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Reliability and Validity of A Novel Device for Evaluating the Cervical Proprioception. Pain Ther 2023; 12:671-682. [PMID: 36867364 PMCID: PMC10199988 DOI: 10.1007/s40122-023-00487-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 02/06/2023] [Indexed: 03/04/2023] Open
Abstract
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).
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Du LB, Wang Y, Wu J, Zhu J, Wang Z, Zhang L, Liu P. Head-Cervical Spine Motion Measurement in Healthy Population: Comparison of CROM Apparatus and "G-Plus" APP on iPhone. World Neurosurg 2023; 173:e442-e451. [PMID: 36822403 DOI: 10.1016/j.wneu.2023.02.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 02/15/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Assessment of head-cervical spine motion (HCSM) is a vital index of functional evaluation for cervical surgery, but there is a lack of HCSM datasets in the healthy population and no suitable tools to measure HCSM in clinical practice. The objectives of this study were to obtain the normal values of HCSM in a healthy population, test the reliability and validity of an APP "G-Plus," and analyze related influencing factors of HCSM. METHODS We measured HCSM in 6 directions of 500 healthy people with a CROM apparatus and "G-Plus." The intraclass correlation coefficient (ICC) was used to test the reliability of "G-Plus." The validity of "G-Plus" measurements as compared with the CROM apparatus was tested by Bland-Altman statistics. We used multiple linear regression analysis to test the correlation among age, gender, body mass index (BMI), neck configuration (ratio of cervical circumference to cervical length), and HCSM. RESULTS Excellent interrater and intrarater reliability were demonstrated for CROM (ICC:0.929-0.993) and "G-Plus" (ICC: 0.898-0.991). Bland-Altman plots demonstrated an acceptable agreement between CROM and "G-Plus." Age was negatively correlated with HCSM. HCSM in females was superior to males except for flexion. Neck configuration affected HCSM in the direction of extension, right lateral flexion, and left and right rotation. BMI was correlated with flexion and extension. CONCLUSIONS "G-Plus" is a reliable and convenient tool for HCSM measurement in clinical practice. The presentation of datasets of HCSM in healthy population provides a basic reference for cervical function assessment. Age, gender, BMI, and neck configuration are significantly correlated to HCSM.
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Affiliation(s)
- Long-Bin Du
- Division of Spine Surgery, Department of Orthopedics, Daping Hospital of Army Medical University, Chongqing, China
| | - Yu Wang
- Division of Spine Surgery, Department of Orthopedics, Daping Hospital of Army Medical University, Chongqing, China
| | - Jian Wu
- Division of Spine Surgery, Department of Orthopedics, Daping Hospital of Army Medical University, Chongqing, China
| | - Jun Zhu
- Division of Spine Surgery, Department of Orthopedics, Daping Hospital of Army Medical University, Chongqing, China
| | - Zhong Wang
- Division of Spine Surgery, Department of Orthopedics, Daping Hospital of Army Medical University, Chongqing, China
| | - Liang Zhang
- Division of Spine Surgery, Department of Orthopedics, Daping Hospital of Army Medical University, Chongqing, China
| | - Peng Liu
- Division of Spine Surgery, Department of Orthopedics, Daping Hospital of Army Medical University, Chongqing, China; State Key Laboratory of Trauma: Burns & Combined Wound, Institute for Traffic Medicine of Army Medical University, Chongqing, China.
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Khan AR, Aafreen, Khan A, Ahmed H, Shaphe MA, Qasheesh M. Test–retest reliability and validity of cervical range of motion measurement using a smartphone clinometer and compass application among individuals with and without neck pain. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2023. [DOI: 10.12968/ijtr.2022.0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Background/Aims Cervical disorders are major health problems in our society and an important source of disability. Assessing range of motion is a significant part of the physical therapist’s role when evaluating a patient presenting with cervical disorders. The purpose of this study was to evaluate the intrarater relibility as well as the criterion validity of two phone applications (clinometer and compass) when assessing the cervical range of motion among individuals with and without neck pain. Methods In total, 80 participants were included in this study and split into two groups. Group A comprised 40 participants (18 women and 22 men) without neck pain. Group B included 40 participants (26 women and 14 men) with neck pain (mean pain rating on visual analogue scale 3.76 ± 0.93). Cervical range of motion was measured with the clinometer application (flexion, extension, right and left lateral flexion) and compass application (right and left rotation). The readings were compared with a universal goniometer. Estimates of reliability and validity were then established using the intraclass correlation coefficient, standard error of measurement and minimum detectable change. Results The smartphone applications had good intrarater reliability when compared to a universal goniometer, showing good to excellent validity (intraclass correlation coefficient >0.65) for all six cervical ranges of motion in participants with and without neck pain. Conclusions The smartphone clinometer application was found to be valid and reliable in measuring frontal and sagittal cervical ranges of motion in participants with and without neck pain. The compass application was found to be valid and reliable when assessing the horizontal cervical range of motion in a seated position. The applications will benefit physiotherapists when assessing cervical range of motion.
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Affiliation(s)
| | - Aafreen
- Department of Physiotherapy, Integral University, Lucknow, India
| | - Ashfaque Khan
- Department of Physiotherapy, Integral University, Lucknow, India
| | - Hashim Ahmed
- Department of Medical Rehabilitation Science, College of Applied Medical Science, Najran University, Najran, Saudi Arabia
| | - Mohammad Abu Shaphe
- Department of Physical Therapy, College of Applied Medical Science, Jazan University, Jazan, Saudi Arabia
| | - Mohammed Qasheesh
- Department of Physical Therapy, College of Applied Medical Science, Jazan University, Jazan, Saudi Arabia
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Reddy RS, Alahmari KA, Samuel PS, Tedla JS, Kakaraparthi VN, Rengaramanujam K. Intra-rater and inter-rater reliability of neutral and target lumbar positioning tests in subjects with and without non-specific lower back pain. J Back Musculoskelet Rehabil 2021; 34:289-299. [PMID: 33285625 DOI: 10.3233/bmr-200010] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Proprioception, one's sense of movement and position, is a common term used in back rehabilitation. Kinesthetic rehabilitation may be useful in managing lower back pain; however, reliable measures are required to quantify lumbar proprioception sense. OBJECTIVE To investigate intrarater and interrater reliability of neutral lumbar positioning (NLP) and target lumbar positioning (TLP) tests and compare the position sense errors in subjects with non-specific low back pain and healthy controls. METHODS Intrarater (between-day) and interrater (within-day) reliability of NLP and TLP tests were assessed in 30 subjects with low back pain and 30 healthy subjects using a digital inclinometer. NLP is evaluated when the subject is repositioned to neutral from flexion, while TLP is evaluated in lumbar flexion, by bending laterally left and right. RESULTS Intrarater reliability for NLP tests had ICC values of 0.85 and 0.89 and TLP tests had 0.78 and 0.92. Likewise, interrater reliability for NLP had ICC values of 0.75 and 0.85, and for the TLP test, the interrater reliability had 0.78 and 0.93. Subjects with back pain had significantly larger neutral and target lumbar proprioceptive errors compared to healthy controls (p< 0.001). CONCLUSIONS Intrarater and interrater reliability showed good agreement for both NLP and TLP tests of lumbar proprioception. Subjects with nonspecific low back pain have impaired lumbar proprioceptive sense.
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Artificial intelligence prediction of the effect of rehabilitation in whiplash associated disorder. PLoS One 2020; 15:e0243816. [PMID: 33332408 PMCID: PMC7746175 DOI: 10.1371/journal.pone.0243816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 11/18/2020] [Indexed: 12/29/2022] Open
Abstract
The active cervical range of motion (aROM) is assessed by clinicians to inform their decision-making. Even with the ability of neck motion to discriminate injured from non-injured subjects, the mechanisms to explain recovery or persistence of WAD remain unclear. There are few studies of ROM examinations with precision tools using kinematics as predictive factors of recovery rate. The present paper will evaluate the performance of an artificial neural network (ANN) using kinematic variables to predict the overall change of aROM after a period of rehabilitation in WAD patients. To achieve this goal the neck kinematics of a cohort of 1082 WAD patients (55.1% females), with mean age 37.68 (SD 12.88) years old, from across Spain were used. Prediction variables were the kinematics recorded by the EBI® 5 in routine biomechanical assessments of these patients. These include normalized ROM, speed to peak and ROM coefficient of variation. The improvement of aROM was represented by the Neck Functional Holistic Analysis Score (NFHAS). A supervised multi-layer feed-forward ANN was created to predict the change in NFHAS. The selected architecture of the ANN showed a mean squared error of 308.07–272.75 confidence interval for a 95% in the Monte Carlo cross validation. The performance of the ANN was tested with a subsample of patients not used in the training. This comparison resulted in a medium correlation with R = 0.5. The trained neural network to predict the expected difference in NFHAS between baseline and follow up showed modest results. While the overall performance is moderately correlated, the error of this prediction is still too large to use the method in clinical practice. The addition of other clinically relevant factors could further improve prediction performance.
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van der Burg SJ, Pouw MH, Brink M, Dekker H, Kunst HPM, Hosman AJF. Clinical relevance of occipital condyle fractures. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2020; 11:173-179. [PMID: 33100766 PMCID: PMC7546049 DOI: 10.4103/jcvjs.jcvjs_100_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 07/09/2020] [Indexed: 12/02/2022] Open
Abstract
Context: No consensus about classification, treatment, and clinical relevance of occipital condyle fractures (OCFs) exists. Aims: The aim of the study was to determine radiological, clinical, and functional outcome of OCFs and thereby determine its clinical relevance. Settings and Design: This was a retrospective analysis of a prospective follow-up study. Materials and Methods: From May 2005 to May 2008, all OCFs were included from a Level-1 trauma center. Patient files were reviewed for patient and fracture characteristics. Fracture classification was done according to the Anderson criteria. Clinical outcome was assessed by completing two questionnaires, radiological outcome by computed tomography imaging, and functional outcome by measuring active cervical range of motion using a Cybex EDI-320. Statistical Analysis Used: A Fisher's exact Test was used in categorical variables and a one-sample t-test for comparing means of active cervical range of motion in occipital fracture patients with normal values. An independent samples t-test was carried out to compare the means of groups with and without accompanying cervical fractures for each motion. Results: Thirty-nine patients were included (4 type I, 16 type II, and 19 type III). Twenty-seven patients completed follow-up, of whom 26 were treated conservatively. Fracture healing was established in 25 of 28 fractures at a median follow-up of 19 months. Eleven patients had none to minimal pain or disability at follow-up, 12 had mild, and two had moderate pain or disability on questionnaires. No statistically significant difference in active cervical range of motion was identified comparing means stratified for accompanying cervical fractures. Conclusions: Conservatively treated patients with an OCF generally show favorable radiological and clinical outcome.
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Affiliation(s)
- Stijn J van der Burg
- Department of Orthopaedic Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | - Martin H Pouw
- Department of Orthopaedic Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | - Monique Brink
- Department of Medical Imaging, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | - Helena Dekker
- Department of Medical Imaging, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | - Henricus P M Kunst
- Department of Otorhinolaryngology, Radboud University Nijmegen Medical Centre, Nijmegen.,Department of Otorhinolaryngology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Allard J F Hosman
- Department of Orthopaedic Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
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Takatalo J, Ylinen J, Pienimäki T, Häkkinen A. Intra- and inter-rater reliability of thoracic spine mobility and posture assessments in subjects with thoracic spine pain. BMC Musculoskelet Disord 2020; 21:529. [PMID: 32778081 PMCID: PMC7418198 DOI: 10.1186/s12891-020-03551-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 07/31/2020] [Indexed: 11/17/2022] Open
Abstract
Background The thoracic spine (TS) has been neglected in the study of the spine despite its essential role in the stability and posture of the entire spinal complex. Therefore, there is an inevitable need to investigate the reproducibility of different thoracic spinal posture measures used in subjects with TS pain. Methods Thirty-two subjects (16 females and 16 males, mean age 39 years) were evaluated by two physiotherapists on the same day to gauge inter-rater reliability and on two consecutive days to gauge intra-rater reliability. TS posture was assessed by observation, and thoracic spine mobility was measured by manual assessment of segmental flexion and extension mobility in a seated position. Additionally, posterior-to-anterior accessory mobility in a prone position was assessed manually. Moreover, cervicothoracic flexion in a seated position, thoracic posture, and thoracic flexion and extension mobility in a standing position were assessed with a tape measure, and flexion and extension mobility in a seated position and TS posture in seated and standing positions were measured with an inclinometer. The intraclass correlation coefficient (ICC), standard error of measurement (SEM), mean difference (MD), Bland-Altman (B&A) plot features and coefficient of repeatability (CR) were calculated. Results The mean and standard deviation (SD) of the duration of TS pain was 22 (SD 45) months, with the intensity of pain being rated at 27 (SD 21) mm on a visual analogue scale (VAS). Intra-rater reliability was very strong (ICC ≥ 0.80) for the evaluation of seated and standing upper TS posture, standing whole TS posture and seated lower TS posture with an inclinometer. Moreover, TS posture evaluation with a measuring tape, posture inspection in a seated position, and manual assessment of segmental extension were found to have very strong intra-rater reliability. Inter-rater reliability was very strong for inclinometer measurements of standing and seated upper TS posture as well as standing whole TS posture. Conclusion Intra-rater reliability was higher than inter-rater reliability in most of the evaluated measurements. Overall, posture measurements with an inclinometer were more reliable than mobility measurements with the same instrument. The manual assessments can be used reliably when same evaluator performs the examination. Trial registration Clinical Trials, NCT01884818. Registered 24 June 2013, https://clinicaltrials.gov/ct2/show/NCT01884818?cond=thoracic+spine&cntry=FI&rank=1
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Affiliation(s)
- Jani Takatalo
- Faculty of Sport and Health Sciences, University of Jyvaskyla, Jyväskylä, Finland. .,Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland.
| | - Jari Ylinen
- Central Finland Central Hospital, Jyväskylä, Finland
| | - Tuomo Pienimäki
- The Social Insurance Institution of Finland, Helsinki, Finland
| | - Arja Häkkinen
- Faculty of Sport and Health Sciences, University of Jyvaskyla, Jyväskylä, Finland.,Central Finland Central Hospital, Jyväskylä, Finland
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Kubas C, Chen YW, Echeverri S, McCann SL, Denhoed MJ, Walker CJ, Kennedy CN, Reid WD. Reliability and Validity of Cervical Range of Motion and Muscle Strength Testing. J Strength Cond Res 2017; 31:1087-1096. [PMID: 27467513 DOI: 10.1519/jsc.0000000000001578] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Kubas, C, Chen, Y-W, Echeverri, S, McCann, S, Denhoed, M, Walker, C, Kennedy, C, and Reid, WD. Reliability and validity of cervical range of motion and muscle strength testing. J Strength Cond Res 31(4): 1087-1096, 2017-Cervical range of motion (ROM) and strength are fundamental measures to assess treatment effectiveness. The JTECH wireless devices provide versatile means of quantifying these measurements. The purpose of this study was to determine intrarater and interrater reliabilities and concurrent validity of the JTECH wireless dual inclinometer and handheld dynamometer. This study included 20 healthy subjects (mean age = 28.7 ± 7.8 years). The directions of ROM movement measured were cervical flexion, extension, lateral flexion, and rotation. Isometric strength was measured for flexion, extension, and lateral flexion. Two testers measured cervical ROM and isometric strength for each subject using the JTECH devices during 2 or 3 sessions to determine reliability. The same ROM and muscle strength movements were measured using the CROM3 and MicroFET2, respectively, to assess concurrent validity. Reliability and validity were analyzed using intraclass correlation coefficient (ICC), along with SEM and minimal detectable change. The results of this study showed that the intrarater reliability of the JTECH inclinometer and dynamometer was moderate to excellent (ICCs (3,1) = 0.53-0.90 and 0.74-0.91, respectively). The interrater reliability of the JTECH inclinometer was moderate to excellent (ICCs (2,3) = 0.69-0.89), whereas the JTECH dynamometer showed excellent interrater reliability (ICCs (2,3) = 0.84-0.88). The JTECH inclinometer and dynamometer showed moderate to excellent concurrent validity (ICCs (3,2) = 0.65-0.91 and 0.91-0.96, respectively). With the ease of use, portability, and ability to record multiple measurements without stopping, these devices can be applied to clinical and research settings.
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Affiliation(s)
- Christian Kubas
- 1Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; and 2Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Alahmari KA, Reddy RS, Silvian PS, Ahmad I, Kakaraparthi VN, Alam MM. Association of age on cervical joint position error. J Adv Res 2017; 8:201-207. [PMID: 28203459 PMCID: PMC5292654 DOI: 10.1016/j.jare.2017.01.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 12/19/2016] [Accepted: 01/01/2017] [Indexed: 12/22/2022] Open
Abstract
This study quantitatively assesses the association between age and cervical joint position error (JPE) and compares JPE between young and older asymptomatic subjects. Subjects (n = 230) ranging in age from 17 to 70 years volunteered to participate in the study. Cervical JPE was measured for all subjects with the active movement angle reproduction test in degrees using a digital inclinometer; testing was done in all cervical movement directions (flexion, extension, side-bending right and left, rotation right and left). Subjects were divided into two groups: young (n = 169, mean age: 32.4 years; range 17–49 years) and older (n = 61, mean age: 61.9 years; range 50–70 years) and JPE was compared. Pearson’s product-moment correlation coefficients were significant and positive for the association of age on cervical JPE in flexion (r = 0.71), extension (r = 0.81), side-bending right (r = 0.77), side-bending left (r = 0.84), rotation right (r = 0.84), and rotation left (r = 0.84). JPE was significantly larger (for all movement directions) in the older subject group (P < 0.001). Advancing age was significantly associated with the increasing cervical JPE and older subjects showed greater errors when compared to younger subjects.
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Affiliation(s)
- Khalid A Alahmari
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
| | - Ravi Shankar Reddy
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
| | - Paul S Silvian
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
| | - Irshad Ahmad
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
| | - Venkata Nagaraj Kakaraparthi
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
| | - Mohammed Mehtab Alam
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
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Cejudo A, Sainz de Baranda P, Ayala F, Santonja F. Test-retest reliability of seven common clinical tests for assessing lower extremity muscle flexibility in futsal and handball players. Phys Ther Sport 2015; 16:107-13. [DOI: 10.1016/j.ptsp.2014.05.004] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 04/30/2014] [Accepted: 05/26/2014] [Indexed: 11/26/2022]
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Wang J, Qian Z, Ren L, Ren L. A dynamic finite element model of human cervical spine with in vivo kinematic validation. CHINESE SCIENCE BULLETIN-CHINESE 2014. [DOI: 10.1007/s11434-014-0452-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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The shift of segmental contribution ratio in patients with herniated disc during cervical lateral bending. BMC Musculoskelet Disord 2014; 15:273. [PMID: 25112463 PMCID: PMC4243537 DOI: 10.1186/1471-2474-15-273] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 08/01/2014] [Indexed: 11/20/2022] Open
Abstract
Background Abnormal intervertebral movements of spine have been reported to be associated
with trauma and pathological conditions. The importance of objective spinal motion
imaging assessment in the frontal plane was frequently underestimated. The
clinical evaluation of the segmental motion contribution could be useful for
detecting the motion pattern of individual vertebrae. Therefore the purpose of
this study was to investigate the shift of segmental contribution ratio in
patients with herniated disc during cervical lateral bending to provide additional
insights to cervical biomechanics. Methods A total of 92 subjects (46 healthy adult subjects and 46 disc-herniated
patients) were enrolled in this case–control study. The motion images during
cervical lateral bending movements were digitized using a precise image protocol
to analyze the intervertebral motion and contribution. Results Our results showed that the intervertebral angulation during cervical lateral
bending for the C2/3 to C6/7 segments were 7.66°±2.37°, 8.37°±2.11°, 8.91°±3.22°,
7.19°±2.29°, 6.31°±2.11°, respectively for the healthy subjects. For the patients
with herniated disc, the intervertebral angulation for the C2/3 to C6/7 segments
were 6.87°±1.67°, 7.83°±1.79°, 7.73°±2.71°, 5.13°±2.05°, 4.80°±1.93°,
respectively. There were significant angulation and translational differences
between healthy subjects and the patients with herniated disc in the C5/6 and C6/7
segments (P=0.001-0.029). The segmental contributions of the individual vertebral
segments were further analyzed. There was a significant increase in segmental
contribution ratio of C3/4 (P=0.048), while a significant decrease in contribution
ratio of C5/6 (P=0.037) was observed in the patients with herniated disc. Our
results indicated that the segmental contribution shifted toward the middle
cervical spine in the patients with herniated disc. Conclusions The segmental contributions of cervical spine during lateral bending movement
were first described based on the validated radiographic protocol. The detection
of the shift of segmental contribution ratio could be helpful for the diagnosis
the motion abnormality resulted from the disc or, facet pathologies, and arthritic
changes of cervical spine.
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Branney J, Breen AC. Does inter-vertebral range of motion increase after spinal manipulation? A prospective cohort study. Chiropr Man Therap 2014; 22:24. [PMID: 25035795 PMCID: PMC4102240 DOI: 10.1186/s12998-014-0024-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 06/18/2014] [Indexed: 01/06/2023] Open
Abstract
Background Spinal manipulation for nonspecific neck pain is thought to work in part by
improving inter-vertebral range of motion (IV-RoM), but it is difficult to measure
this or determine whether it is related to clinical outcomes. Objectives This study undertook to determine whether cervical spine flexion and extension
IV-RoM increases after a course of spinal manipulation, to explore relationships
between any IV-RoM increases and clinical outcomes and to compare palpation with
objective measurement in the detection of hypo-mobile segments. Method Thirty patients with nonspecific neck pain and 30 healthy controls matched for age
and gender received quantitative fluoroscopy (QF) screenings to measure flexion
and extension IV-RoM (C1-C6) at baseline and 4-week follow-up between September
2012-13. Patients received up to 12 neck manipulations and completed NRS, NDI and
Euroqol 5D-5L at baseline, plus PGIC and satisfaction questionnaires at follow-up.
IV-RoM accuracy, repeatability and hypo-mobility cut-offs were determined. Minimal
detectable changes (MDC) over 4 weeks were calculated from controls. Patients and
control IV-RoMs were compared at baseline as well as changes in patients over 4
weeks. Correlations between outcomes and the number of manipulations received and
the agreement (Kappa) between palpated and QF-detected of hypo-mobile segments
were calculated. Results QF had high accuracy (worst RMS error 0.5o) and repeatability (highest SEM 1.1o,
lowest ICC 0.90) for IV-RoM measurement. Hypo-mobility cut offs ranged from 0.8o
to 3.5o. No outcome was significantly correlated with increased IV-RoM above MDC
and there was no significant difference between the number of hypo-mobile segments
in patients and controls at baseline or significant increases in IV-RoMs in
patients. However, there was a modest and significant correlation between the
number of manipulations received and the number of levels and directions whose
IV-RoM increased beyond MDC (Rho=0.39, p=0.043). There was also no agreement
between palpation and QF in identifying hypo-mobile segments (Kappa
0.04-0.06). Conclusions This study found no differences in cervical sagittal IV-RoM between patients with
non-specific neck pain and matched controls. There was a modest dose-response
relationship between the number of manipulations given and number of levels
increasing IV-RoM - providing evidence that neck manipulation has a mechanical
effect at segmental levels. However, patient-reported outcomes were not related to
this.
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Affiliation(s)
- Jonathan Branney
- Institute of Musculoskeletal Research & Clinical Implementation, Anglo-European College of Chiropractic, 13-15 Parkwood Road, Bournemouth BH5 2DF, UK ; The School of Health & Social Care, Bournemouth University, Royal London House, Christchurch Road, Bournemouth BH1 3LT, UK
| | - Alan C Breen
- Institute of Musculoskeletal Research & Clinical Implementation, Anglo-European College of Chiropractic, 13-15 Parkwood Road, Bournemouth BH5 2DF, UK
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14
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Abstract
STUDY DESIGN Cohort study. OBJECTIVE To generate normal values for active range of motion (ACROM) of the cervical spine in asymptomatic persons. SUMMARY OF BACKGROUND DATA There is a lack of normal values for ACROM based on large groups and stratified for different age categories. METHODS Four hundred asymptomatic persons were included, 100 for each decade of age from 20 years to 60 years and in each subgroup 50 males and 50 females. ACROM was measured with the cervical range of motion (CROM) device. Analysis of variance and the Scheffé post hoc test was used to investigate the differences of ACROM between the decades of age. Linear regression analysis was performed to examine the influence of age and sex on ACROM. RESULTS The results of this study show that the ACROM decreases significantly in persons older than 50 years for all directions except extension and side flexion compared with that in the subgroup aged 40 to 50. Age had an overall significant effect on the ACROM for all directions. Sex proved to have no significant effect on the ACROM. CONCLUSION Normal values were established for ACROM in a group of 400 persons without neck complaints. It was demonstrated that age has a significant influence on the ACROM, but sex has no influence. LEVEL OF EVIDENCE N/A.
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Triano JJ, Budgell B, Bagnulo A, Roffey B, Bergmann T, Cooperstein R, Gleberzon B, Good C, Perron J, Tepe R. Review of methods used by chiropractors to determine the site for applying manipulation. Chiropr Man Therap 2013; 21:36. [PMID: 24499598 PMCID: PMC4028787 DOI: 10.1186/2045-709x-21-36] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 08/29/2013] [Indexed: 01/13/2023] Open
Abstract
Background With the development of increasing evidence for the use of manipulation in the management of musculoskeletal conditions, there is growing interest in identifying the appropriate indications for care. Recently, attempts have been made to develop clinical prediction rules, however the validity of these clinical prediction rules remains unclear and their impact on care delivery has yet to be established. The current study was designed to evaluate the literature on the validity and reliability of the more common methods used by doctors of chiropractic to inform the choice of the site at which to apply spinal manipulation. Methods Structured searches were conducted in Medline, PubMed, CINAHL and ICL, supported by hand searches of archives, to identify studies of the diagnostic reliability and validity of common methods used to identify the site of treatment application. To be included, studies were to present original data from studies of human subjects and be designed to address the region or location of care delivery. Only English language manuscripts from peer-reviewed journals were included. The quality of evidence was ranked using QUADAS for validity and QAREL for reliability, as appropriate. Data were extracted and synthesized, and were evaluated in terms of strength of evidence and the degree to which the evidence was favourable for clinical use of the method under investigation. Results A total of 2594 titles were screened from which 201 articles met all inclusion criteria. The spectrum of manuscript quality was quite broad, as was the degree to which the evidence favoured clinical application of the diagnostic methods reviewed. The most convincing favourable evidence was for methods which confirmed or provoked pain at a specific spinal segmental level or region. There was also high quality evidence supporting the use, with limitations, of static and motion palpation, and measures of leg length inequality. Evidence of mixed quality supported the use, with limitations, of postural evaluation. The evidence was unclear on the applicability of measures of stiffness and the use of spinal x-rays. The evidence was of mixed quality, but unfavourable for the use of manual muscle testing, skin conductance, surface electromyography and skin temperature measurement. Conclusions A considerable range of methods is in use for determining where in the spine to administer spinal manipulation. The currently published evidence falls across a spectrum ranging from strongly favourable to strongly unfavourable in regard to using these methods. In general, the stronger and more favourable evidence is for those procedures which take a direct measure of the presumptive site of care– methods involving pain provocation upon palpation or localized tissue examination. Procedures which involve some indirect assessment for identifying the manipulable lesion of the spine–such as skin conductance or thermography–tend not to be supported by the available evidence.
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Affiliation(s)
- John J Triano
- Canadian Memorial Chiropractic College, 6100 Leslie St., Toronto, Ontario, Canada
| | - Brian Budgell
- Canadian Memorial Chiropractic College, 6100 Leslie St., Toronto, Ontario, Canada
| | | | | | - Thomas Bergmann
- Northwestern Health Sciences University, Bloomington, MN, USA
| | | | - Brian Gleberzon
- Canadian Memorial Chiropractic College, 6100 Leslie St., Toronto, Ontario, Canada
| | - Christopher Good
- University of Bridgeport College of Chiropractic, Bridgeport, CT, USA
| | | | - Rodger Tepe
- Logan College of Chiropractic, Chesterfield, MO, USA
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Tousignant-Laflamme Y, Boutin N, Dion AM, Vallée CA. Reliability and criterion validity of two applications of the iPhone™ to measure cervical range of motion in healthy participants. J Neuroeng Rehabil 2013; 10:69. [PMID: 23829201 PMCID: PMC3706352 DOI: 10.1186/1743-0003-10-69] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Accepted: 06/14/2013] [Indexed: 11/10/2022] Open
Abstract
SUMMARY OF BACKGROUND DATA Recent smartphones, such as the iPhone, are often equipped with an accelerometer and magnetometer, which, through software applications, can perform various inclinometric functions. Although these applications are intended for recreational use, they have the potential to measure and quantify range of motion. The purpose of this study was to estimate the intra and inter-rater reliability as well as the criterion validity of the clinometer and compass applications of the iPhone in the assessment cervical range of motion in healthy participants. METHODS The sample consisted of 28 healthy participants. Two examiners measured cervical range of motion of each participant twice using the iPhone (for the estimation of intra and inter-reliability) and once with the CROM (for the estimation of criterion validity). Estimates of reliability and validity were then established using the intraclass correlation coefficient (ICC). RESULTS We observed a moderate intra-rater reliability for each movement (ICC = 0.65-0.85) but a poor inter-rater reliability (ICC < 0.60). For the criterion validity, the ICCs are moderate (>0.50) to good (>0.65) for movements of flexion, extension, lateral flexions and right rotation, but poor (<0.50) for the movement left rotation. CONCLUSION We found good intra-rater reliability and lower inter-rater reliability. When compared to the gold standard, these applications showed moderate to good validity. However, before using the iPhone as an outcome measure in clinical settings, studies should be done on patients presenting with cervical problems.
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17
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Isolated transverse process fractures of the subaxial cervical spine: a clinically insignificant injury or not?: a prospective, longitudinal analysis in a consecutive high-energy blunt trauma population. Spine (Phila Pa 1976) 2010; 35:E965-70. [PMID: 20479701 DOI: 10.1097/brs.0b013e3181c9464e] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective single cohort study. OBJECTIVE To analyze the incidence, associated injuries, treatment outcomes and associated adverse events of isolated transverse process fractures (TPFs) of the subaxial cervical spine in a high-energy blunt trauma population. SUMMARY OF BACKGROUND DATA Currently, TPFs of the subaxial cervical spine are considered to be clinically insignificant. However, this hypothesis is based on clinical experience and has never been supported by research previously. METHODS During a 32-month period, routine computed tomography scans of the spine were obtained in high-energy blunt trauma patients. Patients with isolated TPFs of the subaxial cervical spine were prospectively identified. For each enrolled patient, gender, age, mechanism of injury, trauma severity, neurologic deficit, injury levels, affected structures, treatment, radiographic follow-up, functional outcome (Cybex goniometer, neck disability index), and patient satisfaction (10 point visual analog scale) were recorded. RESULTS Of 865 enrolled patients, 21 patients (2.4%) had 25 isolated TPFs of the subaxial cervical spine. The seventh vertebra was involved predominantly (76%). The initial treatment regimen was unrestricted movement in all patients. No associated adverse events were observed. A follow-up of 13 to 39 months was available in 14 patients. Follow-up showed a stable and intact subaxial cervical spine in all patients' radiographs, a patient satisfaction of 9.3 (SD 1.48), a Cybex measured range of motion in the sagittal plane of 109 degrees (SD 12.5, 95-129), the frontal plane of 70 (SD 17.8, 37-100) and the transverse plane of 144 (SD 12.5, 116-164), and a mean neck disability index score of 3.93 (SD 8.24). CONCLUSION The incidence of isolated TPFs of the subaxial cervical spine was 2.4%. Unrestricted movement resulted in satisfying functional, anatomic, and neurologic outcomes without associated adverse events. This study confirms that isolated TPFs of the subaxial cervical spine can be considered as clinically insignificant and do not require treatment.
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Sohn JH, Choi HC, Lee SM, Jun AY. Differences in cervical musculoskeletal impairment between episodic and chronic tension-type headache. Cephalalgia 2010; 30:1514-23. [DOI: 10.1177/0333102410375724] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Tension-type headache (TTH) is a headache in which musculoskeletal impairments of the craniocervical region may play an important role in its pathogenesis. We investigated the presence of myofascial, postural and mechanical abnormalities in patients with frequent episodic and chronic tension-type headache (ETTH and CTTH, respectively). Methods: The study population consisted of 36 patients with ETTH, 23 with CTTH and 42 control subjects. Myofascial trigger points (MTrPs) were identified in the upper trapezius, sternocleidomastoid, temporalis and suboccipital muscles. Sagittal C7-tragus angle was measured to evaluate flexor head posture (FHP), and neck mobility was assessed using an inclinometer. Results: Only active MTrPs were significantly different between the ETTH and CTTH groups ( p < .001). Patients with CTTH showed a larger sagittal C7-tragus angle ( p = .011), that is, greater FHP and restricted neck mobility for both rotations compared to controls ( p < .001). Although active MTrPs were correlated with the frequency and duration of headache, no correlations were observed for FHP or neck mobility. Conclusion: Active MTrPs in the craniocervical region contribute to triggering or maintenance of TTH and posture or neck mobility may be a result of chronic headache.
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Affiliation(s)
- J-H Sohn
- Hallym University College of Medicine, Republic of Korea
| | - H-C Choi
- Hallym University College of Medicine, Republic of Korea
| | - S-M Lee
- Hallym University College of Medicine, Republic of Korea
| | - A-Y Jun
- Hallym University College of Medicine, Republic of Korea
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Williams MA, McCarthy CJ, Chorti A, Cooke MW, Gates S. A Systematic Review of Reliability and Validity Studies of Methods for Measuring Active andPassive Cervical Range of Motion. J Manipulative Physiol Ther 2010; 33:138-55. [PMID: 20170780 DOI: 10.1016/j.jmpt.2009.12.009] [Citation(s) in RCA: 140] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Revised: 08/23/2009] [Accepted: 09/22/2009] [Indexed: 11/29/2022]
Affiliation(s)
- Mark A Williams
- Clinical Trials Unit, University of Warwick, Coventry, United Kingdom.
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20
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Cattrysse E, Provyn S, Kool P, Gagey O, Clarys JP, Van Roy P. Reproducibility of kinematic motion coupling parameters during manual upper cervical axial rotation mobilization: A 3-dimensional in vitro study of the atlanto-axial joint. J Electromyogr Kinesiol 2009; 19:93-104. [PMID: 17728151 DOI: 10.1016/j.jelekin.2007.06.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2007] [Revised: 06/21/2007] [Accepted: 06/21/2007] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The reproducibility of the 3-dimensional (3D) kinematic aspects of motion coupling patterns of segmental manual mobilizing techniques is not yet known. This study analyzes the segmental 3D aspects of manual mobilization of the atlanto-axial joint in vitro. METHODS AND MATERIALS Twenty fresh human cervical specimens were studied in a test-retest situation with two examiners. The specimens were manually mobilized using three different techniques: a regional mobilization technique, a segmental mobilization technique on the atlas with manual fixation of the axis and a segmental mobilization applying a locking technique. Segmental kinematics were registered with a Zebris CMS20 ultrasound-based tracking system. The 3D aspects of motion coupling between main axial rotation and coupled lateral bending were analyzed by six parameters: the range of motion the three motion components, the cross-correlation, the ratio and the shift. RESULTS The results indicate stronger intra- than inter-examiner reproducibility. The range of motion of the axial rotation component shows a substantial level of intra- and inter-examiner reproducibility (ICC's 0.67-0.76). The parameters describing the coupling patterns show only moderate to substantial intra-examiner reproducibility for the more experienced of the two examiners (ICC's 0.55-0.68). All other correlations were not significant and no differences could be observed between regional versus segmental techniques. CONCLUSION Reproducibility of segmental 3D-aspects of manual mobilization of the atlanto-axial joint in an in vitro situation can differ between examiners. The results of the present study may indicate a possible tendency to higher reproducibility if mobilizations are performed by an examiner with high expertise and experience in applying the specific techniques. Continued investigation including more examiners with different levels of experience and different techniques is necessary to confirm these observations.
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Affiliation(s)
- E Cattrysse
- Vrije Universiteit Brussel, Faculty of Physical Education and Physiotherapy, Department of Experimental Anatomy, Laarbeeklaan 103, B1090 Brussels, Belgium.
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Assink N, Bergman GJD, Knoester B, Winters JC, Dijkstra PU. Assessment of the cervical range of motion over time, differences between results of the Flock of Birds and the EDI-320: A comparison between an electromagnetic tracking system and an electronic inclinometer. ACTA ACUST UNITED AC 2008; 13:450-5. [PMID: 17681865 DOI: 10.1016/j.math.2007.05.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2005] [Revised: 04/30/2007] [Accepted: 05/23/2007] [Indexed: 11/12/2022]
Abstract
The objective of this study was to analyse cervical range of motion, assessed over time by means of a digital inclinometer (EDI-320) and a three-dimensional electromagnetic tracking device (Flock of Birds). The maximum active cervical range of motion was assessed with two measurement devices in three sessions over time, with 6-week intervals. In total, 26 women and 24 men (mean age: 44.4, SD: 9.9) without known pathology of the cervical spine participated. Four movements were measured axial rotation with the cervical spine in a flexed and in an extended position, flexion-extension, and lateral bending. The results showed that the factor time was significant for rotation in extension and rotation in flexion. The factor device was significant for all movements measured, and the interaction term between time and device was significant for all movements except rotation in extension. The Flock of Birds measured significantly higher ranges of motion on all motions except for lateral bending. A substantial variation in cervical range of motion was observed over time (ranging from -5.6 to 8.1) as well as between devices (ranging from -13.1 to 29.9). Substantial and significant differences in cervical range of motion were found over time as well as differences between the Flock of Birds and the EDI-320.
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Affiliation(s)
- Nienke Assink
- Centre for Rehabilitation, University Medical Centre Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands.
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22
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van Niekerk SM, Louw Q, Vaughan C, Grimmer-Somers K, Schreve K. Photographic measurement of upper-body sitting posture of high school students: a reliability and validity study. BMC Musculoskelet Disord 2008; 9:113. [PMID: 18713477 PMCID: PMC2542508 DOI: 10.1186/1471-2474-9-113] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2007] [Accepted: 08/20/2008] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND All the reported measures of sitting posture, as well as photographs, have one flaw, as these measures are external to the body. These measures use calculations from external bony landmarks to estimate spinal posture, on the understanding that what is being measured externally reflects the shape, health and performance of structures of the underlying spine. Without a comparative measure of the relative position of the structures of the spine, the validity of any external spinal posture measure cannot be established. This paper reports on a study which tests the validity of photographs to measure adolescent sitting posture. METHODS The study was conducted in a laboratory at the Department of Human Biology, University of Cape Town. A random sample of 40 adolescents were recruited from the Cape metropolitan schools, to detect differences of three degrees or more between the repeated measures of upright, normal or slouched posture (photographs) and between the posture photographs and LODOX measures. Eligible participants were healthy male and female subjects aged 15 or 16 years old, in Grade 10, and who were undertaking Computer or Computype studies at their schools. Two posture measurement tools were used in the study, namely: Photographs were taken using the Photographic Posture Analysis Method (PPAM) and Radiographs were taken using the LODOX (LODOX (Pty) Ltd) system. Subjects' posture was assessed in simulated computer workstations. The following angles were measured: the sagittal head angle, cervical angle, protraction/retraction angle, arm angle and the thoracic angle. RESULTS Data from 39 subjects (19 males, 20 females) was used for analysis (17 15-year-olds (7 boys and 10 girls), 22 16-year-olds (12 boys and 10 girls)). All but one photographic angle showed moderate to good correlation with the LODOX angles (Pearson r values 0.67-0.95) with the exception being the shoulder protraction/retraction angle Pearson r values. Bland Altman limits of agreement illustrated a slight bias for all angles. The reliability study findings from repeated photographs demonstrated moderate to good correlation of all angles (ICC values 0.78-0.99). CONCLUSION The findings of this study suggest that photographs provide valid and reliable indicators of the position of the underlying spine in sitting. Clinically it is important to know whether a patient is showing true progression in relation to a postural intervention. Based on the results of this study, the PPAM can be used in practice as a valid measure of sitting posture.
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de Koning CHP, van den Heuvel SP, Staal JB, Smits-Engelsman BCM, Hendriks EJM. Clinimetric evaluation of active range of motion measures in patients with non-specific neck pain: a systematic review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2008; 17:905-21. [PMID: 18427843 PMCID: PMC2443270 DOI: 10.1007/s00586-008-0656-3] [Citation(s) in RCA: 117] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2007] [Revised: 02/11/2008] [Accepted: 03/09/2008] [Indexed: 11/30/2022]
Abstract
The study is to provide a critical analysis of the research literature on clinimetric properties of instruments that can be used in daily practice to measure active cervical range of motion (ACROM) in patients with non-specific neck pain. A computerized literature search was performed in Medline, Cinahl and Embase from 1982 to January 2007. Two reviewers independently assessed the clinimetric properties of identified instruments using a criteria list. The search identified a total of 33 studies, investigating three different types of measurement instruments to determine ACROM. These instruments were: (1) different types of goniometers/inclinometers, (2) visual estimation, and (3) tape measurements. Intra- and inter-observer reliability was demonstrated for the cervical range of motion instrument (CROM), Cybex electronic digital instrument (EDI-320) and a single inclinometer. The presence of agreement was assessed for the EDI-320 and a single inclinometer. The CROM received a positive rating for construct validity. When clinical acceptability is taken into account both the CROM and the single inclinometer can be considered appropriate instruments for measuring the active range of motion in patients with non-specific neck pain in daily practice. Reliability is the aspect most frequently evaluated. Agreement, validity and responsiveness are documented less frequently.
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Affiliation(s)
| | | | - J. Bart Staal
- Department of Epidemiology, Centre for Evidence Based Physiotherapy and Caphri Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Bouwien C. M. Smits-Engelsman
- Avans+, University for Professionals, Breda, The Netherlands
- Motor Control Lab, Department of Kinesiology, K.U. Leuven, Leuven, Belgium
| | - Erik J. M. Hendriks
- Dutch Institute for Allied Health Care (NPi), Amersfoort, The Netherlands
- Department of Epidemiology, Centre for Evidence Based Physiotherapy and Caphri Research Institute, Maastricht University, Maastricht, The Netherlands
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Test-retest reproducibility of elbow goniometric measurements in a rigid double-blinded protocol: intervals for distinguishing between measurement error and clinical change. J Shoulder Elbow Surg 2007; 16:788-794.e2. [PMID: 17967547 DOI: 10.1016/j.jse.2007.02.134] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2006] [Accepted: 02/22/2007] [Indexed: 02/01/2023]
Abstract
Increasingly, goniometry of elbow motion is used for qualification of research results. Expression of reliability is in parameters not suitable for comparison of results. We modified Bland and Altman's method, resulting in the smallest detectable differences (SDDs). Two raters measured elbow excursions in 42 individuals (144 ratings per test person) with an electronic digital inclinometer in a classical test-retest crossover study design. The SDDs were 0 +/- 4.2 degrees for active extension; 0 +/- 8.2 degrees for active flexion, both without upper arm fixation; 0 +/- 6.3 degrees for active extension; 0 +/- 5.7 degrees for active flexion; 0 +/- 7.4 degrees for passive flexion with upper arm fixation; 0 +/- 10.1 degrees for active flexion with upper arm retroflexion; and 0 +/- 8.5 degrees and 0 +/- 10.8 degrees for active and passive range of motion. Differences smaller than these SDDs found in clinical or research settings are attributable to measurement error and do not indicate improvement.
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Hayen A, Dennis RJ, Finch CF. Determining the intra- and inter-observer reliability of screening tools used in sports injury research. J Sci Med Sport 2007; 10:201-10. [PMID: 17194623 DOI: 10.1016/j.jsams.2006.09.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2006] [Revised: 09/01/2006] [Accepted: 09/14/2006] [Indexed: 11/16/2022]
Abstract
Sports injury etiological studies explore the relationships between potential injury risk factors and injury outcomes. The ability of such studies to clearly identify intrinsic risk factors for sports injury depends on the accuracy of their measurement. Measurements need to be reproducible over time and repeatable by different observers, as well as within a given individual. The importance of the reliability of pre-participation screening protocols and other clinical assessment tools has been identified in a number of published studies. However, a review of these studies indicates that a variety of statistical techniques have been used to calculate intra- and inter-observer reliability. While the intra-class correlation coefficient (ICC) is the most often cited measure, a range of statistical approaches to estimating ICCs have been used. It is therefore difficult to determine which statistical method is most appropriate in the context of measuring intrinsic risk factors in sports injury research. This paper summarises a statistical method for the concurrent assessment of intra- and inter-observer reliability and presents an argument for why this approach should be adopted by sports injury researchers using screening protocols that collect continuous data.
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Affiliation(s)
- Andrew Hayen
- NSW Injury Risk Management Research Centre, University of New South Wales, NSW, Australia
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Wu SK, Lan HHC, Kuo LC, Tsai SW, Chen CL, Su FC. The feasibility of a video-based motion analysis system in measuring the segmental movements between upper and lower cervical spine. Gait Posture 2007; 26:161-6. [PMID: 16987665 DOI: 10.1016/j.gaitpost.2006.07.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2005] [Revised: 07/13/2006] [Accepted: 07/27/2006] [Indexed: 02/02/2023]
Abstract
The evaluation of the range of motion (ROM) and static posture in the cervical spine are important in physical examination. Despite offering dynamic assessment without radiation, the video-based motion analysis system has not yet been applied to measure the cervical segmental movements. The purposes of this study were to develop a neck model to differentiate the movements and posture between upper and lower cervical spine, and to examine the reliability of measuring cervical motion with surface markers and the aid of videofluoroscopy. Sixteen healthy adult subjects (eight males and eight females) participated in this study. Ten surface markers were used to estimate the discrepancies in cervical vertebral angles compared with corresponding bony landmarks throughout the ROM. The average intraclass correlation coefficients (ICCs) of the paired vertebral angles between surface markers and bony landmarks ranged from 0.844 to 0.975 and the mean absolute difference (MAD) averaged 2.96 degrees. Our results indicate high consistency between surface markers and bony landmarks throughout the cervical movements. The mean upper (C0-C2) and lower (C2-C7) cervical joint angles in the neutral position were 18.59+/-4.33 degrees and 23.98+/-6.15 degrees, respectively. Furthermore, the reliability of the digitizing procedure within raters (ICC=0.850-0.999; MAD=0.58-2.42 degrees) and between raters (ICC=0.759-0.988; MAD=0.59-2.66 degrees) suggests that the neck motion analysis model is a feasible method for investigating static neck posture or dynamic motion between upper and lower cervical spine.
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Affiliation(s)
- Shyi-Kuen Wu
- Institute of Biomedical Engineering, National Cheng Kung University, 1 University Road, Tainan 701, Taiwan
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Wu SK, Kuo LC, Lan HCH, Tsai SW, Chen CL, Su FC. The quantitative measurements of the intervertebral angulation and translation during cervical flexion and extension. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2007; 16:1435-44. [PMID: 17464516 PMCID: PMC2200749 DOI: 10.1007/s00586-007-0372-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2006] [Revised: 02/26/2007] [Accepted: 03/31/2007] [Indexed: 11/28/2022]
Abstract
The insufficient exploration of intervertebral translation during flexion and extension prevents the further understanding of the cervical biomechanics and treating the cervical related dysfunction. The objective of this study was to quantitatively measure the continuous intervertebral translation of healthy cervical spine during flexion and extension by videofluoroscopic technique. A total of 1,120 image sequences were analyzed for 56 healthy adult subjects by a precise image protocol during cervical flexion and extension. O: ur results showed there were no statistical angular differences among five spinal levels in either flexion or extension, except for the comparison between C2/3 (13.5 degrees) and C4/5 (22.6 degrees) angles. During cervical flexion, the smallest anterior translations were 0.7 mm at C2/3 level, followed by 0.9 mm at C6/7, 1.0 mm at C3/4, 1.1 mm at C5/6, and the largest 1.2 mm at C4/5 levels. The significantly greater translations were measured in the posterior direction at C3/4 (1.1 mm, P = 0.037), C4/5 (1.3 mm, P = 0.039), and C5/6 (1.2 mm, P = 0.005) levels than in the anterior one. The relatively fluctuant and small average posterior translation fashion at C6/7 level (0.4 mm) possibly originated from the variations in the direction of translation during cervical extension among subjects. Normalization with respect to the widths of individual vertebrae showed the total translation percentages relative to the adjacent vertebrae were 9.5, 13.7, 16.6, 15.0, and 8.6% for C2/3 to C6/7 levels, respectively, and appeared to be within the clinical-accepted ranges of translation in cervical spine. The intervertebral translations of cervical spine during flexion and extension movements were first described in quality and quantity based on the validated radiographic protocol. This analysis of the continuous intervertebral translations may be further employed to diagnose translation abnormalities like hypomobility or hypermobility and to monitor the treatment effect on cervical spines.
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Affiliation(s)
- Shyi-Kuen Wu
- Institute of Biomedical Engineering, National Cheng Kung University, 1 University Road, Tainan, 701 Taiwan
- Department of Physical Therapy, HungKuang University, Taichung County, Taiwan
| | - Li-Chieh Kuo
- Department of Occupational Therapy, National Cheng Kung University, Tainan, Taiwan
| | - Haw-Chang H. Lan
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Sen-Wei Tsai
- Department of Physical Therapy, HungKuang University, Taichung County, Taiwan
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chiung-Ling Chen
- Institute of Biomedical Engineering, National Cheng Kung University, 1 University Road, Tainan, 701 Taiwan
- School of Occupational Therapy, Chung-Shan Medical University, Taichung, Taiwan
| | - Fong-Chin Su
- Institute of Biomedical Engineering, National Cheng Kung University, 1 University Road, Tainan, 701 Taiwan
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Demaille-Wlodyka S, Chiquet C, Lavaste JF, Skalli W, Revel M, Poiraudeau S. Cervical range of motion and cephalic kinesthesis: ultrasonographic analysis by age and sex. Spine (Phila Pa 1976) 2007; 32:E254-61. [PMID: 17426621 DOI: 10.1097/01.brs.0000259919.82461.57] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Exploratory experimental design. OBJECTIVE To assess cervical range of motion (ROM) and ability to return the head to a neutral position in healthy subjects according to age and sex. SUMMARY OF BACKGROUND DATA Cervical ROM and ability to return the head to a neutral position have been studied, but no data on the influence of age and sex in this movement is available. METHODS We divided 232 healthy volunteers able to sit for 20 minutes into 6 age groups: 15-24, 25-34, 35-44, 45-54, 55-65, and older than 65 years. Zebris 3-dimensional ultrasonography measured the active cervical ROM and ability to return the head to the neutral position. Bone landmarks and vertical position were defined for each subject. Recorded data were neutral position, lateral bending (right and left), flexion-extension, and axial rotation (right and left). We evaluated patients' ability, without external intervention, to return the head to a self-defined neutral position. RESULTS ROM was affected by age as assessed by analysis of variance (F = 27.8 in the sagittal plane, F = 12.1 in the frontal plane, and F = 19.7 in the axial plane; all P < 0.0001), but neither sex nor age affected ability to return the head to a neutral position (F = 0.615, P = 0.688 on the left; F = 0.808, P = 0.545 on the right). Maximal ROM was observed for right axial rotation. CONCLUSIONS We provide a database by age and sex for patient ability to return the head to the neutral position and for cervical ROM. This database could be used as a reference in clinical applications.
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Affiliation(s)
- Samantha Demaille-Wlodyka
- Department of Physical and Rehabilitation Medicine, Hôpital Cochin AP-HP, Université René Descartes, Paris, France
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Strimpakos N, Sakellari V, Gioftsos G, Papathanasiou M, Brountzos E, Kelekis D, Kapreli E, Oldham J. Cervical spine ROM measurements: optimizing the testing protocol by using a 3D ultrasound-based motion analysis system. Cephalalgia 2006; 25:1133-45. [PMID: 16305602 DOI: 10.1111/j.1468-2982.2005.00970.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The aim of this study was to evaluate the intra- and inter-examiner reliability and validity of neck range of motion (ROM) measurements. Thirty-five healthy subjects were assessed in all neck movements from two initial positions, sitting and standing, actively (open and closed eyes) and passively by using a 3D ultrasound-based motion analysis device (Zebris). Three tests were employed to assess intra-examiner reliability and two examiners used for the inter-examiner reliability. X-rays in neck flexion and extension were used to validate the Zebris system. The standing position yielded higher intraclass correlation coefficient (ICC) values (>0.86) with less error [smallest detectable difference (SDD)<13.8%] than sitting (ICC>0.79, SDD<14%). Passive assessment of neck ROM presented better reproducibility than active assessment with open or closed eyes in both positions. The inter-examiner reliability was moderate (ICC=0.43-0.68). The correlation between the Zebris system and X-rays was high in both flexion and extension movements. The results showed that the most reliable protocol for assessment of neck ROM is a passive measurement in the standing position. The measurements were well validiated against X-rays and the experience of the investigators must be considered before any comparison among studies is employed.
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Affiliation(s)
- N Strimpakos
- Centre for Rehabilitation Science, University of Manchester, Manchester, UK, and Department of Radiology, Evgenidion Hospital, Athens, Greece.
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30
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Hoving JL, Pool JJM, van Mameren H, Devillé WJLM, Assendelft WJJ, de Vet HCW, de Winter AF, Koes BW, Bouter LM. Reproducibility of cervical range of motion in patients with neck pain. BMC Musculoskelet Disord 2005; 6:59. [PMID: 16351719 PMCID: PMC1343553 DOI: 10.1186/1471-2474-6-59] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2005] [Accepted: 12/13/2005] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Reproducibility measurements of the range of motion are an important prerequisite for the interpretation of study results. The aim of the study is to assess the intra-rater and inter-rater reproducibility of the measurement of active Range of Motion (ROM) in patients with neck pain using the Cybex Electronic Digital Inclinometer-320 (EDI-320). METHODS In an outpatient clinic in a primary care setting 32 patients with at least 2 weeks of pain and/or stiffness in the neck were randomly assessed, in a test- retest design with blinded raters using a standardized measurement protocol. Cervical flexion-extension, lateral flexion and rotation were assessed. RESULTS Reliability expressed by the Intraclass Correlation Coefficient (ICC) was 0.93 (lateral flexion) or higher for intra-rater reliability and 0.89 (lateral flexion) or higher for inter-rater reliability. The 95% limits of agreement for intra-rater agreement, expressing the range of the differences between two ratings were -2.5 +/- 11.1 degrees for flexion-extension, -0.1 +/- 10.4 degrees for lateral flexion and -5.9 +/- 13.5 degrees for rotation. For inter-rater agreement the limits of agreement were 3.3 +/- 17.0 degrees for flexion-extension, 0.5 +/- 17.0 degrees for lateral flexion and -1.3 +/- 24.6 degrees for rotation. CONCLUSION In general, the intra-rater reproducibility and the inter-rater reproducibility were good. We recommend to compare the reproducibility and clinical applicability of the EDI-320 inclinometer with other cervical ROM measures in symptomatic patients.
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Affiliation(s)
- Jan Lucas Hoving
- Institute for Research in Extramural Medicine, VU University Medical Centre, Amsterdam, the Netherlands
- Department of Clinical Epidemiology, Cabrini Hospital and Monash University Department of Epidemiology and Preventive Medicine, Melbourne, Australia
| | - Jan JM Pool
- Institute for Research in Extramural Medicine, VU University Medical Centre, Amsterdam, the Netherlands
| | - Henk van Mameren
- Department of Anatomy and Embryology, Faculty of Medicine, Maastricht University, the Netherlands
| | | | - Willem JJ Assendelft
- Department of General Practice and Nursing Home Medicine, LUMC Medical Centre, Leiden, the Netherlands
| | - Henrica CW de Vet
- Institute for Research in Extramural Medicine, VU University Medical Centre, Amsterdam, the Netherlands
| | - Andrea F de Winter
- Department of Social Psychiatry, University of Groningen, the Netherlands
| | - Bart W Koes
- Department of General Practice, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Lex M Bouter
- Institute for Research in Extramural Medicine, VU University Medical Centre, Amsterdam, the Netherlands
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31
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de Winter AF, Heemskerk MAMB, Terwee CB, Jans MP, Devillé W, van Schaardenburg DJ, Scholten RJPM, Bouter LM. Inter-observer reproducibility of measurements of range of motion in patients with shoulder pain using a digital inclinometer. BMC Musculoskelet Disord 2004; 5:18. [PMID: 15196309 PMCID: PMC434511 DOI: 10.1186/1471-2474-5-18] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2003] [Accepted: 06/14/2004] [Indexed: 01/28/2023] Open
Abstract
Background Reproducible measurements of the range of motion are an important prerequisite for the interpretation of study results. The digital inclinometer is considered to be a useful instrument because it is inexpensive and easy to use. No previous study assessed inter-observer reproducibility of range of motion measurements with a digital inclinometer by physical therapists in a large sample of patients. Methods Two physical therapists independently measured the passive range of motion of the glenohumeral abduction and the external rotation in 155 patients with shoulder pain. Agreement was quantified by calculation of the mean differences between the observers and the standard deviation (SD) of this difference and the limits of agreement, defined as the mean difference ± 1.96*SD of this difference. Reliability was quantified by means of the intraclass correlation coefficient (ICC). Results The limits of agreement were 0.8 ± 19.6 for glenohumeral abduction and -4.6 ± 18.8 for external rotation (affected side) and quite similar for the contralateral side and the differences between sides. The percentage agreement within 10° for these measurements were 72% and 70% respectively. The ICC ranged from 0.28 to 0.90 (0.83 and 0.90 for the affected side). Conclusions The inter-observer agreement was found to be poor. If individual patients are assessed by two different observers, differences in range of motion of less than 20–25 degrees can not be distuinguished from measurement error. In contrast, acceptable reliability was found for the inclinometric measurements of the affected side and the differences between the sides, indicating that the inclimeter can be used in studies in which groups are compared.
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Affiliation(s)
- Andrea F de Winter
- Institute for Research in Extramural Medicine, VU University Medical Center, van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands
- Department of Social Psychiatry, University of Groningen, P.O. Box 30001, 9700 RB Groningen, the Netherlands
| | - Monique AMB Heemskerk
- Institute for Research in Extramural Medicine, VU University Medical Center, van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands
- Dutch National Institute for Allied Health Professions, P.O. Box 1161, 3800 BD Amersfoort, the Netherlands
| | - Caroline B Terwee
- Institute for Research in Extramural Medicine, VU University Medical Center, van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands
| | - Marielle P Jans
- Institute for Research in Extramural Medicine, VU University Medical Center, van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands
- TNO Work and Employment, P.O. Box 718, 2130 AS Hoofddorp, the Netherlands
| | - Walter Devillé
- Institute for Research in Extramural Medicine, VU University Medical Center, van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands
- Netherlands Institute for Health Services Research (NIVEL), P.O. Box 1568, 3500 BN Utrecht, the Netherlands
| | - Dirk-Jan van Schaardenburg
- Department of Rheumatology, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, the Netherlands
| | - Rob JPM Scholten
- Institute for Research in Extramural Medicine, VU University Medical Center, van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands
- Dutch Cochrane Centre, J2-229, Academic Medical Center, P.O. Box 22660, 1100 DD Amsterdam, the Netherlands
| | - Lex M Bouter
- Institute for Research in Extramural Medicine, VU University Medical Center, van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands
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Abstract
The literature on physical and functional measurements for the cervical spine is more limited than for the lumbar spine. Most of the studies so far have dealt with the methods for range-of-motion measurements in the cervical spine. These studies indicate that newer computer-guided, three-dimensional measurements systems may provide more precise and reliable data than inclinometer-based techniques and visual estimation methods. The research available also shows a correlation between training and strength improvement in the cervical spine. In addition to physical measurements, several tests have been developed to measure pain level, psychologic factors, disability from neck pain, and generic health, which can assist the clinician in choosing the most appropriate treatment for patients with neck pain. Furthermore, functional measurement systems, such as FCEs, have been developed to describe the functional limitations that a patient may have as a result of a spinal injury. Except for the range-of-motion measurement methods, much more research is required to determine which measurement systems provide the optimal balance between reliability and validity and pragmatic considerations such as time and expense.
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Affiliation(s)
- Michael K Schaufele
- Department of Orthopaedics, Emory University, 1365 Clifton Road, Atlanta, GA 30322, USA.
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