Change in a clinical measure of cervical movement sense following four weeks of kinematic training.

BACKGROUND: Training targeted towards improving cervical movement accuracy is an effective strategy in the management of neck pain. Relatively complex measures have been validated to measure this in research although a simple clinical measure using a head mounted laser tracing a standardised pattern has been shown to be reliable. It is not known if this method demonstrate clinically meaningful change to training. OBJECTIVE: To assess change responsiveness of the clinical cervical movement sense (CCMS) test following home kinematic training (KT). STUDY DESIGN: Pre-post treatment observational study. METHODS: The CCMS measure was assessed in 56 patients with chronic neck pain (41 intervention, 15 control) at baseline and 4 weeks post intervention by blinded assessors. Task completion time and error number were assessed reviewing video of the performances. Change pre-post intervention was compared between groups. RESULTS: There was a significantly greater mean improvement in the intervention (-9.2 ± 9.3) seconds) for completion time and combined time and error (-13.3 ± 16) compared to the control group for time (-2.0 ± 9.8) and combined time and error (-1.8 ± 14) with moderate to high effect sizes (Cohen's d 0.76). There was a non-significant trend for decreased number of errors in the intervention (-4.1 ± 9.0) compared to control group (0.2 ± 8.3). CONCLUSION: Completion time of the CCMS test appears to be able to demonstrate meaningful change following four weeks of KT. This further supports its clinical utility as a measure of cervical movement accuracy and provides direction for future clinical use.

[Israeli guidelines for prevention of low back pain].

INTRODUCTION: Due to the lack of international consensus regarding the efficiency of various methods for prevention of low back pain (LBP), this article describes the Israeli guidelines for prevention of L.B.P., based on the recommendations of the European Commission, COST Action B13. OBJECTIVE: Consolidation of Israeli guidelines for prevention of L.B.P. METHOD: In September 2004, the Israeli low back pain work group gathered in Haifa, to discuss and reach a consensus relating to the LBP prevention guidelines. The forum was sponsored by the Israeli Medical Association. LITERATURE SEARCH: The recommendations of the European committee, COST B13, served as the main source of information. The European group based its conclusions on systematic reviews mainly from the Cochrane, Embase, and Medline databases, and other smaller databases for more specific topics. The search covered the years 1966-2003. Information was also gathered through personal contacts with experts in the field. Additional searches were conducted for recent RCT's, published following the most recent systematic reviews. The final recommendations were sent to be reviewed by international experts in LBP. Summary of recommendations for the general population: Physical exercise is recommended for prevention of sick leave due to LBP and for the occurrence or duration of further episodes (Level A). There is insufficient consistent evidence to recommend for or against any specific type or intensity of exercise (Level C). Information and education on back problems, if based on bio-psychosocial principles, should be considered (Level C), but information and education focused principally on a biomedical or biomechanical model cannot be recommended (Level C). Back schools based on traditional biomedical/biomechanical information, advice and instruction are not recommended for prevention in LBP (Level A). High intensity programs, which comprise both an educational/skills program and exercises, can be recommended for patients with recurrent and persistent back pain (Level B). Lumbar supports or back belts are not recommended (Level A). There is no robust evidence for or against recommending any specific chair or mattress for prevention in LBP (Level C), though persisting symptoms may be reduced with a medium-firm rather than a hard mattress (Level C). There is no evidence to support recommending manipulative treatment for prevention in LBP (Level D). Shoe insoles are not recommended for the prevention of back problems (Level A). There is insufficient evidence to recommend for or against correction of leg length (Level D). Despite the intuitive appeal of the idea, there is no evidence, at this time, that attempts to prevent LBP in schoolchildren will have any impact on LBP in adults (Level D).

Evidence for exercise therapy in mechanical neck disorders.

In spite of neck disorders being so common in the population, little evidence supporting effective interventions has been identified. The objective of this systematic review was to determine if various exercise methods are effective in treating the different mechanical neck disorders occurring in adults. Sixteen trials were included: nine randomized controlled trials (RCTs) and seven randomized comparative trials (CTs). The average PEDro score indicated moderate methodological quality. PEDro results showed the subject- and therapist-blinding criteria to be inappropriate. Findings revealed relatively strong evidence supporting the effectiveness of proprioceptive exercises and dynamic resisted strengthening exercises of the neck-shoulder musculature for chronic or frequent neck disorders. Moderate evidence was found to support early mobilizing exercises in acute whiplash patients. The evidence identified could not support the effectiveness of group exercise, neck schools or single sessions of extension-retraction exercises. Clinicians are encouraged to incorporate these findings into their practice when planning the management of mechanical neck disorders. There is great need for well-designed RCTs to further investigate the topic and perhaps evaluate exercise effectiveness in relation to more specific disorders, e.g., discogenic vs facet joint originated disorder.