The influence of age, gender, lifestyle factors and sub-clinical neck pain on the cervical flexion-rotation test and cervical range of motion

The flexion-rotation test (FRT) is commonly used when assessing cervicogenic headache. Additionally, active range of motion (AROM) is frequently used to evaluate impairment in neck pain. No studies have investigated the interaction of the FRT and AROM with age, gender, pain and lifestyle factors. The purpose of this study was to determine the influence of these factors on the FRT and cervical AROM. A group of 66 participants (aged 20-78) were studied, 28 experienced sub-clinical neck pain (recurrent neck pain or discomfort which has not received treatment from a healthcare professional) while 38 did not. Age, gender, lifestyle factors and sub-clinical neck pain were assessed using a questionnaire. Measurement of AROM was performed by two examiners blind to the results of the questionnaire. Multiple linear regression analysis found that 59% of the variance in the FRT was explained by the presence of sub-clinical pain and cervical lateral flexion measures. Secondly, 58-72% of the variance in active cervical ROM measures was influenced by factors including the FRT, gender and movements of the neck in other planes. This study found that lifestyle factors do not influence the cervical FRT and AROM.     

Management of acute neck pain: A case series describing immediate and short term clinical outcomes following use of the Multifidus Isometric Technique

BackgroundAcute facet capsular entrapment results in sudden onset of pain and reduced ability to perform active cervical motions. The Multifidus Isometric Technique (MIT) is a type of manual therapy intervention theorized to target the entrapped facet capsule and pull the entrapped synovial folds from the facet joint resulting in decreased pain and increased function.PurposeTo describe immediate MIT clinical outcomes for patients with acute neck pain.MethodsConsecutive patients (n = 30; 70% female) with sudden onset of neck pain received MIT within 48 hours of symptom onset. Clinical outcome measures included: 1) 11-point Numeric Pain Rating Scale (NPRS); 2) cervical AROM, and 3) the Neck Disability Index (NDI). Paired-sample t-testing was used to assess for within and between-session changes in outcome measure scores.ResultsWithin-session NPRS improvements were observed during all cervical AROM movements (p < .01), with initial treatment associated with greater improvements on average (M = 2.4 ± 1.6 points) compared to the second treatment (M = 0.6 ± 0.9 points). Similarly, most within-session AROM measures improved during both sessions (p < .01) with greater average improvements observed following the initial treatment session and for cervical rotation to the symptomatic side (M = 26.5 ± 9.6 vs. 8.0 ± 9.7°). Between-session NDI scores improved (M = 15.3 ± 9.8, p < .01) with approximately 60% of patients achieving a minimally clinically important difference of 14 percentage points.DiscussionThe MIT is a potentially beneficial intervention for patients with acute neck pain. Future studies consisting of longer follow-up time points and comparison treatment groups are needed to test MIT effectiveness.     

Reliability of a seated three-dimensional passive intervertebral motion test for mobility,end-feel,and pain provocation in patients with cervicalgia

Objectives:

Neck pain can be evaluated with passive intervertebral motion (PIVM). No study has evaluated the reliability of three-dimensional (3D) segmental PIVM testing of the cervical spine in symptomatic subjects in a functional, seated position. The purpose of this study was to evaluate inter-rater reliability of such 3D PIVM technique for pain provocation, hypomobility, and end-feel detection.

Methods:

Subjects (n = 63), age 44±15·6 years, neck pain 3·4±1·6 cm with visual analog scale, were evaluated by two of three raters with varied manual therapy education and experience. To perform the test, the rater passively invoked side-bending motion at each cervical joint from C2–C3 to C6–C7, allowing segmental synkinetic rotation and extension to occur. Each joint was assessed for hypomobility, hard end-feel, and pain provocation. Kappa statistics were used to determine the inter-rater reliability for each variable for joints C2–C3 through C6–C7 for both the most painful and least painful sides.

Results:

Percent agreements for pain provocation, hypomobility, and end-feel ranged 65–83%, 62–84%, and 68–87%, respectively. Kappa values for pain provocation, hypomobility, and end-feel on the most painful side were fair to moderate (0·29–0·53, 0·21–0·48, and 0·25–0·50, respectively), and on the least painful side were fair to substantial (0·43–0·65, 0·33–0·58, and 0·28–0·60, respectively).

Discussion:

This is the first investigation to assess reliability of 3D cervical segmental testing in sitting and to assess reliability of end-feel. The seated 3D PIVM test has sufficient clinical reliability for use in patients with cervicalgia for the assessment of hypomobility, end-feel, and pain provocation.     

Normal range of motion of the cervical spine: an initial goniometric study.

The purposes of this study were (1) to determine normal values for cervical active range of motion (AROM) obtained with a "cervical-range-of-motion" (CROM) instrument on healthy subjects whose ages spanned 9 decades, (2) to determine whether age and gender affect six cervical AROMs, and (3) to examine the intratester and intertester reliability of measurements obtained. Measurements were made on 337 subjects (171 females and 166 males) whose ages ranged from 11 to 97 years. Measurements were taken by five physical therapists with 7 to 30 years of clinical and teaching experience. Among male and female subjects of the same age, females had a greater AROM than did males for all AROMs except neck flexion. Among both males and females, each of the six cervical AROMs decreased significantly with age. From two pilot studies separate from the acquisition of the normal database, we determined our intratester and intertester reliabilities for making neck AROM measurements with the CROM instrument. We concluded that AROM measurements on the cervical spine with the CROM instrument demonstrated good intratester and intertester reliability, because the intraclass correlation coefficients were generally greater than .80.     

Inter- and intra-examiner reliability of single and composites of selected motion palpation and pain provocation tests for sacroiliac joint

The sacroiliac joint (SIJ) has been implicated as a potential source of low back and buttock pain. Several types of motion palpation and provocation tests are used to examine the SIJ. It has been suggested that use of a cluster of motion palpation or provocation tests is a more acceptable method than single test to assess SIJ. This study examined the inter- and intra-examiner reliability of single and composites of the motion palpation and provocation tests together. Twenty-five patients between the ages of 20 and 65 years participated. Four motion palpation and three provocation tests were examined three times on both sides (left, right) by two examiners. Kappa coefficient and prevalence-adjusted and bias-adjusted kappa (PABAK) were calculated to evaluate the reliability. PABAK for intra- and inter-examiner reliability of individual tests ranged from 0.36 to 0.84 (95% CI: -0.22 to 1.12) and 0.52 to 0.84 (95% CI: -0.18 to 1.08) which is considered fair to substantial. PABAK for intra- and inter-examiner reliability for clusters of motion palpation or provocation tests ranged from 0.44 to 0.92 (95% CI: -0.36 to 1.2) which is considered moderate to excellent reliability. PABAK for intra- and inter-examiner reliability of composites of motion palpation and provocation tests ranged from 0.44 to 1.00 (95% CI: -0.22 to 1.12) and 0.52 to 0.92 (95% CI: -0.02 to 1.32) which is considered substantial to excellent. It seems that composites of motion palpation and provocation tests together have reliability sufficiently high for use in clinical assessment of the SIJ.     

Reliability of the Joint Position Sense Error Test for Women With Neck Pain and Asymptomatic Men and Women

ObjectiveThe purpose of this study was to evaluate the intra-rater between-days reliability of the joint position sense error (JPSE) test in asymptomatic men and women, as well as in women with neck pain.MethodsFourteen asymptomatic men and 27 women (14 asymptomatic and 13 with neck pain) participated. The JPSE test was performed during right and left cervical rotation (10 trials for each side) in 2 sessions, with at least 7 days between them. The head repositioning error during the JPSE test (in degrees) was measured and used to calculate the intra-rater between-days reliability of the test, evaluated through the intraclass correlation coefficient and Bland-Altman analyses. Independent t tests were calculated to compare the head repositioning errors of asymptomatic women and men. The minimal detectable change was also calculated.ResultsThe neck pain group showed higher intraclass correlation coefficient values (0.866 and 0.773, good reliability) compared to the asymptomatic men (0.478 and 0.403, poor reliability) and to the asymptomatic women (-0.161 and 0.504, poor and moderate reliability, respectively) for both right and left cervical rotation, respectively. Considering Bland-Altman analyses, the neck pain group showed better agreement between the measurements for right cervical rotation than the asymptomatic groups.ConclusionThe results indicate that the methodology used to perform the JPSE test in this study may be a reliable way to assess the proprioception of women with neck pain in clinical settings.     

Specific therapeutic exercise of the neck induces immediate local hypoalgesia.

This study compared the effect of 2 specific cervical flexor muscle exercise protocols on immediate pain relief in the cervical spine of people with chronic neck pain. In addition, the study evaluated whether these exercise protocols elicited any systemic effects by studying sympathetic nervous system (SNS) function and pain at a location distant from the cervical spine. Participants were randomly allocated into either a cranio-cervical flexion (CCF) coordination exercise group (n = 24) or a cervical flexion (CF) endurance exercise group (n = 24). Measures of pain and SNS function were recorded immediately before and after a single session of the exercise interventions. Pain measures included visual analogue scale (VAS) ratings of neck pain at rest and during active cervical motion and pressure pain threshold (PPT) and thermal pain threshold (TPT) recordings over the cervical spine and at a remote site on the leg. Measures of SNS function consisted of blood flow, skin conductance, skin temperature, heart rate, and blood pressure. Immediately after 1 session of exercise, there was a reasonably sized increase of 21% (P < .001, d = 0.88) and 7.3% (P = .03, d = 0.47) in PPT locally at the neck for the CCF exercise and the CF exercise, respectively. There were no changes in local neck TPT with either exercise. Pressure pain threshold and TPT at the leg and SNS did not change after exercise. Only the CCF exercise demonstrated a small improvement in VAS ratings during active movement (change on 10-cm VAS: CCF, 0.42 cm (P = .04). This study shows that specific CCF therapeutic exercise is likely to provide immediate change in mechanical hyperalgesia local to the neck with translation into perceived pain relief on movement in patients with chronic neck pain. PERSPECTIVE: This study showed an immediate local mechanical hypoalgesic response to specific exercise of the cervical spine. Understanding the pain-relieving effects of exercise will assist the clinician in prescribing the most appropriate exercise protocols for patients with chronic neck pain.     

Intra- and interindividual reliability of muscle pain induced by an intramuscular injection of hypertonic saline injection into the quadriceps

Background

Intramuscular injections of hypertonic saline are commonly used to induce experimental muscle pain, but reliability data on this technique are lacking. This study investigated the intra- and interindividual reliability of pain measures from a hypertonic saline injection into the vastus lateralis.

Methods

Fourteen healthy participants (6 female) attended three laboratory visits where they received an intramuscular injection of 1 mL hypertonic saline into the vastus lateralis. Changes in pain intensity were recorded on an electronic visual analogue scale, and pain quality was assessed after pain had resolved. Reliability was assessed with the coefficient of variation (CV), minimum detectable change (MDC) and intraclass correlation coefficient (ICC) with 95% CIs.

Results

Mean pain intensity displayed high levels of intraindividual variability (CV = 16.3 [10.5–22.0]%) and ‘poor’ to ‘very good’ relative reliability (ICC = 0.71 [0.45–0.88]) but had a MDC of 11 [8–16] au (out of 100). Peak pain intensity exhibited high levels of intraindividual variability (CV = 14.8 [8.8–20.8]%) with ‘moderate’ to ‘excellent’ levels of relative reliability (ICC = 0.81 [0.62–0.92]), whereas the MDC was 18 [14–26] au. Measures of pain quality exhibited good reliability. Interindividual variability in pain measures was high (CV > 37%).

Conclusions

Intramuscular injections of 1 mL of hypertonic saline into the vastus lateralis display substantial levels of interindividual variability, but MDC is below the clinically important changes in pain. This model of experimental pain is suitable for studies involving repeated exposures.

Significance

Many pain research studies have performed intramuscular injections of hypertonic saline to investigate responses to muscle pain. However, the reliability of this technique is not well established. We examined the pain response over three repeated sessions of a hypertonic saline injection. The pain induced by hypertonic saline has considerable interindividual variability but has largely acceptable intraindividual reliability. Therefore, the injections of hypertonic saline to induce muscle pain are a reliable model of experimental muscle pain.     

单纯后纵韧带增生型颈椎病责任间盘的确认及其射频治疗

目的:观察单纯后纵韧带增生型颈椎病的微创治疗效果。方法:具有颈、肩和上背部至少一处持续6个月以上酸、胀、麻、重或痛的患者30例,采用射频温度递增诱发试验代替椎间盘造影试验确定责任间盘及相对应的责任增生后纵韧带,采用射频热凝方式治疗单纯后纵韧带增生型颈椎病。结果:30例患者围术期及术后180天内未出现局部感染和颈脊神经损伤等并发症。术后72小时有14例颈、肩、上背部等部位原有症状全部消失,感觉轻松;13例原有症状明显减轻,感觉也比较轻松;3例原有症状部分消失或减轻另部分没有减轻。疗效优良率达到90%。术后72 h和术后180天的视觉模拟评分(visual analogue scale,VAS)较术前均有明显降低。结论:成对管状电极射频椎间盘成形术可用于单纯后纵韧带增生型颈椎病的治疗。     

Intra- and inter-rater reliability of movement and palpation tests in patients with neck pain: A systematic review

Neck pain is common and often becomes chronic. Various clinical tests of the cervical spine are used to direct and evaluate treatment. This systematic review aimed to identify studies examining the intra- and/or interrater reliability of tests used in clinical examination of patients with neck pain. A database search up to April 2016 was conducted in PubMed, CINAHL, and AMED. The Quality Appraisal of Reliability Studies Checklist (QAREL) was used to assess risk of bias. Eleven studies were included, comprising tests of active and passive movement and pain evaluating participants with ongoing neck pain. One study was assessed with a low risk of bias, three with medium risk, while the rest were assessed with high risk of bias. The results showed differing reliabilities for the included tests ranging from poor to almost perfect. In conclusion, active movement and pain for pain or mobility overall presented acceptable to very good reliability (Kappa >0.40); while passive intervertebral tests had lower Kappa values, suggesting poor reliability. It may be a coincidence that the studies indicating very good reliability tended to be of higher quality (low to moderate risk of bias), while studies finding poor reliability tended to be of lower quality (high risk of bias). Regardless, the current recommendation from this review would suggest the clinical use of tests with acceptable reliability and avoiding the use of tests that have been shown to not be reliable. Finally, it is critical that all future reliability studies are of higher quality with low risk of bias.     

Effect of neck exercise on sitting posture in patients with chronic neck pain

BACKGROUND AND PURPOSE: Poor sitting posture has been implicated in the development and perpetuation of neck pain symptoms. This study had 2 purposes: (1) to compare change in cervical and thoracic posture during a distracting task between subjects with chronic neck pain and control subjects and (2) to compare the effects of 2 different neck exercise regimens on the ability of people with neck pain to maintain an upright cervical and thoracic posture during this task. SUBJECTS: Fifty-eight subjects with chronic, nonsevere neck pain and 10 control subjects participated in the study. METHOD: Change in cervical and thoracic posture from an upright posture was measured every 2 minutes during a 10-minute computer task. Following baseline measurements, the subjects with neck pain were randomized into one of two 6-week exercise intervention groups: a group that received training of the craniocervical flexor muscles or a group that received endurance-strength training of the cervical flexor muscles. The primary outcomes following intervention were changes in the angle of cervical and thoracic posture during the computer task. RESULTS: Subjects with neck pain demonstrated a change in cervical angle across the duration of the task (mean=4.4 degrees ; 95% confidence interval [CI]=3.3-5.4), consistent with a more forward head posture. No significant difference was observed for the change in cervical angle across the duration of the task for the control group subjects (mean=2.2 degrees ; 95% CI=1.0-3.4). Following intervention, the craniocervical flexor training group demonstrated a significant reduction in the change of cervical angle across the duration of the computer task. DISCUSSION AND CONCLUSION: This study showed that people with chronic neck pain demonstrate a reduced ability to maintain an upright posture when distracted. Following intervention with an exercise program targeted at training the craniocervical flexor muscles, subjects with neck pain demonstrated an improved ability to maintain a neutral cervical posture during prolonged sitting.     

Interrater reliability of the history and physical examination in patients with mechanical neck pain

OBJECTIVE: To examine the interrater reliability of the history and physical examination in patients with mechanical neck pain. DESIGN: Single-group repeated measures for interrater reliability. SETTING: Outpatient physical therapy clinic. PARTICIPANTS: Twenty-two patients with mechanical neck pain underwent a standardized history and physical examination by a physical therapist. INTERVENTION: Following a 5-minute break, a second therapist who was blind to the findings of examiner 1 performed the second standardized history and physical examination. MAIN OUTCOME MEASURES: The Cohen kappa and weighted kappa were used to calculate the interrater reliability of ordinal level data from the history and physical examination. Intraclass correlation coefficients model 2,1 (ICC(2,1)) and the 95% confidence intervals were calculated to determine the interrater reliability for continuous variables. RESULTS: The kappa coefficients ranged from -.06 to .90 for the variables obtained from the history. Reliability values for categorical data collected during the physical examination ranged from no to substantial agreement depending on the particular test and measure. ICC(2,1) for cervical range of motion (ROM) measurements ranged between .66 and .78. CONCLUSIONS: We have reported the interrater reliability of the history and physical examination in a group of patients with a primary report of neck pain. The reliability variables varied considerably for manual assessment techniques and were significantly higher for the examination of muscle length and cervical ROM. Ultimately, it will be up to each clinician to determine if a particular test or measure poses adequate reliability to assist in the clinical decision making process.     

Inter-examiner reliability of a classification system for patients with non-specific low back pain

There is a lack of studies examining whether mechanism-based classification systems (CS) acknowledging biological, psychological and social dimensions of long-lasting low back pain (LBP) disorders can be performed in a reliable manner. The purpose of this paper was to examine the inter-tester reliability of clinicians' ability to independently classify patients with non-specific LBP (NSLBP), utilising a mechanism-based classification method. Twenty-six patients with NSLBP underwent an interview and full physical examination by four different physiotherapists. Percentage agreement and Kappa coefficients were calculated for six different levels of decision making. For levels 1–4, percentage agreement had a mean of 96% (range 75–100%). For the primary direction of provocation Kappa and percentage agreement had a mean between the four testers of 0.82 (range 0.66–0.90) and 86% (range 73–92%) respectively. At the final decision making level, the scores for detecting psychosocial influence gave a mean Kappa coefficient of 0.65 (range 0.57–0.74) and 87% (range 85–92%). The findings suggest that the inter-tester reliability of the system is moderate to substantial for a range of patients within the NSLBP population in line with previous research.     

Interobserver reliability of physical examination of shoulder girdle

The object of this study was to assess interobserver reliability in 23 tests concerning physical examination of the shoulder girdle. A physical therapist and a physical therapist/manual therapist independently performed a physical examination of the shoulder girdle in 91 patients with shoulder complaints of varying severity and duration. The observers assessed 23 items in total: active and passive abductions, passive external rotation, hand in neck (HIN) test, hand in back (HIB) test, impingement test according to Neer, springing test of the first rib and joint play test of the acromioclavicular joint. The interobserver reliability was evaluated by means of a Cohen's Kappa, the weighted Kappa and the intraclass correlation (ICC). Criteria for acceptable reliability were: Kappa value>or=0.60, ICC>or=0.75 or an absolute agreement>or=80%. The results showed that Kappa values varied from 0.09 (springing test first rib, stiffness) to 0.66 (springing test first rib, pain), weighted Kappa varied from 0.35 (pain during HIB) to 0.73 (range of motion HIB) and ICC varied from 0.54 (abduction passive starting point painful arc) to 0.96 (active and passive ranges of motion in abduction). In total 11 (48%) items fulfilled the criteria of acceptable reliability. In conclusion, there appears to be a great deal of variation in the reliability of the tests used in the physical examination of the shoulder girdle. Over 50% of the tests did not meet the statistical criteria for acceptable reliability.     

Interrater and Intrarater Reliability and Minimum Detectable Change of Ultrasound for Active Myofascial Trigger Points in Upper Trapezius Muscle in Individuals With Shoulder Pain

ObjectiveWe sought to investigate the interrater and intrarater reliability of ultrasound and the minimum detectable change (MDC) for the trigger points (TrPs) active in the upper trapezius (UT) muscle in individuals with shoulder pain.MethodsForty individuals with shoulder pain were investigated for the presence of active TrPs in the UT muscle by means of ultrasound for the parameters of gray scale, muscle thickness of UT muscle at rest, and contraction and area of TrPs. The intrarater reliability was performed on 2 days, and interrater reliability on the same day. For the gray scale, the reliability was evaluated using the kappa coefficient (κ), while the other parameters were measured by the intraclass correlation coefficient (ICC), standard error of measurement (SEM), and MDC.ResultsFor the gray scale, the intrarater agreement was almost perfect (κ = 1.00) and the interrater agreement was substantial (κ = 0.75). The intrarater and interrater reliability were excellent for most of the parameters, except for the area of TrPs (intrarater: ICC = 0.71, substantial; interrater: ICC = 0.52, substantial). The MDC for intrarater reliability varied between 0.04 and 0.05 (SEM% between 2.4% and 38.87%), and that for interrater reliability ranged from 0.05 to 0.07 (SEM% between 3.18% and 55.10%), with a higher value for area.ConclusionParameters such as gray scale, resting muscle thickness, and muscle contraction of the UT muscle, obtained through ultrasound, showed excellent intrarater and interrater reliability with low SEM%. The intrarater and interrater reliability for the area deserves a caveat regarding their use.     

Intertester reliability of clinical judgments of medial knee ligament integrity

The purpose of this study was to determine the intertester reliability of judgments based on tibiofemoral joint abduction (TFJA) tests of the medial collateral ligament (MCL). The TFJA tests were performed by three physical therapists on 50 patients with unilateral knee problems. The therapists used the techniques they normally use in clinical practice and tested TFJA with the knee in both 0 and 30 degrees of flexion. Three variables were evaluated: the amount of TFJA, pain elicited during the test, and the type of end-feel. When the test was performed with the subjects' knees in 0 degrees of flexion, the weighted Kappa value for judgments of motion was .06, the Kappa value for judgments of whether pain was elicited was .40, and the Kappa value for end-feel was .00. For the 30-degree test position, the weighted Kappa value for judgments of the amount of TFJA was .16, and the Kappa values for judgments of pain and end-feel were .33 and .38, respectively. The results suggest that judgments based on TFJA tests may not be reliable when taken in a clinical setting by physical therapists.     

Reliability of a measurement of neck flexor muscle endurance

BACKGROUND AND PURPOSE: Neck flexor muscle endurance has been negatively correlated with cervical pain and dysfunction. The purposes of this study were to determine rater reliability in subjects both with and without neck pain and to determine whether there was a difference in neck flexor muscle endurance between the 2 groups. SUBJECTS: Forty-one subjects with and without neck pain were enrolled in this repeated-measures reliability study. METHODS: Two raters used an isometric neck retraction test to assess neck flexor muscle endurance for all subjects during an initial session, and subjects without neck pain returned for testing 1 week later. RESULTS: For the group without neck pain, intrarater reliability was good to excellent (intraclass correlation coefficient [ICC(3,1)]=.82-.91), and interrater reliability was moderate to good (ICC[2,1]=.67-.78). The associated standard error of measurement (SEM) ranged from 8.0 to 11.0 seconds and from 12.6 to 15.3 seconds, respectively. For the group with neck pain, interrater reliability was moderate (ICC[2,1]=.67, SEM=11.5). Neck flexor muscle endurance test results for the group without neck pain (mean=38.95 seconds, SD=26.4) and the group with neck pain (mean=24.1 seconds, SD=12.8) were significantly different. DISCUSSION AND CONCLUSION: Reliability coefficients differed between the 2 groups and ranged from moderate to excellent and improved after the first test session. The interrater reliability of data obtained with the neck flexor muscle endurance test in people with neck pain must be improved in order for clinicians to distinguish a clinically meaningful change from measurement error. Neck flexor muscle endurance was both statistically and clinically greater for subjects without neck pain than for those with neck pain.     

Reliability of measurements of cervical spine range of motion--comparison of three methods

To determine reliabilities within and between persons measuring cervical active range of motion (AROM) three methods were examined: use of a cervical-range-of-motion (CROM) instrument, use of a universal goniometer (UG), and visual estimation (VE). Measurements were made on 60 patients with orthopedic disorders of the cervical spine who were divided into three groups of 20 subjects each. All subjects were tested in a standardized seated position using operationally defined goniometric placements and nongoniometric estimation techniques. Cervical flexion and extension, lateral flexion, and rotation were measured. Intraclass correlation coefficients (ICCs) were used to quantify within-tester and between-tester reliability. We found that goniometric measurements of AROM of the cervical spine made by the same physical therapist had ICCs greater than .80 when made with the CROM device or the UG. When different physical therapist measured the same patient's cervical AROM, the CROM device had ICCs greater than .80, whereas the UG and VE generally had ICCs less than .80.     

Impact of wheelchair seat height on neck and shoulder range of motion during functional task performance

Wheelchair users are at high risk for developing repetitive stress injuries (RSI) of the cervical spine and glenohumeral joints due to increased demands on active range of motion (AROM) when performing functional tasks from a seated position. The addition of a seat elevation device may alleviate the risk factors that lead to the development of RSI. However, there are no studies which establish that wheelchair seat height impacts upon arthrokinematic requirements at vulnerable joints. Additionally, Medicare and most insurance carriers do not cover the cost of power seat elevators because this feature has not been shown to be a “medical necessity.” This study examined differences in AROM at the cervical spine and glenohumeral joint during performance of two functional tasks while seated in a wheelchair with the seat elevation feature at minimum and maximum height. Results revealed statistically significant differences in AROM requirements for cervical extension and shoulder abduction between the two wheelchair seat heights. These findings provide preliminary support for the value of the power seat elevation function in minimizing the risk of RSI at the shoulder complex and cervical spine in wheelchair users.