Measures of upper limb function for people with neck pain. A systematic review of measurement and practical properties

Construct validity of the Single Arm Military Press (SAMP) test for upper limb function in patients with neck pain

BACKGROUND

Neck pain (NP) is often associated with upper limb disability (ULD). A clinically feasible measure to evaluate ULD in NP patients is necessary. The Single Arm Military Press (SAMP) is a ULD performance-based measure, specifically for NP patients. The validity of the SAMP in patients is still unknown.

OBJECTIVE

To explore the construct validity (hypotheses testing) of the SAMP in NP patients.

METHODS

A total of 210 NP patients and 81 controls were recruited. The SAMP; Disability of the Arm, Shoulder, and Hand (DASH); and Neck Disability Index (NDI) were completed at baseline and 4-7 days later. The Visual Analogue Scale (VAS) was used to measure NP and ULD severity pre-testing in both occasions. Patients were divided into 4-subgroups based on their NDI score. Convergent validity was examined using Pearson correlation. The t-test and analysis of variance (ANOVA) were used to evaluate discriminant and known groups' validity. To determine SAMP cut-off scores, the sensitivity and specificity were explored.

RESULTS

A negative correlation between the SAMP and DASH/NDI scores was found in the patient group (r = -0.91 and -0.87, p < 0.01). The t-test revealed substantial differences (t = -23.96) in score between patients and controls. Also, ANOVA revealed substantial differences (f = 20.86) between the patients' subgroups. The area under the curve (AUC) for patients and controls exceeded 0.90 when sensitivity and specificity were at equal importance.

CONCLUSION

The SAMP can distinguish between NP patients and controls, and between different NP disability levels. The responsiveness of the SAMP needs to be investigated.

Content and psychometric evaluations of questionnaires for assessing physical function in people with arm-shoulder-hand disorders. A systematic review of the literature

PURPOSE

The aim was to investigate how structured assessment of physical function can be performed in people with musculoskeletal disorders in arm-shoulder-hand. Specifically, we aimed to determine:• Which questionnaires are available for structured assessment of physical function in people with musculoskeletal disorders in arm-shoulder-hand?• What aspects of physical function do those questionnaires measure?• What are the psychometric properties of the questionnaires?

MATERIALS AND METHODS

By means of a systematic review, questionnaires and psychometric tests of those were identified. ICF was used to categorise the content of the questionnaires, and the COSMIN checklist was used to assess the psychometric evaluations.

RESULTS

Nine questionnaires were identified. Most items focused on activities rather than functions. Commonly, a couple of psychometric measurements had been tested, most often reported being adequate. Only one questionnaire had been tested for all aspects. Variation in scope and insufficient reports regarding validity and reliability make comparisons and decisions on use difficult both in clinical practice and for research purposes.

CONCLUSIONS

The level of psychometric evaluation differs, and often only a few aspects of validity and reliability have been tested. The questionnaires address activity issues to a higher extent than function.IMPLICATIONS FOR REHABILITATIONThis review investigates the content and quality of nine ASH questionnaires.The questionnaires addressed activity issues to a higher extent than function.The level of psychometric testing of the questionnaires differed.DASH, Quick-DASH, and SPADI were the questionnaires that were most often evaluated with various psychometric tests, and with adequate results.

Convergent Validity and Test-Retest Reliability of the Unsupported Upper Limb Exercise Test in Patients with Chronic Neck Pain

Chronic neck pain (CNP) causes decreased functionality of the upper extremity. A standardized measurement tool is needed for evaluating upper limb capacity in patients with CNP. The unsupported upper-limb exercise test (UULEX) is a simple, inexpensive field test developed to measure peak arm exercise capacity, but there has been no report of its validity and reliability for use with patients with CNP. Our aim in this study was to determine the validity and test-retest reliability of the UULEX for this purpose. In this cross-sectional observational study, 44 patients (33 women, 11 men; M age = 37.7, SD = 13.2 years), performed the UULEX twice, within a 1-week interval for test-retest reliability as measured by the intraclass correlation coefficient (ICC). We correlated the UULEX with the Six Minute Pegboard Ring Test (6PBRT), the 30-second Push-Up Test, and the Disability of Arm, Shoulder, and Hand Questionnaire (DASH) to assess its convergent validity. The UULEX demonstrated excellent test-retest reliability with ICC = 0.97 and 0.95 for test duration and the final weight on board, respectively. We found moderate to strong correlations between the UULEX and the 6PBRT (r = 0.844), the 30-second Push Up Test (r = 0.741) and the DASH (r = -0.639), and all were significant, (p < 0.05). MDC values were determined to be 57.7 seconds for test duration and 0.22 kg for final weight on board. Thus, the UULEX test was valid and reliable for assessing upper extremity functional capacity in patients with CNP.

Profiling and Association over Time between Disability and Pain Features in Patients with Chronic Nonspecific Neck Pain: A Longitudinal Study

OBJECTIVES

To longitudinally investigate the relationships between neck/arm disability and pain profile measures in individuals with chronic nonspecific neck pain (NSNP) at baseline, one month, and six months after a standardized physiotherapy intervention. A secondary aim was to compare pain sensitivity of individuals with chronic NSNP at baseline to healthy controls.

METHODS

A total of sixty-eight individuals with chronic NSNP and healthy controls were recruited. Neck disability index (NDI), the 11-item disabilities of the arm, shoulder, and hand questionnaire (QuickDASH), temporal summation (TS), pressure pain thresholds (PPTs), pain intensity and pain extent were assessed in individuals with chronic NSNP. For the cross-sectional assessment, TS and PPTs were compared to healthy controls.

RESULTS

After following a standardized physiotherapy intervention, local and distal PPTs to the neck region decreased at one and six month follow-ups, respectively. Pain extent decreased at one and six months. Furthermore, a positive correlation between neck/arm disability and pain intensity was found at baseline, whereas moderate positive correlations (e.g., between NDI and pain extent) at baseline, one and six month follow-ups and negative correlations at six months (e.g., between arm disability and PPTs) were found.

DISCUSSION

Overall, these findings indicate that pain sensitivity can worsen following treatment despite reduced pain extent and unchanged neck disability and pain intensity scores over a six-month period in individuals with chronic NSNP.

Translation, cross-cultural adaptation and validation of the Upper Limb Functional Index (ULFI) into Brazilian Portuguese in patients with chronic upper limb musculoskeletal disorders

OBJECTIVE

The purpose of this study was to translate, cross-culturally adapt, and validate the Upper Limb Functional Index (ULFI) into Brazilian Portuguese (ULFI-Br).

METHODS

The translation and cross-cultural adaptation of the ULFI was performed according to international recommendations. The ULFI-Br was applied to 190 patients with chronic upper limb musculoskeletal disorders to verify structural validity. The QuickDASH, the SF-36 and a Numerical Pain Scale (NPS) were completed by 180 patients to assess construct validity using the Spearman correlation (ρ). The internal structure of the ULFI-Br was evaluated by exploratory and confirmatory factor analysis with fit indices chi-square/degrees of freedom (DF), Root Mean Square Error of Approximation (RMSEA), Comparative Fit Index (CFI) and Tucker Lewis Index (TLI). A subsample of 51 patients was used to assess test-retest reliability using the intra-class correlation coefficient (ICC), standard error of measurement (SEM) and minimum detectable change at the 90th percentile (MDC₉₀). Internal consistency was assessed by Cronbach's alpha (α). Floor and ceiling effects were also assessed.

RESULTS

Factor analysis identified an uni-dimensional structure with acceptable fit indices (RMSEA = 0.063, CFI = 0.918, TLI = 0.910). The ULFI-Br showed excellent reliability (ICC = 0.909) and adequate internal consistency (α = 0.897). The SEM was 6.11% and the MDC₉₀ was 14.26%. The ULFI-Br demonstrated high correlation with the QuickDASH (ρ = -0.721), and moderate to low correlation with other questionnaires. There were no floor or ceiling effects.

CONCLUSION

The ULFI-Br showed adequate measurement properties in patients with chronic upper limb musculoskeletal disorders indicating its suitability for use as a measure of upper limb functional status in Brazil.

Interrater and intrarater reliability of the single arm military press (SAMP) test for upper limb function in patients with non-specific neck pain

BACKGROUND

Performance measures that assess the upper limb disability (ULD) in patients with neck pain can provide useful information for making clinical decisions regarding the optimal management of those patients. The Single Arm Military Press (SAMP) test is a performance based ULD measure developed specifically for populations with neck pain. In this test, patients are asked to lift a 1 kg weight repetitively overhead for 30 s with repetitions counting as the score. Whilst the test has been shown to be acceptable and feasible for use by clinicians and patients, its reliability in a patient group is still unknown.

OBJECTIVE

To assess the interrater, intrarater reliability and measurement error of the SAMP test in patients with non-specific neck pain (NSNP).

METHODS

A total of 210 patients with NSNP and 81 healthy subjects were recruited for this study. The Disabilities of the Arm, Shoulder and Hand (DASH) and the Neck Disability Index (NDI) were assessed at baseline to ensure eligibility of the participants. The SAMP test was assessed at baseline and repeated 4-7 days later. A VAS symptom score was used to establish the stability of the participants across time. Interrater, intrarater reliability and measurement error were evaluated using Interclass Correlation Coefficient (ICC2,1) and the standard error of measurement (SEM).

RESULTS

The ICCs for interrater and intrarater reliability for the SAMP test ranged from 0.993 to 0.996 in the patient group. The SEM was ≤1 and smaller than the Smallest Detectable Change (SDC) and Bland-Altman plot indicated that the test is accurate.

CONCLUSION

The almost perfect interrater and intrarater reliability and low levels of measurement error indicate that the 1 kg SAMP test has potential for evaluating upper limb functional capacity in female patients with NSNP. Before the test can be fully recommended, further studies are required to evaluate the validity and responsiveness of the SAMP test in population with NSNP and other neck disorders.

Utilisation of outcome measures in the management of non-specific neck pain: A national survey of current physiotherapy practice in the UK

BACKGROUND

Routine utilisation of outcome measures (OMs) is an integral part of physiotherapy rehabilitation when managing non-specific neck pain (NSNP). Numerous relevant OMs exist; however, the extent to which OMs are used by physiotherapists in the UK for NSNP is unknown.

OBJECTIVE

To determine current utilisation patterns of OMs in UK physiotherapy practice when managing NSNP.

METHODS

An online web-based survey instrument was developed and physiotherapists were invited to participate if they were currently practicing in the UK and had some experience of managing patients with neck pain. Logistic regression analyses using the generalised linear models was carried out to identify characteristics associated with OMs utilisation.

RESULTS

A total of 2101 surveys were completed. One-third of the respondents reported not using OMs when managing NSNP. Lack of time and clear guidance about the suitability of available OMs were the most commonly reported reasons. A majority of the two-thirds of those who reported using OMs were consistently using pain and range of motion rating measures. Physical/functional limitations, psychological distress, and quality of life constructs, which are frequently associated with NSNP, were rarely measured. Years of practice (p = 0.000), nation (p = 0.019) and proportion of patients with neck pain (p = 0.034) variables were found to be independently associated with frequent use of OMs.

CONCLUSION

This survey established the poor integration of OMs in the UK when managing NSNP. Further attention is required to identify or develop OMs which are feasible for use in busy clinical practice and to market them more effectively to physiotherapists.

Reliability and validity of the Upper Limb Functional Test (ULIFT) for women after breast cancer surgery

PURPOSE

To evaluate the reliability and convergent validity of the Upper Limb Functional Test (ULIFT) in women after breast cancer surgery.

MATERIALS AND METHODS

A cross-sectional study with 25 women (mean age 50 ± 7.3 years) with breast cancer submitted to a surgery intervention within a minimum period of three years. Intraclass correlation coefficients (ICCs) were calculated to assess the test-retest reliability. A Bland-Altman plot examined the agreement between the times to complete two tests. Validity was established by correlating the ULIFT and DASH total score. The receiver operating characteristic (ROC) curve was used to determine the cut-off point for ULIFT in order to discriminate patients with some level of upper limb dysfunction.

RESULTS

The ULIFT showed high reproducibility (ICC = 0.89; p < 0.001), learning effect of 7.21%, and a moderate correlation with the DASH total score (r = 0.536; R² = 0.28; p = 0.006). The standard error of measurement was 6.9 s and the smallest real difference was 19.1 s. The ROC curve indicated a cut-off point of 109.2 s (sensitivity = 68.7%; specificity = 77.8%; area under ROC curve = 0.77).

CONCLUSIONS

The ULIFT could be a valid and reliable test to assess upper limb functionality in patients submitted to breast cancer surgery.Implications for rehabilitationThe ULIFT is a reliable and valid test to assess upper limb function in women after breast cancer surgery, considering specifically the lifting and range of motion construct of unilateral upper limb function.The ULIFT could help identify those most at risk of developing upper limb dysfunction after breast cancer surgery and could benefit the follow-up of a postoperative rehabilitation program.Two ULIFTs should be performed in order to achieve patient's best performance.

Measuring upper limb disability for patients with neck pain: Evaluation of the feasibility of the single arm military press (SAMP) test

BACKGROUND

Non-specific neck pain (NSNP) is frequently associated with upper limb disability (ULD). Consequently, evaluation of ULD using an outcome measure is necessary during the management of patients with NSNP. The Single Arm Military Press (SAMP) test is a performance-based ULD measure developed for populations with neck pain. During the SAMP test, patients are asked to repeatedly lift a weight above their head for 30 s. The number of repetitions is counted. Its clinical utility in a patient group is still unknown.

OBJECTIVE

This study investigates the feasibility of the SAMP test from patients and clinicians' perspectives.

METHODS

Seventy female patients with NSNP were randomly allocated into one of three groups. Participants in each group completed the SAMP test using one of three proposed weights (½kg, 1 kg or 1½kg). The feasibility of the SAMP test was established using structured qualitative exit feedback interviews for patients and administrating clinicians.

RESULTS

Participants using ½kg achieved the highest number of repetitions, but a high proportion reported the weight as extremely light, whereas those who tested using the 1½kg achieved the lowest number of repetitions and participants reported the weight as being heavy. Participants tested using 1 kg achieved an average number of repetitions and a high proportion reported the weight as acceptably heavy. Clinicians and patients reported that the SAMP test was efficient and convenient.

CONCLUSION

The 1 kg SAMP test is feasible for use in female patients with NSNP. The measurement properties of the SAMP test should be determined in a patient group.

Preseason Neck Mobility Is Associated With Throwing-Related Shoulder and Elbow Injuries, Pain, and Disability in College Baseball Pitchers

Background

Shoulder and elbow injuries in baseball pitchers, which can lead to significant pain and disability, have been on the rise at all levels of play for 3 decades. Despite anatomic and neurophysiological relationships, neck mobility has not been explored as a contributor to shoulder and elbow injuries in baseball pitchers.

Hypothesis

Impaired neck mobility will increase the risk of shoulder and elbow injuries in college baseball pitchers.

Study Design

Cohort study; Level of evidence, 2.

Methods

Posture, neck mobility, and shoulder passive range of motion were measured in healthy college baseball pitchers during the 2018 preseason. Time loss (days lost because of shoulder or elbow injuries) and patient-reported disability via Functional Arm Scale for Throwers (FAST) scores were used to dichotomize pitchers into injured and uninjured groups. Receiver operating characteristic curves were generated, and accuracy values and risk ratios (RRs) were calculated to assess the diagnostic utility of the physical measures. Time-to-injury analysis was conducted to assess the timing of injuries.

Results

A total of 49 pitchers (mean age, 19.92 ± 1.48 years; mean height, 187.04 ± 6.02 cm; mean weight, 89.14 ± 12.08 kg) completed the study. There were 10 pitchers (20.4%) who sustained a time-loss injury >7 days because of a shoulder or elbow injury. A Cervical Flexion-Rotation Test (CFRT) finding on the dominant side of ≤39° resulted in over 9 times the increased risk of time-loss injuries (RR, 9.38 [95% CI, 1.28-68.49]). Time-to-injury analysis demonstrated differences between the 2 groups (χ² = 7.667; P = .01). Pitchers with a >39.25° finding on the CFRT played a mean 109.4 of 112 days (95% CI, 105-114) before the injury, while pitchers with ≤39.25° only played 83.6 of 112 days (95% CI, 68-99). A CFRT finding of ≤38° (RR, 3.91 [95% CI, 1.23-12.39]), cervical flexion range of motion of ≤64° (RR, 10.56 [95% CI, 1.50-74.34]), and weight of >86.9 kg (RR, 10.42 [95% CI, 1.14-213.70]) were also associated with an increased risk of patient-reported pain and disability on the FAST pitcher module.

Conclusion

College baseball pitchers with less neck mobility during the preseason had an increased risk of time loss and shoulder and elbow disability during the season. The predictive value of these measures as part of a risk screening profile should be further explored.

Systematic review of the measurement properties of performance-based functional tests in patients with neck disorders

OBJECTIVES

The purpose of this systematic review is to identify and synthesise studies evaluating performance-based functional outcome measures designed to evaluate the functional abilities of patients with neck pain.

DESIGN

Systematic review.

DATA SOURCES

A literature search using PubMed, Scopus, CINAHL, EMBASE, COCHRANE, Google Scholar and a citation mapping strategy was conducted until July 2019.

ELIGIBILITY CRITERIA

More than half of the study's patient population had neck pain or a musculoskeletal neck disorder and completed a functional-based test. Clinimetric properties of at least one performance-based functional tests were reported. Both traumatic and non-traumatic origins of neck pain were considered.

DATA EXTRACTION AND SYNTHESIS

Relevant data were then extracted from selected articles using an extraction guide. Selected articles were appraised using the Quality Appraisal for Clinical Measurement Research Reports Evaluation Form (QACMRR).

RESULTS

The search obtained 12 articles which reported on four outcome measures (functional capacity evaluations (FCE), Baltimore Therapeutic Equipment Work Simulator II (BTEWS II), Functional Impairment Test-Hand and Neck/Shoulder/Arm (FIT-HaNSA)) and a physiotherapy test package, to assess the functional abilities in patients with mechanical neck pain. Of the selected papers: one reports content validity, five construct validity, four reliability, one sensitivity to change and one both reliability and construct validity. QACMRR scores ranged from 68% to 95%.

CONCLUSIONS

This review found very good quality evidence that the FIT-HaNSA has excellent inter and intra-rater reliability and very weak to weak convergent validity. Excellent quality evidence of fair test-retest reliability, weak convergent validity and very weak known groups validity for the BTEWS II test was found. Good to excellent quality evidence exists that an FCE battery has poor to excellent reliability and very weak to strong validity. Good to excellent quality of weak to strong validity and trivial to strong effect sizes were found for a physiotherapy test package.

PROSPERO REGISTRATION NUMBER

CRD42018112358.

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

BACKGROUND

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSION

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