Validation of the Cervical Torsion Test and Head Neck Differentiation Test in Patients with Peripheral Vestibular Hypofunction.

OBJECTIVE: This study compared adults with peripheral vestibular hypofunction (VH) to healthy controls and assessed the sensitivity and specificity of the Cervical Torsion Test (CTT) and the Head Neck Differentiation Test (HNDT). This study aimed to determine whether neck problems affected primary outcomes. METHODS: This cross-sectional study included adults from a specialist consultation for dizziness. VH had been diagnosed with the video Head Impulse Test. Exclusion criteria were conditions following head or neck trauma and diseases of the central nervous system. Sensitivity and specificity of the index tests were calculated, and regression analyses were performed to test for contributing factors. RESULTS: A total of 19 patients with VH and a historical cohort of 19 matched healthy controls were included. Most patients with VH (84.2%) experienced symptoms in at least 1 test component, compared to 5.2% of the control group. Of patients with VH, 78.9% had symptoms during the HNDT "en bloc" (en bloc = head and trunk rotated together) whereas only 26.3% reported symptoms during the CTT en bloc. Best discriminatory validity was found for the HNDT en bloc, with a sensitivity of 0.79 (95% CI = 0.54-0.94), a specificity of 0.86 (95% CI = 0.65-0.97), and a positive likelihood ratio of 5.79 (95% CI = 1.97-17.00). The number of symptoms of CTT "in torsion" (in torsion = trunk rotated actively with fixed head) was increased by a factor of 1.13 (95% CI = 1.01-1.27) for every additional point on the Neck Disability Index. CONCLUSIONS: The CTT and HNDT can serve as nonlaboratory tests in patients with dizziness. The HNDT en bloc has the best discriminatory validity, finding those with and those without VH. Symptom reproduction during torsion may help to identify when neck problems may contribute to dizziness. IMPACT: The HNDT en bloc may be useful for ruling VH in or out in patients with dizziness. Positive CTT and HNDT in torsion components may verify the likelihood of additional neck involvement.

Efficacy of chronic neck pain self-treatment using press needles: a randomized controlled clinical trial.

Background: Chronic neck pain is common among Japanese individuals, but few receive treatment. This randomized controlled trial aimed to evaluate the efficacy of acupuncture using press needles in the self-treatment of chronic neck pain and preliminarily identify the characteristics of patients likely to benefit from this treatment. Methods: Fifty participants with chronic neck pain were allocated to receive either press needle or placebo treatment for 3 weeks. The visual analogue scale (VAS) and motion-related VAS (M-VAS) scores for neck pain, Neck Disability Index score, and pressure pain threshold were measured at baseline, after the first session, at the end of the last session, and 1 week after the last session. Changes in the outcomes were analyzed using analysis of variance, and the relationships between the variables were evaluated using structural equation modeling. Results: Intervention results as assessed by VAS score revealed no significant differences in the ANOVA. A between-groups comparison of M-VAS scores at the end of the last session and baseline showed a significant difference (press needle: -21.64 ± 4.47, placebo: -8.09 ± 3.81, p = 0.025, d = -0.65). Structural equation modeling revealed a significant pain-reducing effect of press needle treatment (ß = -0.228, p = 0.049). Severity directly affected efficacy (ß = -0.881, p < 0.001). Pain duration, baseline VAS and Neck Disability Index scores were variables explaining severity, while age and occupational computer use were factors affecting severity. Conclusion: Self-treatment with press needles for chronic neck pain did not significantly reduce the VAS score compared to placebo but reduced the motion-related pain as assessed by M-VAS score. A direct association was observed between pain severity and the effectiveness of press needles, and the impact of age and computer were indirectly linked by pain severity. Clinical Trial Registration: Identifier UMIN-CTR, UMIN000044078.

Chronic Neck Pain Prevalence Before and After COVID-19 Restrictions and Its Relationship With Digital Device Screen Viewing: A Population Study.

Objective: To estimate the prevalence of chronic neck pain (CNP) among the adult population in Peru during the post-coronavirus disease 2019 (COVID-19) restriction period compared with that during the pre-pandemic period and evaluate its association with prolonged digital devices connected to the internet (DDCI) screen viewing. Methods: We conducted a cross-sectional study using a representative sample of adults living in Peru in November 2022. A structured survey was employed to identify CNP, and the exposure variable was set as the duration of DDCI screen viewing. The McNemar test was used to compare CNP prevalence pre- and post-COVID-19 restrictions, and ordinal logistic regression was used to evaluate its association with prolonged screen viewing. Results: A total of 1,202 individuals participated, with 52.8% females and 79.9% residing in urban areas. Following the restrictions, the prevalence of CNP occurring daily or almost daily and at least once a week was 14.8% and 27.8%, respectively (95% confidence Interval [95% CI], 12.6-17.3 and 24.9-30.9), representing a significant increase (p<0.001) compared with pre-pandemic estimates. Notably, among those viewing DDCI screens for ≥8 hours, the odds ratio for CNP frequency escalation compared with those who did not or rarely view screens was 1.61 (95% CI, 1.04-2.50; p=0.033). Conclusion: Approximately 4 of 10 adults in Peru experienced CNP following the lifting of COVID-19 social restrictions, more than double the pre-pandemic prevalence. Furthermore, prolonged viewing of DDCI screens increased the risk of having this condition.

Disability and pain after anterior cervical decompression and fusion: A group-based trajectory analysis.

OBJECTIVES: This study aimed to identify the clusters of patients with different developmental trajectories of pain and disability after anterior cervical decompression and fusion (ACDF). METHODS: Group-based trajectory analysis among 318 patients undergoing the ACDF. RESULTS: Three developmental trajectories of disability were identified: "Steadily good functioning," "Improved functioning," and "Steadily poor functioning." Three developmental trajectories of neck pain were identified: "Worsened pain," "Pain relief," and "Steadily severe pain." Two developmental trajectories of arm pain were identified: "Decreased arm pain" and "Severe arm pain with only short-term relief." No associations were found between sex, preoperative pain duration, or body weight and probability to be classified into a particular disability trajectory group. Female sex (relative risk ratio (RRR) 1.78) and longer history of preoperative pain (RRR 2.31-2.68) increased the probability to be classified into a group with steadily severe neck pain. Longer history of preoperative pain increased the probability to be classified into group with severe arm pain with only short-term pain relief (RRR 2.68). CONCLUSION: After the ACDF, dissimilar developmental trajectories of pain and disability were identified between the patient clusters. While sex, preoperative pain duration, and body weight were not associated with differences in improvement in disability level, female sex and longer duration of preoperative pain were correlated with more severe neck and arm pain after surgery.

Effects of scapular treatment on chronic neck pain: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Chronic neck pain (CNP) is a common public health problem that affects daily living activities and quality of life. There is biomechanical interdependence between the neck and scapula. Studies have shown that shoulder blade function might be related to chronic neck pain. We therefore evaluated the effects of scapular targeted therapy on neck pain and function in patients with CNP. METHODS: Databases, including MEDLINE (via PubMed), EMBASE (via Ovid), Ovid, Web of Science, and Scopus, were systematically searched for randomized controlled trials published in English investigating treatment of the scapula for CNP before July 16, 2023. RESULTS: A total of 313 participants were included from 8 RCTs. Compared with those in the control group, the intervention in the scapular treatment group exhibited greater improvement in pain intensity (standardized mean difference (SMD) = 2.55; 95% CI = 0.97 to 4.13; P = 0.002), with moderate evidence. Subgroup analysis for pain intensity revealed a significant difference between the sexes, with only the female population (SMD = 6.23, 95% CI = 4.80 to 7.65) showing better outcomes than those with both sexes (SMD = 1.07, 95% CI = 0.57 to 1.56) (p < 0.00001). However, moderate evidence demonstrated no improvement in neck disability after scapular treatment (SMD of 0.24[-0.14, 0.62] of Neck Disability Index or Northwick Park Neck Pain Questionnaire). No effect of scapular treatment was shown on the pressure pain threshold (PPT). The cervical range of motion (CROM) and electromyographic activity of neck muscles could not be conclusively evaluated due to limited support in the articles, and further study was needed. However, the patient's head forward posture appeared to be corrected after scapular treatment. CONCLUSION: Scapular therapy was beneficial for relieving pain intensity in patients with CNP, especially in women. Head forward posture might also be corrected with scapular therapy. However, scapular therapy may have no effect on the PPT or neck disability. However, whether scapular therapy could improve CROM and cervical muscle activation in patients with CNPs had not been determined and needed further study.

McKenzie neck exercise versus cranio-cervical flexion exercise on strength and endurance of deep neck flexor muscles, pain, disability, and craniovertebral angle in individuals with chronic neck pain: a randomized clinical trial.

PURPOSE: To compare the effectiveness of McKenzie neck exercise and cranio-cervical flexion (CCF) exercise on strength and endurance of deep neck flexor (DNF) muscles, pain, disability, and craniovertebral angle (CVA) in individuals with chronic neck pain. METHODS: Forty individuals with chronic neck pain were randomly allocated to the McKenzie neck or CCF exercise group. Each group performed exercises at home daily. The strength and endurance of DNF muscles were measured at baseline, immediately after the first exercise session, and each week follow-up for six weeks. Average pain over the past week was measured at baseline and each week follow-up for six weeks. Disability and CVA were measured at baseline and the end of six weeks. RESULTS: At six weeks, both groups exhibited significant improvements across all outcome variables (p < 0.001) but there were no differences between groups (p > 0.05). The significant difference from baseline in the strength of DNF muscles was observed as early as the second week of each intervention (p ≤ 0.001). The significant difference from baseline in the endurance of DNF muscles was observed as early as the first week in the CCF exercise group (p < 0.05) and the second week in the McKenzie neck exercise group (p < 0.05). A significant decrease in pain intensity from baseline was observed after the first week in the McKenzie neck exercise group (p < 0.001) while it was after the second week in the CCF exercise group (p < 0.05). CONCLUSION: Both the McKenzie neck exercise and CCF exercise produced similar effects in enhancing the strength and endurance of the DNF muscles, decreasing pain, alleviating neck disability, and improving the CVA.

Influence of short bouts of stair climbing on young adults during prolonged sitting on posture, discomfort, and musculoskeletal performance outcomes: a counterbalanced pilot randomised crossover trial.

Prolonged sitting is postulated to influence musculoskeletal performance (cervical flexor endurance, balance, and agility), discomfort and alter cervical spine angles during work-based computer use. Stair climbing breaks may be a great addition at typical and home offices however remain unexplored for its impact on musculoskeletal performance. In our counterbalanced pilot crossover trial, 24 adults were randomised to three interventions: (1) prolonged sitting, (2) interrupted by 2 min of self-paced, and (3) externally paced stair climbing for 2 h. Cervical spine angles were measured every 30 min while balance, agility, endurance, and discomfort were assessed before and after 120 min. Stair climbing interruptions have favourable effects on agility (F = 8.12, p = 0.009, ηp2 = 0.26) and musculoskeletal discomfort, but failed to improve other musculoskeletal outcomes associated with prolonged sitting. Brief stair climbing interruptions are effective in improving discomfort and agility while pragmatic trials are warranted for translated effects.

Stair climbing interventions are known for their cardiovascular benefits, however their impact on musculoskeletal performance remains unclear. In our randomised crossover pilot study, we explored the effects of stair climbing interruptions on cervical posture, endurance, agility, and balance during 120 min of prolonged sitting. Stair climbing interruptions were favourable in reducing time to complete agility tasks and neck/shoulder discomfort score compared to prolonged sitting. However other performance measures remained unaltered.

Neck and shoulder pain in thoracic adolescent idiopathic scoliosis 10 years after posterior spinal fusion.

PURPOSE: We aimed to determine the clinical significance of neck and shoulder pain (NSP) 10 years after posterior spinal fusion (PSF) for thoracic adolescent idiopathic scoliosis (AIS) and the relationship between radiographic parameters and NSP. METHODS: Of 72 patients who underwent PSF for thoracic AIS (Lenke 1 or 2) between 2000 and 2013, we included 52 (46 females; Lenke type 1 in 34 patients and type 2 in 18; mean age, 25.6 years) who underwent NSP evaluation using visual analog scale (VAS, 10 cm) 10 years postoperatively (follow-up rate, 72.2%). Correlation analyses were performed using Spearman's rank correlation coefficient (r). RESULTS: The VAS for NSP was 2.6 cm in median and 3.4 cm in mean at 10 years. The VAS had significant negative correlations with several SRS-22 domain scores (rs = - 0.348 for pain, - 0.347 for function, - 0.308 for mental health, and - 0.372 for total) (p < 0.05). In addition, the VAS score was significantly correlated with cervical lordosis (CL) (rs = 0.296), lumbar lordosis (rs = - 0.299), and sacral slope (rs = 0.362) (p < 0.05). Furthermore, at the 10-year follow-up, CL was significantly negatively correlated with T1 slope (rs = - 0.763) and thoracic kyphosis (TK) (- 0.554 for T1-12 and - 0.344 for T5-12) (p < 0.02). CONCLUSION: NSP was associated with deterioration in SRS-22 scores, indicating that NSP is a clinically significant long-term issue in PSF for thoracic AIS. Restoring or maintaining the TK and T1 slopes, which are controllable factors during PSF, may improve cervical lordosis and alleviate NSP at 10-year follow-up.

The epidemiology of neck and low back pain in Iran: a national and sub-national analysis from 1990 to 2019.

Background: Neck pain (NP) is a condition influenced by multiple factors. It places a significant burden on individuals suffering from NP and on social and economic systems. On a global scale, low back pain (LBP) stands out as a significant contributor to years lost to disability, and this burden is on the rise due to population growth and aging. Methods: The Global Burden of Disease database was used to collect data on the prevalence, incidence, and years lived with disability (YLD) of NP and LBP between 1990 and 2019. Various factors, including age group, gender, Iran, and its 31 provinces, were used to classify the data. Results: Iran accounted for 0.86 million incident cases of NP in 2019, with age-standardized incident rate per 100 000 population of 934.1. Tehran has the maximum age-standardized prevalence, incidence, and YLD. Iran accounted for the age-standardized incidence rate for LBP per 100 000 population of 3492.9, and it reduced to -8.35% from 1990. Mazandaran exhibits the highest levels of prevalence, incidence, and YLD for LBP in 2019. In Iran, the point prevalence of NP in 2019 was higher in females and increased with age up to 50-54 years for females and 70-74 years for males. However, there is only a slight difference between females and males in Iran regarding LBP prevalence. Conclusions: In this study, the authors report the prevalence, incidence, YLD, and age-standardized rates for NP and LBP in the world's general population and Iran's population based on its sub-nations in 1990 and 2019.

Effect of Kinesio taping versus mechanical cervical traction combined with physiotherapy program on chronic neck pain in young female university students.

Background: Mechanical neck pain is common among young female university students and can lead to disability and reduced physical activity. Objectives: The aim of this study was to compare the effect of Kinesio taping (KT) to mechanical cervical traction (MCT) on young female university students with chronic neck pain. Methods: Sixty young female university students with mechanical neck pain participated in this study; their ages ranged from 19 years to 23 years. They were assigned to three equal groups: the control group (A) received infrared, massage, stretching, and strengthening exercises three days per week for 6 weeks. Experimental group B received cervical traction in addition to the same program as the control, and experimental group C received KT in addition to the same program as the control group. Absolute pain intensity by the visual analogue scale (VAS) and neck disability index (NDI) were measured pre-and post-treatment intervention. Data were gathered at baseline, and after 6 weeks of intervention for three groups. Results: The MANOVA test showed a significant reduction in NDI and pain level after 6 weeks between pre-and post-treatment intervention in group B (P<0.001 and P<0.001, respectively). There was a significant reduction in pain after 6 weeks in group C. There was also a significant reduction in NDI and pain level after 6 weeks in group B versus control group (P<0.001 and P=0.001, respectively). In addition, a significant reduction in pain level and NDI after 6 weeks was detected in group B compared to group C (P<0.001, P=0.014, respectively) while a significant reduction in pain level only between the control group (A) and group C was detected (P<0.001). Conclusion: In young female university students with mechanical neck pain, cervical traction combined with physiotherapy program was found to be more effective than KT with physiotherapy program or physiotherapy program alone in reducing pain and enhancing functional abilities after 6 weeks. This will help physiotherapists make more informed decisions concerning the clinical effects of MCT.

Effect of oculomotor exercises in patients with non-specific chronic neck pain and associated visual complaints.

Background: Neck pain is a common musculoskeletal disorder, the most common type being non-specific chronic neck pain. It usually involves postural or mechanical causes. In Individuals with neck pain, a notable prevalence of visual complaints has been predominantly reported. It can be linked to the mismatch in the cervical afferent output. Objective: This study aimed to assess the effect of oculomotor exercises on neck pain, neck disability, gaze stability and visual complaints among individuals with non-specific chronic neck pain and associated visual complaints. Methods: A total of 32 individuals with non-specific chronic neck pain and associated visual complaints were equally randomised into two groups. To receive either: stretching to the sternocleidomastoid and anterior scalene along with neck Isometric exercises (Group A, conventional) or the conventional protocol along with oculomotor exercises (Group B, experimental). The protocol was given for three alternate days a week for three weeks, a total of nine sessions. The outcome measures were the Visual Analogue Scale (VAS) for pain, Neck Disability Index (NDI) for disability, Dynamic Visual Acuity (DVA) test for gaze stability and Visual Complaints Index (VCI) for visual complaints. Results: Significant results were seen for the DVA (p=0.002) and VCI (p=0.024), suggesting improvements in gaze stability and visual complaints using oculomotor exercises. Conclusion: From this study, we highlighted that oculomotor exercises along with conventional treatment led to improvement in visual complaints and gaze stability in patients with non-specific chronic neck pain and associated visual complaints.

Cervicogenic Headaches: A Literature Review and Proposed Multifaceted Approach to Diagnosis and Management.

Cervicogenic headaches are a secondary headache disorder attributable to cervical spine dysfunction resulting in head pain with or without neck pain. Diagnosis of this condition has been complicated by varied clinical presentations, causations, and differing diagnostic criteria. In this article, we aim to clarify the approach to diagnosing cervicogenic headaches by providing an overview of cervicogenic headaches, clinical case examples, and a practical diagnostic algorithm based on the most current criteria. A standardized approach will aid in confirmation of the diagnosis of cervicogenic headaches and facilitate further research into this condition.

Predicting mechanical neck pain intensity in computer professionals using machine learning: identification and correlation of key features.

Introduction: Mechanical neck pain has become prevalent among computer professionals possibly because of prolonged computer use. This study aimed to investigate the relationship between neck pain intensity, anthropometric metrics, cervical range of motion, and related disabilities using advanced machine learning techniques. Method: This study involved 75 computer professionals, comprising 27 men and 48 women, aged between 25 and 44 years, all of whom reported neck pain following extended computer sessions. The study utilized various tools, including the visual analog scale (VAS) for pain measurement, anthropometric tools for body metrics, a Universal Goniometer for cervical ROM, and the Neck Disability Index (NDI). For data analysis, the study employed SPSS (v16.0) for basic statistics and a suite of machine-learning algorithms to discern feature importance. The capability of the kNN algorithm is evaluated using its confusion matrix. Results: The "NDI Score (%)" consistently emerged as the most significant feature across various algorithms, while metrics like age and computer usage hours varied in their rankings. Anthropometric results, such as BMI and body circumference, did not maintain consistent ranks across algorithms. The confusion matrix notably demonstrated its classification process for different VAS scores (mild, moderate, and severe). The findings indicated that 56% of the pain intensity, as measured by the VAS, could be accurately predicted by the dataset. Discussion: Machine learning clarifies the system dynamics of neck pain among computer professionals and highlights the need for different algorithms to gain a comprehensive understanding. Such insights pave the way for creating tailored ergonomic solutions and health campaigns for this population.

Effects of Telerehabilitation on Pain and Disability in Patients with Chronic Neck Pain: A Systematic Review and Meta-Analysis.

(1) Background: This systematic review and meta-analysis explores the effectiveness of telerehabilitation in patients suffering from chronic neck pain, specifically on pain and disability. The research delves into an area of growing significance within the realm of healthcare, aiming to understand the impact of digital interventions on the rehabilitation process for individuals with prolonged neck pain. (2) Methods: The comprehensive review encompasses a wide array of studies evaluating the collective outcomes of numerous trials focused on telerehabilitation strategies. In this systematic review, PubMed/MEDLINE, Scopus, and Web of Science databases were systematically searched to identify studies on telerehabilitation's impact on pain. (3) Results: Eight studies met the inclusion criteria. Using the Downs and Black quality assessment, three studies were classified as good and five as fair. The authors identify specific modalities within telerehabilitation, such as remote exercise programs and virtual consultations, that contribute significantly to positive patient outcomes. Meta-analysis indicated a significant overall effect of telerehabilitation on pain reduction (MD = -1.27; 95% CI = -2.06; -0.47; p = 0.002). These findings support telerehabilitation's efficacy in pain management. (4) Conclusions: The synthesis of evidence presented in this systematic review and meta-analysis underscores the potential of telerehabilitation as an effective and accessible means of managing chronic neck pain, offering valuable insights for both healthcare practitioners and policymakers in advancing patient-centered care.

Identifying Predictors of Neck Disability in Patients with Cervical Pain Using Machine Learning Algorithms: A Cross-Sectional Correlational Study.

(1) Background: Neck pain intensity, psychosocial factors, and physical function have been identified as potential predictors of neck disability. Machine learning algorithms have shown promise in classifying patients based on their neck disability status. So, the current study was conducted to identify predictors of neck disability in patients with neck pain based on clinical findings using machine learning algorithms. (2) Methods: Ninety participants with chronic neck pain took part in the study. Demographic characteristics in addition to neck pain intensity, the neck disability index, cervical spine contour, and surface electromyographic characteristics of the axioscapular muscles were measured. Participants were categorised into high disability and low disability groups based on the median value (22.2) of their neck disability index scores. Several regression and classification machine learning models were trained and assessed using a 10-fold cross-validation method; also, MANCOVA was used to compare between the two groups. (3) Results: The multilayer perceptron (MLP) revealed the highest adjusted R2 of 0.768, while linear discriminate analysis showed the highest receiver characteristic operator (ROC) area under the curve of 0.91. Pain intensity was the most important feature in both models with the highest effect size of 0.568 with p < 0.001. (4) Conclusions: The study findings provide valuable insights into pain as the most important predictor of neck disability in patients with cervical pain. Tailoring interventions based on pain can improve patient outcomes and potentially prevent or reduce neck disability.

Two Methods of Forward Head Posture Assessment: Radiography vs. Posture and Their Clinical Comparison.

Background: Forward head posture (FHP) and altered cervical lordotic curvatures are common spine displacements often associated with neck pain and disability. Two primary categories for determining FHP exist: radiographic and postural measurements. Methods: This study investigated the correlation between the craniovertebral angle (CVA), the radiographically measured C2-C7 sagittal vertical axis (SVA), and cervical lordosis (absolute rotation angle: ARA C2-C7) in a sample of participants with chronic myofascial pain (CMP). In 120 participants, we performed both a postural measurement of the CVA and a lateral cervical radiograph, where the C2-C7 SVA and ARA C2-C7 were measured. A linear-regression R2 value to assess the correlation between the CVA, C2-C7 SVA, and ARA C2-C7 was sought. Results: A statistically significant weak linear fit was identified (Spearman's r = 0.549; R2 = 0.30, p < 0.001) between the CVA and C2-C7 SVA, having considerable variation between the two measures. A statistically significant linear fit (very weak) was identified for the lordosis ARA C2-C7 and the CVA: Spearman's r = 0.524; R2 = 0.275; p < 0.001. A value of 50° for the CVA corresponded to a value of 20 mm for the C2-C7 SVA on an X-ray. Conclusion: While the CVA and radiographic C2-C7 SVA are weakly correlated in an individual, they seem to represent different aspects of sagittal cervical balance. The CVA cannot replace radiographically measured cervical lordosis. We recommend that more emphasis be given to radiographic measures of sagittal cervical alignment than the CVA when considering patient interventions.

Effectiveness and safety of manual therapy when compared with oral pain medications in patients with neck pain: a systematic review and meta-analysis.

BACKGROUND: This systematic review and meta-analysis seeks to investigate the effectiveness and safety of manual therapy (MT) interventions compared to oral pain medication in the management of neck pain. METHODS: We searched from inception to March 2023, in Cochrane Central Register of Controller Trials (CENTRAL), MEDLINE, EMBASE, Allied and Complementary Medicine (AMED) and Cumulative Index to Nursing and Allied Health Literature (CINAHL; EBSCO) for randomized controlled trials that examined the effect of manual therapy interventions for neck pain when compared to medication in adults with self-reported neck pain, irrespective of radicular findings, specific cause, and associated cervicogenic headaches. We used the Cochrane Risk of Bias 2 tool to assess the potential risk of bias in the included studies, and the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach to grade the quality of the evidence. RESULTS: Nine trials (779 participants) were included in the meta-analysis. We found low certainty of evidence that MT interventions may be more effective than oral pain medication in pain reduction in the short-term (Standardized Mean Difference: -0.39; 95% CI -0.66 to -0.11; 8 trials, 676 participants), and moderate certainty of evidence that MT interventions may be more effective than oral pain medication in pain reduction in the long-term (Standardized Mean Difference: - 0.36; 95% CI - 0.55 to - 0.17; 6 trials, 567 participants). We found low certainty evidence that the risk of adverse events may be lower for patients that received MT compared to the ones that received oral pain medication (Risk Ratio: 0.59; 95% CI 0.43 to 0.79; 5 trials, 426 participants). CONCLUSIONS: MT may be more effective for people with neck pain in both short and long-term with a better safety profile regarding adverse events when compared to patients receiving oral pain medications. However, we advise caution when interpreting our safety results due to the different level of reporting strategies in place for MT and medication-induced adverse events. Future MT trials should create and adhere to strict reporting strategies with regards to adverse events to help gain a better understanding on the nature of potential MT-induced adverse events and to ensure patient safety. TRIAL REGISTRATION: PROSPERO registration number: CRD42023421147.

Ultrasonographic measurement indicated patients with chronic neck pain had reduced diaphragm thickness and mobility along with declined respiratory functions.

BACKGROUND: Chronic neck pain (CNP) is a prevalent musculoskeletal condition including notable impairments in respiratory function. The diaphragm, serving dual roles in respiration and spinal stability, is intricately linked to the cervical spine through fascial, neurophysiological, and biomechanical connections. However, to date, none has investigated the diaphragm function in patients with CNP. OBJECTIVES: To investigate the diaphragm function, respiratory muscle strength, and pulmonary function in patients with CNP. In addition, their associations were also examined. DESIGN: A case-control study. METHODS: A total of 54 participants were recruited including 25 patients with CNP (CNP group) and 29 healthy adults (CON group). Pulmonary function including forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1), and respiratory muscle strength represented by maximal inspiratory (MIP) and maximal expiratory pressure (MEP), as well as diaphragm function including ultrasonographic measures of mobility and thickness changes during maximal inspiration and expiration were assessed in all participants. Additionally, the intensity of pain and disability were evaluated using a Visual Analog Scale and Neck Disability Index only in patients with CNP. RESULTS: Significant reductions of the FVC, FEV1, MIP, and MEP were found in the CNP group compared to the CON group (p < 0.05). The diaphragm mobility and thickness changes were also significantly decreased in the CNP group than the CON group with medium effect sizes (p < 0.05). Only diaphragm thickness change was positively correlated with FVC, FEV1, and MEP in patients with CNP. Furthermore, MEP showed the strongest contribution to diaphragm thickness change based on the regression analysis. CONCLUSIONS: Impaired diaphragm function, respiratory muscle strength, and pulmonary function were observed in patients with CNP. Patients with smaller diaphragm thickness change had poorer pulmonary function and reduced maximal expiratory muscle strength. Diaphragm assessment and intervention may be considered in CNP management.

Intra- and Inter-rater Reliability of the Lumbar-Locked Thoracic Rotation Test in Patients With Neck Pain.

PURPOSE: Neck pain is a common musculoskeletal disorder. Therefore, establishing effective physical therapy for neck pain is one of the most important issues. In addition, in physical therapy for neck pain, it is important to evaluate the thoracic spine, which is an adjacent region of the neck. The lumbar-locked rotation test is designed to evaluate the rotational range of the thoracic spine. However, the reliability of the test when performed on patients with neck pain has not been confirmed. OBJECTIVE: We aimed to determine the intra- and inter-rater reliability of the lumbar-locked rotation test in patients with neck pain. METHODS: In this study involving 43 patients, two separate examiners measured thoracic spine rotation. Both examiners conducted three measurements for each side, before and after a five-minute interval. Reliability was assessed using various intra-class correlation coefficient (ICC) models. RESULTS: The intra-rater reliability showed ICC values of 0.99 for both examiners. The inter-rater reliability showed ICC values of 0.98 for both right and left thoracic rotations. CONCLUSION: The findings strongly suggest that the lumbar-locked rotation test has high within-session intra- and inter-rater reliability for patients with neck pain. This test can be considered a reliable method of measuring the thoracic spine rotational range of motion in patients with neck pain in clinical practice.

Effects of Virtual Reality Therapy Combined With Conventional Rehabilitation on Pain, Kinematic Function, and Disability in Patients With Chronic Neck Pain: Randomized Controlled Trial.

BACKGROUND: Neck pain is a common condition that leads to neck motor dysfunction and subsequent disability, with a significant global health care burden. As a newly emerging tool, virtual reality (VR) technology has been employed to address pain and reduce disability among patients with neck pain. However, there is still a lack of high-quality studies evaluating the efficacy of VR therapy combined with conventional rehabilitation for patients with chronic neck pain, particularly in terms of kinematic function. OBJECTIVE: This study aims to investigate the effect of VR therapy combined with conventional rehabilitation on pain, kinematic function, and disability in patients with chronic neck pain. METHODS: We conducted an assessor-blinded, allocation-concealed randomized controlled trial. Sixty-four participants experiencing chronic neck pain were randomly allocated into the experimental group that underwent VR rehabilitation plus conventional rehabilitation or the control group receiving the same amount of conventional rehabilitation alone for 10 sessions over 4 weeks. Pain intensity, disability, kinematic function (cervical range of motion, proprioception, and mean and peak velocity), degree of satisfaction, and relief of symptoms were evaluated at 3 timepoints (baseline, postintervention, and at 3 months follow-up). A 2*3 mixed repeated measures analysis of variance was utilized for analyzing the difference across indicators, with a significant difference level of .05. RESULTS: Both groups demonstrated significant improvements in pain, disability, and kinematic functions (P<.05) at postintervention and at 3-month follow-up. The experimental group showed superior therapeutic outcomes compared to the control group in pain reduction (mean difference from the baseline: 5.50 vs 1.81 at posttreatment; 5.21 vs 1.91 at the 3-month follow-up, respectively; P<.001), disability improvement (mean difference from baseline: 3.04 vs 0.50 at posttreatment; 3.20 vs 0.85 at the 3-month follow-up, respectively; P<.001), and enhanced kinematic functions (P<.05). Moreover, participants in the experimental group reported better satisfaction and relief of symptoms than the control group (P<.05), with better initiative for exercising during the follow-up period. However, there was no between-group difference of improvement in proprioception. No adverse events were reported or observed in our research. CONCLUSIONS: The findings of our study support the efficacy of combining VR therapy with conventional rehabilitation in alleviating pain, enhancing kinematic function, and reducing disability of patients with chronic neck pain. Future research should focus on refining the therapeutic protocols and dosages for VR therapy as well as on optimizing its application in clinical settings for improved convenience and effectiveness. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2000040132; http://www.chictr.org.cn/showproj.aspx?proj=64346.