Changes in Multiple Aspects of Pain Outcomes After Rehabilitation: Analysis of Pain Data in a Randomized Controlled Trial Evaluating the Effects of Adding Sensorimotor Training to Manual Therapy and Exercise for Chronic Neck Pain.

OBJECTIVES: To examine changes in pain outcomes to fully evaluate the effect of adding sensorimotor training to manual therapy and exercise in patients with chronic neck pain and sensorimotor deficits. Concordance was examined between pain distribution and pain intensity and patient-reported outcomes. METHODS: Participants (n=152) were randomly allocated into 4 intervention groups: One group received local neck treatment (NT) comprising manual therapy and exercise and the other 3 groups received additional sensorimotor training (either joint position sense/oculomotor exercises, balance exercises or both). Treatment was delivered twice a week for 6 weeks. Pain and patient-reported outcomes were measured at baseline, posttreatment, and 3-, 6- and 12-month follow-ups. RESULTS: There were greater changes in pain location, extent, and intensity at 6- and 12-month follow-ups in the sensorimotor training groups compared with the NT group ( P <0.05). A greater number of patients in the sensorimotor training groups gained ≥50% reduction in pain extent and intensity relative to the NT group at 6 and 12 months ( P <0.05). Clinical improvement in pain extent was concordant with pain intensity (adjusted kappa=056 to 0.66, %agreement=78.3 to 82.9, P <0.001) and disability (adjusted kappa=0.47 to 0.58, % agreement=73.7 to 79.0, P <0.01) at 3-, 6- and 12-month follow-ups, but not with function and well-being. The concordance tended to decline with time. DISCUSSION: Multiple aspects of the pain experience improved in the longer term by adding sensorimotor training to NT for patients with neck pain and sensorimotor deficits. The concordance between pain and patient-reported outcomes was not always evident and varied over time, suggesting the need for multidimensional assessments of pain.

Stimulated cervical afferent input increases postural instability in older people with chronic neck pain: a cross-sectional study.

BACKGROUND: Several potential causes can impair balance in older people. The neck torsion maneuver may be useful in demonstrating impaired balance caused by the stimulation of cervical proprioceptive input. Whereas evidence suggests impaired standing balance in older people with chronic neck pain, balance impairment during the neck torsion position and its relationship with clinical characteristics have not yet been investigated in this population. The aims of this study were to investigate whether the neck torsion position could significantly influence balance responses in older people with chronic non-specific neck pain and to determine the relationships between the balance responses and characteristics of neck pain. METHODS: Sixty-eight older people (34 with chronic non-specific neck pain and 34 controls) participated in the study. Balance was tested using a force plate during comfortable stance with eyes open under four conditions: neutral head on a firm surface, neutral head on a soft surface, neck torsion to left and right on a firm surface and neck torsion to left and right on a soft surface. Balance outcomes were anterior-posterior (AP) and medial-lateral (ML) displacements, sway area and velocity. Characteristics of neck pain were intensity, duration and disability. RESULTS: Overall, the neck pain group exhibited greater AP and ML displacements, sway area and velocity in the neck torsion position on firm and soft surfaces compared to controls (partial eta squared (η²p) = 0.06-0.15, p < 0.05). The neck pain group also had greater AP displacement, sway area and velocity in the neutral position on a soft surface compared to controls (η²p = 0.09-0.16, p < 0.05). For both groups, the neck torsion position displayed overall greater postural sway compared to the neutral position (η²p = 0.16-0.69, p < 0.05). There were no relationships between the postural sway outcomes and characteristics of neck pain (p > 0.05). CONCLUSION: The neck torsion maneuver, stimulating the receptors resulted in increased postural sway in older people, with a more pronounced effect in those with neck pain. The study provides evidence supporting the use of neck torsion for assessing impaired balance related to abnormal cervical input in older people with chronic non-specific neck pain.

Effects of slouched sitting posture on clavicular and scapular orientations and movements in individuals with neck pain with scapular dysfunction.

BACKGROUND: It has been suggested that sitting posture affects clavicular, scapular and spinal kinematics, however its effects in people with neck pain and scapular dysfunction remain unknown. The study aimed to determine the clavicular and scapular kinematics in different sitting postures in patients with neck pain and scapular dysfunction. METHODS: Thirty-four participants with neck pain and scapular dysfunction were recruited into the study. Kinematics of the clavicle and scapula were recorded using motion analysis at rest and during arm elevation (at 30, 60, 90, and 120 degrees) in a slouched and upright sitting posture. RESULTS: Compared to the upright sitting posture, the slouched sitting posture had increased clavicular protraction and elevation as well as scapular internal rotation and anterior tilt at rest and during the arm raising and lowering phases (at 30, 60, 90, and 120 degrees) (p < 0.05). The slouched sitting also had increased scapular upward rotation in the lowering phase at all angles (p < 0.05). SIGNIFICANCE: The slouched sitting posture has a significant influence on clavicular and scapular kinematics. Awareness of good sitting posture should be encouraged in patients with neck pain and scapular dysfunction.

Active behavioural physiotherapy intervention for acute non-specific neck pain: a cluster randomised double-blind pilot and feasibility clinical trial.

PURPOSE: To evaluate the feasibility of an active behavioural physiotherapy intervention (ABPI) and procedures to prevent the transition to chronicity in patients with acute non-specific neck pain (ANSNP). MATERIALS AND METHODS: A cluster-randomised double-blind (assessors and participants), parallel 2-arm (ABPI versus standard physiotherapy intervention [SPI]) pilot and feasibility clinical trial was conducted owing to a pre-specified published protocol. Six public hospitals were recruited and cluster-randomised (computer-generated randomisation with block sampling). Sixty participants (30 in each arm, 10 per hospital) were assessed at baseline and 3 months following baseline for neck disability index, numerical pain rating scale, cervical range-of-motion, fear-avoidance beliefs questionnaire and EuroQol 5-dimension 5-level. RESULTS: All procedures worked well. The participants' median age was 36.5 (range 21-59, interquartile range: 20.75) years. Participants in the ABPI demonstrated better improvement in all outcomes compared to SPI. Furthermore, the number of fully recovered participants following ABPI (27/30, 90.00%) was higher than SPI (16/30, 53.33%) with fewer treatment sessions and lower costs of management. CONCLUSIONS: The findings suggest that the ABPI is feasible and valuable (e.g. a high number of fully recovered participants, fewer treatment sessions and reduced management costs compared to the SPI) in conducting a future definitive trial to evaluate the effectiveness of the ANSNP management. TRIAL REGISTRATION: TCTR20180607001Implications for RehabilitationAn active behavioural physiotherapy intervention (ABPI) is feasible to manage acute non-specific neck pain.The ABPI demonstrated a high number of fully recovered participants, fewer treatment sessions and reduced management costs compared to the standard physiotherapy intervention.The ABPI is valuable to conduct a future definitive trial to evaluate the effectiveness of acute non-specific neck pain management.

Reliability of changes in neck pain and cervical rotation range following manual scapular repositioning.

BACKGROUND: Manual scapular repositioning may result in change in neck pain and cervical rotation range. However, the reliability of such changes performed by examiners remains unknown. OBJECTIVE: To evaluate the reliability of changes in neck pain and cervical rotation range following manual scapular repositioning performed by two examiners and the agreement between these measures and patients' perceptions of change. DESIGN: Cross-sectional study. METHODS: Sixty-nine participants with neck pain and altered scapular position were recruited. Two physiotherapists performed the manual scapular repositioning. Neck pain intensity was measured using a 0-10 numerical scale and cervical rotation range with a cervical range of motion (CROM) device at baseline and in the modified scapular position. Participants' perceptions of any change were rated on a five-item Likert scale. Clinically relevant changes in pain (>2/10) and range (≥7°) were defined as "improved" or "no change" for each measure. RESULTS: ICCs for changes in pain and range between examiners were 0.92 and 0.91. For clinically relevant changes, percent agreement and kappa values between examiners were 82.6%, 0.64 for pain and 84.1%, 0.64 for range. Percent agreement and kappa values between participants' perceptions and measured changes were 76.1%, 0.51 for pain and 77.5%, 0.52 for range. CONCLUSION: Changes in neck pain and rotation range following manual scapular repositioning demonstrated good reliability between examiners. There was moderate agreement between the measured changes and patients' perceptions.

A cluster analysis of cervicocephalic kinesthetic sensibility in persons with nonspecific neck pain.

INTRODUCTION: Inter-individual variability may contribute to impaired cervicocephalic kinesthetic sensibility (CKS) in patients with nonspecific neck pain. OBJECTIVES: To identify subgroups of participants with nonspecific neck pain based on cervical joint position errors (JPEs) and to determine potential factors associated with identified subgroups. METHODS: One hundred participants with nonspecific neck pain (unidentified pathoanatomical cause) and 50 controls were recruited. JPEs were measured in cervical extension and rotation, using a laser pointer. JPEs were expressed as absolute (AEs), constant (CEs), and variable (VEs) errors. Clinical characteristics were pain intensity, duration, disability, side of pain, dizziness, psychological features, and range of motion. All tests were performed within 1 day. A cluster analysis was conducted based on AEs. A logistic regression was used to identify factors associated with the cluster groups. RESULTS: Analysis divided neck pain participants into two groups: cluster 1 with greater impaired CKS (n = 36) and cluster 2 with lesser impaired CKS (n = 64). The AEs (all cervical movements) and CE (left rotation) were larger in cluster 1 than 2 (p ≤ .002). Overall, participants in clusters 1 and 2 had larger AEs, CEs, and VEs than controls (p ≤ .04). The presence of dizziness was a risk factor associated with cluster 1 (OR=2.5, p = .04). The other characteristics were not associated with the cluster groups (p ≥ .09). CONCLUSION: The AEs identified two subgroups of patients with nonspecific neck pain. Participants in subgroup 1 had greater impaired CKS, and participants in subgroup 2 had lesser impaired CKS. Dizziness was a potential risk factor associated with greater impaired CKS.

Axioscapular and neck extensor muscle behavior during isometric shoulder exertions in patients with nonspecific neck pain with and without a scapular downward rotation posture.

BACKGROUND: A common observation in persons with neck pain is scapular downward rotation (SDR) with altered muscle behavior. Evidence of changes in axioscapular muscles in neck pain patients remains inconclusive, which may reflect population heterogeneity in previous studies. RESEARCH QUESTION: Are there differences in behavior of the axioscapular (upper trapezius: UT, lower trapezius: LT and serratus anterior: SA) and neck extensor (NE) muscles during isometric shoulder tasks in patients with neck pain with SDR, patients with no scapular dysfunction and healthy controls? METHODS: Sixty participants with nonspecific neck pain (30 with SDR and 30 without scapular dysfunction) and 30 controls were recruited. Electromyographic signals were recorded unilaterally from the UT, LT, SA and NE during different isometric shoulder tasks (30° flexion, 30°abduction and 30°external rotation) at 20%, 50% and 100% maximal voluntary contraction (MVC). Activity of UT, LT, SA and NE was normalized with respect to reference contractions. The UT/LT, UT/SA and LT/SA ratios were calculated for each task. RESULTS: The neck pain group with SDR had increased UT activity in 30°flexion (20%MVC) and 30°abduction (20% and 50%MVC) compared to the neck pain and control groups without scapular dysfunction (p < 0.05). There were no between group differences in LT and SA activity (p > 0.05). The neck pain groups had greater NE activity in all tasks (p < 0.001). Finally, the neck pain group with SDR had higher UT/LT and UT/SA ratios in a few tasks at low force levels (p ≤ 0.01). SIGNIFICANCE: Greater UT activity and UT/LT and UT/SA ratios during particularly low force isometric shoulder tasks suggest that SDR is associated with altered axioscapular motor control. Greater NE activity in both neck pain groups suggests altered motor control related to neck pain. Changes in the NE and UT behavior should be considered in management of patients with neck pain with observable SDR.

Live and video observations of scapular dyskinesis in individuals with nonspecific neck pain: A reliability study.

BACKGROUND: Scapular dyskinesis (SD) has been demonstrated in neck pain patients, however reliability of SD test in this population is still lacking. OBJECTIVE: To investigate inter-rater and intra-rater (live versus video) reliability of SD by observation in neck pain patients. METHODS: Sixty-nine participants with nonspecific neck pain (31.7 ± 14.3 years) were recruited. SD was tested on the ipsilateral side of neck pain during unilateral and bilateral arm elevation. Two examiners categorized SD using two classification systems: simple (yes/no) and specific type (winging, dysrhythmia, mixed abnormality or normal). Video recordings were reviewed by one examiner. RESULTS: For inter-rater reliability, agreement and kappa (κ) values for unilateral test were 94.20%, 0.82 by simple classification and 72.46%, 0.59 by specific type. Agreement and κ values for bilateral test were 91.30%, 0.68 by simple classification and 65.22%, 0.52 by specific type. For intra-rater reliability, agreement and κ values for unilateral test were 92.75%, 0.77 by simple classification and 71.01%, 0.57 by specific type. Agreement and κ values for bilateral test were 91.30%, 0.65 by simple classification and 65.22%, 0.52 by specific type. CONCLUSION: Observation assessment demonstrated good-to-very good inter-rater and moderate-to-good intra-rater (live versus video) reliability for assessing SD in neck pain patients.

Effectiveness of adding rehabilitation of cervical related sensorimotor control to manual therapy and exercise for neck pain: A randomized controlled trial.

BACKGROUND: Local neck treatments and sensorimotor training can improve cervical proprioception and balance, but it remains unclear what treatments and treatment combination achieve the best outcomes. OBJECTIVES: To investigate the most effective interventions to improve disturbances in joint position sense (JPS) and balance and their effects on neck pain, dizziness and related features in the short- and long-terms. DESIGN: 2x2 factorial, randomized controlled trial. METHODS: Participants with neck pain (n = 152) were randomly allocated to one of four intervention groups: i) local neck treatment (NT), ii) NT + JPS/oculomotor exercises (JPS/OC), iii) NT + balance exercises, and iv) all treatments. Participants received 12 treatments over 6 weeks. Primary outcomes were postural sway and joint position error. Secondary outcomes included gait speed, dizziness, pain intensity and disability, cervical range of motion, functional ability, and quality of life. Outcome measures were taken at baseline, posttreatment and 3-, 6- and 12-month follow-ups. RESULTS: All four interventions resulted in short- and long-term improvements in primary and secondary outcomes with medium to large effect sizes, but JPS and balance in neck torsion improved most with the addition of a combined program of JPS/OC + balance exercises to NT while balance in neck neutral improved most with the addition of balance exercises. Adding sensorimotor training was also more effective in maintaining levels of improvement in neck pain and disability at 6- and 12-months. Effect sizes of additional treatment benefits were medium to large. CONCLUSIONS: Adding specific training of JPS/OC and balance to NT best addresses deficits in cervical proprioception and balance. CLINICAL TRIAL REGISTRATION NUMBER: xxxxx.

Pain-side related difference in cross-sectional area of the longus colli muscle and its relationship with standing balance in persons with non-specific neck pain.

BACKGROUND: Longus colli muscle has a significant role in postural control. A reduction of longus colli cross-sectional area (CSA) has been demonstrated in neck pain patients. However, pain-side related difference and its relationship with clinical features and standing balance remain unclear. OBJECTIVE: To investigate side-to-side difference in the longus colli CSA and to determine the relationships of the CSA with clinical characteristics and standing balance in neck pain patients. STUDY DESIGN: Cross-sectional study. MATERIALS AND METHODS: Fifty participants with chronic non-specific neck pain (20 unilateral and 30 bilateral) were recruited. CSA of the longus colli muscle was measured using ultrasound imaging. Balance was measured using a force platform during a narrow stance with eyes open, eyes closed, and neck torsion (left and right). Balance outcomes were sway area and displacement in anterior-posterior (AP) and medial-lateral (ML) directions. Clinical characteristics were neck pain intensity, disability, and duration. RESULTS: The longus colli CSA was reduced on the painful side in patients with unilateral neck pain (p < 0.01). There was a trend towards reduced CSA on the more painful side in those with bilateral neck pain (p = 0.08). The reduced CSA was mostly correlated with the greater AP sway displacement and sway area (r ranged from -0.27 to -0.54, p < 0.05). The longus colli CSA was not correlated with pain intensity, disability, and duration (p > 0.05). CONCLUSION: The longus colli CSA was reduced on the painful side of neck pain. The reduced CSA was correlated with impaired standing balance, but not with clinical characteristics of neck pain.

3D measurement of clavicular and scapular orientations: The association with clinical characteristics and responsiveness to scapular repositioning in patients with neck pain.

BACKGROUND: Clavicular and scapular orientations vary between neck pain patients as do clinical features and responses (changes in pain and rotation range) to scapular repositioning. Associations between these factors are unknown. OBJECTIVES: To identify subgroups of neck pain patients based on three-dimensional (3D) measures of clavicular and scapular orientations and differences between subgroups in clinical characteristics and responses to scapular repositioning. DESIGN: Cross-sectional study. METHODS: Eligible participants were recruited as part of a larger study. The 3D clavicular and scapular orientations were analyzed on the more painful side of the neck using a hierarchical cluster analysis. Clinical characteristics were neck pain location, intensity, duration, disability and presence of headache. Responses to scapular repositioning were classified as "yes and no". RESULTS: Fifty-eight participants (29 responsive; 29 non-responsive to scapular repositioning) participated in the study. Analysis identified two distinct subgroups: subgroup1 had greater clavicular retraction and scapular downward rotation (n = 26) and subgroup2 had greater clavicular elevation and scapular internal rotation and anterior tilt (n = 32). Headache and dominant pain in the upper neck were more frequent in subgroup 1 while dominant pain in the lower neck was frequent in subgroup 2 (p < 0.01). Most participants who responded positively to scapular repositioning (88.5%) were in subgroup1 and most non-responsive participants (81.2%) in subgroup2. CONCLUSIONS: The 3D clavicular and scapular orientations identified two subgroups of neck pain patients. Participants with predominantly downward scapular rotation were distinguished by pain in the upper neck, presence of headache and a positive response to scapular repositioning.

Clavicular and scapular, but not spinal kinematics vary with scapular dyskinesis type during arm elevation and lowering in persons with neck pain.

BACKGROUND: Scapular dyskinesis is often observed in patients with neck pain. However, it is unknown whether clavicular, scapular and spinal kinematics vary with different types of scapular dyskinesis during arm movement. RESEARCH QUESTION: Are there differences in clavicular, scapular and spinal kinematics during unilateral arm elevation and lowering among neck pain patients presenting with (i) scapular winging, (ii) with dysrhythmia, (iii) with no scapular abnormality and (iv) healthy controls? METHODS: Sixty participants with neck pain (20 in each group) and 20 asymptomatic controls were recruited. The 3D kinematic data were measured during unilateral arm elevation and lowering at 30°, 60°, 90°, and 120° in the scapular plane. A three-way mixed-effects ANOVA was used to determine the main effects (group, phase and angle) and the interactions between three independent variables on the kinematic data. RESULTS: The neck pain group with scapular winging had decreased clavicular retraction and increased scapular internal rotation and anterior tilt compared to the other neck pain and control groups at all angles during both phases of arm movement (p < 0.01). The neck pain group with scapular dysrhythmia had decreased scapular upward rotation compared to all other groups (p < 0.01). Some alterations in the kinematics existed during the lowering phase compared to the raising phase for all groups (p < 0.05). Spinal kinematics were similar across all groups (p > 0.05). SIGNIFICANCE: Specific patterns of clavicular and scapular kinematics were identified during arm movement relevant to the type of observed scapular dyskinesis in patients with neck pain. Such findings stand to inform more precise and relevant motor training in rehabilitation and improve understanding of the association between altered scapular kinematics and neck pain.

The effectiveness of home-based balance and pulmonary rehabilitation program in individuals with chronic obstructive pulmonary disease: a randomized controlled trial.

BACKGROUND: Balance impairment and increased fall risk have been demonstrated in individuals with chronic obstructive pulmonary disease (COPD). However, studies investigating the effects of balance training especially when combined with pulmonary rehabilitation (PR) program in home-based setting are scarce. AIM: To examine whether adding balance training to home-based pulmonary rehabilitation improves balance, fall risk, and disease-related symptoms in individuals with COPD. DESIGN: Randomized, controlled, assessor-blinded trial with parallel two-group design. SETTING: Home-based setting. POPULATION: Forty-eight individuals diagnosed with COPD. METHODS: Participants with COPD were randomly allocated to either a home-based PR or home-based balance training combined with PR (PR-BT) group (24 per group). Both groups exercised three days per week for eight-week. Primary outcomes were fall risk index and functional balance as measured by the Physiological Profile Assessment (PPA) and Timed Up and Go (TUG), respectively. Secondary outcomes were the Activities-specific Balance Confidence (ABC), Modified Medical Research Council dyspnea (mMRC), Six-Minute Walk Test (6MWT), and COPD assessment test (CAT). All outcome measures were assessed at baseline, post-intervention, and three-month follow-up. RESULTS: All participants completed the trial, with no reported adverse events. At post-intervention, the PR-BT group demonstrated significantly greater improvements in PPA fall risk score (PR-BT: 1.1±0.8, PR: 2.4±1.5), TUG (PR-BT: 10.7±1.3, PR: 14.4±4.4 s) and these improvements remained at three-month follow-up (all P<0.01). The ABC, mMRC, and CAT scores were also significant better for the PR-BT than the PR group both after intervention and at three-month follow-up (all P<0.05). CONCLUSIONS: Eight-week home-based balance and PR program is effective in improving balance as well as dyspnea, and well-being in individuals with COPD. CLINICAL REHABILITATION IMPACT: Home-based balance and PR program is a promising approach for COPD rehabilitation especially in patients who are at risk of falls.

Translation and Validation of the Dizziness Handicap Inventory into Thai Language.

OBJECTIVE: To translate and evaluate psychometric properties of Thai version of the Dizziness Handicap Inventory (DHI-TH). STUDY DESIGN: A cross-sectional study. SETTING: Ambulatory. PATIENTS: Fifty patients with dizziness at a vestibular clinic. MAIN OUTCOME MEASURES: Translation and cross-cultural adaptation of the original English version of the DHI was performed according to published guidelines. Psychometric evaluation included internal consistency, content validity, test-retest reliability, convergent validity, discriminant ability, and responsiveness. Responsiveness was examined in 28 patients with vestibular dysfunction who received vestibular rehabilitation for 6 to 8 weeks. RESULTS: There were no floor and ceiling effects. The Cronbach's alpha was good for the total score (0.87) and subscale scores (0.70 physical, 0.73 emotional, and 0.71 functional). Excellent test-retest reliability was demonstrated for the total and subscales (ICC ranged from 0.91 to 0.97, p < 0.001). The SEM was 3.50 and the MDC was 9.68. The total and subscales of DHI-TH were moderately correlated with the SF-36-TH scores (r ranged from -0.40 to -0.63). An optimal cut-off point for detection of dizziness was 21 points (98% sensitivity, 94% specificity). Responsiveness of the DHI-TH was excellent. The ES and SRM were large (1.25 and 1.59, respectively). The DHI-TH discriminated well between patients with self-perceived improved dizziness versus unchanged dizziness (AUC = 0.87). The MCID was 17 points (82.0% sensitivity, 82.0% specificity). CONCLUSION: The DHI-TH demonstrated good psychometric properties for patients with dizziness. The DHI-TH is a valid and reliable instrument recommended as a measure of disability and quality of life in Thai patients with dizziness.

Altered neuromuscular activity and postural stability during standing balance tasks in persons with non-specific neck pain.

OBJECTIVES: To compare neck, trunk, and lower extremity muscle activity in standing in persons with neck pain (NP) to healthy controls and determine associations with postural sway. METHODS: Participants included 25 persons with NP and 25 controls. Surface electromyography was recorded bilaterally from neck (sternocleidomastoid, SCM; splenius capitis, SC; upper trapezius, UT), trunk (erector spinae, ES), and lower extremity (rectus femoris, RF; biceps femoris, BF; tibialis anterior, TA; medial gastrocnemius, GN) muscles. Postural sway was measured using a force platform in narrow stance with eyes open/closed, on firm/soft surfaces. RESULTS: Compared to controls, the NP group demonstrated higher activity in all muscles, except UT and had higher amplitude ratios for neck muscles (SCM, SC) for all tasks (p < .05). No between-group difference was found in amplitude ratios for lower extremity muscles, except for GN. Lower extremity activity was moderately correlated with larger postural sway for both groups (r = 0.41-0.66, p < .05). There were no correlations between sway and neck and trunk muscle activity (p > .05). CONCLUSION: Increased muscle activity with NP is associated with increased postural sway. Both groups used similar postural control strategies, but the increased neck activity in the NP group is likely related to the NP disorder rather than postural instability.

Effects of tandem walk and cognitive and motor dual- tasks on gait speed in individuals with chronic idiopathic neck pain: a preliminary study.

Introduction: Gait impairment has been associated with neck pain. It is relevant to understand the possible influence of narrow-based walk and an attention-demanding secondary task on gait performance in neck pain.Purpose: To investigate the effects of tandem walk and cognitive and motor dual-tasks on gait speed in persons with chronic idiopathic neck pain (CINP) compared with controls.Methods: A cross-sectional study. Thirty participants with CINP and 30 asymptomatic controls participated in the study. Gait speed was assessed using a timed 10-m walk test at a comfortable pace under four conditions: (1) comfortable walk (as reference); (2) tandem walk (single task); (3) cognitive dual-task walking; and (4) motor dual-task walking. Dual-task interference was calculated.Results: There was no difference in comfortable gait speed between groups (p= 0.40). The CINP group had slower gait speed during the tandem walk than controls (p= 0.02). The dual-task interference on gait speed was not different between groups (p = 0.67 for cognitive, p = 0.93 for motor).Conclusion: Participants with CINP had impaired gait stability during tandem walk. An attention-demanding secondary task did not influence gait speed in individuals with CINP compared to controls. The study suggests that tandem walk could be considered as an assessment tool and part of rehabilitation for neck pain.

Slower reaction and response times and impaired hand-eye coordination in individuals with neck pain.

BACKGROUND: Neck pain is associated with sensorimotor dysfunction. Research is sparse of the effect of neck pain on reaction and response times and hand-eye coordination. OBJECTIVES: To investigate hand and foot reaction and response times and hand-eye coordination in individuals with neck pain and to determine any relationships with clinical features of neck pain. METHODS: Sixty individuals with neck pain and 60 controls of similar age and gender were recruited. Tests of simple reaction and response time were measured on the dominant hand and foot. Hand-eye coordination was measured by tracing a variety of coordination patterns with different levels of difficulty. Clinical features measured were intensity and duration of pain, and neck disability. RESULTS: Hand and foot reaction and response times were significantly slower in the neck pain group compared to controls (all p < 0.001). The neck pain group took longer to trace the hand-eye coordination task at the hardest level (p = 0.03). Neck disability scores correlated with hand reaction time (r = 0.4, p = 0.005) and time taken in hand-eye coordination tasks (r = 0.2 for all levels, p < 0.05). Reaction and response times were correlated with time taken in the hand-eye coordination test (r = 0.2-0.4, p < 0.01). CONCLUSIONS: Individuals with neck pain had slower hand and foot reaction and response times and impaired hand-eye coordination, suggesting deficits in sensorimotor function. Training speed, as a function of acuity, and hand-eye coordination might be considered in clinical assessment. Further research is needed to identify potential underlying mechanisms of the slower and less well coordinated movement.

Profiling the Extent and Location of Pain in Migraine and Cervicogenic Headache: A Cross-sectional Single-Site Observational Study.

OBJECTIVES: The primary aim was to quantify and compare the location and extent of pain in people with either episodic migraine, chronic migraine, or cervicogenic headache. A secondary aim was to examine the associations between pain extent and headache features, quality of life, and psychological distress for each headache type. DESIGN: A cross-sectional, single-site, observational study. SETTING: Headache outpatient clinic. SUBJECTS: From a sample of 390 patients, 114 patients with migraine or cervicogenic headache (48 episodic migraine, 30 chronic migraine, 36 cervicogenic headache) were eligible for the study. METHODS: Pain location and extent were determined using a novel approach for digital pain drawing acquisition and analysis. Headache features included intensity and history duration. Quality of life was measured using the SF-36 and psychological distress using the Hospital Anxiety and Depression Scale. RESULTS: Overall, pain was most frequently reported in the frontal and temporal regions in patients with either episodic or chronic migraine, whereas pain was most frequent in the suboccipital region in patients with cervicogenic headache. A larger pain extent was moderately correlated with higher headache intensity (rs = 0.53, P = 0.003) and poorer quality of life (rs ranged from -0.36 to -0.40, P < 0.05) in patients with chronic migraine, whereas pain extent was associated with longer headache duration in those with cervicogenic headache (rs = 0.35, P = 0.04). No correlation was found between pain extent and psychological features for any headache type (P > 0.05). CONCLUSIONS: Despite some differences, there was a large symptomatic overlap between headache types, highlighting the limitations of using pain location in the differential diagnosis of headache.

Balance Impairment and Effectiveness of Exercise Intervention in Chronic Obstructive Pulmonary Disease-A Systematic Review.

OBJECTIVE: To systematically review the evidence for balance impairment and effectiveness of interventions on balance in people with chronic obstructive pulmonary disease (COPD). DATA SOURCES: Four electronic databases (Scopus, CINAHL, PubMed, Cochrane Library databases) were searched from inception until June 30, 2019. STUDY SELECTION: Two reviewers independently searched with keywords focusing on COPD, postural control, and exercise. Cross-sectional studies related to balance and randomized controlled trials (RCTs) related to the effectiveness of exercise intervention on balance outcomes were included. DATA EXTRACTION: Two reviewers independently extracted data of balance impairment on participants, exercise training on balance outcome measures. Methodological quality of cross-sectional studies was assessed using the National Institutes of Health (NIH) Quality Assessment Tool. Methodological quality of RCTs was assessed using the Physiotherapy Evidence Database (PEDro) scale and bias was analyzed using the Cochrane risk of bias. DATA SYNTHESIS: A narrative review with descriptive synthesis was used. Fifteen cross-sectional studies and 4 RCTs met the final inclusion criteria. The quality of 10 cross-sectional studies were rated as moderate to high (NIH score≥7). Most studies demonstrated impaired balance in people with COPD than in people without COPD. The quality of all included RCTs was good to excellent (PEDro score=6-9). One RCT had a low risk of bias. Generally, pulmonary rehabilitation program combined with balance training, Tai Chi, and cycling exercise showed significant improvement in balance in people with COPD. CONCLUSIONS: Impaired balance is evident in people with COPD. Available RCTs suggest that exercise interventions may improve balance performance in COPD patients. However, more research on the effect of exercise interventions on balance in COPD patients is still required.

High-intensity interval training combined with resistance training improved apnea-hypopnea index but did not modify oxygen desaturation index and oxygen saturation nadir in obese children with obstructive sleep apnea.

PURPOSE: To investigate the effect of high-intensity interval training (HIIT) combined with resistance training (RT) on sleep indices and vascular functions in obese children with obstructive sleep apnea (OSA). METHODS: A quasi-experimental study. Forty-four obese children with OSA were allocated into either an exercise intervention (n = 22) or a usual care control group (n = 22). The exercise group received 24 min of HIIT (> 60% heart rate reserved) and 20 min of RT (50-80% one-repetition maximum), three times per week for 8 weeks. Primary outcomes included the apnea-hypopnea index (AHI), oxygen desaturation index (ODI), and oxygen saturation (SaO2) nadir. Secondary outcomes included the Sleep-Related Breathing Disorder-Pediatric Sleep Questionnaire (SRBD-PSQ) scores, vascular functions (flow-mediated dilation and mean blood flow velocity), and anthropometric variables. Outcomes were measured at baseline, at week 8, and at week 16. RESULTS: No baseline differences were observed between groups. The compliance rate of exercise training was 99.47%. The AHI significantly decreased in the exercise group compared with the control group at week 16 (median AHI 1.30 to 0.60 and 1.00 to 1.60 episode/h, p = 0.01), but not at week 8. There were no differences between the groups in regard to the ODI and SaO2 nadir and any secondary outcomes at weeks 8 and 16 (all p > 0.05). CONCLUSIONS: The eight-week HIIT combined with RT decreased AHI in obese children with OSA at week 16 follow-up. No changes in the ODI, SaO2 nadir, SRBD-PSQ, vascular function, and anthropometric outcomes were revealed at any time point. Further research is warranted.