直立海绵垫姿势描记在评定正常人和眩晕患者平衡功能中的重测信度研究

目的:研究直立海绵垫姿势描记方法在分析人体姿势稳定性、评价正常人和眩晕患者姿势平衡能力时的信度。方法:25例正常人和34例病情处于稳定期的眩晕患者在3d内重复进行2次海绵垫姿势描记。测试4种不同站立条件下的静态姿势,依次为T1:睁眼站立于坚硬平板;T2:闭眼站立于坚硬平板;T3:睁眼站立海绵垫上;T4:闭眼站立海绵垫上。每种站立条件下各站立30s。记录测试中发生倾倒的情况;对于未倾倒者,姿势描记仪记录人体直立时足底压力中心晃动的平均速度(SV),作为姿势稳定性的参数。结果:健康对照组在各测试条件下未发生倾倒,而眩晕组有10例受试者在至少一次海绵垫姿势描记中发生倾倒,这部分患者结果不纳入信度分析。①49例受试者3d内重测的SV具有高度相关性(T1-T4四种测试条件下的ICC为0.973、0.931、0.932、0.887);②健康对照组和眩晕组在第一次测试中的SV比较,T2(P=0.049)和T4(P<0.001)条件下差异有显著性意义;第二次测试中的SV比较,T4条件下差异极显著性意义(P=0.001);③比较眩晕组中两次测试中倾倒发生的例数,差异无显著性意义(P=0.787)。结论:在评价正常人和病情处于稳定期的眩晕患者的平衡功能时,直立海绵垫时姿势描记具有较好的信度,提示该方法可用于评价前庭康复治疗对眩晕患者平衡功能的影响。     

静态直立姿势定量评定的可靠性研究

目的:研究整体姿势评估系统(global posture system, GPS)定量评估静态直立姿势的可靠性。方法:16例从门诊招募产生的受试者(24.2±5.8)岁,由1名经验丰富的物理治疗师和1名经验不足的矫形器师用GPS系统对受试者进行重复整体姿势评估。用组内相关系数(intraclass correlation coefficient,ICC)分析评估者内和评估者间信度。结果:GPS评估具有良好的评估者内部可靠性(ICC0.702)和评估者间可靠性(ICC0.722)。其中,髂前上棘(ASIS)的骨盆对线(ICC=0.552),髂后上棘(PSIS)的骨盆对线(ICC=0.560)和双肩对线(ICC=0.575)的评估者间ICC为中等可靠性。结论:GPS评估系统能为评估者提供整体姿势评估的可靠性数据。     

应用脊柱姿势图评测正常人的信度研究

脊柱姿势与颈痛和腰痛密切相关，特别是与其发生率和恢复程度呈正相关。目前评测脊柱姿势的方法主要是影像学检查，如：X线、MRI等。临床上简单、易操作、较为直观地反映脊柱姿势的评测方法非常缺乏。脊柱姿势图是由美国PneuMex公司10年前首创，因其较为精确地评估脊柱曲度，包括颈前曲、胸后曲、腰前曲、骶后曲以及脊柱整体倾斜程度，而广泛应用于国外医疗工作中。为了解该脊柱姿势图在临床评测中国人的可靠性，本研究将探讨同一检查者与不同检查者使用脊柱姿势图评测正常人的可重复性。     

综合功能评定法（CFE）的研究：（三）信度研究（下）

本文报道了综合功能评定法的评定者间一致性的研究结果。两位评定者对同一组103例正常人分别进行了评定,将评定结果进行统计学处理,Kappa值为0．75,说明两位评定者的评定结果具有高度的一致性。证明该量表具有高度的评定者间一致性,信度可靠。     

Sensitivity of clinical assessments of sagittal head posture

Rationale, aims and objectives  Historically, clinicians visually evaluate posture using anatomical landmarks. Advances in technology made digital photographs now feasible to use in clinical practice. Photogrammetry may increase the reliability of the assessment of postural changes. However, differences between visually estimated and photogrammetric recorded changes in posture need to be tested. The objective of this study was to evaluate the sensitivity of visual assessments of changes in head posture in the sagittal plane in relation to photogrammetric recorded data.
Methods  The head posture of 29 female subjects in a sagittal plane was assessed visually and photogrammetrically. The visual assessment of head posture was conducted using a postural grid with a plumb for checking the alignment. The patients were classified as having forward head posture (FHP), slight FHP or no FHP. Photogrammetry of head posture was performed using the Alcimage software^® (Alcimar B. Soares, Uberlândia, MG, Brasil). Three reference points were used to measure the head posture angle: mentus, external auditory meatus and manubrium. The visually classified groups were compared in relation to the photogrammetric angles using one-way anova .
Results  A significant difference was found between the FHP and no FHP groups ( P  = 0.001), and between the FHP and slight FHP groups ( P  = 0.002). However, no significant difference was found between the slight FHP and no FHP groups.
Conclusions  Visual assessments of sagittal head posture were sensitive to detect differences between no FHP and FHP groups, but were not sensitive to detect differences between no FHP and slight FHP groups. Head posture photogrammetry is recommended to quantitatively detect less evident differences in head posture.     

Myofascial trigger points, neck mobility, and forward head posture in episodic tension-type headache

OBJECTIVE: To assess the differences in the presence of trigger points (TrPs) in head and neck muscles, forward head posture (FHP) and neck mobility between episodic tension-type headache (ETTH) subjects and healthy controls. In addition, we assess the relationship between these muscle TrPs, FHP, neck mobility, and several clinical variables concerning the intensity and the temporal profile of headache. BACKGROUND: TTH is a headache in which musculoskeletal disorders of the craniocervical region might play an important role in its pathogenesis. Design.-A blinded, controlled pilot study. METHODS: Fifteen ETTH subjects and 15 matched controls without headache were studied. TrPs in both upper trapezius, both sternocleidomastoids, and both temporalis muscles were identified according to Simons and Gerwin diagnostic criteria (tenderness in a hypersensible spot within a palpable taut band, local twitch response elicited by snapping palpation, and elicited referred pain with palpation). Side-view pictures of each subject were taken in both sitting and standing positions, in order to assess FHP by measuring the craniovertebral angle. A cervical goniometer was employed to measure neck mobility. All measures were taken by a blinded assessor. A headache diary was kept for 4 weeks in order to assess headache intensity, frequency, and duration. RESULTS: The mean number of TrPs for each ETTH subject was 3.7 (SD: 1.3), of which 1.9 (SD: 0.9) were active, and 1.8 (SD: 0.9) were latent. Control subjects only had latent TrPs (mean: 1.5; SD: 1). TrP occurrence between the 2 groups was significantly different for active TrPs (P < .001), but not for latent TrPs (P > .05). Differences in the distribution of TrPs were significant for the right upper trapezius muscles (P= .04), the left sternocleidomastoid (P= .03), and both temporalis muscles (P < .001). Within the ETTH group, headache intensity, frequency, and duration outcomes did not differ depending on TrP activity, whether the TrP was active or latent. The craniovertebral angle was smaller, ie, there was a greater FHP, in ETTH patients than in healthy controls for both sitting and standing positions (P < .05). ETTH subjects with active TrPs in the analyzed muscles had a greater FHP than those with latent TrPs in both sitting and standing positions, though differences were only significant for certain muscles. Finally, ETTH patients also showed lesser neck mobility than healthy controls in the total range of motion as well as in half-cycles (except for cervical extension), although neck mobility did not seem to influence headache parameters. CONCLUSIONS: Active TrPs in the upper trapezius, sternocleidomastoid, and temporalis muscles were more common in ETTH subjects than in healthy controls, although TrP activity was not related to any clinical variable concerning the intensity and the temporal profile of headache. ETTH patients showed greater FHP and lesser neck mobility than healthy controls, although both disorders were not correlated with headache parameters.     

Forward head posture and neck mobility in chronic tension-type headache: a blinded, controlled study

Forward head posture (FHP) and neck mobility were objectively assessed in 25 patients with chronic tension-type headache (CTTH) and 25 healthy controls. Side-view pictures were taken in a sitting position to measure the cranio-vertebral angle. A cervical goniometer was employed to measure the range of all cervical motions. Patients with CTTH showed a smaller cranio-vertebral angle (45.3 degrees +/- 7.6 degrees) than controls (54.1 degrees +/- 6.3 degrees), thus presenting a greater FHP (P < 0.001). Patients also had lesser neck mobility for all cervical movements, except for right lateral flexion (P < 0.01). There was a positive correlation between the cranio-vertebral angle and neck mobility. Within the CTTH group, a negative correlation was found between the cranio-vertebral angle and headache frequency, but neck mobility did not correlate with headache parameters. Further research is needed to define a potential role of FHP and restricted neck mobility in the origin or maintenance of TTH.     

治疗性运动对头前倾并发颈痛患者颈部功能和生活质量影响的Meta分析

目的 系统分析治疗性运动对头前倾并发颈痛患者颈部功能和生活质量的效果。方法 计算机检索PubMed、Web of Science、Embase、Medline、Science Direct、EBSCO、Springlink、中国知网、维普、万方数据库。文献类型为不同类型治疗性运动对头前倾并发颈痛患者颈部功能和生活质量的随机对照试验,检索时间为建库至2022年4月。由2名研究人员独立对文献进行筛选,研究人员采用Cochrane风险评估量表与物理治疗证据数据库量表进行文献质量评价,运用Revman 5.4软件进行Meta分析。结果 最终纳入11篇文献,共416例患者。1a级证据证明肩胛骨稳定性训练能有效改善头前倾并发颈痛患者头前倾角度(MD=3.62, 95%CI 2.41～4.83, P <0.001),减轻颈部疼痛(MD=1.32, 95%CI 0.18～2.46, P=0.02)。1b级证据证明肩胛骨稳定性训练可减轻功能残疾(MD=-0.92, 95%CI-1.11～-0.74, P <0.001);1b级证据证明颈深屈肌训练能改善头前倾角度(MD=-0.83, 95%C...     

Neck mobility and forward head posture are not related to headache parameters in chronic tension-type headache

The relationship between the changes in forward head posture (FHP), neck mobility and headache parameters was analysed in 25 patients with chronic tension-type headache (CTTH) undergoing a physical therapy programme. Side-view pictures were taken to measure the cranio-vertebral angle in the sitting and standing positions. A cervical goniometer was employed to measure the range of all cervical motions. A headache diary was kept to assess headache intensity, frequency and duration. All patients received six sessions of physical therapy over 3 weeks. Outcomes were assessed at baseline, after treatment and 1 month later. Neck mobility and headache parameters showed a significant improvement after the intervention, whereas posture changes did not reach statistical significance. No correlations were found between FHP, neck mobility and headache parameters at any stage. Changes in these outcomes throughout the study were not correlated either. FHP and neck mobility appear not to be related to headache intensity, duration or frequency in patients suffering from CTTH. Although patients showed a reduction in the range of motion in the neck, it is uncertain whether this is consistent with TTH.     

Myofascial trigger points, neck mobility and forward head posture in unilateral migraine

This paper describes the differences in the presence of myofascial trigger points (TrPs) in the upper trapezius, sternocleidomastoid, temporalis and suboccipital muscles between unilateral migraine subjects and healthy controls, and the differences in the presence of TrPs between the symptomatic side and the non-symptomatic side in migraine subjects. In addition, we assess the differences in the presence of both forward head posture (FHP) and active neck mobility between migraine subjects and healthy controls and the relationship between FHP and neck mobility. Twenty subjects with unilateral migraine without side-shift and 20 matched controls participated. TrPs were identified when there was a hypersensible tender spot in a palpable taut band, local twitch response elicited by the snapping palpation of the taut band and reproduction of the referred pain typical of each TrP. Side-view pictures were taken in both sitting and standing positions to measure the cranio-vertebral angle. A cervical goniometer was employed to measure neck mobility. Migraine subjects showed a significantly greater number of active TrPs (P<0.001), but not latent TrPs, than healthy controls. Active TrPs were mostly located ipsilateral to migraine headaches (P<0.01). Migraine subjects showed a smaller cranio-vertebral angle than controls (P<0.001), thus presenting a greater FHP. Neck mobility in migraine subjects was less than in controls only for extension (P=0.02) and the total range of motion in flexion/extension (P=0.01). However, there was a positive correlation between the cranio-vertebral angle and neck mobility. Nociceptive inputs from TrPs in head and neck muscles may produce continuous afferent bombardment of the trigeminal nerve nucleus caudalis and, thence, activation of the trigeminovascular system. Active TrPs located ipsilateral to migraine headaches might be a contributing factor in the initiation or perpetuation of migraine.     

Effects of sling-based manual therapy on cervicothoracic junction in patients with neck pain and forward head posture: A randomized clinical trial

ObjectiveThe purpose of this study was to investigate the effect of 4 weeks of sling-based manual therapy on the cervicothoracic junction (CTJ) area in patients with neck pain and forward head posture.DesignSingle-blind randomized controlled trial.SettingOutpatient, Chonbuk National University hospital, Republic of Korea.SubjectsA total of 22 participants with neck pain (Numeric Pain Rating Scale >3) and forward head posture (craniovertebral angle <51) were randomly assigned to a CTJ group or a control group (n = 11 each).InterventionIn the control group, joint mobilization and motor control training was applied for the upper cervical spine (C0–C1). The CTJ group applied the same intervention to the upper cervical spine and cervicothoracic junction (C7-T3).Main measuresNumeric pain rating scale and neck disability index, craniovertebral angle, active range of motion, and muscle activity were evaluated before and after 4 weeks of intervention.ResultThe CTJ group participants showed significant improvement in the craniovertebral angle and cervical extension range after the intervention than the control group (P = 0.025, P = 0.001). While both groups presented significant differences after the intervention regarding Numeric pain rating scale, neck disability index, and muscle activity (sternocleidomastoid and anterior scalene muscle), there were no statistically significant differences between the groups (P > 0.05).ConclusionOur results suggest that the CTJ and the upper cervical region in patients with neck pain and forward head posture represent an area which if approached by manual therapy, improves cervical mobility and posture.     

An ultrasonographic investigation of deep neck flexor muscles cross-sectional area in forward and normal head posture

Background

As one of the most common work-related musculoskeletal disorders and postural deviations, forward head posture (FHP), is considered to lead to muscle imbalance.

Quantitative measurements of forward head in college-aged students: A conformational study of intra-rater and inter-rater reliability of a novel Posture Measuring Device

IntroductionMedical professionals frequently encounter forward head postures (FHP) in the treatment of cervical spine pain. In the clinical setting, FHP measurements are often described subjectively using the phrase, “patient demonstrates forward head posture.” There are reliable tools that can objectively measure FHP, but they are not frequently used in the clinical setting on a regular basis because the tools are unavailable, inconvenient or overly time-consuming. The objective of this study was to confirm if FHP can be reliably measured using a novel posture-measuring device. The Posture Measuring Device (PMD) was designed to quickly obtain objective measurements of FHP in the outpatient clinical setting. A pilot study demonstrated good to excellent reliability in intra-rater (test-retest) measurements and good interrater reliability using two first-year Doctor of Physical Therapy Students as raters. This study is to confirm that the PMD is able to provide intra-rater and interrater reliability using two physical therapists and two second-year Doctor of Physical Therapy students to obtain FHP measurements.MethodsTwenty-three college-aged subjects were measured individually using a PMD by a panel of four raters consisting of two physical therapists and two second-year physical therapy students to develop interrater reliability. Each rater measured each subject twice on two separate occasions to obtain a measure of intra-rater (relative) reliability.ResultsPearson Correlations demonstrate high intra-rater correlation with inconsistent interrater correlation. The average measured Intraclass Correlation Coefficient (ICC) was .822 with a 95% confidence interval indicating a high degree of reliability between the eight measurements performed on each subject. Cronbach's alpha results confirm the ICC findings of strong correlation among the eight raters (α = 0.87).Discussion and conclusionObjective measurement of forward head posture is valuable to document and monitor patient response to treatment. This study identifies a convenient and time-efficient method for measuring forward head in the clinical setting. The PMD demonstrated a high degree of reliability in intra-rater measurements of FHP.