Factors associated with neck pain in fighter aircrew: a systematic review and meta-analysis.

Neck pain is a common complaint among fighter aircrew, impacting workforce health and operational capability. This systematic review aimed to identify, evaluate and synthesise the current evidence for factors associated with the occurrence of neck pain among fighter aircrew. Six electronic databases were searched in June 2019 and updated in June 2020 utilising the maximum date ranges. Included studies were appraised for methodological quality, ranked according to level of evidence and relevant data extracted. Where methods were homogeneous and data availability allowed, meta-analyses were performed. A total of 20 studies (16 cross sectional, one case-control, one retrospective cohort and two prospective cohort) were eligible for inclusion. Of the 44 factors investigated, consistent evidence was reported for greater occurrence of neck pain among aircrew operating more advanced aircraft and those exposed to more desk/computer work, while another 12 factors reported consistent evidence for no association. Of the 20 factors where meta-analyses could be performed, greater occurrence of neck pain was indicated for aircrew: flying more advanced aircraft, undertaking warm-up stretching and not placing their head against the seat under greater +Gz. Despite many studies investigating factors associated with neck pain among fighter aircrew, methodological limitations limited the ability to identify those factors that are most important to future preventive programmes. High-quality prospective studies with consistent use of definitions are required before we can implement efficient and effective programmes to reduce the prevalence and impact of neck pain in fighter aircrew. PROSPERO registration number: CRD42019128952.Neck pain is a common complaint among fighter aircrew, impacting workforce health and operational capability. This systematic review aimed to identify, evaluate and synthesise the current evidence for factors associated with the occurrence of neck pain among fighter aircrew.

Improving screening for physical impairments and access to early physiotherapy after neck dissection surgery: a translational controlled trial.

PURPOSE: Lack of routine screening for a range of physical impairments that can result after neck dissection (ND) may hinder physiotherapy referral and treatment. The purpose of this study was to implement an intervention that targeted both physiotherapists and surgeons to increase their post-operative physical screening of ND patients and in turn improve physiotherapy referral rates. METHODS: The authors undertook a translational controlled pilot study, conducted over a 12-month period that utilised three tertiary hospital sites. The target groups were physiotherapists at one intervention site and surgeons at the other intervention site, with the third hospital acting as a control site and receiving usual care. The intervention included a physiotherapy brochure and a clinical pathway for screening, to promote early identification and prompt referral of patients with a physical impairment. The primary outcome variables were screening and referral rates between sites at the study end-point. RESULTS: Logistic regression analyses were conducted on n = 174 to assess differences in screening and referral rates between sites. Patients at the intervention site that targeted physiotherapists had four times the odds of being screened for shoulder dysfunction compared to the control site (p = 0.0002), and three times the odds of being referred to physiotherapy (0.0039). There were no statistically significant differences in the odds of patients being screened for shoulder dysfunction or referred to physiotherapy at the intervention site that targeted surgeons. CONCLUSION: The translational intervention undertaken by physiotherapists resulted in significantly greater screening and referral rates of post-operative ND patients for physiotherapy.

Maximizing shoulder function after accessory nerve injury and neck dissection surgery: A multicenter randomized controlled trial.

BACKGROUND: Shoulder pain and dysfunction after neck dissection may result from injury to the accessory nerve. The effect of early physical therapy in the form of intensive scapular strengthening exercises is unknown. METHODS: A total of 59 neck dissection participants were prospectively recruited for this study. Participants were randomly assigned to either the intervention group (n = 32), consisting of progressive scapular strengthening exercises for 12 weeks, or the control group (n = 29). Blinded assessment occurred at baseline, and at 3, 6, and 12 months. RESULTS: Three-month data were collected on 52 participants/53 shoulders. Per-protocol analysis demonstrated that the intervention group had statistically significantly higher active shoulder abduction at 3 months compared to the control group (+26.6°; 95% confidence interval [CI] 7.28-45.95; p = .007). CONCLUSION: The intervention is a favorable treatment for maximizing shoulder abduction in the short term. The effect of the intervention compared to usual care is uncertain in the longer term.

Scapular muscle exercises following neck dissection surgery for head and neck cancer: a comparative electromyographic study.

BACKGROUND: Shoulder pain and dysfunction can occur following neck dissection surgery for cancer. These conditions often are due to accessory nerve injury. Such an injury leads to trapezius muscle weakness, which, in turn, alters scapular biomechanics. OBJECTIVE: The aim of this study was to assess which strengthening exercises incur the highest dynamic activity of affected trapezius and accessory scapular muscles in patients with accessory nerve dysfunction compared with their unaffected side. DESIGN: A comparative design was utilized for this study. METHODS: The study was conducted in a physical therapy department. Ten participants who had undergone neck dissection surgery for cancer and whose operated side demonstrated clinical signs of accessory nerve injury were recruited. Surface electromyographic activity of the upper trapezius, middle trapezius, rhomboid major, and serratus anterior muscles on the affected side was compared dynamically with that of the unaffected side during 7 scapular strengthening exercises. RESULTS: Electromyographic activity of the upper and middle trapezius muscles of the affected side was lower than that of the unaffected side. The neck dissection side affected by surgery demonstrated higher levels of upper and middle trapezius muscle activity during exercises involving overhead movement. The rhomboid and serratus anterior muscles of the affected side demonstrated higher levels of activity compared with the unaffected side. LIMITATIONS: Exercises were repeated 3 times on one occasion. Muscle activation under conditions of increased exercise dosage should be inferred with caution. CONCLUSIONS: Overhead exercises are associated with higher levels of trapezius muscle activity in patients with accessory nerve injury following neck dissection surgery. However, pain and correct scapular form must be carefully monitored in this patient group during exercises. Rhomboid and serratus anterior accessory muscles may have a compensatory role, and this role should be considered during rehabilitation.

Impact of neck dissection on scapular muscle function: a case-controlled electromyographic study.

OBJECTIVE: To assess the dynamic activity of scapular muscles in patients with accessory nerve dysfunction after neck dissection surgery, compared with both their unaffected side and with age- and sex-matched controls. DESIGN: A case-control investigation. SETTING: Physiotherapy department of a hospital. PARTICIPANTS: Two groups of 10 participants were recruited. One group consisted of neck dissection patients with demonstrated clinical signs of accessory nerve injury. The second group was composed of matched healthy individuals. INTERVENTIONS: Surface electromyographic activity of the upper trapezius, middle trapezius, rhomboid major, and serratus anterior muscles was compared dynamically during scapular strengthening exercises. MAIN OUTCOME MEASURES: Electromyographic activity comparisons were made between the neck dissection affected side, the neck dissection unaffected side, and the matched healthy control side. Raw data and data expressed as a percentage of maximal voluntary isometric contraction were compared. RESULTS: The neck dissection affected side demonstrated significantly less upper trapezius and middle trapezius muscle activity compared with the neck dissection unaffected side and matched control group. The neck dissection unaffected side had significantly less upper trapezius muscle activity than the matched control group. CONCLUSIONS: Trapezius muscle activity is significantly reduced in accessory nerve shoulder dysfunction as a result of neck dissection, both in the affected and unaffected sides. This needs to be considered in the rehabilitation of this patient group.

Physiotherapy for accessory nerve shoulder dysfunction following neck dissection surgery: a literature review.

BACKGROUND: Neck dissection is an operation that can result in accessory nerve injury. Accessory nerve shoulder dysfunction (ANSD) describes the pain and impaired range of motion that may occur following neck dissection. The aim of this review was to establish the level of evidence for the effectiveness of physiotherapy in the postoperative management of ANSD. METHODS: A literature search of physiotherapy and ANSD using Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Physiotherapy Evidence Database (PEDro), and Cochrane Library databases was undertaken. RESULTS: Physiotherapy has been shown to be well tolerated in this patient group following surgery. However, few studies exist as to the effect of physiotherapy on ANSD. CONCLUSIONS: There is a need for research to investigate the effects of early, appropriate physiotherapy on the development of ANSD following neck dissection surgery. Such a study has the potential to improve the functional outcome and quality of life in this patient group, and ultimately to promote best practice guidelines for management.