Effectiveness of Therapeutic Exercise on Forward Head Posture: A Systematic Review and Meta-analysis.

OBJECTIVE: The purpose of this systematic review and meta-analysis was to summarize the results related to the effects of corrective exercises on postural variables in individuals with forward head posture (FHP). METHODS: A systematic review of the electronic literature through February 2017 was independently performed by 2 investigators. The electronic databases searched included PubMed, MEDLINE, Web of Science, ScienceDirect, Cochrane Central Register of Controlled Clinical Trials, Google Scholar, and Scopus. Methodological quality was evaluated using the Physiotherapy Evidence Database scale. Meta-analyses were carried out for craniovertebral angle (CVA), cranial angle (CA), and pain intensity. RESULTS: Seven randomized clinical trials comprising 627 participants met the study criteria. The between-groups pooled random odds ratios for CVA, CA, and pain were 6.7 (confidence interval [CI] = 2.53-17.9, P = .0005), 0.7 (CI = 0.43-1.2, P = .2), and 0.3 (95% CI = 0.13-0.42, P < .001), respectively. No publication bias was observed. Level 1a evidence (strong) indicates exercise training can effectively modify CVA, and level 1b evidence (moderate) indicates exercise may improve pain but not CA. CONCLUSION: The findings suggest that therapeutic exercises may result in large changes in CVA and moderate improvement in neck pain in participants with FHP. The precise nature of the relationship between FHP and musculoskeletal pain, and improvements in both after therapeutic exercise, remains to be established.

Workplace Factors Associated With Neck Pain Experienced by Computer Users: A Systematic Review.

INTRODUCTION: The purpose of this systematic review was to examine literature on workplace factors associated with neck pain or symptoms in computer users performing clerical functions. METHODS: A systematic search of the Cochrane, Medline, CINAHL, and EMBASE databases was conducted for observational and experimental studies published since 2000. This review applied the case definition of The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. RESULTS: Seven hundred twenty-nine studies were identified. Seven hundred and two studies were excluded. Twenty-seven studies fulfilled inclusion criteria and were assessed for risk of bias. Cross-sectional studies were commonly at risk from nonresponse bias and lack of adequate case definitions. Experimental studies were mostly at risk of bias due to confounding and participant recruitment methods. CONCLUSIONS: Neck pain was not significantly associated with high job demands, low skill discretion, low decision authority, or low peer support. However, when these variables were combined with increased duration of computing tasks, or ergonomic demands, they reached significance. Supervisor support was found to be the only significant buffer capable of preventing these variables reaching significance in female office workers.

Effect of education on non-specific neck and low back pain: A meta-analysis of randomized controlled trials.

BACKGROUND: Neck and low back pain are significant health problems due to their high prevalence among the general population. Educational intervention commonly aims to reduce the symptoms and risk for additional problems by increasing the participant's knowledge, which in turn will alter the person's behavior. The primary aim of this study was to review randomize controlled trials (RCTs) to gain insights into the effectiveness of education for the prevention and treatment of non-specific neck and low back pain. METHODS: Publications were systematically searched from 1982 to March 2015 in several databases. Relevant RCTs were retrieved and assessed for methodological quality. Meta-analysis was conducted to examine the effectiveness of education for the prevention and treatment of non-specific neck and low back pain. The overall quality of evidence was assessed using the GRADE system. RESULTS: Thirty-six RCTs (30 high-quality studies) were identified. A total of 15 RCTs, which compared education programs to no education program, were included for further analysis. All studies included investigated the effectiveness of education with intermediate- and long-term follow-ups. The results showed that education programs were not effective in preventing and treating neck pain as well as treating low back pain. Conflicting evidence was found for the effectiveness of education on prevention of low back pain. CONCLUSIONS: Evidence suggests that education programs are not recommended in preventing or treating neck pain as well as treating low back pain, unless supplementary high-quality studies provide evidence to the contrary.

Psychosocial, Physical, and Neurophysiological Risk Factors for Chronic Neck Pain: A Prospective Inception Cohort Study.

UNLABELLED: The purpose of this investigation was to identify modifiable risk factors for the development of first-onset chronic neck pain among an inception cohort of healthy individuals working in a high-risk occupation. Candidate risk factors identified from previous studies were categorized into psychosocial, physical, and neurophysiological domains, which were assessed concurrently in a baseline evaluation of 171 office workers within the first 3 months of hire. Participants completed monthly online surveys over the subsequent year to identify the presence of chronic interfering neck pain, defined as a Neck Disability Index score ≥5 points for 3 or more months. Data were analyzed using backward logistic regression to identify significant predictors within each domain, which were then entered into a multivariate regression model adjusted for age, sex, and body mass index. Development of chronic interfering neck pain was predicted by depressed mood (odds ratio [OR] = 3.36, 95% confidence interval [CI] = 1.10-10.31, P = .03), cervical extensor endurance (OR = .92, 95% CI, .87-.97, P = .001), and diffuse noxious inhibitory control (OR = .90, 95% CI, .83-.98, P = .02) at baseline. These findings provide the first evidence that individuals with preexisting impairments in mood and descending pain modulation may be at greater risk for developing chronic neck pain when exposed to peripheral nociceptive stimuli such as that produced during muscle fatigue. PERSPECTIVE: Depressed mood, poor muscle endurance, and impaired endogenous pain inhibition are predisposing factors for the development of new-onset chronic neck pain of nonspecific origin in office workers. These findings may assist with primary prevention by allowing clinicians to screen for individuals at risk of developing chronic neck pain.

The effect of pillow height on muscle activity of the neck and mid-upper back and patient perception of comfort.

OBJECTIVE: The purpose of this study was to evaluate the comfort and the electromyographic (EMG) activity of the neck and mid-upper back of asymptomatic adults using foam pillows of 3 different heights. METHODS: Twenty-one asymptomatic adults used foam pillows of 3 different heights (1: 5 cm, 2: 10 cm, and 3: 14 cm). Comfort was assessed using a 100-mm visual analog scale. Electromyographic activity was assessed in the lateral position. We calculated the root mean square (RMS) in 500-millisecond windows of bilateral EMG activity of the sternocleidomastoid and upper and middle trapezius, normalized by maximal isometric contraction of each individual. The RMS of the EMG signals was compared among pillow heights using repeated-measures analysis of variance (P < .05). RESULTS: The middle trapezius muscle of the down-side showed the highest RMS in height 1 when compared with heights 2 (P = .0163) and 3 (P = .0313), with no statistical significance between pillow heights 2 and 3 for this muscle. There were no statistical differences between pillows 2 and 3 in any muscle activity. Height 2 was considered the most comfortable (P < .001) compared with heights 1 and 3, and height 1 the least comfortable (P < .001) compared with the other heights. CONCLUSION: For the participants in this study, there was an association among pillow height, myoelectric activity, and comfort.

Influencia postural de la técnica en rotación del atlas en pacientes con cervicalgia mecánica crónica / No disponible

Introducción: La cervicalgia mecánica crónica (CMC) es una patología común en la sociedad actual. Se define como dolor con una duración de al menos 3 meses desde el inicio de los síntomas, altera las funciones sensoriomotoras, y por tanto, la capacidad de mantener una postura correcta, incluyendo una reducción del rango de movimiento. Objetivos: Valorar el efecto de la manipulación en rotación del atlas (MRA) sobre la estabilometría en pacientes que padezcan: (i) dolor cervical de más de 3 meses de evolución y (ii) presenten un test de flexión-rotación cervical (TFRC) positivo. Material y Métodos: Estudio experimental, controlado, aleatorizado, doble ciego. Han participado 24 pacientes con CMC, 12 formaron parte del Grupo Experimental (GE) y 12 del Grupo Control (GC). Se midió la estabilometría con una plataforma de presiones, y el TFRC, estas mediciones se repitieron post-intervención inmediata, tras 7 y 15 días. Resultados: Encontramos que el gasto energético del paciente, para mantener la postura (L/S) mejora al final del estudio y se observa una mejora significativa (-79.20±5.45;p<0.001) a los 15 días, período en el que su organismo podría haberse adaptado a la nueva situación. Hay un claro aumento de los grados de rotación inmediatamente después de la manipulación (8.33±0.95;p<0.001). Conclusiones: La manipulación en rotación del atlas mejora la movilidad en rotación de la cabeza, y con el paso de los días hay una disminución en el esfuerzo para mantener la postura bípeda, con lo que mejora el gasto energético postural de los pacientes (AU)

No disponible

The effect of intra-operative transcutaneous electrical nerve stimulation on posterior neck pain following thyroidectomy.

Posterior neck pain following thyroidectomy is common because full neck extension is required during the procedure. We evaluated the effect of intra-operative transcutaneous electrical nerve stimulation on postoperative neck pain in patients undergoing total thyroidectomy under general anaesthesia. One hundred patients were randomly assigned to one of two groups; 50 patients received transcutaneous electrical nerve stimulation applied to the trapezius muscle and 50 patients acted as controls. Postoperative posterior neck pain and anterior wound pain were evaluated using an 11-point numerical rating scale at 30 min, 6 h, 24 h and 48 h following surgery. The numerical rating scale for posterior neck pain was significantly lower in the transcutaneous electrical nerve stimulation group compared with the control group at all time points (p < 0.05). There were no significant differences in the numerical rating scale for anterior wound pain at any time point. No adverse effects related to transcutaneous electrical nerve stimulation were observed. We conclude that intra-operative transcutaneous electrical nerve stimulation applied to the trapezius muscle reduced posterior neck pain following thyroidectomy.

Cervicalgia mecánica y postura / Mechanical neck pain and posture

Introducción: El dolor y las molestias en el cuello son uno de los síntomas más comunes asociados al trabajo con alta prevalencia. Un desequilibrio o alteración postural en un segmento corporal podría provocar cambios en el sistema miofascioesquelético. Objetivos: Revisar el cuerpo de conocimientos que la literatura científica recoge sobre la relación entre las cervicalgias mecánicas crónicas y las alteraciones posturales laborales. Material y Método: Se realizó una búsqueda bibliográfica en las bases de datos Medline y Cochrane, y en Google Académico, empleando los descriptores «mechanical neck pain», «posture», «neck pain» , «abdominal wall» y «myofascial trigger point». Resultados: Hay evidencias científicas que apuntan a una correlación entre posicionamientos anómalos del tracto cráneo-cervical, con relación a puestos de trabajo en los que se debe permanecer largos periodos de tiempo delante de la pantalla del ordenador, con las cervicalgias mecánicas crónicas y alteraciones a nivel de la función respiratoria. Conclusiones: El osteópata debe revisar la postura y todo lo que puede provocar disfunciones respiratorias, en la evaluación del paciente, como prevención o tratamiento de las cervicalgias mecánicas crónica (AU)

Introduction: Pain and discomfort in the neck are one of the most common symptoms associated with working with high prevalence. An imbalance or postural alteration in a body segment could cause changes in the myofaskeletal system. Objective: To review the body of knowledge contained in scientific literature on the relationship between chronic mechanical neck pain and occupational postural alterations. Material and methods: A bibliographic search was performed in the Medline and Cochrane databases, and in Google Academic, using the descriptors «mechanical neck pain», «posture», «neck pain», «abdominal wall» and «myofascial trigger point». Results: There is scientific evidence pointing to a correlation between anomalous positions of the cranio-cervical tract, in relation to jobs in which long periods of time are spent in front of the computer screen, with chronic mechanical neck pain and alterations in respiratory functioning. Conclusions: The osteopath should review posture and anything that can cause respiratory dysfunctions in the evaluation of the patient, such as prevention or treatment of chronic mechanical neck pain (AU)

Randomized-controlled trial comparing yoga and home-based exercise for chronic neck pain.

OBJECTIVES: Chronic neck pain is a significant public health problem with only very few evidence-based treatment options. There is growing evidence for the effectiveness of yoga for relieving musculoskeletal disorders. The aim of this study was to evaluate the effect of Iyengar yoga compared with exercise on chronic nonspecific neck pain. METHODS: Patients were randomly assigned to either yoga or exercise. The yoga group attended a 9-week yoga course and the exercise group received a self-care manual on home-based exercises for neck pain relief. The main outcome measure was the present neck pain intensity (100 mm visual analog scale). Secondary outcome measures included functional disability (Neck Disability Index), pain at motion (visual analog scale), health-related quality of life (Short Form-36 questionnaire), cervical range of motion, proprioceptive acuity, and pressure pain threshold. RESULTS: Fifty-one patients (mean age 47.8 y ; 82.4% female) were randomized to yoga (n=25) and exercise (n=26) intervention. After the study period, patients in the yoga group reported significantly less neck pain intensity compared with the exercise group [mean difference: -13.9 mm (95% CI, -26.4 to -1.4), P=0.03]. The yoga group reported less disability and better mental quality of life. Range of motion and proprioceptive acuity were improved and the pressure pain threshold was elevated in the yoga group. DISCUSSION: Yoga was more effective in relieving chronic nonspecific neck pain than a home-based exercise program. Yoga reduced neck pain intensity and disability and improved health-related quality of life. Moreover, yoga seems to influence the functional status of neck muscles, as indicated by improvement of physiological measures of neck pain.

Coffee intake and development of pain during computer work.

BACKGROUND: The present study sought to determine if subjects who had consumed coffee before performing a simulated computer office-work task found to provoke pain in the neck and shoulders and forearms and wrists exhibited different time course in the pain development than the subjects who had abstained from coffee intake. FINDINGS: Forty eight subjects all working fulltime, 22 with chronic shoulder and neck pain and 26 healthy pain-free subjects, were recruited to perform a computer-based office-work task for 90 min. Nineteen (40%) of the subjects had consumed coffee (1/2 -1 cup) on average 1 h 18 min before start. Pain intensity in the shoulders and neck and forearms and wrists was rated on a visual analogue scale every 15 min throughout the work task.During the work task the coffee consumers exhibited significantly lower pain increase than those who abstained from coffee. CONCLUSIONS: Subjects who had consumed coffee before starting a pain provoking office work task exhibited attenuated pain development compared with the subjects who had abstained from coffee intake. These results might have potentially interesting implications of a pain-modulating effect of caffeine in an everyday setting. However, studies with a double blind placebo controlled randomized design are needed.

Efectividad del tratamiento Acupuntural en la cervicalgia / Effectiveness of Acupuncture Treatment in Cervical Pain

Se realiza un estudio, longitudinal, prospectivo; descriptivo en pacientes que asistieron a la consulta del Centro de Salud con Camas (CSCC) de Torbeck, Departamento Sur de Haití, con el objetivo de determinar la efectividad del tratamiento acupuntural en pacientes con Cervicalgia, en el período comprendido entre enero y junio de 2011. Se estudió un universo de 73 pacientes y se seleccionó una muestra de 60 pacientes, de éstos 30 con tratamiento medicamentoso (Grupo B) y 30 pacientes en los cuales se empleo el tratamiento con acupuntura (Grupo A). Observamos que en ambos grupos el sexo femenino fue el más afectado, con un predominio entre 31 y 60 años. El síntoma fundamental para ambos grupos fue el dolor (100 porciento). Los pacientes a los cuales se les aplico el tratamiento con acupuntura evolucionaron de forma satisfactoria entre el segundo y cuarto día de iniciado el tratamiento y los pacientes del grupo B entre el 5 y 6 día. La acupuntura resultó una terapéutica efectiva en el manejo de la Cervicalgia, con muy pocas reacciones indeseables para el paciente y cero costos medicamentosos (AU)

A study is performed, longitudinal, prospective, descriptive in patients who attended the consultation of The Health Center With Beds (CSCC) of Torbeck, in the Southern Department of Haiti, in order to determine the effectiveness of acupuncture treatment in patients with cervical pain, in the period between January and June 2011. We studied a universe of 73 patients and a sample of 60 patients, from these persons 30 used drug therapy (Group B) and 30 patients which used acupuncture (Group A). We note that in both groups, the females were the most affected, with a prevalence between 31 and 60. The main symptom for both groups was pain (100 persent). Patients who were administered the acupuncture successfully evolved between the second and fourth days of starting treatment and patients in group B between 5 and 6 days. Acupuncture is an effective therapy in the management of neck pain, with few adverse reactions of the patient and drug zero cost (AU)

Randomized controlled pilot study: pain intensity and pressure pain thresholds in patients with neck and low back pain before and after traditional East Asian "gua sha" therapy.

Gua Sha is a traditional East Asian healing technique where the body surface is "press-stroked" with a smooth-edged instrument to raise therapeutic petechiae that last 2-5 days. The technique is traditionally used in the treatment of both acute and chronic neck and back pain. This study aimed to measure the effects of Gua Sha therapy on the pain ratings and pressure pain thresholds of patients with chronic neck pain (CNP) and chronic low back pain (CLBP). A total of 40 patients with either CNP or CLBP (mean age 49.23 ± 10.96 years) were randomized to either a treatment group (TG) or a waiting list control group (WLC). At baseline assessment (T1), all patients rated their pain on a 10 cm visual analog scale (VAS). Patients' pressure pain thresholds (PPT) at a site of maximal pain (pain-maximum) and an adjacent (pain-adjacent) site were also established. The treatment group then received a single Gua Sha treatment. Post-intervention measurements were taken for both groups at T2, seven days after baseline assessment (T1), using the same VAS and PPT measurements in precisely the same locations as at T1. Final analysis were conducted with 21 patients with CNP and 18 patients with CLBP. The study groups were equally distributed with regard to randomization. Patients in both the CNP and the CLBP treatment groups reported pain reduction (p < 0.05) and improved health status from their one Gua Sha treatment, as compared to the waiting list group. Pain sensitivity improved in the TG in CNP, but not in CLBP patients, possibly due to higher pressure sensitivity in the neck area. No adverse events were reported. These results suggest that Gua Sha may be an effective treatment for patients with chronic neck and low back pain. Further study of Gua Sha is warranted.

A case of potential treatment of remote pain after sacral nerve stimulation for chronic urinary retention.

OBJECTIVE: A case is presented in which a 58-year-old man developed a potential unintended and durable treatment of pain at remote sites (cervical region and low back) after sacral nerve stimulation for chronic urinary retention. METHODS: Proper placement of the electrodes in the S3 foramen was confirmed by physiological response and fluoroscopy. RESULTS: Potential causality was shown by recurrent pain with the stimulators turned off and abatement of pain with the stimulators turned on. DISCUSSION: The current case presents a potential example of neurological crosstalk and highlights the inherent complexity in human neural physiology. Further research may reveal novel treatment strategies for patients with voiding dysfunction and chronic pain syndromes.

The effect of a corporate chair massage program on musculoskeletal discomfort and joint range of motion in office workers.

OBJECTIVES: The aim of this study was to determine the effects of workplace manual technique interventions for female participants on the degree of joint range of motion and on the level of musculoskeletal ache, pain, or discomfort experienced when performing workplace responsibilities. DESIGN: Nineteen (19) female volunteers were given chair massages on-site twice per week for 1 month. SETTINGS/LOCATION: Participants included individuals in administration and management from a company in Ljubljana, Slovenia. SUBJECTS: A total of 19 female volunteers 40-54 years of age enrolled for this study. Fifteen (15) of them completed all measurements. INTERVENTIONS: The Cornell Musculoskeletal Discomfort Questionnaire was used, and range-of-motion measurements in degrees were taken. OUTCOME MEASURES: Subjects completed a series of self-report questionnaires that asked for information concerning musculoskeletal discomfort for the neck, upper back, and lower back in the form of a body diagram. A range-of-motion test (to compare the change in joint angles) was performed with a goniometer to assess cervical lateral flexion, cervical flexion, cervical extension, lumbar flexion, and lumbar extension. RESULTS: Between the first and the last measurements, a significant difference (p<0.05) was found in increased range of motion for cervical lateral flexion (28.8%). Wilcoxon signed rank test showed a significant increase (p<0.05) in range of motion for cervical lateral flexion (42.4±6.3 to 48.3±7.3), cervical extension (63.2±12.4 to 67.2±12.3), and a significant decrease (p<0.05) in the Cornell Musculoskeletal Discomfort Questionnaire values for the neck (2.7±0.8 to 1.9±0.6) and the upper back (2.7±0.7 to 2.2±0.8) from the phase 2 to 3. Significant reductions were also shown in the Cornell Musculoskeletal Discomfort Questionnaire values for the neck (2.8±0.8 to 1.9±0.6) and the upper back (2.7±0.8 to 2.2±0.8) from the phase 1 to 3. CONCLUSIONS: On-site massage sessions twice per week for 1 month are the most effective interventions (compared to one session or no massage intervention) for decreasing the duration of musculoskeletal ache, pain, or discomfort and for increasing range of motion.

Comparing biofeedback with active exercise and passive treatment for the management of work-related neck and shoulder pain: a randomized controlled trial.

OBJECTIVES: To compare the effects of biofeedback with those of active exercise and passive treatment in treating work-related neck and shoulder pain. DESIGN: A randomized controlled trial with 3 intervention groups and a control group. SETTING: Participants were recruited from outpatient physiotherapy clinics and a local hospital. PARTICIPANTS: All participants reported consistent neck and shoulder pain related to computer use for more than 3 months in the past year and no severe trauma or serious pathology. A total of 72 potential participants were recruited initially, of whom a smaller group of individuals (n=60) completed the randomized controlled trial. INTERVENTIONS: The 3 interventions were applied for 6 weeks. In the biofeedback group, participants were instructed to use a biofeedback machine on the bilateral upper trapezius (UT) muscles daily while performing computer work. Participants in the exercise group performed a standardized exercise program daily on their own. In the passive treatment group, interferential therapy and hot packs were applied to the participants' necks and shoulders. The control group was given an education booklet on office ergonomics. MAIN OUTCOME MEASURES: Pain (visual analog scale), neck disability index (NDI), and surface electromyography were assessed preintervention and postintervention. Pain and NDI were reassessed after 6 months. RESULTS: Postintervention, average pain and NDI scores were reduced significantly more in the biofeedback group than in the other 3 groups, and this was maintained at 6 months. Cervical erector spinae muscle activity showed significant reductions postintervention in the biofeedback group, and there were consistent trends of reductions in the UT muscle activity. CONCLUSIONS: Six weeks of biofeedback training produced more favorable outcomes in reducing pain and improving muscle activation of neck muscles in patients with work-related neck and shoulder pain.

Aplicações da acupuntura e auriculoterapia no cenario odontologico e na atenção primaria em saude / The use of acupuncture and auriculotherapy in dentistry and in the primary health care

Considerada atualmente como uma importante tecnologia de saúde especialmente nos casos em que a terapêutica convencional não proporciona resultados satisfatórios, a acupuntura tem demonstrado efetiva redução da dor no tratamento das desordens oromiofaciais, cefaléias e cervicalgias. Neste contexto, três capítulos compuseram o presente estudo. No primeiro capítulo foi conduzida uma revisão de literatura para a compilação sistemática de pontos acupunturais localizados em áreas do corpo humano passíveis de punção durante o atendimento clínico do paciente na cadeira odontológica. Foram encontrados 142 acupontos diretamente relacionados com as principais afecções ligadas à prática da odontologia, além dos pontos auriculares mais freqüentemente empregados neste contexto. No segundo capítulo, foram apresentadas observações clínicas sobre a eficácia do uso da acupuntura e auriculoterapia como recurso terapêutico aplicado à odontologia. Nesta segunda revisão da literatura, 09 tipos de acomentimentos bucofaciais tratados por meio das terapias supracitadas foram encontrados e organizados sistematicamente de acordo com: o tipo de afecção, tratamento acupuntural empregado e resultados obtidos. No terceiro capítulo, foi realizado um estudo clínico sobre o uso da acupuntura e auriculopressão no tratamento de pacientes adultos com cervicalgia crônica, atendidos em um serviço público de atenção primária à saúde, localizado no sul da Espanha. Foi constatada a redução significante da intensidade da dor, do consumo de analgésicos, da incapacidade e das desordens do sono causadas por dor (p<0,0001). (AU)

Currently considered an important technology in health, especially in cases where conventional therapy does not provide satisfactory results, acupuncture has demonstrated effective reduction of pain in the treatment of oromyofaciais disorders, headaches and neck pain. In this context three chapters were included in this study. In the first chapter it was conducted a review of the literature for the systematic compilation of acupuncture points located in the human body areas that could be punctured on the dental chair during the clinical care of patients. It was found 142 acupoints directly related to the main diseases linked to the practice of dentistry, and ear points most frequently used in this context. In the second chapter, were presented clinical observations about efficacy of acupuncture use and auriculotherapy as a treatment applied to dentistry. In this second review of the literature, 09 types of involvement bucomaxilofacial treated with the therapies cited above were systematically organized according to: the type of disease, acupunctural treatment employed and outcomes. In the third chapter, we present a study on the clinical use of acupuncture and auriculopressure in the treatment of adult patients with chronic neck pain attended in a public primary health care service located in southern Spain. A significant reduction was found in the pain intensity, analgesic consumption, disability and sleep disorders caused by pain (p<0.0001). (AU)

Evaluation of a single accelerometer based biofeedback system for real-time correction of neck posture in computer users.

The worldwide adoption of computers is closely linked to increased prevalence in neck and shoulder pain. Many ergonomic interventions are available; however, the lifetime prevalence of neck pain is still estimated as high as 80%. This paper introduces a biofeedback system using a novel single accelerometer placement. This system allows the user to react and correct for movement into a position of bad posture. The addition of visual information provides artificial proprioceptive information on the cranial-vertebral angle. Six subjects were tested for 5 hours with and without biofeedback. All subjects had a significant decrease in the percentage of time spent in bad posture when using biofeedback.

Characterization of health status and modifiable risk behavior among United States adults using chiropractic care as compared with general medical care.

OBJECTIVE: The causes of death in the United States have moved from infectious to chronic diseases with modifiable behavioral risk factors. Simultaneously, there has been a paradigm shift in health care provisions with increased emphases on prevention and health promotion. Use of professional complementary and alternative medicine, such as chiropractic care, has increased. The purpose of this study was to characterize typical conditions, modifiable risk behaviors, and perceived changes in overall general health of patients seeing chiropractors as compared with general medical doctors in the United States. METHODS: Secondary analyses of the National Health Interview Survey 2005 adult sample (n = 31,248) were performed. Multiple logistic regression models were applied to assess associations of health conditions/risk behaviors of patients with the doctors (chiropractors vs medical doctors) they saw within the past 12 months. RESULTS: Respondents who saw/talked to chiropractors were 9.3%. Among these, 21.4% did not see a medical doctor. Comparing chiropractor-only with medical doctor-only patients, we found no significant difference in smoking/alcohol consumption status, but chiropractor-only patients were more likely to be physically active (odds ratio [OR], 1.5; 95% confidence interval [CI], 1.2-1.8) and less likely to be obese (OR, 0.7; 95% CI, 0.6-0.9). Respondents reporting acute neck (OR, 2.7; 95% CI, 2.2-3.2) and low back pain (OR, 2.4; 95% CI, 2.0-2.8) were more likely to have seen a chiropractor. CONCLUSIONS: Based on these analyses, Americans seem to be using chiropractic care for acute neck and low back pain more so than for other health conditions. However, there is no marked difference in their overall health promotion habits and changes in overall general health based on health care provider types.

Electrical acustimulation of the wrist for chronic neck pain: a randomized, sham-controlled trial using a wrist-ankle acustimulation device.

OBJECTIVES: Chronic neck pain is a common problem and is treated using a variety of conservative treatments. This single-blind, randomized, sham-controlled trial investigated the value of adding electrical stimulation of acupuncture points on the wrist to a standardized program of neck exercises for chronic neck pain. METHODS: At initial recruitment 60 patients were randomly assigned to receive either active or sham electrical stimulation of acupuncture points on the wrist in addition to standardized neck exercise. Active or sham wrist acustimulation was given for 30 minutes 2 times/wk over a period of 4 weeks. A 30 minutes program of standardized neck exercises was also performed simultaneously. RESULTS: Forty-nine patients completed the study (22 active, 27 sham). Statistically significant improvements were found for acustimulation when compared with sham at immediate posttreatment and 1-month posttreatment for Numerical Rating Scale, Northwick Park Neck Pain Questionnaire and Pain Self-Efficacy Questionnaire. In active and sham electrical stimulation group 38.9% and 8.3% of patients reported a reduction of Numerical Rating Scale > 50% at 1-month posttreatment follow-up, respectively. All patients tolerated acustimulation and no adverse effects were reported. DISCUSSION: Electrical acustimulation of the wrist administered as two, 30 minutes sessions /wk added value to standardized neck exercise for chronic neck pain. A 4-week course of treatment produced effects lasting 1-month posttreatment.

The ability of the Acute Low Back Pain Screening Questionnaire to predict sick leave in patients with acute neck pain.

OBJECTIVE: The aim of this study was to investigate the use of the Acute Low Back Pain Screening Questionnaire (ALBPSQ) in patients with acute neck pain in general practice. The ALBPSQ is a biopsychosocial screening questionnaire containing 20 items concerning mainly psychosocial variables. Although originally developed for patients with low back pain, it may also be applicable for patients with neck pain. We evaluated its reliability and determined an optimal cutoff point for predicting future sick leave. METHODS: A prospective study was conducted on consecutive patients with acute neck pain in general practice with a follow-up period of 1 year. Reliability was determined by means of a test-retest procedure with a 1-week interval. The total number of days on sick leave was added up based on self-reported questionnaires. RESULTS: One hundred eighty-seven patients were included in the study, of which 180 patients were included in the analysis. Almost half of the patients were better or much improved within the first week. Test-retest reliability was high (intraclass correlation coefficient, 0.85; 95% confidence interval, 0.73-0.92). Almost 40% of the patients reported sick leave because of neck pain during the follow-up period. An optimal cutoff score of 72 was calculated for predicting future sick leave, with a sensitivity of 77% and a specificity of 62%. The area under the curve of the receiver operator characteristics curve was regarded doubtful (0.66; 95% confidence interval, 0.56-0.76). CONCLUSION: The ALBPSQ has shown to be a reliable instrument and potentially useful in a screening procedure for future sick leave in patients with acute neck pain in general practice.