Measurement properties of a computer adaptive device, the Senscoordination 3D Cervical Trainer, to assess cervical range of motion in people with neck pain.

INTRODUCTION: Clinicians commonly assess cervical range of motion (ROM) in patients with neck pain. Recently, a new instrument has been developed, the Senscoordination 3D Cervical Trainer (SCT), designed to measure neck ROM in addition to joint position error, static and dynamic balance performance, and performance on a 'neuro muscular control test'. This study aims to assess the interrater reliability, concurrent validity, and responsiveness of the SCT using the CROM device as a comparator. METHODS: One hundred patients with non-specific neck pain were included and their active cervical ROM was measured in a random order by two raters in succession using both devices simultaneously at baseline and after personalised physiotherapy management, at 12 week follow up. Convergent validity and responsiveness were quantified by a Pearson correlation coefficient. The intraclass correlation coefficient (ICC) was used to calculate the test-retest reliability of the SCT. The smallest detectable change (SDC) was calculated per movement direction and for the total range of motion. RESULTS: The correlation between the measures obtained with the CROM device and the SCT was high (0.97 or 0.98 depending on direction of movement). Interrater reliability was high for all directions (ICC ranging from 0.81 to 0.97). The SDC ranged from 6.9 for left cervical rotation to 12.2 for right cervical rotation. At the follow up, correlation between the change score on the CROM device and the SCT was high (0.86-0.94 depending on the direction of movement). CONCLUSION: The SCT is a valid, reliable and responsive instrument for measuring cervical ROM.

A study protocol for the validation of a prognostic model with an emphasis on modifiable factors to predict chronic pain after a new episode of acute- or subacute nonspecific idiopathic, non-traumatic neck pain presenting in primary care.

BACKGROUND: The primary objective of this study is to identify which modifiable and non-modifiable factors are independent predictors of the development of chronic pain in patients with acute- or subacute nonspecific idiopathic, non-traumatic neck pain, and secondly, to combine these to develop and internally validate a prognostic prediction model. METHODS: A prospective cohort study will be conducted by physiotherapists in 30 primary physiotherapy practices between January 26, 2020, and August 31, 2022, with a 6-month follow-up until March 17, 2023. Patients who consult a physiotherapist with a new episode of acute- (0 to 3 weeks) or subacute neck pain (4 to 12 weeks) will complete a baseline questionnaire. After their first appointment, candidate prognostic variables will be collected from participants regarding their neck pain symptoms, prior conditions, work-related factors, general factors, psychological and behavioral factors. Follow-up assessments will be conducted at six weeks, three months, and six months after the initial assessment. The primary outcome measure is the Numeric Pain Rating Scale (NPRS) to examine the presence of chronic pain. If the pain is present at six weeks, three months, and six months with a score of NPRS ≥3, it is classified as chronic pain. An initial exploratory analysis will use univariate logistic regression to assess the relationship between candidate prognostic factors at baseline and outcome. Multiple logistic regression analyses will be conducted. The discriminative ability of the prognostic model will be determined based on the Area Under the receiver operating characteristic Curve (AUC), calibration will be assessed using a calibration plot and formally tested using the Hosmer and Lemeshow goodness-of-fit test, and model fit will be quantified as Nagelkerke's R2. Internal validation will be performed using bootstrapping-resampling to yield a measure of overfitting and the optimism-corrected AUC. DISCUSSION: The results of this study will improve the understanding of prognostic and potential protective factors, which will help clinicians guide their clinical decision making, develop an individualized treatment approach, and predict chronic neck pain more accurately.

Reliability of Using a Smartphone Application to Objectify Skull Deformation.

PURPOSE: To establish intrarater and interrater reliability of photographs made in a newly developed smartphone app to determine the severity of infantile skull deformation by taking a cranial photograph of an infant's head. METHODS: Using the app, 1 pediatric physical therapist and 2 pediatric physical therapy master students photographed heads of 30 infants aged up to 12 months receiving treatment for asymmetric or delayed motor development. Modified Cranial Vault Asymmetry Index and Cranial Index determined the severity of skull deformation. RESULTS: Intrarater reliability was excellent both for mCVAI and CI, with an ICC(3,1) = 0.97, and ICC(3,1) = 0.98, respectively. Interrater reliability with an ICC(2,1) = 0.97 for the mCVAI, and ICC(2,1) = 0.99 for the CI was excellent too. CONCLUSION: The reliability of the Skully Care App proved to be excellent when used by pediatric physical therapists.Supplemental Digital Content 1. Video Abstract available at: http://links.lww.com/PPT/A399 .

Consensus of potential modifiable prognostic factors for persistent pain after a first episode of nonspecific idiopathic, non-traumatic neck pain: results of nominal group and Delphi technique approach.

BACKGROUND: Identify and establish consensus regarding potential prognostic factors for the development of chronic pain after a first episode of idiopathic, non-traumatic neck pain. DESIGN: This study used two consensus group methods: a modified Nominal Group (m-NGT) and a Delphi Technique. METHODS: The goal of the m-NGT was to obtain and categorize a list of potential modifiable prognostic factors. These factors were presented to a multidisciplinary panel in a two-round Delphi survey, which was conducted between November 2018 and January 2020. The participants were asked whether factors identified are of prognostic value, whether these factors are modifiable, and how to measure these factors in clinical practice. Consensus was a priori defined as 70% agreement among participants. RESULTS: Eighty-four factors were identified and grouped into seven categories during the expert meeting using the modified NGT. A workgroup reduced the list to 47 factors and grouped them into 12 categories. Of these factors, 26 were found to be potentially prognostic for chronification of neck pain (> 70% agreement). Twenty-one out of these 26 factors were found to be potentially modifiable by physiotherapists based on a two-round Delphi survey. CONCLUSION: Based on an expert meeting (m-NGT) and a two-round Delphi survey, our study documents consensus (> 70%) on 26 prognostic factors. Twenty-one out of these 26 factors were found to be modifiable, and most factors were psychological in nature.

Does the patient and clinician perception of restricted range of cervical movement agree with the objective quantification of movement in people with neck pain? And do clinicians agree in their interpretation?

BACKGROUND: Measurement of cervical range of motion (ROM) is recommended when physically examining people with neck pain. However, little is known about the clinician's perception of "normal" versus restricted movement. Additionally, it is unknown if an objective measure of restricted movement correlates with the patient's perception of movement restriction. METHODS: One hundred patients with neck pain were asked to rate their total amount of restriction, using a movement restriction scale. Two physical therapists (PTs) measured cervical ROM using a CROM device. Assessors independently rated whether the patient was restricted in their cervical ROM for each movement direction ("yes" or "no"). Cohen's kappa was used to assess reliability between both assessor's interpretation for all movement directions. Correlations between the perception of 'normal' versus 'restricted' movement according to both the assessor and patient was compared with an objective classification of movement restriction using normative data. RESULTS: The agreement between PTs was high, ranging from substantial (K: 0.74) to almost perfect (K: 0.94). The correlation between the self-reported restriction scale and objective restriction was 0.44, indicating moderate correlation. The correlation between the PT's interpretation and objective restriction ranged from 0.55 to 0.66 depending on the direction of movement. CONCLUSION: A large proportion (85%) of the patients with neck pain exhibited restricted cervical ROM, relative to normative data. The agreement between PTs was high in judging whether a patient had restricted cervical ROM. However, the judgement of both the patient and the PT was not always in accordance with the objective measure of movement.

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.

Completeness of the description of manipulation and mobilisation techniques in randomized controlled trials in neck pain; A review using the TiDieR checklist.

STUDY DESIGN: A secondary analysis of a systematic review. BACKGROUND: Manipulations or mobilizations are commonly used interventions in patients with mechanical neck pain. The treatment effects have often been studied in randomized controlled trials (RCT) which are generally considered the gold standard in evaluating the treatment effects, mainly due to its high internal validity. External validity is defined as the extent to which the effects can be generalised to clinical practice. An important prerequisite for this is that interventions used in clinical trials can be replicated in clinical practice. It can be questioned if interventions utilized in randomized controlled trials can be translated into clinical practice. OBJECTIVES: The overall aim of this study is to examine whether the quality of the description of manipulation and mobilization interventions is sufficient for to replication of these interventions in clinical practice. METHODS: A comprehensive literature search was performed. Two independent researchers used the Template for Intervention Description and Replication (TIDieR) which is a 12-item checklist for describing the completeness of the interventions. RESULTS: Sixty-seven articles were included that used manipulation and/or mobilization interventions for patients with mechanical neck pain. None of the articles describe the intervention e.g. all the items on the TIDieR list. Considering item 8 (a-f) of the TIDieR checklist only one article described the used techniques completely. CONCLUSION: Manipulation or a mobilization interventions are poorly reported in RCTs, which jeopardize the external validity of RCTs, making it difficult for clinicians and researchers to replicate these interventions.

Prognostic factors for persistent pain after a first episode of nonspecific idiopathic, non-traumatic neck pain: A systematic review.

BACKGROUND: Prognosis of acute idiopathic neck pain is poor. An overview of modifiable and non-modifiable prognostic factors for the development of chronic musculoskeletal neck pain after an episode of idiopathic, non-traumatic neck pain is needed. OBJECTIVE: Identify prognostic factors for pain intensity and perceived non-recovery at three, six and 12 months after a first episode of idiopathic, non-traumatic neck pain. STUDY DESIGN: Systematic review METHODS: Systematic literature search up to October 21, 2017 for prospective prognostic studies with main outcomes perceived non-recovery and pain intensity. The QUIPS was used for quality assessment. RESULTS: Out of 2737 screened articles six prospective studies with high-risk-of-bias were identified, analyzing 47 and 43 factors for the outcome variables 'pain intensity' and 'perceived non-recovery', respectively. Based on univariate- and multivariate analyses we found moderate evidence for 'age> 40 years' and 'concomitant back pain' to be prognostic for 'pain intensity'. For the outcome 'perceived non-recovery' at 12 months, we found moderate evidence for both 'a previous period of neck pain' and 'accompanying headache' as prognostic variables for persistent pain, based on univariate analysis. No prognostic factor was found which was retained in more than one multivariate analysis for the outcome variable 'perceived non-recovery'. However, the quality of the evidence for these prognostic factors was low to very low. CONCLUSION: This review identifies prognostic factors for neck pain, of which only a few are modifiable. Further research is needed before drawing definite conclusions about the prognostic value of these factors.

Clinical reasoning in unimodal interventions in patients with non-specific neck pain in daily physiotherapy practice, a Delphi study.

BACKGROUND: Neck pain is the fourth major cause of disability worldwide but sufficient evidence regarding treatment is not available. This study is a first exploratory attempt to gain insight into and consensus on the clinical reasoning of experts in patients with non-specific neck pain. OBJECTIVE: First, we aimed to inventory expert opinions regarding the indication for physiotherapy when, other than neck pain, no positive signs and symptoms and no positive diagnostic tests are present. Secondly, we aimed to determine which measurement instruments are being used and when they are used to support and objectify the clinical reasoning process. Finally, we wanted to establish consensus among experts regarding the use of unimodal interventions in patients with non-specific neck pain, i.e. their sequential linear clinical reasoning. STUDY DESIGN: A Delphi study. METHODS: A Web-based Delphi study was conducted. Fifteen experts (teachers and researchers) participated. RESULTS: Pain alone was deemed not be an indication for physiotherapy treatment. PROMs are mainly used for evaluative purposes and physical tests for diagnostic and evaluative purposes. Eighteen different variants of sequential linear clinical reasoning were investigated within our Delphi study. Only 6 out of 18 variants of sequential linear clinical reasoning reached more than 50% consensus. CONCLUSION: Pain alone is not an indication for physiotherapy. Insight has been obtained into which measurement instruments are used and when they are used. Consensus about sequential linear lines of clinical reasoning was poor.

The Association of Illness Perception and Prognosis for Pain and Physical Function in Patients With Noncancer Musculoskeletal Pain: A Systematic Literature Review.

BACKGROUND: In the literature, illness perceptions have been reported to be important psychological factors associated with pain intensity and physical function in individuals with musculoskeletal pain. OBJECTIVE: To assess the relationship of illness perceptions with pain intensity and physical function in individuals with noncancer musculoskeletal pain. METHODS: In this systematic review, relevant literature databases, including PubMed, Embase, PsycINFO, CINAHL, and SPORTDiscus, were searched from inception through December 12, 2017. Two authors (E.D.R. and H.W.) independently performed the search procedures, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the A MeaSurement Tool to Assess systematic Reviews guidelines, and the risk-of-bias assessment, using the QUality In Prognosis Studies tool. A qualitative best-evidence synthesis was performed. RESULTS: A total of 26 articles were included in the review. There were 11 cross-sectional studies concerning associations of illness perceptions with pain intensity and 11 cross-sectional studies of associations of illness perceptions with physical function. For the prognosis of pain intensity by illness perceptions, the authors found 4 longitudinal studies, and for the prognosis of physical function by illness perceptions, the authors found 12 longitudinal studies. All studies except 1 had high risk of bias. Across 15 cross-sectional studies on 9 different musculoskeletal conditions, the researchers found limited to moderate evidence for a consistent direction of the relationship of illness perceptions with pain intensity and physical function. Higher maladaptive illness perceptions imply stronger pain intensity and more limitation in physical function. Evidence in longitudinal studies is lacking, especially on pain. CONCLUSION: There is limited to moderate evidence for the cross-sectional relationship between illness perceptions and various musculoskeletal conditions. The prognostic value, however, remains unclear. Future research is recommended to investigate the longitudinal relationship between illness perception domains and outcomes in greater detail. J Orthop Sports Phys Ther 2018;48(10):789-800. Epub 10 May 2018. doi:10.2519/jospt.2018.8072.

The clinical reasoning process in randomized clinical trials with patients with non-specific neck pain is incomplete: A systematic review.

OBJECTIVE: Primarily to evaluate the completeness of the description of the clinical reasoning process in RCTs with patients with non-specific neck pain with an argued or diagnosed cause i.e. an impairment or activity limitation. Secondly, to determine the association between the completeness of the clinical reasoning process and the degree of risk of bias. DATA SOURCES: Pubmed, Cinahl and PEDro were systematically searched from inception to July 2016. STUDY SELECTION: RCTs (n = 122) with patients with non-specific neck pain receiving physiotherapy treatment published in English were included. DATA EXTRACTION: Data extraction included study characteristics and important features of the clinical reasoning process based on the Hypothesis-Oriented Algorithm for Clinicians II (HOAC II)]. DATA SYNTHESIS: Thirty-seven studies (30%) had a complete clinical reasoning process of which 8 (6%) had a 'diagnosed cause' and 29 (24%) had an 'argued cause'. The Spearmans rho association between the extent of the clinical reasoning process and the risk of bias was -0.2. CONCLUSIONS: In the majority of studies (70%) the described clinical reasoning process was incomplete. A very small proportion (6%) had a 'diagnosed cause'. Therefore, a better methodological quality does not necessarily imply a better described clinical reasoning process.

Physical examination of the elbow, what is the evidence? A systematic literature review.

OBJECTIVE: Primary to provide an overview of diagnostic accuracy for clinical tests for common elbow (sport) injuries, secondary accompanied by reproducible instructions to perform these tests. DESIGN: A systematic literature review according to the PRISMA statement. DATA SOURCES: A comprehensive literature search was performed in MEDLINE via PubMed and EMBASE. ELIGIBILITY CRITERIA: We included studies reporting diagnostic accuracy and a description on the performance for elbow tests, targeting the following conditions: distal biceps rupture, triceps rupture, posteromedial impingement, medial collateral ligament (MCL) insufficiency, posterolateral rotatory instability (PLRI), lateral epicondylitis and medial epicondylitis. After identifying the articles, the methodological quality was assessed using the QUADAS-2 checklist. RESULTS: Our primary literature search yielded 1144 hits. After assessment 10 articles were included: six for distal biceps rupture, one for MCL insufficiency, two for PLRI and one for lateral epicondylitis. No articles were selected for triceps rupture, posteromedial impingement and medial epicondylitis. Quality assessment showed high or unclear risk of bias in nine studies. We described 24 test procedures of which 14 tests contained data on diagnostic accuracy. CONCLUSIONS: Numerous clinical tests for the elbow were described in literature, seldom accompanied with data on diagnostic accuracy. None of the described tests can provide adequate certainty to rule in or rule out a disease based on sufficient diagnostic accuracy.

Illness perceptions and activity limitations in osteoarthritis of the knee: a case report intervention study.

This case report describes the process and outcome of an intervention where illness perceptions (IPs) were targeted in order to reduce limitations in daily activities. The patient was a 45-year-old woman diagnosed with posttraumatic secondary osteoarthritis of the lateral patella-femoral cartilage of the right knee. At baseline, the patient reported maladaptive IPs on the Brief Illness Perception Questionnaire Dutch Language Version and limitations in walking stairs, cycling and walking. Fewer limitations in daily activities are hypothesized by changing maladaptive IPs into more favourable IPs. In this case report, discussing maladaptive IPs with the patient was the main intervention. A participatory decision making model was used as a design by which the maladaptive IP were discussed. Six out of eight maladaptive IPs changed favourably and there was a clinically relevant decrease in limitations of daily activities. The Global Perceived Effect was rated as much improved.

Cross-cultural adaptation and measurement properties of the Brief Illness Perception Questionnaire-Dutch Language Version.

OBJECTIVE: Ever since Engel's Biopsychosocial Model (1977) emotions, thoughts, beliefs and behaviors are accepted as important factors of health. The Brief Illness Perception Questionnaire (Brief IPQ) assesses these beliefs. Aim of this study was to cross-culturally adapt the Brief IPQ into the Brief IPQ Dutch Language Version (Brief IPQ-DLV), and to assess its face validity, content validity, reproducibility, and concurrent validity. METHODS: Beaton's guideline was used for cross-culturally adaptation. Face and content validity were assessed in 25 patients, 15 physiotherapists and 24 first-grade students. Reproducibility was established in 27 individuals with chronic obstructive pulmonary disease using Cohen's kappa coefficient (K(w)) and the Smallest Detectable Change (SDC). Concurrent validity was assessed in 163 patients visiting 11 different physical therapists. RESULTS: The Brief IPQ-DLV is well understood by patients, health care professionals and first-grade students. Reliability at 1 week for the dimensions Consequences, Concern and Emotional response K(w)>0.70, for the dimensions Personal control, Treatment control, Identity, K(w)<0.70. A time interval of 3 weeks, reliability coefficients were lower for almost all dimensions. SDC was between 2.45 and 3.37 points for individual measurement purposes and between 0.47 and 0.57 points for group evaluative measurement purposes. Concurrent validity showed significant correlations (P<.05) for four out of eight illness perceptions (IPs) dimensions. CONCLUSION: The face and content properties were found to be acceptable. The reproducibility and concurrent validity needs further investigated.

Outcome measures in physiotherapy management of patients with stroke: a survey into self-reported use, and barriers to and facilitators for use.

UNLABELLED: OBJECTIVE. To investigate physiotherapists' self-reported use of outcome measures as recommended in the Dutch Clinical Practice Guideline on Physiotherapy Management of Patients with Stroke (CPGPS) and to assess perceived barriers to and facilitators for the use of outcome measures in everyday practice. METHOD: A 41-item survey, including the barriers and facilitators questionnaire (BFQ), was sent by post to 400 physiotherapists in each of the following settings in the Netherlands: acute care hospitals (ACH; n = 100), rehabilitation centres (RC; n = 100), nursing homes (NH; n = 100) and private physiotherapy practices (PPP; n = 100). RESULTS: One hundred and eighty-nine physiotherapists returned the survey (47%; ACH, n = 57; RC, n = 67; NH, n = 26 and PPP, n = 39) and the surveys of 167 physiotherapists involved in stroke settings were analysed. These physiotherapists reported regularly using three (median; range 0-7) of the seven recommended outcome measures, with those working in RC or ACH reporting a significantly higher use than their colleagues in PPP (4 vs. 0 and 3 vs. 0; p < 0.001 and p = 0.02, respectively). The BFQ revealed that there were setting-specific facilitators, such as 'a positive attitude towards outcome measures' (as mentioned by 93% of the physiotherapists) and 'acquaintance with outcome measures' (90%), and barriers such as 'changing routines' (32%), 'time investment' (29%) and 'financial compensation' (21%). CONCLUSION: Despite an almost uniformly positive attitude, physiotherapists infrequently use the outcome measures recommended in the CPGPS. Robust setting-specific tailored implementation strategies based on the reported barriers and facilitators are needed.