Comparison of cervical range of motion in two seated postural conditions in adults 50 or older with cervical pain

Evaluation of Apparatus and Protocols to Measure Human Passive Neck Stiffness and Range of Motion

Understanding of human neck stiffness and range of motion (ROM) with minimal neck muscle activation ("passive") is important for clinical and bioengineering applications. The aim of this study was to develop, implement, and evaluate the reliability of methods for assessing passive-lying stiffness and ROM, in six head-neck rotation directions. Six participants completed two assessment sessions. To perform passive-lying tests, the participant's head and torso were strapped to a bending (flexion, extension, lateral bending) or a rotation (axial rotation) apparatus, and clinical bed, respectively. The head and neck were manually rotated by the researcher to the participant's maximum ROM, to assess passive-lying stiffness. Participant-initiated ("active") head ROM was also assessed in the apparatus, and seated. Various measures of apparatus functionality were assessed. ROM was similar for all assessment configurations in each motion direction except flexion. In each direction, passive stiffness generally increased throughout neck rotation. Within-session reliability for stiffness (ICC > 0.656) and ROM (ICC > 0.872) was acceptable, but between-session reliability was low for some motion directions, probably due to intrinsic participant factors, participant-apparatus interaction, and the relatively low participant number. Moment-angle corridors from both assessment sessions were similar, suggesting that with greater sample size, these methods may be suitable for estimating population-level corridors.

Body landmarks and genetic algorithm-based approach for non-contact detection of head forward posture among Chinese adolescents: revitalizing machine learning in medicine

Addressing the current complexities, costs, and adherence issues in the detection of forward head posture (FHP), our study conducted an exhaustive epidemiologic investigation, incorporating a comprehensive posture screening process for each participant in China. This research introduces an avant-garde, machine learning-based non-contact method for the accurate discernment of FHP. Our approach elevates detection accuracy by leveraging body landmarks identified from human images, followed by the application of a genetic algorithm for precise feature identification and posture estimation. Observational data corroborates the superior efficacy of the Extra Tree Classifier technique in FHP detection, attaining an accuracy of 82.4%, a specificity of 85.5%, and a positive predictive value of 90.2%. Our model affords a rapid, effective solution for FHP identification, spotlighting the transformative potential of the convergence of feature point recognition and genetic algorithms in non-contact posture detection. The expansive potential and paramount importance of these applications in this niche field are therefore underscored.

Normative cervical spine kinematics of a circumduction task

Neck pain is a prevalent condition and clinical examination techniques are limited and unable to assess out-of-plane motion. Recent works investigating cervical kinematics during neck circumduction (NC), a dynamic 3D task, has shown the ability to discern those with and without neck pain. The purposes of this study were to establish 1) confidence and prediction intervals of head-to-torso kinematics during NC in a healthy cohort, 2) a baseline summative metric to quantify the duration and magnitude of deviations outside the prediction interval, and 3) the reliability of NC. Thirty-nine participants (25.6 ± 6.3 years, 19F/20M) without neck pain completed left and right NC. A two-way smoothing spline analysis of variance was utilized to determine the mean-fitted values and 90% confidence and prediction intervals for NC. A standardized effect size was calculated and aggregated across all axes (Delta RMSD aggregate), as a summative metric of motion quality. Confidence and prediction intervals were comparable for left and right NC and demonstrated excellent reliability. The average sum of the Delta RMSD aggregate was 2.76 ± 0.55 for left NC and 2.74 ± 0.63 for right NC. The results of this study demonstrate the feasibility of utilizing normative intervals of a NC task to assess head-to-torso kinematics.

A Two Joint Neck Model to Identify Malposition of the Head Relative to the Thorax

Neck pain is a frequent health complaint. Prolonged protracted malpositions of the head are associated with neck pain and headaches and could be prevented using biofeedback systems. A practical biofeedback system to detect malpositions should be realized with a simple measurement setup. To achieve this, a simple biomechanical model representing head orientation and translation relative to the thorax is introduced. To identify the parameters of this model, anthropometric data were acquired from eight healthy volunteers. In this work we determine (i) the accuracy of the proposed model when the neck length is known, (ii) the dependency of the neck length on the body height, and (iii) the impact of a wrong neck length on the models accuracy. The resulting model is able to describe the motion of the head with a maximum uncertainty of 5 mm only. To achieve this high accuracy the effective neck length must be known a priory. If however, this parameter is assumed to be a linear function of the palpable neck length, the measurement error increases. Still, the resulting accuracy can be sufficient to identify and monitor a protracted malposition of the head relative to the thorax.

Joint position error after neck protraction-retraction movements in healthy office workers: a cross-sectional study

Since the upper cervical spine (UCS) has been regarded to be distinct from the lower cervical spine (LCS), joint position error (JPE) needs to be tested separately for both regions. The purpose of this study was to investigate the JPE after cervical protraction/retraction movements, involving opposite movements of extension and flexion for the UCS and LCS. These movements are frequently performed during office work. Cervical JPEs were tracked in thirty healthy office workers while performing four tests of cervical pro-retraction movements with variations in vision and movement direction, and assessed using the Kinect head tracker (Microsoft Corp), placed in front of each participant. The JPE was expressed in constant (CE), absolute (AE) and variable errors (VE). Multilevel linear models evaluated main and interaction effects of vision, movement direction, cervical region and sex. Slightly larger JPEs have been found in the UCS. Vision showed no effect on any outcome variable. No effect exceeded typical measurement errors reported for the Kinect head tracker. This study showed, that JPEs after pro-retraction movements of the head and neck may differ for UCS and LCS. The differences were small and not beyond measurement error reported for the Kinect.

Reliability and diagnostic accuracy of cervicothoracic differentiation testing and regional unloading for identifying improvement after thoracic manipulation in individuals with neck pain

BACKGROUND & PURPOSE

The cervicothoracic differentiation test (CTDT), cervical and thoracic unloading are used clinically to guide treatment. This study sought to determine the reliability and diagnostic accuracy of these tests.

METHODS

A prospective diagnostic accuracy study was performed at two outpatient clinics and one university research center. A convenience sample of 48 individuals with neck pain was recruited. Cervical and thoracic unloading tests and CTDT were performed with symptom relief considered a positive test. Pain was assessed using a visual analog pain scale (VAS) at rest and during provocative movements. The reference standard was pain relief following thoracic manipulation. Change in pain was used to identify improvement at the MCID (15 mm) and 50% improvement thresholds.

RESULTS

All three tests demonstrated high levels of inter-rater reliability, K = 0.90[0.77-1.00]. Of 48 individuals who completed the study, 39 (81.3%) were improved ≥ MCID; compared to 34 (70.8%) at the 50% threshold. As a single test, the CTDT yielded the strongest diagnostic utility (at MCID threshold) based on ROC curve: AUC 0.791 s.e. 0.078; with high specificity (0.89[51.75-99.72]); LR+ 6.23 [0.97-40]; LR- 0.35 [0.20-0.58]; and PPV 96.43. Unloading tests demonstrated high sensitivity, but poor specificity and likelihood ratios. Composite tests improved specificity, but with lower accuracy and minimal changes in ROC area compared to the CTDT in isolation.

CONCLUSIONS

The CTDT is a specific test with significant diagnostic utility to identify individuals who will experience immediate pain relief following thoracic manipulation. The CTDT should be considered during the clinical decision making process when treating individuals with neck pain.

Reliability and validity of clinical tests to assess posture, pain location, and cervical spine mobility in adults with neck pain and its associated disorders: Part 4. A systematic review from the cervical assessment and diagnosis research evaluation (CADRE) collaboration

PURPOSE

To determine the reliability and validity of clinical tests to assess posture, pain location, and cervical spine mobility in adults with grades I-IV neck pain and associated disorders (NAD).

METHODS

We systematically searched electronic databases to update the systematic review of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Eligible reliability and validity studies were critically appraised using modified versions of the QAREL and QUADAS-2 instruments, respectively. Evidence from low risk of bias studies were synthesized following best evidence synthesis principles.

RESULTS

We screened 14302 articles, critically appraised 46 studies, and found 32 low risk of bias articles (14 reliability and 18 validity studies). We found preliminary evidence of: 1) reliability of visual inspection, aided with devices (CROM and digital caliper) to assess head posture; 2) reliability and validity of soft tissue palpation to locate tender/trigger points in muscles; 3) reliability and validity of joint motion palpation to assess stiffness and pain provocation in combination; and 4) range of motion tests using visual estimation (in cervical extension only) or devices (digital caliper, goniometer, inclinometer) to assess cervical mobility.

CONCLUSIONS

We found little evidence to support the reliability and validity of clinical tests to assess head posture, pain location and cervical mobility in adults with NAD grades I-III. More advanced validity studies are needed to inform the clinical utility of tests used to evaluate patients with NAD.

Correlation among smartphone addiction, craniovertebral angle, scapular dyskinesis, and selected anthropometric variables in physiotherapy undergraduates

Objectives

Smartphone addiction has been indicated to reduce the craniovertebral angle, thereby causing a forward head posture and increasing scapular dyskinesis. This study determined the correlation among smartphone addiction level, craniovertebral angle, scapular dyskinesis, and selected anthropometric variables in physiotherapy undergraduates.

Methods

Seventy-seven participants were recruited from the Department of Physiotherapy, College of Medicine, University of Lagos, through a purposive sampling technique. The smartphone addiction level was assessed with the short version Smartphone Addiction Scale (English version). Craniovertebral and scapular dyskinesis were assessed using the photographic method. Descriptive and inferential statistics were used to analyse the data at an alpha level of 0.05.

Results

The analysis in this study revealed that many undergraduates are addicted to using smartphones. There was no significant difference in the addiction level (p = 0.367) and in scapular dyskinesis (p = 0.129) between male and female participants. However, there was a significant difference in craniovertebral angle (p = 0.032) between male and female participants. There was a significant relationship among smartphone addiction, craniovertebral angle (r = 0.306, p = 0.007), and scapular dyskinesis (r = 0.363, p = 0.007) in male and female participants.

Conclusion

A high level of smartphone addiction reduces the craniovertebral angle and increases scapular dyskinesis. Therefore, the smartphone addiction level should be assessed in all patients with neck and shoulder pain to plan appropriate management.

Development of the circumduction metric for identification of cervical motion impairment

Introduction

Chronic neck pain results in considerable personal, clinical, and societal burden. It consistently ranks among the top three pain-related reasons for seeking healthcare. Despite its prevalence, neck pain is difficult to both assess and treat. Quantitative approaches are required since diagnostic imaging techniques rarely provide information on movement-related neck pain, and most common clinical assessment tools are limited to single plane motion measurement.

Methods

In this study, the ability of an inertial measurement unit to document the cervical motion characteristics of 28 people with chronic neck pain and 23 healthy controls was assessed. A total of six circumduction metrics and one neck circumduction trajectory model were proposed as identification metrics.

Results

Five metrics demonstrated significant differences between the two groups. The neck circumduction trajectory model successfully distinguished between the two groups.

Discussion

The evaluation of the proposed metrics provides proof of concept that novel metrics can be captured with relative ease in the clinical setting using an inexpensive wearable sensor headband. The derivation of the proposed model may open new lines of inquiry into the clinical utility of assessing the multiplanar movement of cervical circumduction. The results obtained from this study also provide additional insight for the development of a sensitive, quantifiable and real-world neck evaluation strategies.

Intrarater and Inter-rater Reliability of Active Cervical Range of Motion in Patients With Nonspecific Neck Pain Measured With Technological and Common Use Devices: A Systematic Review With Meta-regression

OBJECTIVES

The purpose of this systematic review was to compare intrarater and inter-rater reliability of active cervical range of motion (ACROM) measures obtained with technological devices to those assessed with low-cost devices in patients with nonspecific neck pain. As a secondary outcome, we investigated if ACROM reliability is influenced by the plane of the assessed movement.

METHODS

Medline, Scopus, Embase, the Cochrane Library, CINHAL, PEDro, and gray literature were searched until August 2016. Inclusion criteria were reliability design, population of adults with nonspecific neck pain, examiners of any level of experience, measures repeated at least twice, and statistical indexes on reliability. A device was considered inexpensive if it cost less than €500. The risk of bias of included studies was assessed by Quality Appraisal of Reliability Studies.

RESULTS

The search yielded 35 151 records. Nine studies met all eligibility criteria. Their Quality Appraisal of Reliability Studies mean score was 3.7 of 11. No significant effect of the type of device (inexpensive vs expensive) on intraclass correlation coefficient (ICC) was identified for intrarater (ICC = 0.93 vs 0.91; P > .99) and inter-rater reliability (ICC = 0.80 vs 0.87; P > .99). The plane of movement did not affect inter-rater reliability (P = .11). Significant influences were identified with intrarater reliability (P = .0001) of inexpensive devices, where intrarater reliability decreased (P = .01) in side bending, compared with flexion-extension.

CONCLUSIONS

The use of expensive devices to measure ACROM in adults with nonspecific neck pain does not seem to improve the reliability of the assessment. Side bending had a lower level of intrarater reliability.

Kinematic Magnetic Resonance Imaging Assessment of the Degenerative Cervical Spine: Changes after Anterior Decompression and Cage Fusion

Study Design A prospective cohort study. Objective Decompression and fusion of cervical vertebrae is a combined procedure that has a high success rate in relieving radicular symptoms and stabilizing or improving cervical myelopathy. However, fusion may lead to increased motion of the adjacent vertebrae and cervical deformity. Both have been postulated to lead to adjacent segment pathology (ASP). Kinematic magnetic resonance imaging (MRI) has been increasingly used to evaluate range of motion (ROM) of the cervical spine and ASP. Our objective was to measure ASP, cervical curvature, and ROM of individual segments of the cervical spine using kinematic MRI before and 24 months after monosegmental cage fusion. Methods Eighteen patients who had single-level interbody fusion were included. ROM (using kinematic MRI) and degeneration, spinal stenosis, and cervical curvature were measured preoperatively and 24 months postoperatively. Results Using kinematic MRI, segmental motion of the cervical segments was measured with a precision of less than 3 degrees. The cervical fusion did not affect the ROM of adjacent levels. However, pre- and postoperative ROM was higher at the levels immediately adjacent to the fusion level compared with those further away. In addition, at 24 months postoperatively, the number of cases with ASP was higher at the levels immediately adjacent to fusion level. Conclusions Using kinematic MRI, ROM after spinal fusion can be measured with high precision. Kinematic MRI can be used not only in clinical practice, but also to study intervention and its effect on postoperative biomechanics and ASP of cervical vertebrae.

Effects of forward head posture on static and dynamic balance control

[Purpose] To determine the effects of forward head posture on static and dynamic balance control. [Subjects and Methods] This study included 30 participants who were included into a forward head posture group (n = 14) and a control group (n = 16) according to their craniovertebral angles. Static balance control was assessed according to center of gravity sway velocity and total sway distance using an automatic balance calibration system. Dynamic balance control was assessed using the diagnosis mode of a body-tilt training and measurement system. [Results] Sway velocities on a hard surface with eyes open and closed and those on an unstable sponge surface with eyes closed were significantly higher in the forward head posture group than in the control group. Furthermore, on both the hard and sponge surfaces in the eyes open and closed conditions, total sway distances were significantly higher in the forward head posture group than in the control group. Results of dynamic balance control were not significantly different between groups. [Conclusion] Forward head posture has a greater effect on static balance control than on dynamic balance control.

Reliability and validity of cervical position measurements in individuals with and without chronic neck pain

OBJECTIVES

The cervical range of motion device (CROM) has been shown to provide reliable forward head position (FHP) measurement when the upper cervical angle (UCA) is controlled. However, measurement without UCA standardization is reflective of habitual patterns. Criterion validity has not been reported. The purposes of this study were to establish: (1) criterion validity of CROM FHP and UCA compared to Optotrak data, (2) relative reliability and minimal detectable change (MDC95) in patients with and without cervical pain, and (3) to compare UCA and FHP in patients with and without pain in habitual postures.

METHODS

(1) Within-subjects single session concurrent criterion validity design. Simultaneous CROM and OP measurement was conducted in habitual sitting posture in 16 healthy young adults. (2) Reliability and MDC95 of UCA and FHP were calculated from three trials. (3) Values for adults over 35 years with cervical pain and age-matched healthy controls were compared.

RESULTS

(1) Forward head position distances were moderately correlated and UCA angles were highly correlated. The mean (standard deviation) differences can be expected to vary between 1·48 cm (1·74) for FHP and -1·7 (2·46)° for UCA. (2) Reliability for CROM FHP measurements were good to excellent (no pain) and moderate (pain). Cervical range of motion FHP MDC95 was moderately low (no pain), and moderate (pain). Reliability for CROM UCA measurements was excellent and MDC95 low for both groups. There was no difference in FHP distances between the pain and no pain groups, UCA was significantly more extended in the pain group (P<0·05).

DISCUSSION

Cervical range of motion FHP measurements were only moderately correlated with Optotrak data, and limits of agreement (LOA) and MDC95 were relatively large. There was also no difference in CROM FHP distance between older symptomatic and asymptomatic individuals. Cervical range of motion FHP measurement is therefore not recommended as a clinical outcome measure. Cervical range of motion UCA measurements showed good criterion validity, excellent test-retest reliability, and achievable MDC95 in asymptomatic and symptomatic participants. Differences of more than 6° are required to exceed error. Cervical range of motion UCA shows promise as a useful reliable and valid measurement, particularly as patients with cervical pain exhibited significantly more extended angles.