Patient-reported outcomes measured with and without dizziness associated with non-specific chronic neck pain: implications for primary care

Are the Cross-Culturally Adapted Versions of the Tampa Scale for Kinesiophobia 11-Item Valid, Reliable, and Responsive? A COSMIN-Informed Systematic Review of Measurement Properties

Numerous cultural adaptations of the Tampa Scale of Kinesiophobia 11-item version (TSK-11) scale have emerged since the original version was introduced. We conducted a (COnsensus-based Standards for the selection of health Measurement INstruments) COSMIN-informed systematic review of measurement properties to identify the cross-cultural adaptation of the TSK-11 and report, critically appraise, and systematize its measurement properties. Six databases were searched for studies published since 2005. Studies reporting on the measurement properties of culturally adapted versions of the TSK-11, published in English, Portuguese, and Spanish, were considered for inclusion. The results were synthesized by measurement properties and rated against the COSMIN criteria for good measurement properties. The quality of the evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation approach and presented in a summary of findings table. Twenty-three studies were included, and cultural adaptations for 15 languages were identified: English, Chinese, Cantonese, Swedish, German, Dutch, Arabic, Turkish, Danish, Spanish, Japanese, Brazilian Portuguese, Marathi, Thai, and Persian. There is "high" certainty in the evidence for "sufficient" criterion validity (TSK-17, r = .84) and "insufficient" measurement error (small detectable change range 5.6-6.16). "Moderate" certainty in the evidence for "sufficient" construct validity (87.8% of hypotheses confirmed), test-retest reliability (intraclass correlation coefficient2,1 = .747-.87), and "low" certainty in evidence for "sufficient" responsiveness. The numerous sources of heterogeneity prevent conclusions from being drawn regarding structural validity. Measurement error, responsiveness, and structural validity of the TSK-11 require further investigation. Clinicians should complement the use of TSK-11 with other instruments. Future studies on the structural validity of the questionnaire should standardize the data analysis methods. PERSPECTIVE: This article presents the measurement properties of the cross-cultural adaptations of the TSK-11. Clinicians should be aware that cultural and clinical aspects may influence the structural validity of the questionnaire. Using the TSK-11 as a stand-alone instrument may omit relevant clinical progression in the patient's condition.

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.

Proprioceptive Cervicogenic Dizziness Care Trajectories in Patient Subpopulations: A Scoping Review

Proprioceptive cervicogenic dizziness (PCGD) is the most prevalent subcategory of cervicogenic dizziness. There is considerable confusion regarding this clinical syndrome's differential diagnosis, evaluation, and treatment strategy. Our objectives were to conduct a systematic search to map out characteristics of the literature and of potential subpopulations of PCGD, and to classify accordingly the knowledge contained in the literature regarding interventions, outcomes and diagnosis. A Joanna Briggs Institute methodology-informed scoping review of the French, English, Spanish, Portuguese and Italian literature from January 2000 to June 2021 was undertaken on PsycInfo, Medline (Ovid), Embase (Ovid), All EBM Reviews (Ovid), CINAHL (Ebsco), Web of Science and Scopus databases. All pertinent randomized control trials, case studies, literature reviews, meta-analyses, and observational studies were retrieved. Evidence-charting methods were executed by two independent researchers at each stage of the scoping review. The search yielded 156 articles. Based on the potential etiology of the clinical syndrome, the analysis identified four main subpopulations of PCGD: chronic cervicalgia, traumatic, degenerative cervical disease, and occupational. The three most commonly occurring differential diagnosis categories are central causes, benign paroxysmal positional vertigo and otologic pathologies. The four most cited measures of change were the dizziness handicap inventory, visual analog scale for neck pain, cervical range of motion, and posturography. Across subpopulations, exercise therapy and manual therapy are the most commonly encountered interventions in the literature. PCGD patients have heterogeneous etiologies which can impact their care trajectory. Adapted care trajectories should be used for the different subpopulations by optimizing differential diagnosis, treatment, and evaluation of outcomes.