Machine learning models for classifying non-specific neck pain using craniocervical posture and movement.

OBJECTIVE: Physical therapists and clinicians commonly confirm craniocervical posture (CCP), cervical retraction, and craniocervical flexion as screening tests because they contribute to non-specific neck pain (NSNP). We compared the predictive performance of statistical machine learning (ML) models for classifying individuals with and without NSNP using datasets containing CCP and cervical kinematics during pro- and retraction (CKdPR). DESIGN: Exploratory, cross-sectional design. SETTING AND PARTICIPANTS: In total, 773 public service office workers (PSOWs) were screened for eligibility (NSNP, 441; without NSNP, 332). METHODS: We set up five datasets (CCP, cervical kinematics during the protraction, cervical kinematics during the retraction, CKdPR and combination of the CCP and CKdPR). Four ML algorithms-random forest, logistic regression, Extreme Gradient boosting, and support vector machine-were trained. MAIN OUTCOME MEASURES: Model performance were assessed using area under the curve (AUC), accuracy, precision, recall and F1-score. To interpret the predictions, we used Feature permutation importance and SHapley Additive explanation values. RESULTS: The random forest model in the CKdPR dataset classified PSOWs with and without NSNP and achieved the best AUC among the five datasets using the test data (AUC, 0.892 [good]; F1, 0.832). The random forest model in the CCP dataset had the worst AUC among the five datasets using the test data [AUC, 0.738 (fair); F1, 0.715]. CONCLUSION: ML performance was higher for the CKdPR dataset than for the CCP dataset, suggesting that ML algorithms are more suitable than classical statistical methods for developing robust models for classifying PSOWs with and without NSNP.

Muscle network topology analysis for the classification of chronic neck pain based on EMG biomarkers extracted during walking.

Neuromuscular impairments are frequently observed in patients with chronic neck pain (CNP). This study uniquely investigates whether changes in neck muscle synergies detected during gait are sensitive enough to differentiate between people with and without CNP. Surface electromyography (EMG) was recorded from the sternocleidomastoid, splenius capitis, and upper trapezius muscles bilaterally from 20 asymptomatic individuals and 20 people with CNP as they performed rectilinear and curvilinear gait. Intermuscular coherence was computed to generate the functional inter-muscle connectivity network, the topology of which is quantified based on a set of graph measures. Besides the functional network, spectrotemporal analysis of each EMG was used to form the feature set. With the use of Neighbourhood Component Analysis (NCA), we identified the most significant features and muscles for the classification/differentiation task conducted using K-Nearest Neighbourhood (K-NN), Support Vector Machine (SVM), and Linear Discriminant Analysis (LDA) algorithms. The NCA algorithm selected features from muscle network topology as one of the most relevant feature sets, which further emphasize the presence of major differences in muscle network topology between people with and without CNP. Curvilinear gait achieved the best classification performance through NCA-SVM based on only 16 features (accuracy: 85.00%, specificity: 81.81%, and sensitivity: 88.88%). Intermuscular muscle networks can be considered as a new sensitive tool for the classification of people with CNP. These findings further our understanding of how fundamental muscle networks are altered in people with CNP.

Less is More: Five-item Neck Disability Index to Assess Chronic Neck Pain Patients in Brazil.

STUDY DESIGN: Cross-sectional study. OBJECTIVE: The aim of this study was to assess the structural validity of the Brazilian version of the Neck Disability Index (NDI) in patients with chronic neck pain. SUMMARY OF BACKGROUND DATA: NDI is widely used in clinical and scientific contexts, although its structure has not been evaluated in the Brazilian version. METHODS: Native Brazilian Portuguese speakers, aged ≥18 years, with neck pain complaint of at least 3 months, and minimal pain rating of 3 points at rest or during neck movements were included. Exploratory factorial analysis (EFA) and confirmatory factorial analysis (CFA) were used. In EFA, the adequacy of the model was assessed using Bartlett test of sphericity and Kaiser-Meyer-Olkin test. In CFA, the goodness-of-fit was assessed by the indices: root mean square error of approximation with 90% of confidence interval, comparative fit index, Tucker-Lewis Index, standardized root mean square residual, and χ2/degree of freedom. Akaike information criterion (AIC) and Bayesian information criterion (BIC) were considered to compare the models. RESULTS: Two hundred fifty-four participants with chronic neck pain were included. The NDI model with one domain and five items presented the most adequate goodness-of-fit indexes and the lowest values of AIC and BIC, when compared with models with one domain and 10, eight, or seven items, and with the model with two domains and 10 items. CONCLUSION: In the Brazilian context, the NDI version with one domain and five items (personal care, concentration, work, driving, and recreation) presents the best structure according to the factorial analysis.Level of Evidence: 5.

Treatment based classification systems for patients with non-specific neck pain. A systematic review.

OBJECTIVE: We aimed to identify published classification systems with a targeted treatment approach (treatment-based classification systems (TBCSs)) for patients with non-specific neck pain, and assess their quality and effectiveness. DESIGN: Systematic review. DATA SOURCES: MEDLINE, CINAHL, EMBASE, PEDro and the grey literature were systematically searched from inception to December 2019. STUDY APPRAISAL AND SYNTHESIS: The main selection criterium was a TBCS for patients with non-specific neck pain with physiotherapeutic interventions. For data extraction of descriptive data and quality assessment we used the framework developed by Buchbinder et al. We considered as score of ≤3 as low quality, a score between 3 and 5 as moderate quality and a score ≥5 as good quality. To assess the risk of bias of studies concerning the effectiveness of TBCSs (only randomized clinical trials (RCTs) were included) we used the PEDro scale. We considered a score of ≥ six points on this scale as low risk of bias. RESULTS: Out of 7664 initial references we included 13 studies. The overall quality of the TBCSs ranged from low to moderate. We found two RCTs, both with low risk of bias, evaluating the effectiveness of two TBCSs compared to alternative treatments. The results showed that both TBCSs were not superior to alternative treatments. CONCLUSION: Existing TBCSs are, at best, of moderate quality. In addition, TBCSs were not shown to be more effective than alternatives. Therefore using these TBCSs in daily practice is not recommended.

Classification by pain pattern for patients with cervical spine radiculopathy.

OBJECTIVES: A prospective observational cohort study was conducted to (1) report the prevalence of Mechanical Diagnosis and Therapy (MDT) classifications, Centralization (CEN), and Non-CEN among patients with Cervical Spine Radiculopathy (CSR), and (2) describe the association between classification via CEN and Non-CEN and clinical outcomes at follow-up. METHODS: Data were collected from 680 consecutive patients who presented to outpatient, orthopedic physical therapy clinics with primary complaints of neck pain with and without radiculopathy; thirty-nine patients (6%) met the physical examination inclusion criteria for CSR. First examination and follow-up data were completed by 19 patients. RESULTS: Seventy-nine percent of patients' conditions were classified as Reducible Derangement at first examination and 21% were classified as either Irreducible Derangement, Entrapment, or Mechanically Inconclusive. The prevalence of CEN and Non-CEN was 36.8% and 47.4%, respectively. All patients treated via MDT methods made clinically significant improvements in disability, but not pain intensity, at follow-up. The magnitude of change in clinical outcomes was greatest for patients who exhibited CEN; however, the changes in disability and pain intensity at follow-up were not statistically significant compared to patients who exhibited Non-CEN at first examination. Patients who exhibited CEN were discharged, on average, ten days earlier and had one less treatment visit compared to patients who exhibited Non-CEN. DISCUSSION: The findings of this study show that patients with CSR can be classified and treated via MDT methods and experienced clinically significant improvements in disability, but not pain intensity, at follow-up. Providers should consider MDT classification and treatment to improve clinical outcomes for their patients affected by CSR.

Classifying neck pain status using scalar and functional biomechanical variables - development of a method using functional data boosting.

BACKGROUND: Individuals with neck pain have different movement and muscular activation (collectively termed as biomechanical variables) patterns compared to healthy individuals. Incorporating biomechanical variables as covariates into prognostic models is challenging due to the high dimensionality of the data. RESEARCH QUESTION: What is the classification performance of neck pain status of a statistical model which uses both scalar and functional biomechanical covariates? METHODS: Motion capture with electromyography assessment on the sternocleidomastoid, splenius cervicis, erector spinae, was performed on 21 healthy and 26 individuals with neck pain during walking over three gait conditions (rectilinear, curvilinear clockwise (CW) and counterclockwise (CCW)). After removing highly collinear variables, 94 covariates across the three conditions were used to classify neck pain status using functional data boosting (FDboost). RESULTS: Two functional covariates trunk lateral flexion angle during CCW gait, and trunk flexion angle during CW gait; and a scalar covariate, hip jerk index during CCW gait were selected. The model achieved an estimated AUC of 80.8 %. For hip jerk index, an increase in hip jerk index by one unit increased the log odds of being in the neck pain group by 0.37. A 1° increase in trunk lateral flexion angle throughout gait alone reduced the probability of being in the neck pain group from 0.5 to 0.15. A 1° increase in trunk flexion angle throughout gait alone increased the probability of being in the neck pain group from 0.5 to 0.9. SIGNIFICANCE: Interpreting the physiological significance of the extracted covariates, with other biomechanical variables, suggests that individuals with neck pain performed curvilinear walking using a stiffer strategy, compared to controls; and this increased the risk of being in the neck pain group. FDboost can produce clinically interpretable models with complex high dimensional data and could be used in future prognostic modelling studies in neck pain research.

Multigroup latent class model of musculoskeletal pain combinations in children/adolescents: identifying high-risk groups by gender and age.

BACKGROUND: To investigate the combinations of Musculoskeletal pain (MSP) (neck, shoulder, upper and low back pain) among a sample of Iranian school children. METHODS: The MSP combinations was modeled by latent class analysis (LCA) to find the clusters of high-risk individuals and multigroup LCA taking into account the gender and age (≤ 13 years and ≥ 14 years of age categories). RESULTS: The lowest and highest prevalence of MSP was 14.2% (shoulder pain in boys aged ≥14 years) and 40.4% (low back pain in boys aged ≤13 years), respectively. The likelihood of synchronized neck and low back pain (9.4-17.7%) was highest, while synchronized shoulder and upper back pain (4.5-9.4%) had the lowest probability. The probability of pain at three and four locations was significantly lower in boys aged ≥14 years than in other gender-age categories. The LCA divided the children into minor, moderate, and major pain classes. The likelihood of shoulder and upper back pain in the major pain class was higher in boys than in girls, while the likelihood of neck pain in the moderate pain class and low back pain in the major pain class were higher in children aged ≥14 years than those aged ≤13 years. Gender-age specific clustering indicated a higher likelihood of experiencing major pain in children aged ≤13 years. CONCLUSIONS: The findings highlight the importance of gender- and age-specific data for a more detailed understanding of the MSP combinations in children and adolescents, and identifying high-risk clusters in this regard.

Can Primary Care for Back and/or Neck Pain in the Netherlands Benefit From Stratification for Risk Groups According to the STarT Back Tool Classification?

OBJECTIVE: To evaluate whether current Dutch primary care clinicians offer tailored treatment to patients with low back pain (LBP) or neck pain (NP) according to their risk stratification, based on the Keele STarT (Subgroup Targeted Treatment) Back-Screening Tool (SBT). DESIGN: Prospective cohort study with 3-month follow-up. SETTING: Primary care. PARTICIPANTS: General practitioners (GPs) and physiotherapists included patients (N=284) with nonspecific LBP, NP, or both. INTERVENTIONS: Patients completed a baseline questionnaire, including the Dutch SBT, for either LBP or NP. A follow-up measurement was conducted after 3 months to determine recovery (using Global Perceived Effect Scale), pain (using Numeric Pain Rating Scale), and function (using Roland Disability Questionnaire or Neck Disability Index). A questionnaire was sent to the GPs and physiotherapists to evaluate the provided treatment. MAIN OUTCOME MEASURES: Prevalence of patients' risk profile and clinicians' applied care, and the percentage of patients with persisting disability at follow-up. A distinction was made between patients receiving the recommended treatment and those receiving the nonrecommended treatment. RESULTS: In total, 12 GPs and 33 physiotherapists included patients. After 3 months, we analyzed 184 patients with LBP and 100 patients with NP. In the LBP group, 52.2% of the patients were at low risk for persisting disability, 38.0% were at medium risk, and 9.8% were at high risk. Overall, 24.5% of the patients with LBP received a low-risk treatment approach, 73.5% a medium-risk, and 2.0% a high-risk treatment approach. The specific agreement between the risk profile and the received treatment for patients with LBP was poor for the low-risk and high-risk patients (21.1% and 10.0%, respectively), and fair for medium-risk patients (51.4%). In the NP group, 58.0% of the patients were at low risk for persisting disability, 37.0% were at medium risk, and 5.0% were at high risk. Only 6.1% of the patients with NP received the low-risk treatment approach. The medium-risk treatment approach was offered the most (90.8%), and the high-risk approach was applied in only 3.1% of the patients. The specific agreement between the risk profile and received treatment for patients with NP was poor for low-risk and medium-risk patients (6.3% and 48.0%, respectively); agreement for high-risk patients could not be calculated. CONCLUSIONS: Current Dutch primary care for patients with nonspecific LBP, NP, or both does not correspond to the recommended stratified-care approach based on the SBT, as most patients receive medium-risk treatment. Most low-risk patients are overtreated, and most high-risk patients are undertreated. Although the stratified-care approach has not yet been validated in Dutch primary care, these results indicate there may be substantial room for improvement.

Neck Pain: Clinical Practice Guidelines Help Ensure Quality Care.

In 2008, physical therapists published the first neck pain clinical practice guidelines. These guidelines have been updated and are now available in the July 2017 issue of JOSPT. To update these guidelines, physical therapists teamed with the International Collaboration on Neck Pain to identify leading practices. These revised guidelines provide direction to clinicians as they screen, evaluate, diagnose, and make treatment-based classifications of neck pain. They also outline the best nonsurgical treatment options based on the published literature. At the end of the day, the best care is a combination of the leading science, the clinical expertise of your health care provider, and your input as the patient. These guidelines help inform the first step in this process. J Orthop Sports Phys Ther 2017;47(7):513. doi:10.2519/jospt.2017.0508.

Clinical and quantitative analysis of patients with crowned dens syndrome.

BACKGROUND: Crowned dens syndrome (CDS) is a radioclinical entity defined by calcium deposition on the transverse ligament of atlas (TLA). In this study, the novel semi-quantitative diagnostic criteria for CDS to evaluate the degree of calcification on TLA by cervical CT are proposed. METHOD: From January 2010 to September 2014, 35 patients who were diagnosed with CDS by cervical CT were adopted as subjects in this study. Based on novel criteria, calcium deposition on TLA was classified into "Stage" and "Grade", to make a score, which was evaluated semi-quantitatively. The correlation between calcification score and CRP level or pain score, and the effects of treatments, such as NSAIDs and corticosteroids, were statistically analyzed. RESULTS: The total calcification score from added "Stage" and "Grade" scores demonstrated a significantly strong and linear correlation with CRP level (R2=0.823, **p<0.01). In the multiple comparison test for the treatment effects, significant improvement of the CRP level and pain score were demonstrated after corticosteroid therapy (**p<0.01) compared with NSAIDs. In the conditional logistic regression analysis, the rapid end of corticosteroid therapy was an independent risk factor for relapse of cervico-occipital pain [OR=50.761, *p=0.0419]. CONCLUSION: The degree of calcification on TLA evaluated by the novel semi-quantitative criteria significantly correlated with CRP level. In the treatment of CDS, it is recommended that a low dosage (15-30mg) of corticosteroids be used as first-line drugs rather than conventional NSAID therapy. Additionally, it is also recommended to gradually decrease the dosage of corticosteroids.

Cluster Analysis of an International Pressure Pain Threshold Database Identifies 4 Meaningful Subgroups of Adults With Mechanical Neck Pain.

OBJECTIVE: To determine pressure pain detection threshold (PPDT) related phenotypes of individuals with mechanical neck pain that may be identifiable in clinical practice. METHODS: This report describes a secondary analysis of 5 independent, international mechanical neck pain databases of PPDT values taken at both a local and distal region (total N=1176). Minor systematic differences in mean PPDT values across cohorts necessitated z-transformation before analysis, and each cohort was split into male and female sexes. Latent profile analysis (LPA) using the k-means approach was undertaken to identify the most parsimonious set of PPDT-based phenotypes that were both statistically and clinically meaningful. RESULTS: LPA revealed 4 distinct clusters named according to PPDT levels at the local and distal zones: low-low PPDT (67%), mod-mod (25%), mod-high (4%), and high-high (4%). Secondary predictor variables were evaluated for intracluster and cross-cluster significance. Low-low cluster was most affected, as indicated by pain intensity, disability, and catastrophization scores all significantly above the cohort-specific and sex-specific mean, and active range of motion scores significantly below the mean. DISCUSSION: The results suggest that there are a large proportion of people with neck pain that present with signs indicating dysfunction beyond the local tissues. Ongoing exploration of these presentations may lead to more informed management and improved outcomes.

Reliability, Construct and Predictive Validity of the Hong Kong Chinese Orebro Musculoskeletal Pain Screening Questionnaire.

Purpose The aim of this study was to evaluate the reliability, construct validity and predictive validity of the Hong Kong Chinese version of the Orebro Musculoskeletal Pain Screening Questionnaire (COMPSQ-HK). Methods The COMPSQ-HK was developed using the forward-backward translation. Internal consistency was assessed using Cronbach's alpha and test-retest reliability was examined using intraclass correlation coefficient with one-way random-effects model (ICC1,1), minimum detectable change (MDC) and 95% limits of agreement (LoA). Construct validity was evaluated by correlating the COMPSQ-HK with the Numeric Pain Rating Scale, Roland-Morris Disability Questionnaire, Northwick Park Neck Pain Questionnaire, Tampa Scale for Kinesiophobia, and Medical Outcomes Study Short Form 12. The predictive validity was investigated using receiver operating characteristics (ROC) curve analyses with sick leave >60 days and return-to-work for ≥4 consecutive weeks as outcomes at 1 year follow-up. The areas under the curve (AUC) were calculated. Results The COMPSQ-HK was administered to 305 patients with acute/subacute low back pain and 160 patients with acute/subacute neck pain. The Cronbach's alphas and ICC1,1 ranged from 0.83 to 0.84 and 0.81 to 0.92 respectively. The MDC were 32.1 and 21.1. The 95% LoA were -32.4 to 31.8 and -15.4 to 26.7. The Pearson r ranged from 0.333 to 0.697 in absolute value. The AUC for the ROC curve analyses ranged from 0.59 to 0.71. Conclusions The COMPSQ-HK has good internal consistency, moderate test-retest reliability, satisfactory construct validity and predictive validity as a screening tool for patients with back and neck pain at risk of chronic disability.

Classification and Treatment of Chronic Neck Pain: A Longitudinal Cohort Study.

BACKGROUND AND OBJECTIVES: Neck pain exerts a steep personal and socioeconomic toll, ranking as the fourth leading cause of disability. The principal determinant in treatment decisions is whether pain is neuropathic or nonneuropathic, as this affects treatment at all levels. Yet, no study has sought to classify neck pain in this manner. METHODS: One hundred participants referred to an urban, academic military treatment facility with a primary diagnosis of neck pain were enrolled and followed up for 6 months. Pain was classified as neuropathic, possible neuropathic, or nonneuropathic using painDETECT and as neuropathic, mixed, or nociceptive by s-LANSS (self-completed Leeds Assessment of Neuropathic Symptoms and Signs pain scale) and physician designation. Based on previous studies, the intermediate possible neuropathic pain category was considered to be a mixed condition. The final classification was based on a metric combining all 3 systems, slightly weighted toward physician's judgment, which is considered the reference standard. RESULTS: Fifty percent of participants were classified as having possible neuropathic pain, 43% as having nonneuropathic pain, and 7% with primarily neuropathic pain. Concordance was high between the various classification schemes, ranging from a low of 62% between painDETECT and physician designation for possible neuropathic pain, to 83% concordance between s-LANSS and the 2 other systems for neuropathic pain. Individuals with neuropathic pain reported higher levels of baseline disability, were more likely to have a coexisting psychiatric illness, and underwent surgery more frequently than other pain categories, but were also more likely to report greater reductions in disability after 6 months. CONCLUSIONS: Although pure neuropathic pain comprised a small percentage of our cohort, 50% of our population consisted of mixed pain conditions containing a possible neuropathic component. There was significant overlap between the various classification schemes.

Feasibility of a Smartphone-Based Exercise Program for Office Workers With Neck Pain: An Individualized Approach Using a Self-Classification Algorithm.

OBJECTIVE: To explore the feasibility of a newly developed smartphone-based exercise program with an embedded self-classification algorithm for office workers with neck pain, by examining its effect on the pain intensity, functional disability, quality of life, fear avoidance, and cervical range of motion (ROM). DESIGN: Single-group, repeated-measures design. SETTING: The laboratory and participants' home and work environments. PARTICIPANTS: Offices workers with neck pain (N=23; mean age ± SD, 28.13±2.97y; 13 men). INTERVENTION: Participants were classified as having 1 of 4 types of neck pain through a self-classification algorithm implemented as a smartphone application, and conducted corresponding exercise programs for 10 to 12min/d, 3d/wk, for 8 weeks. MAIN OUTCOME MEASURES: The visual analog scale (VAS), Neck Disability Index (NDI), Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), Fear-Avoidance Beliefs Questionnaire (FABQ), and cervical ROM were measured at baseline and postintervention. RESULTS: The VAS (P<.001) and NDI score (P<.001) indicated significant improvements in pain intensity and functional disability. Quality of life showed significant improvements in the physical functioning (P=.007), bodily pain (P=.018), general health (P=.022), vitality (P=.046), and physical component scores (P=.002) of the SF-36. The FABQ, cervical ROM, and mental component score of the SF-36 showed no significant improvements. CONCLUSIONS: The smartphone-based exercise program with an embedded self-classification algorithm improves the pain intensity and perceived physical health of office workers with neck pain, although not enough to affect their mental and emotional states.

Subjective and clinical assessment criteria suggestive for five clinical patterns discernible in nonspecific neck pain patients. A Delphi-survey of clinical experts.

BACKGROUND: Nonspecific neck pain patients form a heterogeneous group with different musculoskeletal impairments. Classifying nonspecific neck pain patients into subgroups based on clinical characteristics might lead to more comprehensive diagnoses and can guide effective management. OBJECTIVE: To establish consensus among a group of experts regarding the clinical criteria suggestive of a clinical dominance of 'articular', 'myofascial', 'neural', 'central' and 'sensorimotor control' dysfunction patterns distinguishable in patients with nonspecific neck pain. STUDY DESIGN: Delphi study. METHODS: A focus group with 10 academic experts was organized to elaborate on the different dysfunction patterns discernible in neck pain patients. Consecutively, a 3-round online Delphi-survey was designed to obtain consensual symptoms and physical examination findings for the 5 distinct dysfunction patterns resulting from the focus group. RESULTS: A total of 21 musculoskeletal physical therapists from Belgium and the Netherlands experienced in assessing and treating neck pain patients completed the 3-round Delphi-survey. Respectively, 33 (response rate, 100.0%), 27 (81.8%) and 21 (63.6%) respondents replied to rounds 1, 2 and 3. Eighteen 'articular', 16 'myofascial', 20 'neural', 18 'central' and 10 'sensorimotor control' clinical indicators reached a predefined ≥80% consensus level. CONCLUSION: These indicators suggestive of a clinical dominance of 'articular', 'myofascial', 'neural', 'central', and 'sensorimotor control' dysfunction patterns may help clinicians to assess and diagnose patients with nonspecific neck pain. Future validity testing is needed to determine how these criteria may help to improve the outcome of physical therapy interventions in nonspecific neck pain patients.

[Assessment of rehabilitation progress in patients with cervical radicular pain syndrome after application of high intensity laser therapy - HILT and Saunders traction device]. / Ocena postepów rehabilitacji u pacjentów z zespolami korzeniowymi kregoslupa szyjnego po zastosowaniu laseroterapii wysokoenergetycznej HILT i wyciagu Saunders´a.

UNLABELLED: Osteoarthritis of the spine is a major global health problem, it is an epidemic of our times. It affects all parts of the spine, but the hardest to treat is its cervical region. The cervical spine is most mobile, delicate and sensitive to any load. It requires special care in conservative treatment. To date the selection of effective therapeutic approaches has been controversial. AIM: The aim of the study was to assess the progress of rehabilitation in patients with cervical radicular pain syndrome after using two different methods of treatment: HILT and spinal axial traction with the use of Saunders device. MATERIALS AND METHODS: The randomized study included 150 patients (81 women and 69 men, aged 24-67 years, mean age 45.5) divided into two groups of 75 patients each with characteristic symptoms of radicular pain. The measurement of the range of cervical spine movement of the cervical spine, visual analog scale for pain - VAS and a NDI questionnaire (Neck Disability Index - Polish version) - an indicator of functional disorders - were used to evaluate the effectiveness of the two different therapies. RESULTS: The results obtained by Saunders method remained significantly higher than those obtained when HILT laser therapy was used for most of the examined parameters. A thorough analysis of the results showed greater analgesic efficacy, improved global mobility and reduced functional impairment in patients treated with Saunders method. CONCLUSIONS: Both therapeutic methods manifest analgesic effect and a positive impact on the improvement of range of cervical spine movement in patients with radicular pain in this spine region. HILT laser therapy and Saunders traction device reduce neck disability index in the treated patients.

Validation of the simplified Chinese version of the functional rating index for patients with nonspecific neck pain in mainland China.

STUDY DESIGN: Validation of a self-report questionnaire, Functional Rating Index (FRI). OBJECTIVE: To evaluate the psychometric properties of the simplified Chinese (SC) version of FRI in patients with nonspecific neck pain (NP). SUMMARY OF BACKGROUND DATA: FRI has been cross-culturally validated in few languages with excellent reliability, validity, and clinical utility when it is applied in patients with low back pain. Recently, it has been pointed out that FRI can be employed to assess patients with NP. However, FRI has not been validated in patients with NP in China. METHODS: The cross-culturally adapted 10-item SC-FRI was completed by 122 patients with nonspecific NP, along with the Neck Disability Index, Neck Pain and Disability Scale, 36-Item Short Form Health Survey, and Pain Visual Analogue Scale. Psychometric evaluation included score distribution, internal consistency, test-retest reliability, and construct validity. RESULTS: SC-FRI attained a high completion rate (96.9%). Each item was scored with a normal distribution without any floor and ceiling effects. The internal consistency and test-retest reliability were good to excellent (Cronbach α coefficient = 0.86; intraclass r = 0.97). Construct validity was confirmed by a strong correlation with Neck Disability Index, Neck Pain and Disability Scale, and Visual Analogue Scale (r = 0.77, 0.78, and 0.86, respectively, all P < 0.0001), and with the physical functioning and bodily pain domains (r = -0.69 and -0.66, respectively, both P < 0.0001), and by a weak correlation with the vitality, role-emotional, and mental health domains of 36-Item Short Form Health Survey. CONCLUSION: SC-FRI showed satisfactory clinical utility, internal consistency, test-retest reliability, and construct validity in Chinese-speaking patients with nonspecific NP. LEVEL OF EVIDENCE: 3.

In a secondary care setting, differences between neck pain subgroups classified using the Quebec task force classification system were typically small - a longitudinal study.

BACKGROUND: The component of the Quebec Task Force Classification System that subgroups patients based on the extent of their radiating pain and neurological signs has been demonstrated to have prognostic implications for patients with low back pain but has not been tested on patients with neck pain (NP). The main aim of this study was to examine the association between these subgroups, their baseline characteristics and outcome in chronic NP patients referred to an outpatient hospital department. METHODS: This was an observational study of longitudinal data extracted from systematically collected, routine clinical data. Patients were classified into Local NP only, NP + arm pain above the elbow, NP + arm pain below the elbow, and NP with signs of nerve root involvement (NP + NRI). Outcome was pain intensity and activity limitation. Associations were tested in longitudinal linear mixed models. RESULTS: A total of 1,852 people were classified into subgroups (64 % females, mean age 49 years). Follow ups after 3, 6 and 12 months were available for 45 %, 32 % and 40 % of those invited to participate at each time point. A small improvement in pain was observed over time in all subgroups. There was a significant interaction between subgroups and time, but effect sizes were small. The local NP subgroup improved slightly less after 3 months as compared with all other groups, but continued to have the lowest level of pain. After 6 and 12 months, those with NP + pain above the elbow had improved the least and patients with NP + NRI had experienced the largest improvements in pain intensity. Similar results were obtained for activity limitation. CONCLUSIONS: This study found baseline and outcome differences between neck pain subgroups classified using the Quebec Task Force Classification System. However, differences in outcome were typically small in size and mostly differentiated the local NP subgroup from the other subgroups. A caveat to these results is that they were obtained in a cohort of chronic neck pain patients who only displayed small improvements over time and the results may not apply to other cohorts, such as people at earlier stages of their clinical course and in other clinical settings.

The Neck Disability Index-Russian Language Version (NDI-RU): A Study of Validity and Reliability.

STUDY DESIGN: Cross-cultural adaptation and psychometric testing. OBJECTIVE: To perform a validated Russian translation and then to evaluate the validity and reliability of the Russian language version of the Neck Disability Index (NDI-RU). SUMMARY OF BACKGROUND DATA: Neck pain is highly prevalent and can greatly affect daily activity. The Neck Disability Index (NDI) is the most frequently used scale for self-rating of disability due to neck pain. Its translated versions are applied in many countries. However, the Russian language version of the NDI has not been developed yet. METHODS: Cross-cultural adaptation of the NDI-RU was performed according to established guidelines. Then, the NDI-RU was evaluated for content validity, concurrent criterion validity, internal consistency, test-retest reliability, factor structure, and minimum detectable change. RESULTS: Two hundred thirty-two patients took part in the study in total: 109 in validity (39.5 ± 10 yr), 123 in reliability (38.4 ± 11 yr; 80 in the test-retest phase). A culturally valid translation was achieved. NDI-RU total scores were distributed normally. Floor/ceiling effects were absent. Good values of Cronbach α were obtained for each item (from 0.80 to 0.84) and for the total NDI-RU (0.83). A 2-factor solution was found for the NDI-RU. The average interitem correlation coefficient was 0.53. Intraclass correlation coefficients for test-retest reliability coefficients ranged from 0.65 to 0.92 for different items and 0.91 for the total NDI-RU. Moderate correlation (Spearman rs = 0.62; P < 0.05) was found between the NDI-RU total score and graphic rating scalepain score. Completion of the NDI-RU takes 3.6 ± 1 minutes. CONCLUSION: The development of a Russian language version of the Neck Disability Index resulted in a valid, reliable instrument that can be used both in clinical practice and scientific investigations. LEVEL OF EVIDENCE: 1.