Exploring the Clinical Course of Neck Pain in Physical Therapy: A Longitudinal Study

Objective

To investigate the short-term trajectory of recovery from mechanical neck pain, and predictors of trajectory.

Design

Prospective, longitudinal cohort study with 5 repeated measurements over 4 weeks.

Setting

Community-based physical therapy clinics.

Participants

Convenience sample of community-dwelling adults (N=50) with uncomplicated mechanical neck disorders of any duration.

Interventions

Usual physical therapy care.

Main Outcome Measures

Neck Disability Index (NDI), numeric rating scale (NRS) of pain intensity.

Results

A total of 50 consecutive subjects provided 5 data points over 4 weeks. Exploratory modeling using latent class growth analysis revealed a linear trend in improvement, at a mean of 1.5 NDI points and 0.5 NRS points per week. Within the NDI trajectory, 3 latent classes were identified, each with a unique trend: worsening (14.5%), rapid improvement (19.6%), and slow improvement (65.8%). Within the NRS trajectory, 2 unique trends were identified: stable (48.0%) and improving (52.0%). Predictors of trajectory class suggest that it may be possible to predict the trajectory. Results are described in view of the sample size.

Conclusions

The mean trajectory of improvement in neck pain adequately fits a linear model and suggests slow but stable improvement over the short term. However, up to 3 different trajectories have been identified that suggest neck pain, and recovery thereof, is not homogenous. This may hold value for the design of clinical trials.     

Short Term Effects of Classic Massage Compared to Connective Tissue Massage on Pressure Pain Threshold and Muscle Relaxation Response in Women With Chronic Neck Pain: A Preliminary Study

Objective

The purpose of this study was to evaluate the short-term effects of classic massage (CM) and connective tissue massage (CTM) on pressure pain threshold and muscle relaxation response in women with chronic neck pain.

Methods

Participants included 45 female volunteers (ages between 25 and 45 years) presenting to the Köroglu State Hospital Neurosurgery Polyclinic who had experienced neck pain for 3 to 6 months. The volunteers were randomly assigned to 2 groups (CM or CTM to the thoracic spine and the neck). Each treatment was carried out for 1 session. Outcome measures were obtained before and after treatment, which included pressure pain threshold that was measured with an algometer and muscle relaxation response that was evaluated with electromyography biofeedback (EMG-BF).

Results

Pressure pain threshold of the sternocleidomastoid muscle was significantly different for the CM (P < .05) group. The EMG-BF values were significantly different for the CTM group (P < .05). Comparing the results of CM and CTM, EMG-BF averages favored the CTM group (P < .05).

Conclusion

For the group of women with chronic neck pain that were included in this study, 1 treatment of CTM demonstrated relaxation responses and 1 treatment of CM demonstrated pain reduction.     

Exploring Patient Satisfaction: A Secondary Analysis of a Randomized Clinical Trial of Spinal Manipulation,Home Exercise,and Medication for Acute and Subacute Neck Pain

Objective

The purpose of this study was to assess satisfaction with specific aspects of care for acute neck pain and explore the relationship between satisfaction with care, neck pain, and global satisfaction.

Methods

This study was a secondary analysis of patient satisfaction from a randomized trial of spinal manipulation therapy (SMT) delivered by doctors of chiropractic, home exercise and advice (HEA) delivered by exercise therapists, and medication (MED) prescribed by a medical doctors for acute/subacute neck pain. Differences in satisfaction with specific aspects of care were analyzed using a linear mixed model. The relationship between specific aspects of care and (1) change in neck pain (primary outcome of the randomized trial) and (2) global satisfaction were assessed using Pearson's correlation and multiple linear regression.

Results

Individuals receiving SMT or HEA were more satisfied with the information and general care received than MED group participants. Spinal manipulation therapy and HEA groups reported similar satisfaction with information provided during treatment; however, the SMT group was more satisfied with general care. Satisfaction with general care (r = − 0.75 to − 0.77; R² = 0.55-0.56) had a stronger relationship with global satisfaction compared with satisfaction with information provided (r = − 0.65 to 0.67; R² = 0.39-0.46). The relationship between satisfaction with care and neck pain was weak (r = 0.17-0.38; R² = 0.08-0.21).

Conclusions

Individuals with acute/subacute neck pain were more satisfied with specific aspects of care received during spinal manipulation therapy or home exercise interventions compared to receiving medication. The relationship between neck pain and satisfaction with care was weak.     

腹腔镜辅助逆行法胰颈体尾脾切除术

目的:探讨腹腔镜辅助逆行法胰体尾脾切除术的手术方法及适应证。方法:总结分析2010年5月至2012年10月为8例胰颈体恶性肿瘤患者行腹腔镜辅助逆行胰颈体尾脾切除术的临床资料,肿瘤侵犯周围重要血管,术前经增强CT、MR充分评估,肿瘤左侧胰体尾脾界清,无远处转移。术中腹腔镜完全游离肿瘤左侧胰体尾脾,再于上腹正中做8～10 cm切口,直视下处理胰颈肿瘤与周围重要血管的侵犯、粘连,于门静脉右侧缘离断胰颈部,完整切除、取出胰体尾脾。结果:8例均顺利完成腹腔镜辅助手术,手术时间100～180 min,术中出血量100～200 ml,术后患者恢复顺利。结论:腹腔镜辅助逆行法胰颈体尾脾切除术可作为侵犯周围重要血管但左侧胰体尾界清的胰颈体肿瘤的选择术式,具有患者创伤小、康复快、安全可行等优点。     

Detecting relevant changes and responsiveness of Neck Pain and Disability Scale and Neck Disability Index

Purpose

To investigate relevant change on the Neck Pain and Disability Scale (NPAD) and Neck Disability Index (NDI) and which questionnaire is the most responsive in patients with non-specific chronic neck pain (CNP).

Methods

Seventy-six patients with non-specific CNP in an outpatient tertiary rehabilitation setting were dichotomized into “improved” and “stable” based on global perceived effect (GPE) scores. To investigate relevant change minimal detectable change (MDC) and minimal important change (MIC) with the receiver operator characteristic (ROC) cut-off point were assessed. Comparison of responsiveness was performed using areas under the ROC curve (AUC) and correlations between change scores of NPAD and NDI, and GPE.

Results

MDC and MIC on NPAD (scale 0–100) were 31.7 and 11.5 points, respectively. MDC and MIC on NDI (scale 0–50) were 8.4 and 3.5 points, respectively. Changes should exceed this MDC or MIC cut-off to be interpreted as relevant. AUC was 0.75 for both NPAD and NDI. Correlations between change scores of NPAD and NDI, and GPE were, respectively, 0.48 (95 % CI 0.29–0.64) and 0.49 (95 % CI 0.30–0.64).

Conclusions

Relevant change on both NPAD and NDI assessed with MDC and MIC resulted in different cut-offs and consequently with different amounts of certainty that the patient is improved. Responsiveness of NPAD and NDI was similar.     

Health related quality of life and patient concerns in patients with osteoradionecrosis

The number of patients presenting with osteoradionecrosis (ORN) is likely to increase in future and health related quality of life (HRQOL) is a key outcome. This study aimed to report patient concerns and HRQOL in an osteoradionecrosis cohort over 12 years. Patients attended routine follow-up clinics between 2008 to 2020, where patient reported outcome (PRO) assessment was used before consultations as standard practice. The two PROs were the Patient Concerns Inventory (PCI) and the University of Washington quality of life questionnaire (UW-QOL v4). The study sample comprised 109 patients with ORN seen in 445 clinics when PCI and UW-QOL were used. At clinic, patients were in one of six ORN states: before ORN (26 with data), at diagnosis (12), and following treatment either improved (27), progressed (46), stable (63) or resolved (37). Worst HRQOL outcomes were reported in the progressive group with 50% reporting overall QOL as less than good. Pain was a major dysfunction (63%) as was physical and social-emotional functioning and this group reported many PCI issues, median (IQR) 7 (4-11). Kaplan-Meier estimates of survival with 95% CI after diagnosis with ORN were 96% (90-99%) at 12 months, 89% (81-94%) at 24 months and 73% (61-82%) at 60 months. This study indicates that ORN is a chronic condition with long-term survivorship consequences. More data through cohort studies and trials are needed to assist in decision making for individual patients.     

Head and neck cancer in the south west of England,Hampshire, and the Isle of Wight: trends in survival 1996–2008

There are reasons why survival may have improved in people with head and neck cancer, but few studies have reported on trends in the UK, and results are not consistent. We examined recent trends in survival for people diagnosed with head and neck cancer in the south west of England. Patients were identified over four one-year audits in a population (roughly 6.5 million) served by five cancer networks, and the work was collated by the South West Public Health Observatory (SWPHO) tumour panel. The SWPHO cancer registry provided data on death. Prognostic data, including stage, time to treatment, and deprivation index were extracted or derived from clinical records. A total of 2164 cases of oral, laryngeal, and pharyngeal squamous cell carcinomas (SCC) were diagnosed. Crude total 5-year mortality decreased from 55% (95% CI 50.3–59.4) in people diagnosed in 1996 to 44% (95% CI 37.9–46.4) in those diagnosed in 2003 (p < 0.001). Adjusted hazard ratios (HRs) for death within five years of diagnosis for surveys 2, 3, and 4 (compared with survey 1), respectively, were reduced in subsequent groups: HR 0.79 (95% CI 0.64–0.98), HR 0.70 (95% CI 0.56–0.87), and HR 0.72 (95% CI 0.58–0.90) (chi square for trend, p < 0.001). Improvements over time were most pronounced among those with late-stage disease and with pharyngeal tumours. We have shown that survival has improved for people with head and neck cancer. Further large prospective studies are required to understand how quality of care, treatment, aetiology of tumour, individual risk, and behaviour contribute to survival.     

Co-activation of jaw and neck muscles during submaximum clenching in the supine position

Objective

The purpose of this study was to test the hypothesis that jaw clenching induces co-contraction and low-level long-lasting tonic activation (LLTA) of neck muscles in the supine position.

Design

Ten healthy subjects developed various feedback-controlled submaximum bite forces in different bite-force directions in supine position. The electromyographic (EMG) activity of the semispinalis capitis, semispinalis cervicis, multifidi, splenius capitis, levator scapulae, trapezius, sternocleidomastoideus, masseter and infra/supra-hyoidal muscles was recorded. For normalization of EMG data, maximum-effort tasks of the neck muscles were performed.

Results

Co-contractions of the posterior neck muscles varied between 2% and 11% of their maximum voluntary contraction. Different bite forces and bite-force directions resulted in significant (p < .05) activity differences between the co-contraction levels of the neck muscles. In addition, LLTA of specific neck muscles, provoked by the jaw clenching tasks, was observed.

Conclusions

This study demonstrated for the first time moderate co-contractions of jaw and neck muscles in the supine position under controlled submaximum jaw clenching forces. LLTA of most neck muscles was observed, outlasting clenching episodes and indicating an additional neuromuscular interaction between the two muscle groups.     

淋巴结活检术在HIV/AIDS合并颈部淋巴结核诊断中的应用

目的探讨HIV/AIDS合并颈部淋巴结核的临床特点以及淋巴结活检术在HIV/AIDS合并颈部淋巴结核诊断中的应用价值。方法回顾性分析168例颈部淋巴结肿大的艾μ病患者的淋巴结活检组织切片、临床资料、影像资料、T淋巴细胞亚群、切口分泌物细菌涂片及培养。结果经外科手术获得的168例标本,经病理诊断102例淋巴结结核,其中CD4+P<100个/μL组淋巴结核阳性率较其他组别增高(χ2=5.44,<0.05)。168例患者共发生切口感染4例,窦道形成2例,切口分泌物以结核杆菌为主。所有患者均无食管、气管损伤等重大并发症。结论淋巴结活检术是确诊HIV/AIDS合并颈部淋巴结核的主要方法。     

细针穿刺细胞学检查在门诊诊断儿童颈部肿块的应用价值

目的 探讨细针穿刺细胞学检查（fine needle aspiration cytology,FNAC）在儿童颈部肿块诊断的应用价值.方法 总结296例小儿颈部肿块,门诊行细针穿刺后进行细胞学病理诊断.结果 296例病例中,成功作出诊断的有268例,约占88.2％,其中淋巴结反应性增生248例,恶性淋巴瘤6例,梭形细胞肿瘤5例,唾腺来源肿瘤2例,腮裂囊肿2例,甲状舌管囊肿1例,传染性单核细胞增多症1例,颈部淋巴结结核1例,血管瘤1例,钙化上皮瘤1例,33例不能肯定诊断,建议手术活检,最终有11例接受手术,均为淋巴结炎,其余随访.结论 FNAC在儿童颈部疾病诊断中有重要意义,具有快速、便捷、经济、安全、准确的优点,特别适合性质不明的肿块筛查.