Psychometric properties of the Neck Disability Index and Numeric Pain Rating Scale in patients with mechanical neck pain

Cleland JA, Childs JD, Whitman JM. Psychometric properties of the Neck Disability Index and numeric pain rating scale in patients with mechanical neck pain.

Objective

To examine the psychometric properties including test-retest reliability, construct validity, and minimum levels of detectable and clinically important change for the Neck Disability Index (NDI) and the numeric rating scale (NRS) for pain in a cohort of patients with neck pain.

Design

Single-group repeated-measures design.

Setting

Outpatient physical therapy (PT) clinics.

Participants

Patients (N=137) presenting to PT with a primary report of neck pain.

Interventions

Not applicable.

Main Outcome Measures

All patients completed the NDI and the NRS at the baseline examination and at a follow-up. At the time of the follow-up, all patients also completed the global rating of change, which was used to dichotomize patients as improved or stable. Baseline and follow-up scores were used to determine the test-retest reliability, construct validity, and minimal levels of detectable and clinically important change for both the NDI and NRS.

Results

Test-retest reliability was calculated using an intraclass correlation coefficient (ICC) (NDI ICC=.50; 95% confidence interval [CI], .25-.67; NRS ICC=.76; 95% CI, .51-.87). The area under the curve was .83 (95% CI, .75-.90) for the NDI score and .85 (95% CI, .78-.93) for the NRS score for determining between stable and improved patients. Thresholds for the minimum clinically important difference (MCID) for the NDI were 19-percentage points and 1.3 for the NRS.

Conclusions

Both the NDI and NRS exhibit fair to moderate test-retest reliability in patients with mechanical neck pain. Both instruments also showed adequate responsiveness in this patient population. However, the MCID required to be certain that the change in scores has surpassed a level that could be contributed to measurement error for the NDI was twice that which has previously been reported. Therefore the ongoing analyses of the properties of the NDI in a patient population with neck pain are warranted.     

Correspondence of diagnosis to initial treatment for neck pain

Objectives

A patient care model has been proposed linking patient assessment to diagnosis to treatment to outcomes. Validation of this method is required. McKenzie developed the mechanical diagnosis and therapy (MDT) process to diagnose neck pain and direct its treatment. No study known to the authors has determined the link between MDT diagnosis and treatment for neck pain. The objective of the current study was to determine inter-rater agreement on the link between MDT diagnosis and treatment for neck pain.

Setting

Outpatient physical therapy clinics.

Participants

Fifty-four clinician raters, 20 patients with neck pain.

Design

Clinicians, MDT-trained for neck pain, viewed videotaped examinations of adult patients with neck pain and rated diagnosis and initial treatment.

Main outcomes measures

Inter-rater agreement on the MDT diagnosis-treatment link and derangement-directional preference link.

Results

Inter-rater agreement on the diagnosis-treatment link of derangement-directional preference and not derangement-no directional preference of treatment was with moderate clinical and statistical significance (κ = 0.46, 95% confidence interval 0.45-0.47; P < 0.001; 86% agreement). There was moderate agreement on derangement-directional preference for the ‘derangement-extension’ link (κ = 0.40, 95% confidence interval 0.38-0.41; P < 0.001) and ‘derangement-lateral’ link (κ = 0.45, 95% confidence interval 0.44-0.46; P < 0.001), but with poor agreement for the ‘derangement-flexion’ link (κ = 0.04, 95% confidence interval 0.02-0.05; P < 0.001).

Conclusions

Clinicians trained in MDT for neck pain link diagnosis to initial treatment of patients with neck pain with moderate reliability, specifically using extension or laterally directed preference for treatment. The current study contributes towards validation of the diagnosis-treatment link of the MDT patient care model for neck pain.     

Inter-rater reliability of McKenzie assessment in patients with neck pain

Objectives

To determine inter-rater agreement on diagnostic category using the Mechanical Diagnosis and Therapy (MDT) classification system for neck pain. If the diagnostic category was derangement syndrome, inter-rater agreement on the subcategory and the directional preference of treatment was also determined.

Design

Clinicians viewed videotaped MDT examinations of 20 patients with neck pain and rated the MDT diagnosis independently for each patient. If the diagnostic category was derangement syndrome, the subcategory and directional preference of treatment were also rated.

Setting

Private physical therapy outpatient clinics and a university clinical laboratory.

Participants

Fifty-four clinicians trained in MDT for neck pain from the USA and Canada, and 20 adult patients with neck pain.

Main outcome measures

Inter-rater agreement for MDT diagnosis, derangement subcategory and directional preference of treatment was determined using Kappa and percentage agreement.

Results

Overall, agreement was of moderate clinical significance for diagnosis [κ = 0.55, P < 0.001, confidence intervals (CI) 0.52 to 0.58, 67%], derangement subcategory (κ = 0.47, CI 0.44 to 0.50, P < 0.001; 63%) and directional preference of treatment (κ = 0.46, CI 0.43 to 0.49, P < 0.05; 70%).

Conclusions

Clinicians trained in MDT for neck pain demonstrate moderate agreement when classifying the diagnostic category and treatment for neck pain.     

Ultrasonographic analysis of the neck flexor muscles in patients with chronic neck pain and changes after cervical spine mobilization

Objective

The purpose of this study was to analyze changes in the recruitment of the muscles longus colli (Lco) and sternocledomastoid (SCM) as measured by ultrasonography in patients with chronic neck pain before and immediately after a single cervical Maitland's posterior-anterior central mobilization technique.

Methods

This was a cross-sectional, case-control research design study. Ultrasonographic images of Lco and SCM were taken in 31 patients with chronic neck pain and matched controls during the 5 phases of the craniocervical flexion test before and after a Maitland's posterior-anterior central mobilization session at the cervical spine. Changes in muscle thickness during the test were calculated to infer muscle recruitment. Separate analysis of variance models for each muscle was built.

Results

Both groups showed increases in Lco and SCM recruitment between phases (F = 7.95, P < .001; F = 21.29, P < .001), with patients with chronic neck pain demonstrating lesser increases for Lco changes in thickness compared with controls, mainly at phase 5 (−0.09, P = .004; 95% confidence interval [CI], 0.03-0.15). After the mobilization, Lco recruitment increased more significantly in patients with chronic neck pain, and previous difference between groups in phase 5 was no longer significant (−0.07, P = .07; 95% CI, −0.14 to 0.01). The SCM recruitment decreased in phase 1 for patients with chronic neck pain (P = .01; 95% CI, −0.06 to −0.01).

Conclusion

Cervical mobilization appeared to modulate neck muscles function by increasing deep muscle and reducing superficial muscles recruitment.     

A Randomized Controlled Trial Comparing Manipulation With Mobilization for Recent Onset Neck Pain

Leaver AM, Maher CG, Herbert RD, Latimer J, McAuley JH, Jull G, Refshauge KM. A randomized controlled trial comparing manipulation with mobilization for recent onset neck pain.

Objective

To determine whether neck manipulation is more effective for neck pain than mobilization.

Design

Randomized controlled trial with blind assessment of outcome.

Setting

Primary care physiotherapy, chiropractic, and osteopathy clinics in Sydney, Australia.

Participants

Patients (N=182) with nonspecific neck pain less than 3 months in duration and deemed suitable for treatment with manipulation by the treating practitioner.

Interventions

Participants were randomly assigned to receive treatment with neck manipulation (n=91) or mobilization (n=91). Patients in both groups received 4 treatments over 2 weeks.

Main Outcome Measure

The number of days taken to recover from the episode of neck pain.

Results

The median number of days to recovery of pain was 47 in the manipulation group and 43 in the mobilization group. Participants treated with neck manipulation did not experience more rapid recovery than those treated with neck mobilization (hazard ratio=.98; 95% confidence interval, .66-1.46).

Conclusions

Neck manipulation is not appreciably more effective than mobilization. The use of neck manipulation therefore cannot be justified on the basis of superior effectiveness.     

Low back pain characteristics from undergraduate student to working nurse in Australia: a cross-sectional survey

Background

Nurses are known to be a high risk group for occupational low back pain (LBP). The periods of greatest risk for developing low back pain in this population are not well defined. Recent literature suggests current preventative strategies are not consistently effective in improving low back injury statistics among health care populations.

Objectives

To identify the relative contributions of age and occupational exposure on the prevalence, duration and severity of low back pain episodes among undergraduate nursing students and recently graduated nurses.

Design

Cross-sectional survey.

Settings

Two university undergraduate nursing schools and one public teaching hospital graduate nurse training program in Western Australia.

Participants

897 undergraduate nursing students (years 1, 2 and 3) and 111 graduate nurses recruited by personal invitation during lectures.

Methods

Using a modified version of the Nordic Low Back Questionnaire, information regarding low back pain episode prevalence, impact, duration, frequency and causes was obtained.

Results

Mean age was consistent across all groups (26.7 ± 9.0 years) and had no significant effect on lifetime low back pain prevalence (p = 0.30). Very high lifetime (79%), 12 month (71%) and 7 day (31%) low back pain prevalence rates were consistent across all 3 year groups of undergraduate nursing students, but were significantly higher after 12 months of full-time employment [lifetime (95.5%), 12 month (90%) and 7 day (39%)]. Around 60% of all respondents with low back pain utilised at least one of (a) treatment, (b) medication, or (c) a reduction in activity. Nursing students and graduate nurses attributed the majority of their low back pain to bending or lifting despite recent efforts to reduce manual workplace demands (lifting) on nurses. Strategies for managing low back pain differed between nursing students and graduate nurses.

Conclusions

These results may suggest a rise in occupational exposure from student to working nurse is the primary cause of the increase in low back pain. Increased exposure may be to physical as well as psychological stressors. Given that prevalence rates are very high prior to commencing work, nursing student populations should be a target group for low back pain preventative strategies.     

Ethnic differences in discharge destination among older patients with traumatic brain injury

Chang P-F, Ostir GV, Kuo Y-F, Granger CV, Ottenbacher KJ. Ethnic differences in discharge destination among older patients with traumatic brain injury.

Objective

To estimate the association between ethnicity and discharge destination in older patients with traumatic brain injury (TBI).

Design

A retrospective analysis.

Setting

Nationally representative sample of older patients from the Uniform Data System for Medical Rehabilitation in 2002 and 2003.

Participants

Patients (N=9240) aged 65 years or older who received inpatient rehabilitation services for TBI.

Interventions

Not applicable.

Main Outcome Measures

Discharge destination (home, assisted living facility, institution) and ethnicity (white, black, Hispanic).

Results

Multinomial logit models showed that older Hispanics (odds ratio [OR]=2.24; 95% confidence interval [CI], 1.66-3.02) and older blacks (OR=2; 95% CI, 1.55-2.59) with TBI were significantly more likely to be discharged home than older whites with TBI, after adjusting for relevant risk factors. Older blacks were also 78% less likely (OR=.22; 95% CI, .08-.60) to be discharged to an assisted living facility than whites after adjusting for relevant risk factors.

Conclusions

Our findings indicate that older minority patients with TBI were significantly more likely to be discharged home than white patients with TBI. Studies are needed to investigate underlying factors associated with this ethnic difference.     

Therapeutic use of botulinum toxin type A in treating neck and upper-back pain of myofascial origin: a pilot study

Lew HL, Lee EH, Castaneda A, Klima R, Date E. Therapeutic use of botulinum toxin type A in treating neck and upper-back pain of myofascial origin: a pilot study.

Objective

To determine the efficacy of botulinum toxin type A (BTX-A) in treating neck and upper-back pain of myofascial origin.

Design

A randomized, double-blind, placebo-controlled pilot study.

Setting

Outpatient physical medicine and rehabilitation clinic of a university-affiliated tertiary hospital.

Participants

A total of 29 subjects enrolled from among 45 screened patients. No subject withdrawal due to serious adverse events occurred.

Intervention

Subjects were evaluated at baseline, received a 1-time injection of either BTX-A (treatment group) or saline (control group), and were followed up at 2 weeks and at months 1, 2, 3, 4, and 6.

Main Outcome Measures

Visual analog scale (VAS) for pain, the Neck Disability Index (NDI), and the Medical Outcome Study 36-Item Short-Form Health Survey (SF-36).

Results

Improvements in the VAS and NDI scores were seen in the treatment group but were not significant when compared with the controls. Statistically significant improvements for the treatment group were seen in the SF-36 bodily pain (at months 2 and 4) and mental health (at month 1) scales but not in the other scales, nor in the summary measures. No serious adverse events were reported.

Conclusions

Trends toward improvements in VAS and NDI scores of the BTX-A group are encouraging, but they were possibly due to a placebo effect and were not statistically significant. The BTX-A subjects, at certain time points, showed statistically significant improvements in the bodily pain and mental health scales of the SF-36 compared with controls. Our study had limited power and population base, but the results could be used to properly power follow-up studies to further investigate this topic.     

Relationships among premorbid alcohol use, acute intoxication, and early functional status after traumatic brain injury

Vickery CD, Sherer M, Nick TG, Nakase-Richardson R, Corrigan JD, Hammond F, Macciocchi S, Ripley DL, Sander A. Relationships among premorbid alcohol use, acute intoxication, and early functional status after traumatic brain injury.

Objective

To investigate the relationships among intoxication at time of injury, preinjury history of problem drinking, and early functional status in patients with traumatic brain injury (TBI).

Design

Prospective cohort study.

Setting

Acute inpatient TBI rehabilitation.

Participants

Participants were 1748 persons with TBI.

Interventions

Not applicable.

Main Outcome Measures

Blood alcohol levels (BALs) were obtained at admission to the emergency department, and a history of problem drinking was obtained through interview. Study outcomes, Disability Rating Scale (DRS), and FIM instrument scores were gathered at admission to inpatient rehabilitation.

Results

Multivariate regression analysis revealed that BAL and a history of binge drinking were predictive of DRS, but not FIM, scores. A higher BAL was associated with poorer functional status on the DRS. Paradoxically, a history of binge drinking was associated with more intact functional status on the DRS.

Conclusions

The relationships among intoxication at time of injury, history of problem drinking, and early outcome after TBI were modest. Injury severity had a more significant association with TBI functional status.     

Methodological quality of studies on the measurement properties of neck pain and disability questionnaires: a systematic review

Objective

The aim of this study was to obtain an overview of the methodological quality of studies on the measurement properties of neck pain and disability questionnaires and to describe how well various aspects of the design and statistical analyses of studies on measurement properties are performed.

Methods

A systematic review was performed of published studies on the measurement properties of neck pain and disability questionnaires. Two reviewers independently rated the quality of the studies using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. This checklist was developed in an international Delphi consensus study.

Results

A total of 47 articles were included on the measurement properties of 8 different questionnaires. The methodological quality of the included studies was adequate on some aspects (often, adequate statistical analyses are used for assessing reliability, measurement error, and construct validity) but can be improved on other aspects. The most important methodological aspects that need to be improved are as follows: assessing unidimensionality in internal consistency analysis, stable patients and similar test conditions in studies on reliability and measurement error, and more emphasis on the relevance and comprehensiveness of the items in content validity studies. Furthermore, it is recommended that studies on construct validity and responsiveness should be based on predefined hypotheses and that better statistical methods should be used in responsiveness studies.

Conclusion

Considering the importance of adequate measurement properties, it is concluded that, in the field of measuring neck pain and disability, there is room for improvement in the methodological quality of studies measurement properties.     

A comparison of neck movement in the soft cervical collar and rigid cervical brace in healthy subjects

Objective

The soft cervical collar has been prescribed for whiplash injury but has been shown to be clinically ineffective. As some authors report superior results for managing whiplash injury with a cervical brace, we were interested in comparing the mechanical effectiveness of the soft collar with a rigid cervical brace. Therefore, the purpose of this study was to measure ranges of motion in subjects without neck pain using a soft cervical collar and a rigid brace compared with no orthosis.

Methods

Fifty healthy subjects (no neck or shoulder pain) aged 22 to 67 years were recruited for this study. Neck movement was measured using a cervical range of motion goniometer. Active flexion, extension, right and left lateral flexion, and right and left rotation were assessed in each subject under 3 conditions: no collar, a soft collar, and a rigid cervical brace.

Results

The soft collar and rigid brace reduced neck movement compared with no brace or collar, but the cervical brace was more effective at reducing motion. The soft collar reduced movement on average by 17.4%; and the cervical brace, by 62.9%. The effect of the orthoses was not affected by age, although older subjects had stiffer necks.

Conclusion

Based on the data of the 50 subjects presented in this study, the soft cervical collar did not adequately immobilize the cervical spine.     

Cervical facet joint dysfunction: a review

Kirpalani D, Mitra R. Cervical facet joint dysfunction: a review.

Objective

To review the relevant literature on cervical facet joint dysfunction and determine findings regarding its anatomy, etiology, prevalence, clinical features, diagnosis, and treatment.

Data Sources

A computer-aided search of several databases was performed, including Medline (1966 to present), Ovid (1966 to present), and the Cochrane database (1993 to present).

Study Selection

Selected articles had the following criteria: (1) all articles analyzed cervical facet joint pain—anatomy, prevalence, etiology, diagnosis, treatment; (2) only full, published articles were studied, not abstracts; and (3) all articles were published in English.

Data Extraction

All articles were critically evaluated and included the following categories: randomized controlled trials, meta-analyses, uncontrolled clinical trials, uncontrolled comparison studies, nonquantitative systematic reviews, and literature-based reviews.

Data Synthesis

We examined 45 references that consisted of 44 journal articles and relevant sections from 1 textbook. Cervical facet joints have been well established in the literature as a common nociceptive pain generator, with an estimated prevalence that ranges from 25% to 66% of chronic axial neck pain. No studies have reported clinical examination findings that are diagnostic for cervical facet mediated pain.

Conclusions

Overall the literature provides very limited information regarding the treatment of this condition, with only radiofrequency neurotomy showing evidence of effectively reducing pain from cervical facet joint dysfunction.     

The impact of selective neck dissection on shoulder and cervical spine movements

Objective

To investigate the deficits in function following a function-preserving neck dissection by comparing operative versus non-operative sides for cervical spine and shoulder movements in combination with patient self-completed questionnaires.

Participants

A consecutive cohort of 63 outpatients following levels I-III unilateral selective neck dissection were approached and all agreed to participate in the study.

Methods

Clinical examination included assessment of shoulder, shoulder girdle and cervical spine ranges of movement, measured by goniometry, tape measure and a cervical measurement system. Patient self-completed questionnaires included the University of Washington quality of life questionnaire (UW-QoL), the neck dissection impairment index and the shoulder disability questionnaire.

Results

Following unilateral selective neck dissection there was significant loss of shoulder flexion and abduction in the operated side compared to the non-operated side but not in regard to the other cervical spine and shoulder measurements. The loss of shoulder flexion averaged 9° (95% confidence interval: 3-14°) and the loss of shoulder abduction averaged 8° (95% confidence interval: 2-14°). The UW-QoL shoulder domain clearly identified patients with poor cervical spine and shoulder function.

Conclusion

This study emphasizes the problems patients encounter even with a function-preserving neck dissection. The UW-QoL questionnaire can aid physiotherapists to screen patients needing early intervention and further assessments.     

Racial differences in employment outcomes after traumatic brain injury

Arango-Lasprilla JC, Ketchum JM, Williams K, Kreutzer JS, Marquez de la Plata CD, O'Neil-Pirozzi TM, Wehman P. Racial differences in employment outcomes after traumatic brain injury.

Objective

To examine racial differences in employment status and occupational status 1 year after a traumatic brain injury (TBI).

Design

Retrospective study.

Setting

Longitudinal dataset of the Traumatic Brain Injury Model Systems national database.

Participants

Subjects with primarily moderate to severe TBI (3468 whites vs 1791 minorities) hospitalized between 1989 and 2005.

Interventions

Not applicable.

Main Outcome Measures

Employment status (competitively employed or unemployed) and occupational status (professional/managerial, skilled, or manual labor) at 1 year postinjury.

Results

Race and/or ethnicity has a significant effect on employment status at 1 year postinjury (=58.23, P<.001), after adjusting for preinjury employment status, sex, Disability Rating Scale at discharge, marital status, cause of injury, age, and education. The adjusted odds of being unemployed versus competitively employed are 2.17 times (95% confidence interval, 1.78-2.65) greater for minorities than for whites. Race and ethnicity does not have a significant effect on occupational status at 1 year postinjury.

Conclusions

With this empirical evidence supporting racial differences in employment outcomes between minorities and whites at 1 year postinjury, priority should be given to tailoring interventions to maximize minority survivors' work-related productivity.     

Outcome following a physiotherapist-led intervention for chronic low back pain: the important role of cognitive processes

Objectives

To examine whether patients with chronic low back pain exhibit changes in cognitive factors following Interactive Behavioural Modification Therapy (IBMT), delivered by physiotherapists; and to examine the association between pre- to post-treatment changes in cognitive factors (cognitive processes) and pre- to post-treatment changes in pain, disability and depression.

Design

Observational before-after study.

Setting

Outpatient physiotherapy department.

Participants

One hundred and thirty-seven patients with chronic low back pain.

Interventions

IBMT: ‘Work Back to Life’ rehabilitation programme.

Main outcome measures

Pre- to post-treatment changes in pain, disability and a range of cognitive factors.

Results

Patients demonstrated significant favourable changes for a range of cognitive factors. Furthermore, pre- to post-treatment changes in these cognitive factors explained an additional 22%, 17% and 15% of the variance in changes in pain, disability and depression, respectively, after controlling for other important factors.

Conclusions

Changes that emerge in cognitive factors are strongly related to treatment outcome within a physiotherapy treatment context. Specifically, reductions in fear of movement and catastrophising, and increases in functional self-efficacy appear to be particularly important. Modifying these cognitive factors should be seen as a priority when treating patients with chronic low back pain.     

Differences in isometric neck muscle strength between healthy controls and women with chronic neck pain: the use of a reliable measurement

Cagnie B, Cools A, De Loose V, Cambier D, Danneels L. Differences in isometric neck muscle strength between healthy controls and women with chronic neck pain: the use of a reliable measurement.

Objectives

To determine the intra- and interrater reliability of the Biodex isokinetic dynamometer to measure the maximal isometric strength of the cervical flexors and extensors, to develop an age- and sex-based normative database in a healthy population, and to evaluate the differences in neck strength between women with chronic neck pain and healthy controls.

Design

Cross-sectional.

Setting

Physical and rehabilitation medicine department.

Participants

Ninety-six healthy volunteers (4 age groups: 20-29, 30-39, 40-49, 50-59y; each consisting of 12 men and 12 women) and 30 women with chronic neck pain.

Interventions

Not applicable.

Main Outcome Measures

Peak isometric strength of the cervical muscles was tested for flexion and extension by using the Biodex isokinetic dynamometer. The intra- and interrater reliability of the protocol was evaluated in 12 volunteers.

Results

The reliability for strength was high for both flexion and extension (intraclass correlation coefficient, .92-.96). The mean peak torque for flexion and extension was significantly higher in men (24Nm, 36.4Nm, respectively) compared with women (16.6Nm, 26.5Nm, respectively) (P<.001). Peak torque production for extension was significantly lower in the patient group (22.3Nm) compared with the healthy female control group (26.5Nm) (P=.003). No significant differences in flexion strength between patient and female control group were found.

Conclusions

Results show a high degree of intra- and interrater reliability in measuring isometric neck muscle strength when using the Biodex isokinetic dynamometer. The use of normative data for neck strength when evaluating patients with neck disorders needs to take sex into account. The current study has shown that women with chronic neck pain have lower neck muscle strength in extension than the healthy female group.     

Elevated C-reactive protein associated with decreased high-density lipoprotein cholesterol in men with spinal cord injury

Liang H, Mojtahedi MC, Chen D, Braunschweig CL. Elevated C-reactive protein associated with decreased high-density lipoprotein cholesterol in men with spinal cord injury.

Objectives

To determine if people with spinal cord injury (SCI) have elevated C-reactive protein (CRP), to examine the association of CRP with high-density lipoprotein cholesterol (HDL-C), and to assess the influence of completeness and level of injury on these parameters.

Design

Cross-sectional.

Setting

Urban university.

Participants

Men with SCI (n=129) who were free of infection and/or recent anti-inflammatory medication use as well as their 1:1 age- and race-matched able-bodied counterparts from the 1999-2002 National Health and Nutrition Examination Surveys.

Interventions

Not applicable.

Main Outcome Measures

High CRP was defined as 3mg/L or higher and low HDL-C as less than 1.04mmol/L.

Results

Men with SCI were more likely to have high CRP (odds ratio [OR]=2.29; 95% confidence interval [CI], 1.33-3.95) and low HDL-C (OR=1.81; 95% CI, 1.01-3.27). The OR for low HDL-C in SCI was no longer significant when high CRP was controlled. CRP was higher in complete versus incomplete injury (median, 3.7mg/L vs 1.2mg/L; P=.005), and this elevation was independent of age, smoking, physical activity, waist circumference, and weight. No conclusion can be made on the association of injury level and CRP because of a lack of power.

Conclusions

The elevated CRP, possibly the major risk factor, together with decreased HDL-C may contribute to greater incidence for cardiovascular disease in the SCI population.     

Exercise therapy for office workers with nonspecific neck pain: a systematic review

Objective

The purpose of this study was to evaluate the effectiveness of various types of exercise for prevention and cure of nonspecific neck pain in office workers.

Methods

Publications between 1980 and April 2010 were systematically searched in various databases (PubMed, CINAHL Plus with full text, The Cochrane Library, Science Direct, PEDro, ProQuest, PsycNet, and Scopus). The following key words were used: neck pain, cervical pain, exercise, strengthening, stretching, endurance, office workers, visual display unit, visual display terminal, and computer users. A hand search of relevant journals was also carried out. Relevant randomized controlled trials were retrieved and assessed for methodological quality by 2 independent reviewers. The strength of the evidence was based on methodological quality and consistency of the results.

Results

Nine randomized controlled trials were included in this review, of which 6 were rated as high-quality studies. No exercise type was identified as being effective in the prevention of nonspecific neck pain in office workers. Strong evidence was found for the effectiveness of muscle strengthening and endurance exercises in treating neck pain. Moderate evidence supported the use of muscle endurance exercise in reducing disability attributed to neck pain.

Conclusion

Literature investigating the efficacy of exercise in office workers with nonspecific neck pain was heterogeneous. Within the limitations, for treatment of neck pain, either muscle strengthening or endurance exercise is recommended, whereas for reduction of pain-related disability, muscle endurance exercise is suggested. Further research is needed before any firm conclusions regarding the most effective exercise programs for office workers can be reached.     

Subclinical neck pain and the effects of cervical manipulation on elbow joint position sense

Objective

The objectives of this study were to investigate whether elbow joint position sense (JPS) accuracy differs between participants with a history of subclinical neck pain (SCNP) and those with no neck complaints and to determine whether adjusting dysfunctional cervical segments in the SCNP group improves their JPS accuracy.

Method

Twenty-five SCNP participants and 18 control participants took part in this pre-post experimental study. Elbow JPS was measured using an electrogoniometer (MLTS700, ADInstruments, New Zealand). Participants reproduced a previously presented angle of the elbow joint with their neck in 4 positions: neutral, flexion, rotation, and combined flexion/rotation. The experimental intervention was high-velocity, low-amplitude cervical adjustments, and the control intervention was a 5-minute rest period. Group JPS data were compared, and it was assessed pre and post interventions using 3 parameters: absolute, constant, and variable errors.

Results

At baseline, the control group was significantly better at reproducing the elbow target angle. The SCNP group's absolute error significantly improved after the cervical adjustments when the participants' heads were in the neutral and left-rotation positions. They displayed a significant overall decrease in variable error after the cervical adjustments. The control group participants' JPS accuracy was worse after the control intervention, with a significant overall effect in absolute and variable errors. No other significant effects were detected.

Conclusion

These results suggest that asymptomatic people with a history of SCNP have reduced elbow JPS accuracy compared to those with no history of any neck complaints. Furthermore, the results suggest that adjusting dysfunctional cervical segments in people with SCNP can improve their upper limb JPS accuracy.