Background
Methods
Design
Study sample
Questionnaires and self-reported outcomes
Clinical tests
Test | Subject position and task | Equipment | Outcome | Reference |
---|---|---|---|---|
CCFT
| Supine crook lying position, cervical spine in neutral. Pressure Biofeedback placed suboccipitally and inflated to 20 mmHg. Subject performs cranio-cervical flexion through five progressive stages (22-30 mmHg) | Pressure Biofeedback (Stabilizer Chattanooga Group, South Pacific) | 20,22,24, 26,28,30 mmHg. | [38] |
DCE
| Prone, legs straight, arms by the side. Laser light attached to the head, aimed at a target on the floor (60 cm distant). Subject performs low cervical extension with the cranio-cervical region maintained in a neutral position (light on target). | Laser Light, Head Band, Target sheet | Seconds (0-120) | [48] |
ROM
| Sitting, feet supported. Bubble inclinometer placed on the highest point of the head. Active flexion, extension and lateral flexion are performed. Rotation is performed with the designated equipment (Figure 2). | Bubble inclinometer (Baseline Bubble Inclinometer, Fabrication Enterprises Inc, USA) | Degrees (0-100) | [65] |
JPE
| Sitting, feet supported. Wearing a cap with a centimetre measure attached to the back (horizontal and vertical). Laser light placed behind, with starting position at 0. Active neck rotation, flexion, extension are performed with eyes closed and reposition error is measured. | Laser light, cap with millimetre measure | Millimetre (0-50) | [23] |
GS
| Sitting, feet supported. Black marker on a wall positioned 1 m in front. Subject keeps gaze fixed on the marker while performing active neck rotation, flexion and extension. | Marker | Positive/Negative based on patients report of symptoms such as nausea, dizziness, disturbed vision. | |
SPNT
| Sitting, feet supported. Head in neutral position. Subject follows with eyes, a pen moving horizontally from side to side ~30 cm in front whilst keeping head still. Task repeated with the neck in torsion position | Marker, Pen | Positive/Negative based on patients report of symptoms such as nausea, dizziness, disturbed vision. | [57] |
SWAY
| 1) Standing, feet together. Arms crossed over chest. Keep focus on a black marker positioned 2.5 m in front, stand as still as possible (eyes open and closed). 2) Standing on the non-dominant leg. Arms crossed over chest. Keep focus on a black marker 2.5 m in front, stand as still as possible. | Wii balance board (Nintendo, Kyoto, Japan), SwayWithWii software program | 95% Confidence Ellipse Area | [63] |
Anterior/Posterior sway (cm.) | ||||
Medio/Lateral sway (cm.) | ||||
Centre of Pressure Path Length (cm.) | ||||
PPT
| Supine for PPT over tibialis anterior. Prone for PPT over the infraspinatus and over the cervical column, between the transverse processes of C3 and C4. Pressure applied at a slow rate. | Hand-held algometer (Wagner, FPX algometer, USA) | Kgf | [28] |
Procedure
Sample size
Statistical analysis
Results
Variable | Cases | Controls | |||||
---|---|---|---|---|---|---|---|
(n = 21) | (n = 21) | ||||||
Mean | SD | Range | Mean | SD | Range | p-value | |
Age (years)
| 46.1 | 15.6 | (23–77) | 44.7 | 14.8 | (22–71) | 0.76 |
Height (cm)
| 168.6 | 7.5 | (157–185) | 172 | 6.0 | (160–185) | 0.12 |
Weight (kg)
| 68.1 | 10.3 | (52–88) | 66.2 | 9.1 | (56–88) | 0.53 |
Mean
|
Median
|
Range
|
Mean
|
Median
|
Range
| ||
NDI
| 15.3 | 14 | (11–27) | 1.9 | 2 | (0–4) | <0.01 |
BDI
| 5.7 | 5 | (0–23) | 2.2 | 0 | (0–14) | <0.01 |
SF36-PCS
| 42.1 | 41.1 | (29–64) | 53.8 | 55.5 | (39–62) | <0.01 |
SF36-MCS
| 50.4 | 50.5 | (25–93) | 57.6 | 59.1 | (38–68) | <0.01 |
NRS (P.P.)
| 4.4 | 4 | (1–8) | ------ | ------ | ------ | ------ |
NRS (Week)
| 5.1 | 6 | (2–10) | ------ | ------ | ------ | ------ |
Pain duration (months)
| 92.8 | 30 | (6–420) | ------ | ------ | ------ | ------ |
Test | Variable | Mean | Median | SD | Range |
---|---|---|---|---|---|
CCFT (mmHg.) | CCFT | 24.1 | 23.5 | 2.5 | (20–30) |
DCE (sec.) | Deep cervical extensors | 65.6 | 71.0 | 41.4 | (3–120) |
ROM (degrees) | Flexion | 44.3 | 46.0 | 12.9 | (18–70) |
Extension | 55.1 | 57.3 | 15.1 | (15–90) | |
Left rotation | 70.8 | 72.5 | 14.2 | (20–95) | |
Right rotation | 72.4 | 75.0 | 13.2 | (25–90) | |
Left lateral flexion | 34.8 | 35.0 | 7.5 | (17–48) | |
Right lateral flexion | 35.9 | 34.8 | 7.9 | (17–54) | |
JPE (mm.) | JPE flexion | 5.9 | 4.7 | 3.8 | (0–16) |
JPE extension | 5.8 | 5.5 | 3.4 | (0–16) | |
JPE left rotation | 5.4 | 4.4 | 3.5 | (0–15) | |
JPE right rotation | 5.2 | 4.3 | 2.8 | (0–16) | |
SWAY (cm.) | Romberg eyes open (CEA) | 5.3 | 4.7 | 3.7 | (1.2-18.3) |
Romberg eyes open (A/P) | 2.7 | 2.6 | 0.9 | (1.0-5.0) | |
Romberg eyes open (M/L) | 2.5 | 2.6 | 0.7 | (1.2-4.3) | |
Romberg eyes open (COP) | 4.8 | 4.7 | 1.1 | (2.7-6.5) | |
Romberg eyes closed (CEA) | 8.0 | 7.3 | 4.0 | (2.7-20.6) | |
Romberg eyes closed (A/P) | 3.2 | 3.2 | 0.9 | (2.0-6.5) | |
Romberg eyes closed (M/L) | 3.5 | 3.4 | 0.9 | (1.9-5.6) | |
Romberg eyes closed (COP) | 7.2 | 7.1 | 2.0 | (4.0; 13.3) | |
Singe leg stance (CEA) | 9.6 | 9.4 | 4.1 | (2.9-22.4) | |
Singe leg stance (A/P) | 4.2 | 4.1 | 1.1 | (2.3-6.6) | |
Singe leg stance (M/L) | 3.3 | 3.4 | 0.7 | (1.7-5.6) | |
Singe leg stance (COP) | 12.3 | 12.4 | 3.1 | (6.6-17.4) | |
PPT (kgf)
| PPT Tibialis Anterior | 4.0 | 3.6 | 1.6 | (1.4-6.9) |
PPT C3-C4 | 2.3 | 2.1 | 1.0 | (0.6-5.1) | |
PPT Infraspinatus | 3.1 | 2.7 | 1.5 | (1.1-7.3) |
Test | Variable | N | MDC | ICC | (95% CI) | 95% LOA |
---|---|---|---|---|---|---|
CCFT (mmHg.) |
Inter-reliability 1
| 42 | 4.70 | 0.63 | (0.41; 0.78) | (-4.99; 4.42) |
Inter-reliability 2
| 36 | 3.12 | 0.82 | (0.67; 0.91) | (-3.11; 3.11) | |
Intra-reliability A
| 27 | 2.94 | 0.86 | (0.72; 0.93) | (-3.17; 2.72) | |
Intra-reliability B
| 27 | 3.99 | 0.70 | (0.43; 0.85) | (-3.92; 4.07) | |
DCE (sec.) |
Inter-reliability 1
| 36 | 58.01 | 0.76 | (0.59; 0.86) | (-53.24; 62.78) |
Inter-reliability 2
| 29 | 57.36 | 0.75 | (0.55; 0.87) | (-67.72; 47.00) | |
Intra-reliability A
| 26 | 37.25 | 0.90 | (0.79; 0.95) | (-31.21; 43.29) | |
Intra-reliability B
| 25 | 59.33 | 0.77 | (0.55; 0.89) | (-65.86; 52.79) | |
ROM (degrees) |
Inter-reliability 1
| |||||
Flexion | 42 | 14.65 | 0.82 | (0.66; 0.91) | (-11.29; 18.00) | |
Extension | 42 | 18.90 | 0.80 | (0.62; 0.90) | (-23.50; 14.31) | |
Left rotation | 42 | 11.21 | 0.92 | (0.86; 0.96) | (-10.73; 11.68) | |
Right rotation | 42 | 10.11 | 0.93 | (0.87; 0.96) | (-10.58; 9.63) | |
Left lateral flexion | 42 | 8.31 | 0.85 | (0.74; 0.92) | (-8.22; 8.41) | |
Right lateral flexion | 42 | 9.30 | 0.84 | (0.72; 0.91) | (-9.11; 9.49) | |
ROM
|
Inter-reliability 2
| |||||
Flexion | 36 | 15.02 | 0.83 | (0.70; 0.91) | (-13.72; 16.33) | |
Extension | 36 | 12.60 | 0.92 | (0.85; 0.96) | (-14.13; 11.07) | |
Left rotation | 36 | 9.83 | 0.94 | (0.89; 0.97) | (-11.20; 8.44) | |
Right rotation | 36 | 10.73 | 0.93 | (0.86; 0.96) | (-10.74; 10.74) | |
Left lateral flexion | 36 | 9.35 | 0.83 | (0.66; 0.91) | (-7.40; 11.29) | |
Right lateral flexion | 36 | 10.06 | 0.80 | (0.61; 0.90) | (-7.93; 10.70) | |
ROM
|
Intra-reliability A
| |||||
Flexion | 27 | 17.00 | 0.81 | (0.62; 0.91) | (-13.78; 20.23) | |
Extension | 27 | 21.23 | 0.81 | (0.63; 0.91) | (-22.60; 19.86) | |
Left rotation | 27 | 10.98 | 0.90 | (0.75; 0.95) | (-8.21; 13.76) | |
Right rotation | 27 | 10.64 | 0.89 | (0.76; 0.92) | (-8.42; 12.87) | |
Left lateral flexion | 27 | 8.70 | 0.85 | (0.69, 0.93) | (-8.51; 8.88) | |
Right lateral flexion | 27 | 9.48 | 0.84 | (0.68; 0.92) | (-10.26; 8.71) | |
ROM
|
Intra-reliability B
| |||||
Flexion | 27 | 14.24 | 0.86 | (0.71; 0.93) | (-13.87; 20.23) | |
Extension | 27 | 18.91 | 0.82 | (0.64; 0.91) | (-15.91; 21.91) | |
Left rotation | 27 | 13.05 | 0.87 | (0.73; 0.94) | (-12.12; 13.97) | |
Right rotation | 27 | 11.00 | 0.88 | (0.74; 0.95) | (-8.59; 13.40) | |
Left lateral flexion | 27 | 8.92 | 0.84 | (0.68; 0.92) | (-7.44; 10.40) | |
Right lateral flexion | 27 | 9.12 | 0.85 | (0.70; 0.93) | (-8.23; 10.01) | |
JPE
|
Inter-reliability 1
| |||||
Flexion | 42 | 7.59 | 0.54 | (0.26, 0.73) | (-5.74; 9.44) | |
Extension | 42 | 9.26 | 0.35 | (0.06; 0.59) | (-8.60; 9.92) | |
Left rotation | 42 | 6.99 | 0.58 | (0.34; 0.75) | (-5.91; 8.07) | |
Right rotation | 42 | 8.32 | 0.27 | (-0.02; 0.52) | (-7.25; 9.39) | |
JPE
|
Inter-reliability 2
| |||||
Flexion | 35 | 9.14 | 0.11 | (-0.20; 0.41) | (-7.63; 10.65) | |
Extension | 35 | 8.22 | 0.36 | (0.02; 0.62) | (-8.11, 8.34) | |
Left rotation | 35 | 7.97 | 0.02 | (-0.30; 0.33) | (-6.82; 9.12) | |
Right rotation | 35 | 9.10 | 0.04 | (-0.29; 0.37) | (-8.28; 9.92) | |
JPE
|
Intra-reliability A
| |||||
Flexion | 27 | 7.71 | 0.42 | (0.05; 0.69) | (-7.48; 7.16) | |
Extension | 27 | 7.58 | 0.50 | (0.16; 0.74) | (-7.29, 8.15) | |
Left rotation | 27 | 7.54 | 0.18 | (-0.20; 0.52) | (-8.06; 6.64) | |
Right rotation | 27 | 9.95 | 0.05 | (-0.36; 0.42) | (-10.36;10.55) | |
JPE
|
Intra-reliability B
| |||||
Flexion | 27 | 10.12 | 0.23 | (-0.12; 0.55) | (-10.84; 9.16) | |
Extension | 27 | 8.35 | 0.50 | (0.15; 0.74) | (-8.11; 7.79) | |
Left rotation | 27 | 5.76 | 0.66 | (0.37; 0.83) | (-7.92; 5.86) | |
Right rotation | 27 | 6.16 | 0.35 | (-0.03; 0.65) | (-6.31; 6.14) |
Variable | N | Prevalence of index condition | Expected agreement (%) | Overall agreement (%) | κ -value | PAB-AK | (95% CI) | |
---|---|---|---|---|---|---|---|---|
GS
| Inter 1 | 42 | 0.48 | 50.00 | 85.71 | 0.71 | - | (0.50; 0.93) |
Inter 2 | 36 | 0.56 | 50.46 | 83.33 | 0.66 | - | (0.42; 0.91) | |
Intra A | 27 | 0.43 | 51.03 | 96.30 | 0.92 | - | (0.78; 1.00) | |
Intra B | 27 | 0.50 | 49.93 | 88.89 | 0.78 | - | (0.54; 1.00) | |
SPNTT
| Inter 1 | 42 | 0.27 | 59.98 | 78.57 | 0.46 | 0.57 | (0.17; 0.76) |
Inter 2 | 36 | 0.38 | 52.78 | 86.11 | 0.71 | 0.72 | (0.47; 0.94) | |
Intra A | 27 | 0.22 | 64.33 | 85.19 | 0.59 | 0.70 | (0.24; 0.93) | |
Intra B | 27 | 0.31 | 56.79 | 88.89 | 0.74 | 0.78 | (0.47; 1.00) |
Variable | N | MDC | ICC | (95% CI) | 95% LOA | |
---|---|---|---|---|---|---|
SWAY (cm.) | Romberg eyes open (CEA) | 27 | 7.91 | 0.52 | (0.18; 0.75) | (-7.42; 8.40) |
Romberg eyes open (A/P) | 27 | 1.84 | 0.57 | (0.24; 0.78) | (-1.87; 1.81) | |
Romberg eyes open (M/L) | 27 | 1.68 | 0.39 | (0.03; 0.67) | (-1.50; 1.86) | |
Romberg eyes open (COP) | 25 | 1.38 | 0.79 | (0.57; 0.90) | (-1.38; 1.40) | |
Romberg eyes closed (CEA) | 27 | 6.47 | 0.79 | (0.59; 0.90) | (-6.26; 6.69) | |
Romberg eyes closed (A/P) | 27 | 1.96 | 0.60 | (0.29; 0.80) | (-2.02; 1.98) | |
Romberg eyes closed (M/L) | 27 | 1.71 | 0.69 | (0.43; 0.85) | (-1.71; 1.72) | |
Romberg eyes closed (COP) | 25 | 3.84 | 0.77 | (0.55; 0.89) | (-2.82; 2.83) | |
Single leg stance (CEA) | 21 | 7.80 | 0.58 | (0.21; 0.80) | (-8.54; 7.04) | |
Single leg stance (A/P) | 21 | 1.94 | 0.57 | (0.18; 0.80) | (-1.97; 1.92) | |
Single leg stance (M/L) | 21 | 1.39 | 0.53 | (0.14; 0.78) | (-1.51; 1.27) | |
Single leg stance (COP) | 21 | 4.74 | 0.75 | (0.45; 0.89) | (-4.70; 4.78) | |
PPT (kgf) | Tibialis Anterior | 27 | 1.90 | 0.86 | (0.71; 0.91) | (-1.91; 1.88) |
C3-C4 | 27 | 0.90 | 0.89 | (0.78; 0.95) | (-0.80; 1.01) | |
Infraspinatus | 27 | 1.65 | 0.83 | (0.66; 0.92) | (-1.65; 1.64) |
Variable (n = 42) | NDI | SF36-PCS | NRS (P.P) | ||||
---|---|---|---|---|---|---|---|
Spearman (rho) | p-value | Spearman (rho) | p-value | Spearman (rho) | p-value | ||
CCFT
| -0.40 | <0.01 | 0.56 | <0.01 | -0.37 | 0.02 | |
ROM
| Flexion | -0.47 | <0.01 | 0.31 | 0.04 | -0.46 | <0.01 |
Extension | -0.65 | <0.01 | 0.46 | <0.01 | -0.74 | <0.01 | |
Left rotation | -0.47 | <0.01 | 0.46 | <0.01 | -0.51 | <0.01 | |
Right rotation | -0.54 | <0.01 | 0.47 | <0.01 | -0.53 | <0.01 | |
Left lateral flexion | -0.64 | <0.01 | 0.46 | <0.01 | -0.67 | <0.01 | |
Right lateral flexion | -0.62 | <0.01 | 0.45 | <0.01 | -0.66 | <0.01 | |
JPE
| Flexion | -0.05 | 0.75 | -0.17 | 0.27 | -0.02 | 0.90 |
Extension | -0.04 | 0.82 | 0.07 | 0.65 | -0.13 | 0.40 | |
Left rotation | 0.25 | 0.11 | -0.20 | 0.20 | 0.20 | 0.20 | |
Right rotation | 0.23 | 0.14 | -0.11 | 0.51 | 0.15 | 0.36 | |
DCE
| -0.33 | 0.047 | 0.14 | 0.41 | -0.36 | 0.03 | |
SWAY
| Romberg EO (CEA) | 0.12 | 0.45 | -0.26 | 0.09 | 0.04 | 0.80 |
Romberg EO (A/P) | 0.11 | 0.49 | -0.26 | 0.10 | 0.08 | 0.63 | |
Romberg EO (M/L) | 0.18 | 0.26 | -0.31 | 0.05 | 0.13 | 0.41 | |
Romberg EO (COP) | -0.02 | 0.92 | -0.34 | 0.09 | -0.04 | 0.85 | |
Romberg EC (CEA) | 0.38 | 0.01 | -0.49 | <0.01 | 0.33 | 0.04 | |
Romberg EC (A/P) | 0.40 | <0.01 | -0.49 | <0.01 | 0.35 | 0.02 | |
Romberg EC (M/L) | 0.31 | 0.05 | -0.39 | 0.01 | 0.24 | 0.13 | |
Romberg EC (COP) | 0.09 | 0.66 | -0.37 | 0.07 | 0.21 | 0.31 | |
SLS (CEA)* | 0.35 | 0.04 | 0.33 | 0.06 | 0.39 | 0.02 | |
SLS (A/P)* | 0.38 | 0.02 | -0.37 | 0.03 | 0.36 | 0.04 | |
SLS (M/L)* | 0.29 | 0.09 | -0.32 | 0.06 | 0.32 | 0.06 | |
SLS (COP)* | -0.14 | 0.57 | -0.26 | 0.28 | -0.06 | 0.80 | |
PPT
| Tibialis anterior | -0.28 | 0.08 | 0.13 | 0.42 | -0.34 | 0.03 |
C3-C4 | -0.41 | <0.01 | 0.31 | 0.05 | -0.37 | 0.02 | |
Infraspinatus | -0.33 | 0.03 | 0.25 | 0.11 | -0.43 | <0.01 | |
GS
| Tester A | -0.80 | <0.01 | 0.63 | <0.01 | -0.69 | <0.01 |
Tester B | -0.51 | <0.01 | 0.49 | <0.01 | -0.42 | <0.01 | |
SPNT
| Tester A | -0.49 | <0.01 | 0.39 | 0.01 | -0.55 | <0.01 |
Tester B | -0.52 | <0.01 | 0.45 | <0.01 | -0.42 | <0.01 |
Variable (n = 42) | N | Mean cases | Mean controls | Mean diff. | SE | (95% CI) | p-value | |
---|---|---|---|---|---|---|---|---|
CCFT
| 42 | 23.23 | 24.95 | 1.71 | 0.74 | (0.22; 3.21) | 0.03 | |
ROM
| Flexion | 42 | 38.05 | 50.45 | 12.40 | 3.51 | (19.50; 5.31) | <0.01 |
Extension | 42 | 44.31 | 65.81 | 21.5 | 3.58 | (28.74; 14.26) | <0.01 | |
Left rotation | 42 | 65.36 | 76.31 | 10.95 | -- | -- | 0.01 | |
Right rotation | 42 | 66.90 | 77.86 | 10.95 | -- | -- | <0.01 | |
Left lateral flexion | 42 | 30.29 | 39.33 | 9.05 | 1.84 | (12.77; 5.32) | <0.01 | |
Right lateral flexion | 42 | 31.02 | 40.83 | 9.81 | 1.93 | (13.72; 5.90) | <0.01 | |
JPE
| Flexion | 42 | 5.38 | 6.33 | -0.94 | -- | -- | 0.34 |
Extension | 42 | 5.83 | 5.70 | 0.13 | -- | -- | 0.70 | |
Left rotation | 42 | 6.43 | 4.35 | 2.08 | -- | -- | 0.08 | |
Right rotation | 42 | 5.87 | 4.60 | 1.28 | -- | -- | 0.21 | |
DCE
| 42 | 49.42 | 78.63 | 29.21 | -- | -- | 0.06 | |
SWAY
| Romberg EO (CEA) | 42 | 5.13 | 5.52 | -0.39 | 1.16 | (-2.73; 1.95) | 0.74 |
Romberg EO (A/P) | 42 | 2.60 | 2.70 | -0.10 | 0.28 | (-0.67; 0.47) | 0.72 | |
Romberg EO (M/L) | 42 | 2.51 | 2.56 | -0.05 | 0.22 | (-0.50; 0.40) | 0.82 | |
Romberg EO (COP) | 42 | 4.54 | 4.93 | -0.39 | 0.42 | (-1.27; 0.484 | 0.36 | |
Romberg EC (CEA) | 42 | 9.11 | 6.78 | 2.32 | 1.19 | (-0.70; 4.73) | 0.06 | |
Romberg EC (A/P) | 42 | 3.44 | 2.98 | 0.46 | 0.27 | (-0.09; 0.99) | 0.10 | |
Romberg EC (M/L) | 42 | 3.69 | 3.33 | 0.36 | 0.28 | (-0.20; 0.92) | 0.20 | |
Romberg EC (COP) | 42 | 7.56 | 6.93 | 0.63 | 0.82 | (-1.07; 2.33) | 0.45 | |
SLS (CEA) | 34 | 10.33 | 8.74 | 1.58 | 1.42 | (1.30; 4.47) | 0.27 | |
SLS (A/P) | 34 | 4.47 | 3.81 | 0.66 | 0.35 | (-0.07; 1.38) | 0.07 | |
SLS (M/L) | 34 | 3.38 | 3.18 | 0.21 | 0.24 | (-0.28; 0.69) | 0.40 | |
SLS (COP) | 34 | 11.81 | 12.72 | -0.91 | 1.46 | (-3.99; 2.18) | 0.54 | |
PPT
| Tibialis Anterior | 42 | 3.65 | 4.42 | 0.77 | -- | -- | 0.07 |
C3-C4 | 42 | 1.84 | 2.69 | 0.85 | -- | -- | 0.03 | |
Infraspinatus | 42 | 2.42 | 3.61 | 1.20 | -- | -- | 0.02 | |
GS
| Pearson chi2 = 21.62, p = <0.01 | |||||||
SPNT
| Pearson chi2 = 13.13, p = <0.01 |