important feature in the network since it showed the highest strength value. Using a novel approach to analysis, this study revealed that fear of movement can be associated with a spectrum of neuromuscular/kinematic adaptations in people with a history of neck pain.

Reliability, Validity, and Responsiveness of the Craniocervical Flexion Test in People Who Are Asymptomatic and Patients With Nonspecific Neck Pain: A Systematic Review and Meta-Analysis

OBJECTIVE

Among the tests designed to evaluate neck neuromuscular function, the craniocervical flexion test (CCFT) assesses the function of the deep cervical flexor muscles (DCFs). The purpose of this study was to conduct a review and meta-analysis of published articles about all measurement properties of the different CCFT versions (CCFT Activation Score [CCFT-AS], CCFT Performance Index [CCFT-PI], CCFT Cumulative Performance Index [CCFT-CPI], and CCFT alternative procedures for measuring activation level (CCFT1) or endurance (CCFT2) in people who were asymptomatic and people with nonspecific neck pain.

METHODS

PubMed Central, MEDLINE, CINAHL, Scopus, Web of Science, and Google Scholar were searched from inception to June 30, 2020. Studies were selected if they reported data on reliability, validity, and/or responsiveness of the CCFT in adults who were asymptomatic or who had nonspecific neck pain. Two reviewers independently selected the studies, conducted quality assessment, and extracted the results. All meta-analyses used a random-effects model.

RESULTS

Twenty-one studies met the inclusion criteria. The rating of interrater reliability (assessed for CCFT-AS and CCFT-CPI) was positive only for using the test at a group level. The same rating was ascribed to the intrarater reliability of CCFT-AS, CCFT1, and CCFT2, whereas CCFT-PI and CCFT-CPI showed positive intrarater reliability for assessment of individuals as well. CCFT validity was rated as positive for expressly assessing DCF action when measuring DCF activation through electromyography-not through ultrasonography-or craniocervical flexion motion as well as for differentiating patients who were asymptomatic and patients who had nonspecific neck pain (only the AS version). CCFT validity was rated as negative for investigating the CCFT performance correlation with the severity of nonspecific neck pain. CCFT responsiveness was rated as negative.

CONCLUSIONS

The CCFT is a potentially useful tool for detecting impairment in DCF control and identifying patients who have nonspecific neck pain and who would benefit from a targeted intervention. However, the limited reliability affects its suitability for that purpose. Further research on the reliability of different CCFT versions in which the raters are thoroughly trained is strongly recommended.

IMPACT

The CCFT might help to detect impairment in DCF control and identify patients who have nonspecific neck pain and who would benefit from a targeted intervention. However, the poor reliability of most versions of the test greatly limits its application in clinical practice. Only CCFT-PI and CCFT-CPI seem reliable enough to help in clinical decision-making at the individual level.