Validation of the German version of the Neck Disability Index (NDI)

Does combining oro-facial manual therapy with bruxism neuroscience education affect pain and function in cases of awake bruxism? A pilot study

BACKGROUND

Although awake bruxism is associated with temporomandibular disorder (TMD) as well as head and neck pain, the effects of physical therapy and bruxism education to address these factors have not been investigated.

OBJECTIVE

The aim of this study was to evaluate the effects of oro-facial manual therapy and bruxism neuroscience education (BNE) on awake bruxism over a 3-week period with an open-ended follow-up questionnaire after 3 months.

METHODS

Subjects (n = 28) were randomly allocated to one of two groups, an intervention group and a control group. Data regarding disability, function and pain were collected pre- and post-assessment, with all measures administered in a single-blind fashion. Participants in both groups received six treatment sessions during this period. In addition to manual therapy, participants were provided with information on the neurophysiological mechanisms of bruxism and contributing factors. Individual behavioural guidelines and daily exercises were determined in consultation with the therapist. An introduction to a bruxism specific app (Brux.App) was also provided, which all participants used as an adjunct to their treatment.

RESULTS

The intervention group demonstrated notable improvement as indicated by their scores in the Neck Disability Index (NDI) (p = .008), Pain Disability Index (PDI) (p = .007) and Jaw Disability List (JDL) (p = .03). Furthermore, clinical assessments of the temporomandibular joint (TMJ) revealed a significant progress in terms of mouth opening (p = .03) and lateral jaw movement (laterotrusion) (p = .03). The mechanical pain threshold (PTT) of both the masseter (p = .02) and temporalis muscle (p = .05) also showed significant improvement. At 3-month follow-up, the questionnaire revealed that the majority of the intervention group (13/15, 87%) reported a benefit from the treatment.

CONCLUSION

The reduction in pain and disability together with improvement in function and increased coping suggest a potential modification of awake bruxism through specialised musculoskeletal intervention and BNE tailored to the individual patient.

Analysis of Clinical Pattern of Musculoskeletal Disorders in the Cervical and Cervico-Thoracic Regions of the Spine

Background: Cervical spine disorders (CSDs) are a common cause of neck pain. Proper diagnosis is of great importance in planning the management of a patient with neck pain. Hence, the aim of this study is to provide an overview of the clinical pattern of early-stage functional disorders affecting the cervical and cervico-thoracic regions of the spine, considering the age and sex of the subjects. Methods: Two hundred adult volunteers were included in the study. Manual examination of segments C0/C1-Th3/Th4 was performed according to the methodology of the Katenborn-Evjenth manual therapy concept and the spine curvatures were assessed (cervical lordosis and thoracic kyphosis). Results: The most common restricted movement was lateral flexion to the left, and the least disturbed movement were observed in the sagittal plane (flexion and extension). The most affected segment was C7/Th1 (71.5% participants had problems in this segment), and the least affected segment was Th3/Th4 (69.5% participants had no mobility disorders in this segment). The number of disturbed segments did not differ between men and women (p > 0.05), but increased with age (r = 0.14, p = 0.04). Conclusions: Cervical mobility in adult population is frequently restricted. The number of affected segments increased with age and was not sex-dependent.

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

OBJECTIVE

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

DESIGN

Cross-sectional study.

SETTING

Interdisciplinary outpatient rehabilitation clinic for back and neck pain.

PARTICIPANTS

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

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

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

RESULTS

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

CONCLUSION

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

[Patient-reported outcome measures for assessing health-related quality of life in patients with voice and swallowing disorders]

Standardized and validated patient surveys in the form of questionnaires are becoming increasingly important in otorhinolaryngology. Subjective symptoms and functional limitations but also health-related quality of life are assessed with so-called patient-reported outcome measures (PROMs). Besides patient history and objective findings, these questionnaires can be applied as another important source for ensuring the quality of patient-centered care. In German-speaking countries there are now several PROMs that specifically ask for the patient perspective on voice and swallowing disorders. For patients with voice disorders the following questionnaires based on the Voice Handicap Index (VHI), which are also used internationally, are mainly applied: VHI-30, VHI-12i, and VHI-9i. In the field of oropharyngeal dysphagia, the German versions of the Eating Assessment Tool-10 (EAT-10), des Sydney Swallow Questionnaire SSQ‑G, the Swallowing Quality of Life Questionnaire (SWAL-QoL), and the MD Anderson Dysphagia Inventory (MDADI) are currently mostly used.

Additional effects of pain neuroscience education combined with physiotherapy on the headache frequency of adult patients with migraine: A randomized controlled trial

Aim To assess the efficacy of pain neuroscience education combined with physiotherapy for the management of migraine.Background Physiotherapy can significantly reduce the frequency of migraine, but the evidence is based only on a few studies. Pain neuroscience education might pose a promising treatment, as it addresses migraine as a chronic pain disease.Methods In this non-blinded randomized controlled trial, migraine patients received physiotherapy + pain neuroscience education or physiotherapy alone, preceded by a three-month waiting period. Primary outcomes were frequency of headache (with and without migraine features), frequency of migraine and associated disability.Results Eighty-two participants were randomized and analyzed. Both groups showed a decrease of headache frequency (p = 0.02, d = 0.46) at post-treatment (physiotherapy: 0.77 days, 95%CI: -0.75 to 2.29 and physiotherapy + pain neuroscience education: 1.25 days, 95%CI: -0.05 to 2.55) and at follow-up (physiotherapy: 1.93, 95%CI: 0.07 to 3.78 and physiotherapy + pain neuroscience education: 3.48 days, 95%CI: 1.89 to 5.06), with no difference between groups (p = 0.26, d = 0.26). Migraine frequency was reduced significantly in the physiotherapy + pain neuroscience education group, and not in the physiotherapy group, at post-treatment (1.28 days, 95%CI: 0.34 to 2.22, p = 0.004) and follow-up (3.05 days, 95%CI: 1.98 to 5.06, p < 0.0001), with a difference between groups at follow-up (2.06 days, p = 0.003). Migraine-related disability decreased significantly in both groups (physiotherapy: 19.8, physiotherapy + pain neuroscience education: 24.0 points, p < 0.001, d = 1.15) at follow-up, with no difference between groups (p = 0.583). Secondary outcomes demonstrated a significant effect of time with no interaction between time and group. No harm or adverse events were observed during the study.Conclusion In comparison to physiotherapy alone, pain neuroscience education combined with physiotherapy can further reduce the frequency of migraine, but had no additional effect on general headache frequency or migraine-related disability.Trial Registration The study was pre-registered at the German Clinical Trials Register (DRKS00020804).

Validation of the German version of the STarT-MSK-Tool: A cohort study with patients from physiotherapy clinics

BACKGROUND

The STarT-MSK-Tool is an adaptation of the well established STarT-Back-Tool, used to risk-stratify patients with a wider range of musculoskeletal presentations.

OBJECTIVE

To formally translate and cross-culturally adapt the Keele STarT-MSK risk stratification tool into German (STarT-MSKG) and to establish its reliability and validity.

METHODS

A formal, multi-step, forward and backward translation approach was used. To assess validity patients aged ≥18 years, with acute, subacute or chronic musculoskeletal presentations in the lumbar spine, hip, knee, shoulder, or neck were included. The prospective cohort was used with initial data collected electronically at the point-of-consultation. Retest and 6-month follow-up questionnaires were sent by email. Test-retest reliability, construct validity, discriminative ability, predictive ability and floor or ceiling effects were analysed using intraclass correlation coefficient, and comparisons with a reference standard (Orebro-Musculoskeletal-Pain-Questionnaire: OMPQ) using correlations, ROC-curves and regression models.

RESULTS

The participants' (n = 287) mean age was 47 (SD = 15.8) years, 51% were female, with 48.8% at low, 43.6% at medium, and 7.7% at high risk. With ICC = 0.75 (95% CI 0.69; 0.81) test-retest-reliability was good. Construct validity was good with correlations for the STarT-MSKG-Tool against the OMPQ-Tool of rs = 0.74 (95% CI 0.68, 0.79). The ability of the tool [comparison OMPQ] to predict 6-month pain and disability was acceptable with AUC = 0.77 (95% CI 0.71, 0.83) [OMPQ = 0.74] and 0.76 (95% CI 0.69, 0.82) [OMPQ = 0.72] respectively. However, the explained variance (linear/logistic regression) for predicting 6-month pain (21% [OMPQ = 17%]/logistic = 29%) and disability (linear = 20%:[OMPQ = 19%]/logistic = 26%), whilst being comparable to the existing OMPQ reference standard, fell short of the a priori target of ≥30%.

CONCLUSIONS

The German version of the STarT-MSK-Tool is a valid instrument for use across multiple musculoskeletal conditions and is availabe for use in clinical practice. Comparison with the OMPQ suggests it is a good alternative.

The impact of endoscopic activity on musculoskeletal disorders of high-volume endoscopists in Germany

Physical stress is common in GI endoscopists, leading to musculoskeletal disorders. Considering the increasing complexity of interventional GI endoscopy with prolonged examination time, work-related musculoskeletal disorders have come into focus. However, data on work-related health stress in German endoscopists are elusive. The aim of this study was therefore to investigate the prevalence and consequences of work-related musculoskeletal disorders in German endoscopists. A 24-item questionnaire on endoscopy-associated musculoskeletal disorders and standardized pain assessment was developed by an interdisciplinary team of endoscopists and sports medics. The survey was distributed online by the leading German societies for gastroenterology and endoscopy. Overall, 151 German practicing endoscopists took part in the study. Regarding the average number of endoscopic procedures per week, the study collective consisted mainly of high-volume endoscopists. The survey showed that most participants suffered from general musculoskeletal disorders (82.8%) and from work-related musculoskeletal disorders (76.8%). The most affected body parts were the neck, low back, thumb, and shoulder. Temporary absence from work due to symptoms was reported by 9.9% of the respondents. Over 30% of participating endoscopists stated the need for analgesics or physiotherapy due to musculoskeletal disorders. Age, professional experience and work time were identified as relevant risk factors for musculoskeletal health issues. A high number of German endoscopists are affected by musculoskeletal disorders due to specific working postures and repetitive movements with a large impact on personal health. Further interventional studies are mandatory to improve the risk prevention of endoscopic activity.

Radiological and Clinical Outcomes after Anterior Cervical Discectomy and Fusion (ACDF) with an Innovative 3D Printed Cellular Titanium Cage Filled with Vertebral Bone Marrow

Objectives

To assess the clinical and radiological outcomes after ACDF with 3D printed cellular titanium cages filled with bone marrow and to compare the clinical and radiological results with the current scientific literature.

Methods

ACDF was performed monosegmentally under standardized conditions. X-rays were analyzed to determine the range of motion, fusion rates, and subsidence preoperatively and 3 and 12 months postoperatively. Clinical outcome measurements included neck disability index (NDI), visual analogue scale (VAS) for brachialgia and cervicalgia, and patient satisfaction.

Results

18 patients were included in the study. The mean RoM decreased from 7.7° ± 2.6 preoperatively to 1.7° ± 1.1° after 3 months and 1.8° ± 1.2° 12 months after surgery. The fusion rates were at 94.4% after 3 and 12 months. The mean subsidence was 0.9 mm ± 0.5 mm 3 months postoperatively and 1.1 mm ± 0.5 mm 12 months after surgery. The mean NDI improved significantly from preoperatively to 12 months postoperatively (34.6 ± 6.2 and 3.4 ± 4.1, respectively). The VAS-neck also showed a large improvement from 5.8 ± 2.2 before and 1.3 ± 1.4 12 months after surgery, as did the VAS-arm (6.4 ± 1.5 and 0.9 ± 1.6, respectively). Patient satisfaction was high throughout the follow-up period.

Conclusion

ACDF with a 3D printed titanium cage resulted in fast fusion without pathological subsidence. In comparison to other cage materials such as PEEK, the 3D printed titanium cage was noninferior in regard to its fusion rate and clinical results.

[Does reduction mammoplasty improve neck pain and quality of life?]

INTRODUCTION AND OBJECTIVE

Macromastia often leads to physical complaints involving pain in the shoulder/neck area. In Germany, there are virtually no reliable data on the effects of breast reduction surgery with regard to neck and spine complaints. Therefore, the authors carried out a retrospective study to investigate the effect of breast-reducing surgery on neck pain and quality of life.

METHODS

Between January 1, 2014 and December 31, 2019, 107 breast reductions were performed for macromastia. Medical records and OP reports were evaluated, and the indication for breast reduction documented. Pain was recorded preoperatively on a visual analog scale (VAS). Pretreatments and perioperative complications were also documented and evaluated. All patients were sent a questionnaire, which determined whether the objective of the operation had been achieved, how satisfied the patients were with the result of the operation, and how severe the current pain (VAS) was. The EQ-5D 3L health questionnaire was used to assess quality of life, and the Neck-Disability Index was used to assess neck complaints. Statistical analysis was carried out using the Wilcoxon test.

RESULTS

After an average of 56.5 months (min: 18, max: 90), 76/107 (71%) patients could be re-examined. There were 15 complications. Pain improved from an average of 7.2 preoperatively (min: 0, max: 10) to an average of 1.6 postoperatively (min: 0, max: 4; p < 0.001). The Neck-Disability Index improved from an average of 43.8% (Min: 0, Max: 82) to an average of 10.8% (Min: 0, Max: 52) postoperatively (p < 0.001). In all, 71/76 (93%) of the examined patients were very satisfied or satisfied with the result of the operation.

DISCUSSION AND CONCLUSION

With this study, the authors were able to show that there are often several reasons why breast reduction surgery is performed in patients with macromastia. A high patient satisfaction rate can be achieved and orthopedic clinical complaints associated with macromastia can be treated with a very high success rate.

Anterior cervical corpectomy and fusion with stand-alone cages in patients with multilevel degenerative cervical spine disease is safe

Background

In case of spinal cord compression behind the vertebral body, anterior cervical corpectomy and fusion (ACCF) proves to be a more feasible approach than cervical discectomy. The next step was the placement of an expandable titanium interbody in order to restore the vertebral height. The need for additional anterior plating with ACCF has been debatable and such technique has been evaluated by very few studies. The objective of the study is to evaluate radiographic and clinical outcomes in patients with multilevel degenerative cervical spine disease treated by stand-alone cages for anterior cervical corpectomy and fusion (ACCF).

Methods

Thirty-one patients (66.5 ± 9.75 years, range 53–85 years) were analyzed. Visual Analog Scale (VAS) and the 10-item Neck Disability Index (NDI) were assessed preoperatively and during follow-up on a regular basis after surgery and after one year at least. Assessment of radiographic fusion, subsidence, and lordosis measurement of Global cervical lordosis (GCL); fusion site lordosis (FSL); the anterior interbody space height (ant. DSH); the posterior interbody space height (post. DSH); the distance of the cage to the posterior wall of the vertebral body (CD) were done retrospectively. Mean clinical and radiographic follow-up was 20.0 ± 4.39 months.

Results

VAS-neck (p = 0.001) and VAS-arm (p < 0.001) improved from preoperatively to postoperatively. The NDI improved at the final follow-up (p < 0.001). Neither significant subsidence of the cages nor significant loss of lordotic correction were seen. All patients showed a radiographic union of the surgically addressed segments at the last follow up.

Conclusions

Application of a stand-alone expandable cage in the cervical spine after one or two-level ACCF without additional posterior fixation or anterior plating is a safe procedure that results in fusion. Neither significant subsidence of the cages nor significant loss of lordotic correction were seen.

Trial registration

Retrospectively registered. According to the Decision of the ethics committee, Jena on 25th of July 2018, that this study doesn’t need any registration. https://www.laek-thueringen.de/aerzte/ethikkommission/registrierung/.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-021-04883-5.

The Short-Form Neck Disability index has adequate measurement properties in chronic neck pain patients

Objectives

To assess test–retest reliability, internal consistency, construct validity, and the presence of ceiling and floor effects in the Brazilian version of the Short-Form Neck Disability Index (SF-NDI) in patients with chronic neck pain.

Methods

One hundred and fifty-six patients answered the Numerical Pain Rating Scale (NPRS), Short-Form Neck Disability Index (SF-NDI), Tampa Scale of Kinesiophobia (TKS), Pain Catastrophizing Scale (PCS), and the 36-Item Short-Form Health Survey questionnaire (SF-36). Another sample (n = 51) filled the SF-NDI at two different times, and test–retest reliability was measured using the intraclass correlation coefficient (ICC), standard error of measurement (SEM), and minimum detectable change (MDC). The internal consistency of the SF-NDI was analyzed by Cronbach's alpha. To determine construct validity, Spearman's correlation coefficient was used to determine the magnitude of the correlation between the score of the SF-NDI and other measurement instruments: NPRS, TKS, PCS, SF-36, and original NDI.

Results

SF-NDI presented substantial reliability (ICC = 0.844) and adequate internal consistency (Cronbach's alpha = 0.778). We observed significant values and with a correlation magnitude greater than 0.80 for the SF-NDI with the original NDI, between 0.30 and 0.50 for the correlations with TKS, and the functional capacity and pain domains of the SF-36, and less than 0.30 with the other study instruments. No participant reached the maximum score. Ceiling and floor effects were not observed.

Conclusions

SF-NDI with 5 items has adequate measurement properties in Brazilian chronic neck pain patients.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00586-021-07019-4.

Osteopathic Medicine in Four Chronic Musculoskeletal Pain Diseases: An Observational Trial with Follow-Up

BACKGROUND AND AIM

Patients with chronic musculoskeletal pain diseases (CMPDs) often use osteopathic medicine (OM), although the changes in patients with pain diseases are still insufficiently investigated. This study aimed to observe changes along and after OM in addition to routine care on pain, functioning, and quality of life in patients with four CMPDs.

METHODS

In this observational trial with follow-up, patients suffering from chronic neck pain (CNP, n = 10), chronic low back pain (CLBP, n = 10), chronic shoulder pain (CSP, n = 10), or chronic knee pain (CKP, n = 10) received up to six OM sessions in addition to routine care.

RESULTS

A total of 40 patients (73% female, mean age 47.7 ± 8.3 years, mean pain intensity 59.4 ± 12.5 mm, measured by a visual analog scale [VAS] 0-100 mm) were included. After 26 weeks, there was an improvement in the VAS pain score in the whole population (mean difference to baseline -33.1 mm [95% CI -40.5 to -25.7]), as well in the patients with the four diseases: CNP (-33.7 mm [-54.7 to -12.6]), CLBP (-28.2 mm [-47.9 to -8.4]), CSP (-32.4 [-46.8 to -18.0]), and CKP (-38.1 mm [-49.1 to -27.0]). Regarding disease-specific outcomes, we found improvements in CNP, as measured by the neck disability index (scale 0-50; mean difference -3.6 [-9.0 to 1.9]), CLBP, as measured by the low back pain rating scale (scale 0-60; -3.4 [-12.5 to 5.7]), CSP, as measured by the disabilities of the arm, shoulder and hand score (scale 0-100; -13.4 [-23.1 to -3.7]), and CKP, as measured by the Western Ontario and McMaster Universities Osteoarthritis Index (scale 0-96; -13.0 [-23.5 to -2.5]). These improvements persisted through week 52. No adverse events were observed.

CONCLUSION

The study observed beneficial changes along and after the OM treatment in addition to routine care in patients with four different CMPDs. High-quality, multicenter randomized controlled trials are strongly needed to compare the effectiveness of OM and standard care interventions in treating CMPDs in the future. We have provided sufficient data for sample size calculations for these trials.

Croatian version of the neck disability index can distinguish between acute, chronic and no neck pain : Results of a validation study

OBJECTIVE

Longitudinal study to test the validity and reliability of the Croatian version of the neck disability index (NDI-CRO) for use in patients.

METHODS

Three groups were given NDI-CRO on two occasions, 48 h apart: acute whiplash neck injury group (n = 30), hospital physiotherapists-professional chronic neck pain group (n = 56) and control group (n = 65). To test validity, correlation between NDI-CRO and the pain VAS and PHQ‑9 questionnaire for depression was analyzed. Reliability testing was done using the test-retest experiment and item-total score correlation.

RESULTS

Test-retest showed excellent correlation in all groups: whiplash 0.86, control 0.95 and physiotherapist 0.89 (Spearman r). Item-total score in the 3 analyzed groups showed positive correlation in all 10 categories, varying from 0.43-0.85. The NDI-CRO score showed significant difference between groups (median whiplash 38%, physiotherapist 12% and control 6%, p < 0.05). Validity testing showed positive correlation between NDI and pain VAS (control r = 0.63, physiotherapist r = 0.68 and whiplash r = 0.83, p < 0.05) and PHQ‑9 (control r = 0.49, physiotherapist r = 0.71 and whiplash r = 0.69, p < 0.05). No correlation was found between NDI-CRO and age, gender or radiographic findings. In the whiplash injury group 75% of patients showed moderate to severe disability. The majority of physiotherapists showed mild to moderate disability due to neck pain while 40% showed no disability. In the control group two out of three people reported no disability.

CONCLUSION

The NDI-CRO is a valid index for measuring the degree of neck disability in people with acute and chronic neck pain and in control group. It is strongly correlated with pain VAS and PHQ‑9 index.

Treatment of Unstable Occipital Condylar Fractures in Children-A STROBE-Compliant Investigation

Background and objectives: Occipital condyle fractures (OCF) occur rarely in children. The choice of treatment is based on the Anderson-Montesano and Tuli classification systems. We evaluated the outcome of unstable OCF in children and adolescents after halo-vest therapy. Materials and Methods: We treated 6 pediatric patients for OCF, including 3 patients (2 girls, 1 boy) with unstable OCF. Among the 3 patients with unstable OCF, 2 patients presented with an Anderson-Montesano type III and Tuli type IIB injury, while 1 patient had an Anderson-Montesano type I fracture (Tuli type IIB) accompanied by a C1 fracture. On admission, the children underwent computed tomography (CT) of the head and cervical spine as well as magnetic resonance imaging (MRI) of the cervical spine. We treated the children diagnosed with unstable OCF with halo-vest immobilization. Before removing the halo vest at the end of therapy, we applied the CT and MRI to confirm OCF consolidation. At follow-up, we rated functionality of the craniocervical junction (CCJ) based on the Neck Disability Index (NDI) and Questionnaire Short Form 36 Health Survey (SF-36). Results: All children achieved OCF consolidation after halo-vest therapy for a median of 13.0 weeks (range: 12.5-14.0 weeks). CT and MRI at the end of halo-vest therapy showed no signs of C0/C1 subluxation and confirmed the correct consolidation of OCF. The only complication associated with halo-vest therapy was a superficial infection caused by a halo-vest pin. At follow-up, all children exhibited favorable functionality of the CCJ as documented by the NDI score (median: 3 points; range: 3-11 points) and SF-36 score (median: 91 points; range: 64-96 points). Conclusions: In our small case series, halo-vest therapy resulted in good mid-term outcome in terms of OCF consolidation and CCJ functionality. In pediatric patients with suspected cervical spine injuries, we recommend CT and MRI of the CCJ to establish the diagnosis of OCF and confirm stable fracture consolidation before removing the halo vest.

No evidence for an effect of working from home on neck pain and neck disability among Swiss office workers: Short-term impact of COVID-19

PURPOSE

The aim of this study was to investigate the effect of working from home on neck pain (NP) among office workers during the COVID-19 pandemic.

METHODS

Participants from two Swiss organisations, aged 18-65 years and working from home during the lockdown (n = 69) were included. Baseline data collected in January 2020 before the lockdown (office work) were compared with follow-up data in April 2020 during lockdown (working from home). The primary outcome of NP was assessed with a measure of intensity and disability. Secondary outcomes were quality of workstation ergonomics, number of work breaks, and time spent working at the computer. Two linear mixed effects models were fitted to the data to estimate the change in NP.

RESULTS

No clinically relevant change in the average NP intensity and neck disability was found between measurement time points. Each working hour at the computer increased NP intensity by 0.36 points (95% CI: 0.09 to 0.62) indicating strong evidence. No such effect was found for neck disability. Each work break taken reduced neck disability by 2.30 points (95% CI:  - 4.18 to  - 0.42, evidence). No such effect was found for NP intensity. There is very strong evidence that workstation ergonomics was poorer at home.

CONCLUSION

The number of work breaks and hours spent at the computer seem to have a greater effect on NP than the place of work (office, at home), measurement time point (before COVID-19, during lockdown) or the workstation ergonomics. Further research should investigate the effect of social and psychological factors.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT04169646. Registered 15 November 2019-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04169646 .

Reliability and Validity of Cross Culturally Adapted Punjabi Version of NDI (NDI-P) in Patients with Neck Pain: A Psychometric Analysis

BACKGROUND

Neck disability index (NDI) is one of the commonest patient-reported outcome measures used to evaluate disability related to neck pain. Its application to non-English-speaking Punjabi population is limited as a validated and cross-culturally adapted Punjabi version of NDI is not available. The purpose of the study was to analyze the psychometric properties of Punjabi version of neck disability index (NDI-P) in patients with neck pain.

MATERIALS AND METHODS

The translation and cross-cultural adaptation of Punjabi version of NDI was done according to well-recommended guidelines. The pre-final version was tested on a set of 15 patients and suitable modifications were made. The final version was administered to 100 patients with neck pain of more than 2 weeks duration. Psychometric properties comprising internal consistency, test-re-test reliability, construct validity and factorial structure of the questionnaire were determined.

RESULTS

The developed NDI-P showed excellent internal consistency (Chronbach alpha of NDI-P is 0.87), test-re-test reliability (ICC 0.840) and construct validity (Spearman correlation coefficient with VAS 0.547). Factor analysis proved the questionnaire to be having a 2-factor structure with a total variance of 56.58%.

CONCLUSION

NDI (P) is a reliable and valid instrument for measurement of disability related to neck pain in Punjabi population. It can be used both in research and clinical care settings in future.

Application and utility of a clinical framework for spinally referred neck-arm pain: A cross-sectional and longitudinal study protocol

BACKGROUND

The clinical presentation of neck-arm pain is heterogeneous with varying underlying pain types (nociceptive/neuropathic/mixed) and pain mechanisms (peripheral/central sensitization). A mechanism-based clinical framework for spinally referred pain has been proposed, which classifies into (1) somatic pain, (2) neural mechanosensitivity, (3) radicular pain, (4) radiculopathy and mixed pain presentations. This study aims to (i) investigate the application of the clinical framework in patients with neck-arm pain, (ii) determine their somatosensory, clinical and psychosocial profile and (iii) observe their clinical course over time.

METHOD

We describe a study protocol. Patients with unilateral neck-arm pain (n = 180) will undergo a clinical examination, after which they will be classified into subgroups according to the proposed clinical framework. Standardized quantitative sensory testing (QST) measurements will be taken in their main pain area and contralateral side. Participants will have to complete questionnaires to assess function (Neck Disability Index), psychosocial factors (Tampa Scale of Kinesiophobia, Pain Catastrophizing Scale, Depression, anxiety and stress scale), neuropathic pain (Douleur Neuropathique 4 Questions, PainDETECT Questionnaire) and central sensitization features (Central Sensitization Inventory). Follow-ups at three, six and 12 months include the baseline questionnaires. The differences of QST data and questionnaire outcomes between and within groups will be analyzed using (M)AN(C)OVA and/or regression models. Repeated measurement analysis of variance or a linear mixed model will be used to calculate the differences between three, six, and 12 months outcomes. Multiple regression models will be used to analyze potential predictors for the clinical course.

CONCLUSION

The rationale for this study is to assess the usability and utility of the proposed clinical framework as well as to identify possible differing somatosensory and psychosocial phenotypes between the subgroups. This could increase our knowledge of the underlying pain mechanisms. The longitudinal analysis may help to assess possible predictors for pain persistency.

The effect of osteopathic medicine on pain in musicians with nonspecific chronic neck pain: a randomized controlled trial

Background:

Nonspecific chronic neck pain (cNP) is common in adult violinists and violists and is often treated with osteopathic medicine (OM), although the effectiveness of this treatment has not been determined to date. This study aimed to evaluate the effectiveness and safety of OM in adult violinists and violists with cNP.

Methods:

In a two-armed randomized controlled single-center open trial, adult violinists and violists, including music students, with cNP (⩾12 weeks) were randomized to either five individualized OM sessions (OM group) or to no intervention (control group, CG) in the outpatient clinic for integrative medicine, Charité - Universitätsmedizin Berlin, Germany. All patients received a musicians’ medicine consultation and paracetamol on demand. The primary outcome parameter was the neck pain intensity on a visual analog scale (VAS, 0–100 mm, 0 = no pain, 100 = worst imaginable pain) after 12 weeks. Secondary outcomes included neck pain disability (Neck Disability Index, NDI, 0–100%) after 12 weeks. The last follow-up visit was after 52 weeks. Statistical analysis included analysis of covariance adjusted for respective baseline value.

Results:

Altogether, 62 outpatients were included [OM group (n = 28), CG (n = 34); 81% female; mean age, 41.6 ± 11.1 years; mean baseline neck pain, 55.9 ± 11.6 mm]. After 12 weeks, OM was associated with an improvement in the OM group versus the CG in neck pain on the VAS [14.6 mm (95% confidence interval 8.0; 21.2) versus 40.8 mm (34.7; 46.9), p < 0.001, Cohen’s d = 1.4], and neck pain disability as determined by the NDI [8.8% (6.7; 10.8) versus 17.2% (15.3; 19.1), p < 0.001]. Some improvements were maintained until 52 weeks of follow-up. No serious adverse events were observed.

Conclusions:

The results of this study suggest that OM might be effective in reducing pain intensity in adult violinists and violists with nonspecific cNP. Further studies should investigate the efficacy of OM in comparison with a sham procedure and with other effective therapy methods in high-quality multicenter trials.

Trial registration:

WHO Trial Registration https://apps.who.int/trialsearch/NoAccess.aspx?aspxerrorpath=/trialsearch/Trial2.aspx by German Clinical Trials Register DRKS00009258, Universal Trial Number (UTN): U1111-1173-5943.

Somatosensory profiles in patients with non-specific neck-arm pain with and without positive neurodynamic tests

Despite normal neurological integrity tests, some patients with non-specific neck-arm pain (NSNAP) have heightened nerve mechanosensitivity upon neurodynamic testing. The aim of this study was to determine whether or not a nerve dysfunction is present in patients with positive neurodynamic tests compared to those with negative neurodynamic tests or healthy controls. Somatosensory profiling using quantitative sensory testing (QST) was established in 40 consecutive patients with unilateral NSNAP; 23 had positive upper limb neurodynamic tests (ULNT_POS) and 17 had negative neurodynamic tests (ULNT_NEG) and in 26 healthy controls. QST included measurement of thermal and mechanical detection and pain thresholds in the maximal pain area on the symptomatic side as well as the corresponding contralateral area. Fifty-seven percent of patients with NSNAP had positive neurodynamic tests. Somatosensory profiling revealed a loss of function phenotype in NSNAP patients compared to healthy controls both in the maximal pain area and asymptomatic side. Hyperalgesia (cold, heat and pressure) was present bilaterally in both NSNAP groups. Direct comparison between the patient groups revealed no significant differences in somatosensory profiles. However, the ULNT_POS group demonstrated sensory loss compared to healthy controls in more parameters than the ULNT_NEG group. The ULNT_NEG subgroup represented an intermediate phenotype between ULNT_POS patients and healthy controls in most detection thresholds as well as thermal and pressure pain thresholds. Even though patients with NSNAP present as a spectrum, it remains unclear whether the sensory changes are indicative of a nerve dysfunction/lesion or rather a marker of altered central pain processing.

German translation, cross-cultural adaptation and validation of the Musculoskeletal Health Questionnaire: a cohort study

BACKGROUND

The Musculoskeletal Health Questionnaire (MSK-HQ) was developed to measure the health status of patients with various musculoskeletal conditions across multiple settings including rehabilitation.

AIM

Formal translation and cross-cultural adaptation of the MSK-HQ into German (MSK-HQ<inf>G</inf>), to determine test-retest-reliability, standard error of measurement (SEM), smallest detectable change (SDC), construct validity, responsiveness, minimal important change (MIC), and to test for floor or ceiling effects.

DESIGN

Cohort study with six weeks follow-up.

SETTING

Seven physiotherapy clinics/rehabilitation centres.

POPULATION

Patients with a referral for physiotherapy indicating musculoskeletal complaints of the spine or extremities.

METHODS

Translation and cross-cultural adaptation were carried out in accordance with guidelines provided by the developers. As reference standards we used pain intensity (0-10 numeric rating scale), quality of life (EQ5D-5L) and disability measures (RMDQ, NDI, WOMAC and SPADI) that were combined using z-scores.

RESULTS

On 100 patients (age 44.8±13.4 years, 66% female) the test-retest-reliability intraclass correlation coefficient was 0.87 (95% CI 0.72; 0.93) and for construct validity correlation with the combined disability measure was r<inf>s</inf>=-0.81 (95% CI -0.88, -0.72), the SEM was 3.4, the SDC (individual) 9.4, and the MIC 8.5.

CONCLUSIONS

Overall, the study provides evidence for good reliability and validity for the MSK-HQ<inf>G</inf>. Further studies in different settings and diagnostic subgroups should follow to better understand the psychometric properties of this measure in primary care, rehabilitation and specialist care settings.

CLINICAL REHABILITATION IMPACT

The results demonstrate that the MSK-HQ<inf>G</inf> has sufficient psychometric properties for use in musculoskeletal research and practice. However, the SDC should be kept in mind when using the tool for individual patients. The MSK-HQ<inf>G</inf> has the advantage of being a single instrument that can measure musculoskeletal health status across different pain sites, reducing the burden from the use of multiple tools.

Predicting the outcome of the greater occipital nerve block - an observational study on migraine patients with and without musculoskeletal cervical impairment

BACKGROUND AND OBJECTIVE

The importance of neck pain and the trigeminocervical complex in migraine is of high pathophysiological interest since a block to the greater occipital nerve is more effective for some primary headaches than others. This observational study hypothesised that the response to manual palpation of the upper cervical spine predicts the efficacy of the greater occipital nerve-block.

METHODS

We divided patients, scheduled by a neurologist to receive a greater occipital nerve-block to reduce their migraine symptoms, into three groups: Patients with no pain response to manual palpation of the neck, patients with local pain, and those with referred pain to the head. Primary outcome was the percentage change in headache frequency. Additionally, items from the quantitative sensory testing protocol were included.

RESULTS

Eighty-seven chronic migraine patients were recruited consecutively from a specialised outpatient clinic and 71 were included for analyses and stratified into the three groups: No pain (n = 11), local pain (n = 28), and referred pain to the head (n = 32). Overall, patients experienced a reduction of 1.9 headache days per month (SD 3.4, p < 0,0001). The groups differed significantly in the percentage change of headache frequency (p = 0.041) with the "no pain" group showing the largest reduction. The pressure-pain-threshold over C2 and headache on the day of the intervention influenced the outcome significantly (R² 0,27, p = 0,00078). No serious adverse events occurred. Sixty-five percent of the patients had headaches during the examination. The groups did not differ regarding the distribution of patients with neck-pain in absence of migraine at baseline (p = 0.618).

CONCLUSION

Patients that were less sensitive to palpation in the cervical region and headache-free on the day of the intervention improved more after the greater occipital nerve-block.Registration: Registered a priori at the German Clinical Trials Register (DRKS00015995).

Influences of Neck and/or Wrist Pain on Hand Grip Strength of Industrial Quality Proofing Workers

Background

The aim of this study was to analyze the interaction between neck and/or wrist pain and hand grip strength (HGS) and to investigate factors (age, sex, neck disorders, and carpal tunnel syndrome) influencing the HGS of industrial quality proofing workers (N = 145).

Methods

Standardized questionnaires [Neck Disability Index (NDI), Boston Carpal Tunnel Questionnaire] were used to evaluate existing neck and/or wrist pain. HGS measurements were performed in different wrist positions.

Results

Significant differences between participants with and without neck pain were found in different wrist positions, in neutral wrist position right [without neck pain (n = 48) 46.34 (43.39 - 49.30); with neck pain (n = 97) 38.46 (36.20 - 40.72), F _(1,144)  = 16.82, p < 0.001, ŋ _p ² = 0.11] and left [without neck pain 44.06 (41.19 - 46.94); with neck pain 37.36 (35.13 - 39.58), F _(1,144)  = 12.70, p < 0.001, ŋ _p ² = 0.08]. A significant difference between participants with and without wrist pain was found for neutral wrist position right [without wrist pain (n = 105) 42.53 (40.37 - 44.70); with wrist pain (n = 40) 37.24 (33.56 - 40.91), F _(1,144)  = 6.41, p = 0.01, ŋ _p ² = 0.04]. Regression analysis showed significant results especially for steps two (age and weight, NDI) and three (age and weight, NDI, Boston Carpal Tunnel Questionnaire) for neutral position right (R² = 0.355, R² = 0.357, respectively).

Conclusion

Neck pain has an impact on HGS but should be evaluated in consideration of age and sex.

Cross-cultural adaptation and psychometric evaluation of the Malay version of the Neck Disability Index

Purpose: Translating the Neck Disability Index (NDI) into the Malay language (NDI-M); evaluation of psychometric properties in patients with neck pain.Methods: The NDI-M was translated according to established guidelines. In the first visit, 120 participants completed the NDI-M, visual analogue scale (VAS) for pain and demographic details. 98 participants returned to complete similar questionnaires and the Global Rating of Change (GRoC) scale. The NDI-M was evaluated for internal consistency, test-retest reliability, content validity, construct validity and responsiveness.Results: The NDI-M demonstrated excellent internal consistency (Cronbach's α = 0.84) and good test-retest reliability (ICC_2,1 = 0.79). Content validity was confirmed with no floor or ceiling effects. Construct validity was established revealing three-factor subscales explaining 68% of the total variance. The NDI-M showed a moderate correlation with VAS (R_p = 0.49, p < 0.001). Regarding responsiveness, a moderate correlation between NDI-M change scores and VAS change scores was found (R_p = 0.40, p < 0.001). However, there was no significant correlation between NDI-M with GRoC (R_s = 0.11, p = 0.27).Conclusions: The NDI-M is a reliable and valid tool to measure functional outcomes in patients with neck pain. It is responsive in detecting changes in pain intensity during a patient's rehabilitation journey.Implications for rehabilitationThe NDI was translated into the Malay language and culturally adapted for Malay-speaking patients with neck pain.The NDI-M demonstrated an excellent level of internal consistency and good test-retest reliability. It demonstrated content and construct validity, with three-factor subscales, and moderate responsiveness for pain intensity.The NDI-M is a reliable, valid and responsive instrument to measure functional limitations in patients with neck pain for rehabilitation.

Cross-cultural Adaptation, Reliability, Validity, and Responsiveness of the Simplified-Chinese Version of Neck Disability Index

STUDY DESIGN

Cross-cultural adaptation and psychometric evaluation.

OBJECTIVE

The aim of this study was to translate the Neck Disability Index (NDI) into the simplified-Chinese language and to evaluate the reliability, validity, and responsiveness of the new questionnaire.

SUMMARY OF BACKGROUND DATA

Neck pain is a major health problem resulting in major disability. NDI is the most frequently used scale for self-rating of disability due to neck pain. At present, there is no simplified-Chinese version of the NDI. The aims of this study were to culturally adapt and translate the NDI into the simplified-Chinese language (NDI-SC) and to evaluate its psychometric properties in patients with neck pain.

METHODS

The NDI was translated into simplified-Chinese version based on established guidelines. A total of 70 patients participated in this study. Patients were asked to complete a set of questionnaires comprising of their demographic information, the NDI-SC, and a visual analog scale (VAS) of pain. Fifty-six patients returned after 1 to 2 weeks to complete the same set of questionnaires and the global rating of change (GROC) scale. Then, the NDI-SC was evaluated for content validity, construct validity, internal consistency, test-retest reliability, and responsiveness.

RESULTS

The NDI-SC demonstrated excellent internal consistency (Cronbach α = 0.92) and good test-retest reliability (ICC2,1 = 0.85). Content validity was confirmed as no floor or ceiling effects were detected for the NDI-SC total score. Construct validity was established with factor analysis revealing two-factor subscales explaining 66% of the variance. The NDI-SC showed a strong correlation with VAS (Rp = 0.61, P < 0.001) and a moderate correlation with GROC (Rs = 0.46, P < 0.001). The correlation between NDI-SC change scores and VAS change scores was also moderate (Rp = 0.59, P < 0.001).

CONCLUSION

The results showed that the NDI-SC is a reliable, valid, and responsive instrument to measure functional limitations in patients with neck pain.

LEVEL OF EVIDENCE

3.

Bruxism, temporomandibular dysfunction and cervical impairments in females - Results from an observational study

PURPOSE

Bruxism is highly prevalent and defined as abnormal habitual mouth activity including clenching of the teeth and increased jaw muscle activity. The association between bruxism and temporomandibular dysfunction (TMD) is debated, in particular the association between cervical spine impairments, bruxism, and TMD. Hence the purpose of this study was to identify the relationship between bruxism, TMD, and cervical spine impairments.

METHODS

This observational study categorized 55 female volunteers suitable for evaluation to a bruxism (n = 33) or non-bruxism group (n = 22) based on comprehensive screening using questionnaires and visual observation of the mouth by 2 independent dentists. Following this, both groups were evaluated for TMD, severity and location of head/neck pain, neck disability index (NDI), cervical spine impairments, and tissue mechanosensitivity. Regression analysis was used to evaluate the relationship between bruxism, TMD severity, and cervical impairments.

RESULTS

Coefficients of pain and bruxism were significantly associated with NDI scores (0.43, p < 0.001; 3.24, p = 0.01) with large and medium sized effects. As a consequence, both severity of TMD and bruxism status are independently associated with cervical impairments. Having TMD is an independent predictor for head/neck pain and cervical impairments. Pain associated with movement tests and tissue mechanosensitivity was found to be an important factor in bruxism.

CONCLUSION

Clinicians need to be aware that signs of cervical movement impairment are not likely to be associated with bruxism, rather they should focus on improving orofacial function and tissue mechanosensitivity.

Tissue Stiffness is Not Related to Pain Experience: An Individually Controlled Study in Patients with Chronic Neck and Back Pain

Background

Massage therapies such as cupping are often applied in patients with chronic neck and back pain with the assumption that they can reduce increased tissue stiffness and, therefore, improve pain. The aim of this study was to clarify whether tissue stiffness is related to pain experience in patients with chronic (>3 months) back and neck pain and whether it can be altered by a cupping massage.

Methods

The tissue stiffness of the point of subjectively felt maximum pain intensity of 40 patients with neck (n = 20) or lower back pain (n = 20) was measured by a myometer. Exact contralateral side served as an individual control. Side of higher stiffness was then treated with a cupping massage. 5, 10, 15, and 20 minutes as well as 24 hours after treatment, tissue stiffness was measured again. Patients rated their pain on a standardized pain questionnaire (neck pain disability score (NDI) or Oswestry disability index (ODI), respectively) before and 24 hours after treatment.

Results

Compared to the contralateral control side, the more painful side did not exhibit an increased stiffness of myofascial tissue before treatment (p=0.827). The tissue stiffness and the side difference between treated and nontreated control sides decreased significantly after cupping (p=0.002 and p=0.001, respectively) but returned to baseline after 24 hours. NDI and ODI scores significantly decreased 24 hours after cupping (NDI: p=0.012, ODI: p=0.002).

Conclusion

Tissue stiffness might not be related to pain experience in patients with chronic neck and lower back pain. Trial registration: German Clinical Trial Register (DRKS00011281).

[Joint position error in patients with headache : Systematic review of the literature and experimental data for patients with chronic migraine]

BACKGROUND

Chronic migraine (CM) is a primary headache type associated with a severe reduction in the quality of life. The association of sensorimotor dysfunction in the neck, measured with the joint position error test (JPE), and CM is largely unknown, even though up to 60% of migraine patients report neck pain accompanying the migraine.

METHODS

This manuscript reports a systematic review of the literature on JPE in patients with headache as well as data on an observational study. To determine the JPE of migraine patients, 37 subjects with CM were tested and compared with a control group (CG; n = 22). In an additional analysis, CM patients were divided into two subgroups based on the medical treatment approach. The measurements were taken in the three movement dimensions with five repetitions in each direction using a laser pointer fixed to the head.

RESULTS

The mean JPE in the sagittal plane was 3.7° (SD ± 1.4°) and 3.1° (SD ± 1.1°) for CM (n = 37) and CG, respectively. In the transverse plane it was measured as 3.7° (SD ± 1.5°) for CM and 3.2° (SD ± 1°) for the CG, while it was 3.6° (SD ± 1.2°; CM) and 3.3° (SD ± 1.1°; CG) in the frontal plane. The between group difference was not significant for all movement planes. When groups according to the treatment regimen, both groups showed similar migraine and neck pain features but the JPE was significantly larger in the CM + BTh group compared to the CM without BTh group and the CG. In the sagittal plane, the JPE was 4.21° (SD ± 1.8°) for the CM + BTh compared to 2.99° (SD ± 1.2°) in CM without BTh and 3.21° (SD ± 1.2°) in the CG (p = 0.0053). The difference between CM + BTh and CM without BTh was 1.52° (p = 0.016) after propensity score matching in the sagittal plane.

CONCLUSIONS

Only patients in the CM + BTh group showed a statistically increased JPE. The influence of neck pain does not explain the between group difference. A possible factor is the degree of chronification. This study indicates that the JPE might discriminate a subgroup of migraine patients.

Efficacy of tuina in patients with chronic neck pain: study protocol for a randomized controlled trial

BACKGROUND

Chronic neck pain (CNP) is a common and disabling musculoskeletal disorder in developing and developed countries. Previous studies have shown that tuina and traditional Chinese massage are effective treatments for patients with CNP. However, there is little evidence to support the use of one intervention over the other. The aim of this study is to compare the effects of tuina and traditional Chinese massage in the treatment of pain and disability in patients with CNP.

METHODS/DESIGN

This is a multicenter, assessor- and analyst-blinded, randomized controlled trial with two parallel arms: a tuina group and a traditional Chinese massage group. A total of 356 eligible CNP patients will be randomly assigned to the groups in a 1:1 ratio. The intervention in the tuina group includes both structural and relaxation massage, while the traditional Chinese massage group will receive relaxation massage only. The interventions for both groups will last for 15 min and will be carried out three times a week for a period of 4 weeks. The primary outcome will be changes in the Northwick Park Neck Pain Questionnaire. Secondary outcomes will be measured by a visual analogue scale (VAS), the Neck Disability Index (NDI), and the 36-item Short-Form Health Survey (SF-36). The data will be analyzed at the baseline, at the end of the intervention, and during the 3 months of follow-up by repeated measures analysis of variance. The significance level is 5%. The safety of tuina and traditional Chinese massage will be evaluated after each treatment session. The results of this trial will help clarify the value of tuina and traditional Chinese massage as treatments for CNP and will highlight any differences in the efficacy of the treatments.

DISCUSSION

The purpose of this trial is to determine whether tuina is more effective than traditional Chinese massage in adults with CNP. This trial will, therefore, contribute to providing a solid foundation for clinical treatment of CNP, as well as future research in massage therapy.

TRIAL REGISTRATION

Chinese Clinical Trial Registry, ChiCTR-INR-17013763 . Registered 8 December 2017.

Add-on Effect Of Hot Sand Fomentation To Yoga On Pain, Disability, And Quality Of Life In Chronic Neck Pain Patients

BACKGROUND

Neck pain is one of the commonest complaints and an important public health problem across the globe. Yoga has reported to be useful for neck pain and hot sand has reported to be useful for chronic rheumatism. The present study was conducted to evaluate the add-on effect of hot sand fomentation (HSF) to yoga on pain, disability, quality of sleep (QOS) and quality of life (QOL) of the patients with non-specific neck pain.

MATERIALS AND METHODS

A total of 60 subjects with non-specific or common neck pain were recruited and randomly divided into either study group or control group. Both the groups have received yoga and sesame seed oil (Sesamum Indicum L.) application. In addition to yoga and sesame seed oil, study group received HSF for 15 min per day for 5-days. Assessments were taken prior to and after the intervention.

RESULTS

Results of the study showed a significant reduction in the scores of visual analogue scale for pain, neck disability index (NDI), The Pittsburgh Sleep Quality Index (PSQI), and a significant increase in physical function, physical health, emotional problem, pain, and general health both in study and control groups. However, reductions in pain and NDI along with improvement in social functions were better in the study group as compared with control group.

CONCLUSION

Results of this study suggest that addition of HSF to yoga provides a better reduction in pain and disability along with improvement in the social functioning of the patients with non-specific neck pain than yoga alone.

Effectiveness of a multimodal pain management concept for patients with cervical radiculopathy with focus on cervical epidural injections

Cervical radiculopathy has become an increasing problem worldwide. Conservative treatment options have been recommended in many reviews on cervical radiculopathy, ranging from different types of physiotherapy to waiting for remission by natural history. No multimodal pain management concept (MPM) on an inpatient basis has been evaluated. This study aimed at showing the positive short-term effects of an inpatient multimodal pain management concept with focus on cervical translaminar epidural steroid injection for patients with cervical radiculopathy. 54 patients who had undergone inpatient MPM for 10 days were evaluated before and after 10-days treatment. The NRS (0-10) value for arm pain could be reduced from 6.0 (IQR 5.7-6.8) to 2.25 (IQR 2.0-3.1) and from 5.9 (IQR 4.8-6.0) to 2.0 (IQR 1.7-2.6) for neck pain. Neck pain was reduced by 57.4% and arm pain by 62.5%. 2 days after epidural steroid injection, pain was reduced by 40.1% in the neck and by 43.4% in the arms. MPM seems to be an efficient short-term approach to treating cervical radiculopathy. Cervical translaminar epidural steroid injection is an important part of this concept. In the absence of a clear indication for surgery, MPM represents a treatment option.

Empty polyetheretherketone (PEEK) cages in anterior cervical diskectomy and fusion (ACDF) show slow radiographic fusion that reduces clinical improvement: results from the prospective multicenter "PIERCE-PEEK" study

Background

Anterior cervical diskectomy and fusion (ACDF) is a well-established surgical treatment for radiculopathy and myelopathy. Previous studies showed that empty PEEK cages have lower radiographic fusion rates, but the clinical relevance remains unclear. This paper’s aim is to provide high-quality evidence on the outcomes of ACDF with empty PEEK cages and on the relevance of radiographic fusion for clinical outcomes.

Methods

This large prospective multicenter clinical trial performed single-level ACDF with empty PEEK cages on patients with cervical radiculopathy or myelopathy. The main clinical outcomes were VAS (0–10) for pain and NDI (0–100) for functioning. Radiographic fusion was evaluated by two investigators for three different aspects.

Results

The median (range) improvement of the VAS pain score was: 3 (1–6) at 6 months, 3 (2–8) at 12 months, and 4 (2–8) at 18 months. The median (range) improvement of the NDI score was: 12 (2–34) at 6 months, 18 (4–46) at 12 months, and 22 (2–44) at 18 months. Complete radiographic fusion was reached by 126 patients (43%) at 6 months, 214 patients (73%) at 12 months, and 241 patients (83%) at 18 months. Radiographic fusion was a highly significant (p < 0.001) predictor of the improvement of VAS and NDI scores.

Conclusion

This study provides strong evidence that ACDF is effective treatment, but the overall rate of radiographic fusion with empty PEEK cages is slow and insufficient. Lack of complete radiographic fusion leads to less improvement of pain and disability. We recommend against using empty uncoated pure PEEK cages in ACDF.

Trial registration

ISRCTN42774128. Retrospectively registered 14 April 2009.

Urdu version of the neck disability index: a reliability and validity study

Background

Despite the wide use of the neck disability index (NDI) for assessing disability in patients with neck pain, the NDI has not yet been translated and validated in Urdu. The first purpose of the present study was to translate and cross-culturally adapt the NDI into the Urdu language (NDI-U). The second purpose was to investigate the reliability, validity and responsiveness of the NDI-U in Urdu-speaking patients experiencing chronic mechanical neck pain (CMNP).

Methods

Translation and cross-cultural adaptation of the original version of the NDI were carried out using previously described procedures. Seventy-six patients with CMNP and thirty healthy participants were recruited for the study. NDI-U and visual analogue scales for pain intensity (VAS_pain) and disability (VAS_disability) were administered to all the participants at baseline and to the patients 3 weeks after receiving physiotherapy intervention. The global rating of change scale (GROC) was also administered at this time. Test-retest reliability and internal consistency were carried out on forty-six randomly selected patients two days after they completed the NDI-U. The NDI-U was evaluated for factor analysis, content validity, construct validity (discriminative and convergent validity) and responsiveness.

Results

An intra-class correlation coefficient (ICC_2,1) revealed excellent test-retest reliability for all items (ICC_2,1 = 0.86–0.98) and total scores (ICC_2,1 = 0.99) of the NDI-U. The NDI-U was found internally consistent with a Cronbach’s alpha of 0.90 and a fair to good correlation between single items and the NDI-U total scores (r = 0.34 to 0.89). Factor analysis of the NDI-U produced two factors explaining 66.71% of the variance. Content validity was good, as no floor or ceiling effects were detected for the NDI-U total score. To determine discriminative validity, an independent t-test revealed a significant difference in the NDI-U total scores between the patients and healthy controls (P < 0.001). For convergent validity, Pearson’s correlation coefficient showed a strong correlation between NDI-U and VAS_disability (r = 0.83, P < 0.001) and a moderate correlation between NDI-U and VAS_pain (r = 0.62, P < 0.001). To measure responsiveness, an independent t-test showed a significant difference in the NDI-U change scores between the stable and the improved groups (P < 0.001). Furthermore, moderate correlations were found between the NDI-U change scores and the GROC (r = 0.50, P < 0.001), VAS_disability change scores (r = 0.58, P < 0.001) and VAS_pain change scores (r = 0.55, P < 0.001).

Conclusion

The results showed that the NDI-U is a reliable, valid and responsive questionnaire to measure disability in Urdu-speaking patients with CMNP.

Electronic supplementary material

The online version of this article (doi:10.1186/s12891-017-1469-5) contains supplementary material, which is available to authorized users.

Craniosacral Therapy for the Treatment of Chronic Neck Pain: A Randomized Sham-controlled Trial

Objectives:

With growing evidence for the effectiveness of craniosacral therapy (CST) for pain management, the efficacy of CST remains unclear. This study therefore aimed at investigating CST in comparison with sham treatment in chronic nonspecific neck pain patients.

Materials and Methods:

A total of 54 blinded patients were randomized into either 8 weekly units of CST or light-touch sham treatment. Outcomes were assessed before and after treatment (week 8) and again 3 months later (week 20). The primary outcome was the pain intensity on a visual analog scale at week 8; secondary outcomes included pain on movement, pressure pain sensitivity, functional disability, health-related quality of life, well-being, anxiety, depression, stress perception, pain acceptance, body awareness, patients’ global impression of improvement, and safety.

Results:

In comparison with sham, CST patients reported significant and clinically relevant effects on pain intensity at week 8 (−21 mm group difference; 95% confidence interval, −32.6 to −9.4; P=0.001; d=1.02) and at week 20 (−16.8 mm group difference; 95% confidence interval, −27.5 to −6.1; P=0.003; d=0.88). Minimal clinically important differences in pain intensity at week 20 were reported by 78% within the CST group, whereas 48% even had substantial clinical benefit. Significant between-group differences at week 20 were also found for pain on movement, functional disability, physical quality of life, anxiety and patients’ global improvement. Pressure pain sensitivity and body awareness were significantly improved only at week 8. No serious adverse events were reported.

Discussion:

CST was both specifically effective and safe in reducing neck pain intensity and may improve functional disability and the quality of life up to 3 months after intervention.

Do subjects with acute/subacute temporomandibular disorder have associated cervical impairments: A cross-sectional study

BACKGROUND

There is preliminary evidence of cervical musculoskeletal impairment in some temporomandibular disorder (TMD) pain states.

OBJECTIVES

To determine whether people with TMD, classified as either mild or moderate/severe TMD, have more cervical signs of dysfunction than healthy subjects.

DESIGN

Cross-sectional survey.

METHOD

Based on the Conti Amnestic Questionnaire and examination of the temporomandibular joint (Axis I classification of the Research Diagnostic Criteria for TMD), of 144 people examined 59 were classified to a mild TMD group, 40 to a moderate/severe TMD group and 45 to an asymptomatic control group without TMD. Subjects were evaluated for signs of cervical musculoskeletal impairment and disability including the Neck Disability Index, active cervical range of motion, the Flexion-Rotation Test, mechanical pain threshold of the upper trapezius and obliquus capitis inferior muscles, Cranio-Cervical Flexion test and passive accessory movements of the upper 3 cervical vertebrae.

RESULTS

According to cervical musculoskeletal dysfunction, the control group without TMD were consistently the least impaired and the group with moderate/severe TMD were the most impaired. These results suggest, that the more dysfunction and pain is identified in the temporomandibular region, the greater levels of dysfunction is observable on a number of cervical musculoskeletal function tests. The pattern of cervical musculoskeletal dysfunction is distinct to other cervical referred pain phenomenon such as cervicogenic headache.

CONCLUSION

These findings provide evidence that TMD in an acute/subacute pain state is strongly related with certain cervical spine musculoskeletal impairments which suggests the cervical spine should be examined in patients with TMD as a potential contributing factor.

Patient-reported outcome measures for non-specific neck pain validated in the Italian-language: a systematic review

BACKGROUND

Patient-reported outcome measures can improve the management of patients with non-specific neck pain. The choice of measure greatly depends on its content and psychometric properties. Most questionnaires were developed for English-speaking people, and need to undergo cross-cultural validation for use in different language contexts. To help Italian clinicians select the most appropriate tool, we systematically reviewed the validated Italian-language outcome measures for non-specific neck pain, and analyzed their psychometric properties and clinical utility.

METHODS

The search was performed in MEDLINE, EMBASE, CINAHL, Scopus, Web of Science, and Cochrane Library. All articles published in English or Italian regarding the development, translation, or validation of patient-reported outcome measures available in the Italian language were included. Two reviewers independently selected the studies, extracted data, and assessed methodological quality using the COSMIN checklist.

RESULTS

Out of 4891articles screened, 66 were eligible. Overall, they were of poor or fair methodological quality. Four instruments measuring function and disability (Neck Disability Index, Neck Pain and Disability Scale, Neck Bournemouth Questionnaire, and Core Outcome Measures Index), and one measuring activity-related fear of movement (NeckPix©) were identified. Each scale showed some psychometric weaknesses or problems with functioning, and none emerged as a gold standard.

CONCLUSIONS

Several patient-reported outcome measures are now available for assessing Italian people with non-specific neck pain. While the Neck Disability Index is the one most widely used, the Neck Bournemouth Questionnaire appears the most promising tool from a psychometric point of view.

Effects of yoga on chronic neck pain: a systematic review of randomized controlled trials

[Purpose] The aim of this study was to investigate the effectiveness of yoga in the management of chronic neck pain. [Subjects and Methods] Five electronic databases were searched to identify randomized controlled trials (RCTs) of yoga intervention on chronic neck pain. The trials were published in the English language between January 1966 and December 2015. The Cochrane Risk of Bias Tool was used to assess the quality of the trials. [Results] Three trials were identified and included in this review. A critical appraisal was performed on the trials, and the result indicated a high risk of bias. A narrative description was processed because of the small number of RCTs. Neck pain intensity and functional disability were significantly lower in the yoga groups than in the control groups. [Conclusion] Evidence from the 3 randomly controlled trials shows that yoga may be beneficial for chronic neck pain. The low-quality result of the critical appraisal and the small number of trials suggest that high-quality RCTs are required to examine further the effects of yoga intervention on chronic neck pain relief.

Yoga-based intervention in patients with somatoform disorders: an open label trial

Somatoform disorders are common mental disorders associated with impaired functioning and increased utilization of health resources. Yoga-based interventions have been used successfully for anxiety, depression, and chronic pain conditions. However, literature on the use of yoga in treatment of somatoform disorders is minimal. The current study assessed the effect of a specific yoga-based intervention in patients with somatoform disorders. Consenting patients meeting ICD-10 criteria for somatoform disorders were offered a specific yoga module (1 h per day) as a treatment. Assessments including Visual Analogue Scale (VAS), Brief Pain Inventory (BPI), and others were carried out at baseline and after 2, 6, and 12 weeks. Sixty-four subjects were included in the study and 34 completed 12 weeks follow-up. Significant improvement was noted in pain severity from baseline to 12 weeks after regular yoga sessions. The mean VAS score dropped from 7.24 to 2.88. Worst and average pain score in the last 24 h on BPI dropped from 7.71 to 3.26 and from 6.12 to 2.0,7 respectively. Results of the study suggest that yoga-based intervention can be one of the non-pharmacological treatment options in somatoform disorders. These preliminary findings need replication in larger controlled studies.

Translation, Validation, and Crosscultural Adaptation of the Hebrew Version of the Neck Disability Index

STUDY DESIGN

The present study's design was translation and crosscultural validation of the Neck Disability Index (NDI).

OBJECTIVE

The aim of the study was to translate and culturally adapt the NDI into Hebrew language and to evaluate the psychometric properties of this version.

SUMMARY OF BACKGROUND DATA

As yet, no Hebrew language neck pain and disability questionnaires exist. The NDI is widely used and validated among different patient populations with neck pain.

METHODS

The English version of the NDI was translated into Hebrew according to the published guidelines. A total of 100 patients with neck pain participated in the study. Inclusion criteria were age 18 years and older, neck pain, and ability to read and speak Hebrew. Exclusion criteria were cancer or suspected tumor, neck pain related to vertebral fracture, or neurological disease. Participants were asked to complete the NDI-Hebrew version (NDI-H), Numeric Pain Rating Scale (NPRS), and Patient-Specific Functional Scale (PSFS). Seventy-three patients completed the NDI-H twice in an interval of 2 days. Psychometric properties included test-retest reliability (intraclass correlation coefficient), internal consistency (Cronbach α), convergent validity (Pearson correlation), and factor analysis.

RESULTS

The NDI-H demonstrated excellent test-retest reliability (intraclass correlation coefficient ranged from 0.827 to 0.929; Pv < 0.001). Cronbach α value was excellent (0.855). A very good correlation was found between the NDI-H and NPRS scores (r = 0.611, P < 0.001) and a good correlation between the NDI-H and PSFS score (r = 0.417, P < 0.001). Factor analysis revealed a two-factor solution representing daily function and pain and symptoms.

CONCLUSION

The NDI-H is a valid and reliable instrument to measure functional limitations and disability in Hebrew-speaking patients with neck pain.

LEVEL OF EVIDENCE

NA.

Chronic Neck Pain and Cervico-Craniofacial Pain Patients Express Similar Levels of Neck Pain-Related Disability, Pain Catastrophizing, and Cervical Range of Motion

Background. Neck pain (NP) is strongly associated with cervico-craniofacial pain (CCFP). The primary aim of the present study was to compare the neck pain-related disability, pain catastrophizing, and cervical and mandibular ROM between patients with chronic mechanical NP and patients with CCFP, as well as asymptomatic subjects. Methods. A total of 64 participants formed three groups. All participants underwent a clinical examination evaluating the cervical range of motion and maximum mouth opening, neck disability index (NDI), and psychological factor of Pain Catastrophizing Scale (PCS). Results. There were no statistically significant differences between patients with NP and CCFP for NDI and PCS (P > 0.05). One- way ANOVA revealed significant differences for all ROM measurements. The post hoc analysis showed no statistically significant differences in cervical extension and rotation between the two patient groups (P > 0.05). The Pearson correlation analysis shows a moderate positive association between NDI and the PCS for the group of patients with NP and CCFP. Conclusion. The CCFP and NP patient groups have similar neck disability levels and limitation in cervical ROM in extension and rotation. Both groups had positively correlated the NDI with the PCS.

Efficacy of the Alexander Technique in treating chronic non-specific neck pain: a randomized controlled trial

Objective:

To test the efficacy of the Alexander Technique, local heat and guided imagery on pain and quality of life in patients with chronic non-specific neck pain.

Design:

A randomized controlled trial with 3 parallel groups was conducted.

Setting:

Outpatient clinic, Department of Internal and Integrative Medicine.

Subjects:

A total of 72 patients (65 females, 40.7±7.9 years) with chronic non-specific neck pain.

Interventions:

Patients received 5 sessions of the Alexander Technique - an educational method which aims to modify dysfunctional posture, movement and thinking patterns associated with musculoskeletal disorders. Control groups were treated with local heat application or guided imagery. All interventions were conducted once a week for 45 minutes each.

Main measures:

The primary outcome measure at week 5 was neck pain intensity on a 100-mm visual analogue scale; secondary outcomes included neck disability, quality of life, satisfaction and safety.

Statistics:

Analyses of covariance were applied; testing ordered hypotheses.

Results:

No group difference was found for pain intensity for the Alexander Technique compared to local heat (difference 4.5mm; 95%CI:-8.1;17.1;p=0.48), but exploratory analysis revealed the superiority of the Alexander Technique over guided imagery (difference -12.9mm; 95%CI:-22.6;-3.1,p=0.01). Significant group differences in favor of the Alexander Technique were also found for physical quality of life ( P<0.05). Adverse events mainly included slightly increased pain and muscle soreness.

Conclusion:

The Alexander Technique was not superior to local heat application in treating chronic non-specific neck pain. It cannot be recommended as routine intervention at this time. Further trials are warranted for conclusive judgment.

Practical assessment in patients suffering from musculoskeletal disorders

Short review of exemplary clinical assessment methods to describe clinical evidence-based assessment for patients suffering from symptoms of musculoskeletal pain.History and physical examination are the primary evidence-based assessment instruments for pain patients. Pain scales and questionnaire might allow assessment of different aspects of pain in order to perform an individualized therapy for pain patients.

Extension and flexion in the upper cervical spine in neck pain patients

Neck pain is a common problem in the general population with high risk of ongoing complaints or relapses. Range of motion (ROM) assessment is scientifically established in the clinical process of diagnosis, prognosis and outcome evaluation in neck pain. Anatomically, the cervical spine (CS) has been considered in two regions, the upper and lower CS. Disorders like cervicogenic headache have been clinically associated with dysfunctions of the upper CS (UCS), yet ROM tests and measurements are typically conducted on the whole CS. A cross-sectional study assessing 19 subjects with non-specific neck pain was undertaken to examine UCS extension-flexion ROM in relation to self-reported disability and pain (via the Neck Disability Index (NDI)). Two measurement devices (goniometer and electromagnetic tracking) were employed and compared. Correlations between ROM and the NDI were stronger for the UCS compared to the CS, with the strongest correlation between UCS flexion and the NDI-headache (r = -0.62). Correlations between UCS and CS ROM were fair to moderate, with the strongest correlation between UCS flexion and CS extension ROM (r = -0.49). UCS flexion restriction is related to headache frequency and intensity. Consistency and agreement between both measurement systems and for all tests was high. The results demonstrate that separate UCS ROM assessments for extension and flexion are useful in patients with neck pain.

Reliability and validity of the pain on movement questionnaire (POM) in chronic neck pain

OBJECTIVE

This analysis aimed to determine reliability, validity, and responsiveness of the pain on movement (POM) questionnaire, an instrument developed to determine pain intensity induced by head movement.

DESIGN

Data from nine randomized controlled trials for the treatment of chronic nonspecific neck pain were reanalyzed to determine reliability and validity of the POM questionnaire.

METHODS

POM was assessed as ratings of pain intensity induced by head movement in six different directions. The instrument's structure was assessed using a factor analysis. Reliability (internal consistency) was determined using Cronbach's alpha, and validity (convergent validity) was determined by correlating the POM with pain at rest on a visual analog scale (VAS), the neck disability index (NDI), quality of life (short-form 36 health survey questionnaire [SF-36]) and range of motion. Responsiveness was indicated by sensitivity to changes over time in a subsample of 49 patients.

RESULTS

Overall, 482 patients (mean age 50.3 ± 12.4 years, 72.3% female) were included in the analysis, and 458 of them provided complete data set for the POM. Average POM was 43.9 ± 20.8 mm on the VAS. The POM showed very good reliability as indicated by high internal consistency and moderate validity as indicated by significant correlations with the pain at rest, the NDI, and the SF-36. No correlations were found for POM with range of motion. The POM further proved to be responsive as it was sensitive to changes over time, and those changes were correlated to changes in pain intensity and NDI.

CONCLUSIONS

The POM seems to be a reliable and valid instrument to assess POM in patients with chronic nonspecific neck pain.