A non-randomised pragmatic trial for the early detection and prevention of surgical wound complications using an advanced hydropolymer wound dressing and smartphone technology: The EDISON trial protocol.

Total hip or knee arthroplasty is a highly effective intervention for treating the symptoms of degenerative joint disease or osteoarthritis (OA), often an unwelcome consequence of obesity. A safe and common surgical procedure, hip and knee arthroplasty procedures are not immune to the occurrence of postoperative complications such as surgical site infection (SSI) or surgical wound dehiscence (SWD). While published rates of SSI following hip or knee arthroplasty are low, 1% to 2% in some cases, it is the resulting wound complication and its clinical management and the impact on patient well-being and return to daily life for the 1% to 2% that is of concern. Postoperative complications such as SSI are a major cost driver to the health care system following arthroplasty and often result in extended lengths of stay, readmission for further surgery, primary and community nursing visits, and are a costly burden to health care settings. Early identification of a wound complication through post-discharge surveillance using a fully transparent dressing and smartphone technology and patient education may ameliorate contributing factors or reduce the likelihood of a complication occurring in the first instance. This clinical trial is a non-randomised pragmatic convenience sample carried out in 200 participants of both sexes receiving either a TKA or THA. There will be equal allocation to two groups (100 hips and 100 knees), with 50 in each allocation receiving the interventional dressing and 50 as control. The dressing will be applied prior to discharge and participants will be provided with education on postoperative wound care, when to contact home care nursing for a potential wound problem, and use of their smartphone to capture and send images of their incision site to the study nurses. Participants will also be followed up by home care nursing services at day 14 for suture removal and wound assessment. Participants will complete a patient-reported outcomes survey on day 14 and followed up on day 30 after surgery for wound assessment. The results of this trial may provide a novel pathway using a fully transparent dressing and digital technologies for the prevention of acute readmissions because of wound complications through early detection and intervention.

Cycle Sprint Test for the Evaluation of Lower Limb Muscle Power After Total Knee Arthroplasty: A Proof-of-Concept Study.

BACKGROUND: Lower limb muscle power is emerging as an important determinant of patient function after knee injury or surgery. This study tested proof of concept of a cycle sprint test for the evaluation of lower limb muscle power, as an outcome measure for patients having total knee arthroplasty (TKA). METHODS: Thirty-two patients were enrolled, of which 16 completed all follow-ups (3, 6, and 12 months). All patients completed the Oxford Knee Score and Knee Injury and Osteoarthritis Outcome Score questionnaires, a 10-m walk test, and 30-second sit-stand test. A trainer-mounted road cycle fitted with an instrumented crank was used for the cycle sprint test. Maximum muscle power was measured from 3, 10-second maximal efforts. RESULTS: Significant improvements in Oxford Knee Score and Knee Injury and Osteoarthritis Outcome scores relative to baseline were achieved at each follow-up (P < .001), and functional test performance improved significantly at 6 and 12 months (P < .001). Compared with the baseline of 268W, muscle power was significantly lower at 3 months (239W, -13%, P < .05) and significantly higher at 12 months (308W, +12%, P < .05). CONCLUSION: The concept of muscle power measurement using a cycle sprint test before and after TKA has been demonstrated in this study. Identification of individuals with lower limb muscle power deficits after TKA may inform rehabilitation programs and enhance long-term outcomes.

Validation of a Patient Questionnaire Assessing Patient Satisfaction With Orthopedic Outpatient Clinic Consultation.

Previous qualitative research has identified a number of factors which influence patient satisfaction with orthopedic outpatient clinic visits. To further evaluate these factors, the authors initially generated a number of items or statements representing these factors. This cohort of items was then subjected to analysis by an expert group to assess which 3 items best represented each factor. These items formed the basis of a draft survey which was then administered to 323 orthopedic outpatients to assess these factors as characteristics of patient satisfaction. Items and factors were also assessed against 2 global measures of patient satisfaction. One hundred and one survey responses were returned and subjected to factorial analysis. Results indicated that factors of trust, empathy, and relatedness were not distinguishable and subsequently combined to represent a single factor, the therapeutic relationship. A final 5-factor model is proposed incorporating 3 interpersonal factors (communication, expectation, therapeutic relationship) and 2 environmental factors (clinic wait time, clinical contact time). The factors identified by this study should be considered in surveys evaluating patient satisfaction with orthopedic outpatient services.

Identification of factors influencing patient satisfaction with orthopaedic outpatient clinic consultation: A qualitative study.

BACKGROUND: In recent years, new models of health service delivery in orthopaedic outpatient clinics, including physiotherapists working in orthopaedic triage roles, have become increasingly common. Evaluation of patient satisfaction with orthopaedic clinic services is dependent on an understanding of factors influencing patient satisfaction in this clinical context. OBJECTIVES: The objective of this study was to identify the factors influencing patient satisfaction with orthopaedic outpatient clinic services. STUDY DESIGN: A cross-sectional, qualitative design including focus groups and interviews. METHODS: Interviews and focus group sessions were undertaken with 36 participants representing patients, health professionals and clinical support staff in an orthopaedic outpatient clinic. Interviews and focus groups provided a rich narrative which was subjected to a process of thematic analysis. RESULTS: The analysis identified seven themes influencing patient satisfaction with orthopaedic clinic assessment. These themes were clinic waiting time, clinical contact time, trust, empathy, communication, expectation and relatedness. CONCLUSIONS: Understanding factors influencing patient satisfaction is important to inform organisational and clinical processes that aim to foster high levels of patient satisfaction. Clinician awareness of the interpersonal issues which dominate stakeholders' perspectives of patient satisfaction may improve the patient experience and potentially foster patient behaviours toward a therapeutic advantage. An understanding of these factors in the context of orthopaedic clinics is also important in the development of questionnaires designed to evaluate patient satisfaction with health service delivery.

Day-of-Surgery Mobilization Reduces the Length of Stay After Elective Hip Arthroplasty.

BACKGROUND: To determine the effect of mobilization on the day of surgery on the readiness for discharge and length of stay after elective total hip arthroplasty (THA). METHODS: We devised a randomized control trial with concealed allocation and intention-to-treat analysis. Overall, 126 patients who underwent THA and met the criteria for mobilization on the day of surgery were randomly allocated into 2 groups; the intervention group was mobilized on the day of surgery, n = 58 and the control group was mobilized on the day after surgery, n = 68. Apart from timing of mobilization, both groups received the same postoperative management. The primary outcome measures were length of hospital stay and time to readiness for discharge. RESULTS: The early mobilization group was ready for discharge 63 hours (standard deviation [SD] = 15 hours) after surgery, compared to 70 hours (SD = 18 hours) for the control group (P = .03, 95% CI, 0.7-12.8). There was no significant difference in hospital stay in the early mobilization group (77 hours [SD = 30 hours]), compared to the control group (87 hours [SD = 35 hours]; P = .11, 95% CI, -2.1 to 21.6). Despite this at any point in time after the surgery, the intervention group was 1.8 times (P = .003, 95% CI, = 1.2-2.7) more likely to have been discharged. CONCLUSION: Mobilization on the day of THA surgery significantly increases the probability of discharge at any singular point in time compared with mobilization on the day after surgery and decreases the time to readiness for discharge.

Huntington's Disease: Characteristics of Fallers.

INTRODUCTION: Individuals with Huntington's disease have a high prevalence of falls, but the specific factors that may increase the risk of falling have not been clearly identified in this clinical population. This study aimed to identify the characteristics of individuals with early to mid-stage Huntington's disease who had a history of falls, compared with a cohort with no history of falls. METHODS: Twenty-four participants (10 non-fallers and 14 recurrent fallers) with a diagnosis of early to mid-stage Huntington's disease were included in this study. Falls data were collected using retrospective survey analysis. Participants were assessed using measures of balance (Berg Balance Scale), mobility (Rivermead mobility index [RMI]), fear of falling (Activity-specific Balance Confidence Scale) and gait (6-min walk test; 10-m walk test self-paced and dual tasking). RESULTS: There was no difference in severity of disease state between fallers (Unified Huntington Disease Rating Scale [UHDRS] motor 25.33) and non-fallers (UHDRS motor 25.13) (p = 0.97). The prevalence of falls was high with 66.7% of participants reporting at least one fall and 58.3% reporting two or more falls in the past 12 months. There was no difference in age or gender between recurrent fallers and non-fallers. Recurrent fallers had significantly lower scores on the Activity-specific Balance Confidence Scale (p < 0.01) and the RMI (p < 0.05). The probability of falling increases rapidly with a RMI score of less than 10. DISCUSSION: Recurrent falls are common in people with Huntington's disease. Individuals with a history of falls were found to have a greater fear of falling and lower functional mobility performance than those who did not have a history of falls. These measures may be useful in the identification of individuals with Huntington's disease who might benefit from a falls prevention programme. Copyright © 2014 John Wiley & Sons, Ltd.

Symmetry of trunk and femoro-pelvic movement responses to single leg loading tests in asymptomatic females.

Single leg loading tests are used clinically to examine balance and loading strategies in individuals with lower limb pain. Interpretation of these tests is through pain responses and comparisons with the asymptomatic leg. The purpose of this study was to examine normal differences in trunk and pelvic movement between legs during the single leg stand, single leg squat, hip hitch and hip drop tests, and to compare observational and quantitative assessments of trunk movement during the single leg squat test. Thirty-one asymptomatic females (age = 21.7 ± 3.1 years) performed each test in a random sequence and quantitative analysis of coronal plane trunk lean (magnitude and direction), and femoro-pelvic angle was conducted using photographic image analysis. Within- and between-side minimal significant differences (MD) for femoro-pelvic angle were defined for each test. All tests had excellent within-side reliability (intra-class correlation coefficients (ICC) = 0.87-0.97, standard error of measurement (SEM) = 0.6-1.2°). The between-side MD for femoro-pelvic angle was 6.3, 6.5, 9.7, and 6.7° for the single leg stand, single leg squat, hip hitch and hip drop tests respectively. The magnitude of trunk lean was small, increased with test complexity and was not consistent in relation to the stance leg. Excellent agreement (87-93%) for the direction of trunk movement between observers, and between observational and quantitative analysis (80-96%) was established for the single leg squat test. The patterns of trunk motion, and thresholds for significant difference in femoro-pelvic angle established in this study, will assist the interpretation of single leg loading tests in individuals with lower limb pain disorders.

Clinical and radiological investigation of thoracic spine extension motion during bilateral arm elevation.

STUDY DESIGN: Single-cohort laboratory-based study. OBJECTIVES: To measure thoracic spine extension motion during bilateral arm elevation using functional radiography and photographic image analysis. BACKGROUND: Impairment of thoracic spine extension motion may impact shoulder girdle function. Motion of the thoracic spine during arm movement has not been directly measured using functional radiographic analysis. METHODS: In 21 asymptomatic men, thoracic kyphosis was measured in neutral standing and in end-range bilateral arm elevation, using lateral radiographs and photographic image analysis. Using both measurement techniques, the difference in thoracic kyphosis between the 2 body positions was used to quantify the range of extension motion of the thoracic spine. Bland-Altman plots were used to examine the agreement between measurement techniques. The relationship between the amount of thoracic kyphosis in neutral standing and kyphosis in full bilateral arm elevation was also examined. RESULTS: The mean ± SD increase in thoracic extension with bilateral arm elevation was 12.8° ± 7.6° and 10.5° ± 4.4°, when measured from the radiographs and photographs, respectively. There was a significant correlation between the radiographic and photographic measurements of the amount of thoracic kyphosis measured in neutral posture (r = 0.71, P<.01) and for the kyphosis measured in full bilateral arm elevation (r = 0.79, P<.001). The mean difference between the 2 measurement techniques was 2.1° for kyphosis measured in neutral posture and 0.5° when measured in full bilateral arm elevation. The thoracic kyphosis angle measured in neutral posture was strongly correlated with the thoracic kyphosis angle measured in full bilateral arm elevation when measured with both radiographic (r = 0.80, P<.001) and photographic (r = 0.84, P<.001) techniques. CONCLUSION: In asymptomatic men, bilateral arm elevation is associated with movement of the thoracic spine toward extension, but the amount of movement is variable among individuals.

Inter-examiner agreement in clinical evaluation.

BACKGROUND: The reliability of assessment is an important issue in the evaluation of competence in medical and allied health practice, particularly when assessments are conducted by multiple examiners. The purpose of this study was to examine the agreement between multiple examiners in the assessment of a postgraduate physiotherapy student using a specifically designed performance evaluation system. METHODS: Seven examiners simultaneously watched a recording of a postgraduate student's examination and treatment of one patient. The Postgraduate Physiotherapy Performance Assessment (PPPA) form was used to guide the assessment of performance in key areas of patient examination and management. Each examiner independently recorded a grade for each of five performance categories, and these scores were used to guide the global performance grade and mark. RESULTS: Five examiners agreed on the global performance grade and four of the performance categories. The level of pass grade awarded was more variable, with scores in the performance categories spanning two grades, and in one case, three grades. The two examiners who were not in agreement with the majority consistently awarded higher grades across most performance categories. DISCUSSION: This preliminary study has demonstrated majority agreement in global performance between multiple examiners when physiotherapy clinical practice is assessed against specific performance standards. Not all examiners awarded global grades consistent with the majority, and there was greater variability between examiners when grading performance in specific aspects of practice. These findings highlight the importance of examiner training and review sessions to improve inter-examiner agreement in assessments of clinical performance that require multiple examiners.

Functional radiographic analysis of thoracic spine extension motion in asymptomatic men.

OBJECTIVE: The purposes of this study were to examine the range of thoracic spine extension motion in a group of young, asymptomatic subjects and compare the radiologically derived measurements with those obtained using photographic analysis, and to examine the relationship between the magnitude of the neutral thoracic kyphosis and the range of thoracic spine extension motion. METHODS: In 14 asymptomatic male subjects (mean age ± SD, 30.2 ± 7 years), the thoracic kyphosis in standing and full thoracic spine extension was measured from lateral thoracic spine radiographs and digital photographs. The difference between the 2 measurements was used to define the range of thoracic extension motion. RESULTS: The range of thoracic extension motion measured radiologically was between 0 and 26° (mean ± SD, 12.0° ± 8.9°), whereas the photographic range was between 8° and 23° (mean ± SD, 12.4° ± 4.1°). There was a significant correlation between the photographic and radiographic measurements of extension range (r = 0.69, P < .01). Extension range of motion measured radiologically was significantly correlated with the magnitude of the thoracic kyphosis (r = 0.71, P < .01). CONCLUSION: Functional radiographs of the thoracic spine can be used to measure the extension range of motion and define the extreme of range. The range of thoracic extension motion may be influenced by the magnitude of the neutral kyphosis. This technique may be used in future studies to evaluate the impact of spinal disorders on thoracic spine mobility.

Thoracic spine extension mobility in young adults: influence of subject position and spinal curvature.

STUDY DESIGN: Cross-sectional study. OBJECTIVES: To examine extension mobility of the thoracic spine in young, asymptomatic adults, with particular reference to the influence of subject position and magnitude of the thoracic kyphosis. BACKGROUND: Impairment of thoracic extension motion is commonly associated with mechanical pain disorders in this region of the spine. Knowledge of normal thoracic mobility and the factors that may influence this motion is important in the evaluation and management of thoracic pain disorders. METHODS: In 40 asymptomatic adults, the total and regional thoracic extension range of motion was measured using 2-dimensional photographic image analysis. Extension mobility was measured in standing, sitting, prone, and 4-point kneeling. The association between the magnitude of the habitual thoracic kyphosis and extension mobility was also examined. RESULTS: When measured from the habitual standing position, the mean range of flexion was 11.5° (3.7°) and mean extension range was 8.7° (3.7°). Thoracic extension was significantly greater in unloaded positions compared to loaded positions (P<.001). The standing thoracic kyphosis angle was significantly correlated with the end range thoracic extension angle in all positions (r = 0.63-0.79, P<.001). There was a poor correlation between the thoracic kyphosis angle and thoracic extension range of motion in all positions (r = 0.11-0.34, P>.06). CONCLUSION: When measured from the habitual standing position, thoracic extension range of motion in young individuals is small and poorly correlated with the magnitude of the standing thoracic kyphosis. Unloaded positions (4-point kneeling and prone), compared to positions that load the spine (standing and sitting), appear to promote a greater range of thoracic extension motion.

Changes in mechanical load and extensor muscle activity in the cervico-thoracic spine induced by sitting posture modification.

The influence of whole body sitting posture on cervico-thoracic posture, mechanical load and extensor muscle activity was examined in 23 asymptomatic adults. Cervical and upper thoracic extensor muscle activity measured in guided slouched and lumbo-pelvic neutral postures was normalised to that measured in a self-selected habitual posture. Head and neck posture and gravitational load moment measurements were obtained in each posture. Sagittal head translation, upper cervical extension and load moment were significantly greater in the slouched posture (p < 0.001). Contrasting patterns of cervical and thoracic extensor activity were observed in the slouched and neutral postures, with cervical extensor activity 40% higher in the slouched posture (p < 0.0001). Thoracic extensor activity was significantly higher in the lumbo-pelvic neutral posture than the habitual posture (p = 0.002). The significant changes in extensor muscle activity with postural modification appear to be induced by the associated change in mechanical load moment of the head. STATEMENT OF RELEVANCE: More neutral sitting postures reduce the demand on the cervical extensor muscles and modify the relative contribution of cervical and thoracic extensors to the control of head and neck posture. Postures that promote these patterns of muscular activity may reduce cervical spine loading and the development of posture-related neck pain.

Endurance and fatigue characteristics of the neck flexor and extensor muscles during isometric tests in patients with postural neck pain.

Sustained postural loading of the cervical spine during work or recreational tasks may contribute to the development of neck pain. The aim of this study was to compare neck muscle endurance and fatigue characteristics during sub-maximal isometric endurance tests in patients with postural neck pain, with asymptomatic subjects. Thirteen female patients with postural neck pain and 12 asymptomatic female control subjects completed timed sub-maximal muscle endurance tests for the neck flexor and extensor muscles. Muscle fatigue, defined as the time-dependent decrease in median frequency electromyography (EMG), was examined using surface EMG analysis during the tests. The median extensor test holding time was lower but not significantly different in the neck pain group (165 s) that the control group (228 s) (p = 0.17). There was no difference between groups in the flexor test holding time (neck pain = 36 s, controls = 38 s) (p = 0.96). The neck pain group was characterised by greater variability in neck flexor (p = 0.03) and extensor (p = 0.006) muscle endurance. For both tests, the rate of decrease in median frequency EMG was highly variable within and between groups with no significant difference between groups for the flexor or extensor test (p = 0.05-0.82). Patients with postural neck pain did not have significant impairment of neck muscle endurance or accelerated fatigue compared to control subjects. However, the greater variability in these indices of muscle function may reflect patient-specific changes in muscle function associated with neck pain disorder.

Validity of the Neck Disability Index and Neck Pain and Disability Scale for measuring disability associated with chronic, non-traumatic neck pain.

The purpose of this study was to evaluate the construct and content validity of the Neck Disability Index (NDI) and the Neck Pain and Disability Scale (NPAD) in patients with chronic, non-traumatic neck pain. Twenty patients (mean age=64.5 years) completed a patient-specific questionnaire, the Problem Elicitation Technique (PET), followed by the NDI and NPAD. Content validity was assessed by comparing the items of the NDI and NPAD with problems identified from the PET. Construct validity of the fixed-item questionnaires was examined by establishing the correlation with each other, and with the PET score. Eleven common problems were identified by patients through the PET, of which six were included in the NDI and seven included in the NPAD. The NDI and NPAD scores were strongly correlated (r=0.86, p<0.01), while the correlation between the PET and the fixed-item questionnaires was moderate (NDI: r=0.62, p<0.01; NPAD: r=0.71, p<0.01). Both the NDI and the NPAD include most of the functional problems common to this patient group, and display good content validity. The PET is better able to evaluate the problems specific to the individual patient and is therefore measuring a somewhat different construct to the fixed-item questionnaires.

Reliability of isometric muscle endurance tests in subjects with postural neck pain.

OBJECTIVE: The purpose of this study was to determine the reliability of 3 isometric muscle endurance tests in subjects with postural neck pain. METHODS: Twenty-one subjects with chronic postural neck pain performed 3 submaximal muscle tests twice on the first occasion and once at the second session 3 days later. The tests examined isometric neck flexion, neck extension, and scapular muscle endurance. RESULTS: Reliability was excellent for the neck flexor test (intraclass correlation coefficient [ICC] = 0 93), moderate for the scapular test (ICC = 0.67), and good for the neck extensor test (ICC = 0 88). The standard error of measure for the tests was 6.4, 10.9, and 25.9 seconds, respectively. The minimum change required to represent real change in muscle endurance was 17.8 seconds for the neck flexor test, 30.1 seconds for the scapular test, and 71.3 seconds for the neck extensor test. CONCLUSION: This study showed the reliability of 3 cervical spine and shoulder girdle submaximal muscle endurance tests in patients with postural neck pain.

Influence of posture on the range of axial rotation and coupled lateral flexion of the thoracic spine.

OBJECTIVE: This study examines the influence of posture on the range of axial rotation of the thorax and the range and direction of the coupled lateral flexion. METHODS: The ranges of mid thoracic axial rotation and coupled lateral flexion were measured in 52 asymptomatic subjects (aged 18-43 years) using an optical motion analysis system. To examine the influence of posture on primary and coupled motion, we initiated axial rotation from a neutral sitting posture and from end-range thoracic flexion and extension. RESULTS: There was a significant decrease in the range of thoracic rotation in flexion compared with the neutral and extended postures (P < .001). The mean range of coupled lateral flexion was 8.9% of the axial rotation range in the neutral posture and increased to 14.3% and 23.2% in the extended and flexed postures, respectively. Patterns of coupled motion varied between subjects, but an ipsilateral pattern was more common in the flexed posture, whereas a contralateral pattern was more common in the neutral and extended postures. CONCLUSIONS: The ranges and patterns of coupled motion of the thorax appear to be strongly influenced by the posture from which the movement is initiated. This has important implications in relation to the interpretation of clinical tests of thoracic motion and in consideration of mechanisms of development of thoracic pain disorders.

Postural neck pain: an investigation of habitual sitting posture, perception of 'good' posture and cervicothoracic kinaesthesia.

Impairments of cervico-cephalic kinaesthesia and habitual forward head posture have been considered important in the aetiology of postural neck pain, yet these factors have not been specifically examined in a homogeneous clinical population. The objective of this study was to compare the habitual sitting posture (HSP), perception of good posture and postural repositioning error (PRE) of the cervico-thoracic (CT) spine in individuals with postural neck pain, with a matched group of asymptomatic subjects. Twenty-one subjects with postural neck pain and 22 asymptomatic control subjects were recruited into the study. An optical motion analysis system was used to measure the HSP and perceived 'good' sitting posture. PRE was measured over six trials where the subject attempted to replicate their self-selected 'good' posture. There was no difference between the groups in the HSP but significant differences were identified in the perception of 'good' posture. Posture repositioning error was higher for the head posture variables than for CT and shoulder girdle variables in both groups. However, there was no significant difference in posture repositioning error between groups for any of the posture measures. The findings suggest that individuals with postural neck pain may have a different perception of 'good' posture, but no significant difference in HSP or kinaesthetic sensibility compared with matched asymptomatic subjects.

Physical therapy treatment dose for nontraumatic neck pain: a comparison between 2 patient groups.

STUDY DESIGN: Prospective cohort study. OBJECTIVES: To classify patients with nonacute, nontraumatic neck pain according to the dominant impairment of spinal function, and to determine whether there were differences in the amount of treatment sessions required (treatment dose) to achieve a significant change in the patients disorder. BACKGROUND: Classification of patients with mechanical neck pain may be an important process in optimizing treatment prescription and evaluating treatment response. However, patient classification has not been used to consider possible differences in the amount of treatment sessions (treatment dose) required to achieve a significant change in the neck pain disorder. METHODS AND MEASURES: Ninety-two patients with nonacute, nontraumatic neck pain were classified into 2 groups, according to the dominant impairment of spinal function. Of the 77 patients who completed treatment, 63 (82%) were classified as having a "movement disorder," while the remainder was classified into a "loading disorder" group. Physical therapists who were blinded to the patient classification provided multimodal physical therapy treatment as considered appropriate and the patients were discharged when the optimal treatment response had been achieved. RESULTS: There was no difference in pain intensity or global disability level between the groups at baseline. Both groups achieved a significant improvement in neck pain and disability following treatment, and there was no significant difference between groups in the magnitude of the treatment response. The number of treatment sessions received by the loading group (mean +/- SD, 7.3 +/- 4.5) was significantly lower than the number received by the movement group (mean +/- SD, 11.5 +/- 5.9; 95% CI: -7.6 to -0.8; P<.01). Patients in the loading group were 2.4 times as likely to be discharged at any particular treatment session (95% CI: 1.1 to 4.1, P<.005) compared to those in the movement group. CONCLUSION: For patients with nontraumatic neck pain, classification according to impairment of spinal function may be a useful indicator of the number of physical therapy treatment sessions required to achieve a significant treatment response.

Influence of cranio-cervical posture on three-dimensional motion of the cervical spine.

Although a consistent pattern of ipsilateral movement coupling between cervical spine rotation and lateral flexion has been widely described, variability in these movement patterns has not been reported. In 30 asymptomatic subjects, the ranges of primary and coupled movements were determined in the neutral posture, and in the extremes of cervical spine protraction and retraction. All measurements were performed using the SpinT three-dimensional goniometer for which excellent intra-tester reliability was demonstrated for both primary (ICC(3,1) 0.93-0.98) and coupled (ICC(3,1) 0.76-0.98) movements. The ranges of primary and coupled movements changed significantly when movement was initiated from the end-range postures (P < 0.001). In the neutral posture, approximately 70% of subjects demonstrated an ipsilateral pattern of coupled movement. During cervical rotation, the dominant coupling pattern seen in neutral was no longer retained in retraction, while the protracted posture had a greater influence on the coupled movements accompanying primary lateral flexion. The concept of a stereotypical pattern of cervical spine movement coupling is not supported by these results. The posture in which movements are initiated appears to have a significant influence on the three-dimensional kinematics of the cervical spine.

Variability in pain intensity, physical and psychological function in non-acute, non-traumatic neck pain.

BACKGROUND AND PURPOSE: Variability in clinical presentation among patients with neck pain disorders, in relation to symptom severity and the effect of the disorder on their physical and psychological function, has not been well documented. The present study examined the variability in pain intensity, physical and emotional or cognitive function in patients with non-acute, non-traumatic neck pain, and the extent to which these factors are associated at the time of referral for physiotherapy treatment. METHOD: The study utilized a survey of patients referred for physiotherapy treatment for non-acute, non-traumatic neck pain. Seventy-two patients (mean age 58 years; SD 15.5 years) with a symptom duration ranging from four weeks to 30 years were recruited. Each completed measures of pain intensity using a visual analogue scale, and neck-pain related disability by use of the 'Neck Pain and Disability' scale (NPAD). Frequency distributions were calculated to examine variability in pain intensity, the total NPAD score and the effect of the disorder on different aspects of physical and emotional or cognitive function. Relationships between pain intensity, and physical and psychological function, were also examined. RESULTS: Pain intensity was normally distributed with a mean score of 6.3 cm (SD 2.5 cm). NPAD scores were normally distributed (mean 54.8%; SD 18%). Similar variability was noted in each of the NPAD factor scores for neck function, pain intensity, emotional or cognitive function and activities of daily living. Pain intensity was significantly (p < 0.01) correlated with the total NPAD score (r = 0.55) and with each of the four effects of neck pain represented in the NPAD sub-domains (r = 0.42-0.63). Symptom duration was not significantly correlated with pain intensity, or with the severity of disability, as reflected in the total NPAD score. CONCLUSIONS: The results highlight the variability between patients with neck pain, in relation to pain intensity and the effect of the disorder on physical and psychological function. Identifying the specific effects of the neck pain disorder in individual cases is important when defining the treatment objectives and selecting measures of treatment response.