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ObjectivesTo systematically identify, synthesise and appraise studies on the measurement properties of patient reported outcome measures (PROMs) for anxiety, depression, fear of movement, pain catastrophizing, posttraumatic stress, self-efficacy, and stress in people with whiplash associated disorders (WAD).Study design and settingPsycINFO, Medline, EMBASE, CINAHL, PILOTS, Web of Science, and Scopus were searched (9 November, 2021). Studies evaluating any measurement property of relevant PROMs in WAD were included. Two reviewers independently screened the studies and assessed the measurement properties in accordance with the COSMIN guidelines.ResultsMeasurement properties of 10 PROMs were evaluated in WAD: Pictorial Fear of Activity Scale-Cervical (PFActS-C), Tampa Scale of Kinesiophobia – 11, Pain Catastrophizing Scale (PCS), Pain Self-efficacy Questionnaire (PSEQ), PSEQ-4 item, PSEQ-2a, PSEQ-2b, Self-Efficacy Scale, Harvard Trauma Questionnaire, and Posttraumatic Stress Diagnostic Scale. Content validity was not examined in any of these PROMs in whiplash. Moderate/high quality evidence showed adequate internal structure for the PSEQ, PCS and PFActS-C. Whereas, the original structures of the remaining seven PROMs were not confirmed in whiplash.ConclusionUntil further research on the measurement properties of these PROMs is available, researchers may opt to use the PSEQ, PCS or PFActS-C if the construct is aligned with research aims Objectives: The aim of this study was to systematically identify, synthesize, and appraise studies on the measurement properties of patient-reported outcome measures (PROMs) for anxiety, depression, fear of movement, pain catastrophizing, post-traumatic stress, self-efficacy, and stress in people with whiplash-associated disorders (WAD). Study Design and Setting: PsycINFO, MEDLINE, EMBASE, CINAHL, PILOTS, Web of Science, and Scopus were searched (November 9, 2021). Studies evaluating any measurement property of relevant PROMs in WAD were included. Two reviewers independently screened the studies and assessed the measurement properties in accordance with the COSMIN guidelines. Results: Measurement properties of 10 PROMs were evaluated in WAD: Pictorial Fear of Activity Scale-Cervical (PFActS-C), Tampa Scale of Kinesiophobia-11, Pain Catastrophizing Scale (PCS), Pain Self-Efficacy Questionnaire (PSEQ), PSEQ-4 item, PSEQ-2a, PSEQ-2b, Self-Efficacy Scale, Harvard Trauma Questionnaire, and Post-Traumatic Stress Diagnostic Scale. Content validity was not examined in any of these PROMs in whiplash. Moderate- or high-quality evidence showed adequate internal structure for the PSEQ, PCS, and PFActS-C, whereas the original structures of the remaining seven PROMs were not confirmed in whiplash. Conclusion: Until further research on the measurement properties of these PROMs is available, researchers may opt to use the PSEQ, PCS, or PFActS-C if the construct is aligned with research aims.

The Buffalo Concussion Treadmill Test (BCTT) was developed to identify potential physiological system impairment (PSI) underlying persistent symptoms post-mild traumatic brain injury (mTBI). This study evaluates PSI in individuals 4 weeks to 6 months post-mTBI using the BCTT "failure" criteria, and additional exploratory measures of test duration and heart rate (HR) response.Tertiary hospital and university.Participants included 73 individuals 4 weeks to 6 months post-mTBI and a comparison group of 39 healthy controls (HCs). The mTBI group was further subgrouped at screening into those considering themselves asymptomatic (Asymp mTBI) (n = 35) or symptomatic (Symp mTBI) (n = 36).Observational cohort study.BCTT; failure rate (%), test duration (minutes), HR responses.Thirty percent of the mTBI group (including 50% of the Symp and 9% of the Asymp subgroups) failed the BCTT. BCTT duration and associated overall HR change was significantly lower in the mTBI group and Symp subgroup compared with HCs. Compared with HCs maximal HR percentage was higher for the first 4 minutes of the test in the mTBI group, and for the first 2 minutes of the test for the Symp subgroup.Individuals post-mTBI demonstrated PSI impairment subacutely. In some individuals this was despite an initially reported absence of symptoms. The study also showed some preliminary evidence that BCTT duration and HR responses may be additionally informative post-mTBI.

To determine reference values, including the appropriate number of repetitions, and test-retest reliability of the torsion and conventional cervical joint position sense (JPS) tests.Phase 1) Cross-sectional design to determine reference values and the appropriate number of repetitions; Phase 2) repeated-measures concordance design (test-retest reliability). Sixty-eight healthy participants performed 10 repetitions of randomized rotation left and right for both cervical JPS tests using a laser projected onto a target. Thirty participants returned for the same evaluation process one week later.The age-stratified reference values for the torsion JPS test showed greater absolute error as age increased. Stable levels of performance were obtained with 6-7 repetitions for both tests. Moderate to good reliability was found with 7 or more repetitions for left rotation [Torsion JPS test, Intraclass Correlation Coefficient (ICC; 95% CI) = 0.85 (0.68-0.93); Conventional JPS test, ICC = 0.78 (0.53-0.89)], and 6-7 or more repetitions for right rotation [Torsion JPS test, 6 repetitions, ICC = 0.79 (0.56-0.90); Conventional JPS test, 7 repetitions, ICC = 0.82 (0.61-0.91)]. Standard Error of Measurement (SEM) and Minimal Detectable Change (MDC) stabilized at 7 repetitions in both tests [Torsion JPS test (SEM ≤ 1.0°; MDCThe reference values generated for the torsion JPS test may help identify the presence of impairments cervical proprioception. At least 7 repetitions optimize stability, reliability and responsiveness in the torsion and conventional cervical JPS tests.

Local neck treatments and sensorimotor training can improve cervical proprioception and balance, but it remains unclear what treatments and treatment combination achieve the best outcomes.To investigate the most effective interventions to improve disturbances in joint position sense (JPS) and balance and their effects on neck pain, dizziness and related features in the short- and long-terms.2x2 factorial, randomized controlled trial.Participants with neck pain (n = 152) were randomly allocated to one of four intervention groups: i) local neck treatment (NT), ii) NT + JPS/oculomotor exercises (JPS/OC), iii) NT + balance exercises, and iv) all treatments. Participants received 12 treatments over 6 weeks. Primary outcomes were postural sway and joint position error. Secondary outcomes included gait speed, dizziness, pain intensity and disability, cervical range of motion, functional ability, and quality of life. Outcome measures were taken at baseline, posttreatment and 3-, 6- and 12-month follow-ups.All four interventions resulted in short- and long-term improvements in primary and secondary outcomes with medium to large effect sizes, but JPS and balance in neck torsion improved most with the addition of a combined program of JPS/OC + balance exercises to NT while balance in neck neutral improved most with the addition of balance exercises. Adding sensorimotor training was also more effective in maintaining levels of improvement in neck pain and disability at 6- and 12-months. Effect sizes of additional treatment benefits were medium to large.Adding specific training of JPS/OC and balance to NT best addresses deficits in cervical proprioception and balance.xxxxx.

Scapular dyskinesis is often observed in patients with neck pain. However, it is unknown whether clavicular, scapular and spinal kinematics vary with different types of scapular dyskinesis during arm movement.Are there differences in clavicular, scapular and spinal kinematics during unilateral arm elevation and lowering among neck pain patients presenting with (i) scapular winging, (ii) with dysrhythmia, (iii) with no scapular abnormality and (iv) healthy controls?Sixty participants with neck pain (20 in each group) and 20 asymptomatic controls were recruited. The 3D kinematic data were measured during unilateral arm elevation and lowering at 30°, 60°, 90°, and 120° in the scapular plane. A three-way mixed-effects ANOVA was used to determine the main effects (group, phase and angle) and the interactions between three independent variables on the kinematic data.The neck pain group with scapular winging had decreased clavicular retraction and increased scapular internal rotation and anterior tilt compared to the other neck pain and control groups at all angles during both phases of arm movement (p 0.01). The neck pain group with scapular dysrhythmia had decreased scapular upward rotation compared to all other groups (p 0.01). Some alterations in the kinematics existed during the lowering phase compared to the raising phase for all groups (p 0.05). Spinal kinematics were similar across all groups (p 0.05).Specific patterns of clavicular and scapular kinematics were identified during arm movement relevant to the type of observed scapular dyskinesis in patients with neck pain. Such findings stand to inform more precise and relevant motor training in rehabilitation and improve understanding of the association between altered scapular kinematics and neck pain.

Cervical arterial dissection (CeAD) is a serious condition that can mimic a musculoskeletal condition. A diagnostic tool using five key criteria could help prompt early medical referral, but these criteria may occur in healthy people or benign neck pain/headache. To determine the frequency of CeAD criteria in healthy individuals and those with neck pain/headache, and identify refinements needed to improve specificity. An interview and neurological screen to identify the presence of the five criteria was conducted. Definitions were refined and the frequency of the modified criteria in each individual was determined. The criteria were re-administered using data from 37 CeAD cases of the derivation cohort, to examine how the modifications impact sensitivity of the tool. One hundred healthy and 20 participants with neck pain/headache were interviewed. Most participants had ≤ 2 criteria, mainly age or trauma, 3% had 3 criteria, but had migraine or resolving symptoms. None had >3. Modifications to definitions were needed to improve potential specificity of the tool (96.7%). Changes did not impact sensitivity of the tool (81%). Further refinements may be required. Strictly defined CeAD criteria may assist in identifying when to refer, when to wait and monitor, or when management can proceed. Trialing the tool in those with migraine and in emergency departments to calculate risk scores is recommended.

Bite is an important function of the human stomatognathic system. Despite this, it is commonly impaired in temporomandibular disorder (TMD) populations. The aim of this review is to evaluate the effectiveness of conservative interventions on self-reported and physical measures of bite function in individuals with TMD.This review was performed in compliance with PRISMA guidelines. An electronic search was performed on databases including PubMed, CINAHL, Embase, and Cochrane Central. Inclusion criteria were journal articles evaluating the effect of any non-pharmacological conservative interventions on bite function in participants diagnosed with TMD. Risk of bias for individual studies was assessed using the Cochrane risk-of-bias v2 tool, and the NIH NHLBI pre-post tool. Data was synthesised based on outcome measures of bite function, and the quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach.Eleven studies were eligible for this review. Interventions included splinting, photobiomodulation, needling, exercise, manual therapy, and patient education, which were evaluated using mastication-related pain, self-reported chewing difficulty, and bite force/endurance outcome measures. Findings suggested manual therapy, needling, oral splinting, exercise, and PBM interventions may improve bite function in TMD, although confidence in cumulative evidence ranged from moderate to very low. There was no evidence that patient education improved bite function.Conservative interventions may be helpful to address bite-related impairments associated with TMD, although further research is needed to improve the quality of evidence and direct clinical guidelines.

Clavicular and scapular orientations vary between neck pain patients as do clinical features and responses (changes in pain and rotation range) to scapular repositioning. Associations between these factors are unknown.To identify subgroups of neck pain patients based on three-dimensional (3D) measures of clavicular and scapular orientations and differences between subgroups in clinical characteristics and responses to scapular repositioning.Cross-sectional study.Eligible participants were recruited as part of a larger study. The 3D clavicular and scapular orientations were analyzed on the more painful side of the neck using a hierarchical cluster analysis. Clinical characteristics were neck pain location, intensity, duration, disability and presence of headache. Responses to scapular repositioning were classified as "yes and no".Fifty-eight participants (29 responsive; 29 non-responsive to scapular repositioning) participated in the study. Analysis identified two distinct subgroups: subgroup1 had greater clavicular retraction and scapular downward rotation (n = 26) and subgroup2 had greater clavicular elevation and scapular internal rotation and anterior tilt (n = 32). Headache and dominant pain in the upper neck were more frequent in subgroup 1 while dominant pain in the lower neck was frequent in subgroup 2 (p 0.01). Most participants who responded positively to scapular repositioning (88.5%) were in subgroup1 and most non-responsive participants (81.2%) in subgroup2.The 3D clavicular and scapular orientations identified two subgroups of neck pain patients. Participants with predominantly downward scapular rotation were distinguished by pain in the upper neck, presence of headache and a positive response to scapular repositioning.

ObjectiveTo investigate the frequency and clinical aspects of patients with neck pain who responded and did not respond to scapular repositioning and to determine the clinical features associated with a positive response.DesignCross-sectional study.SettingResearch unit, Department of Physical Therapy, Chiang Mai University.ParticipantsVolunteers with non-specific neck pain aged 18–59 years were recruited between May 2020 and February 2021 from hospitals, clinics, university and community.Outcome measuresClinical data documented were neck pain (intensity, duration and disability), the presence of headache, type of scapular dysfunction, cervical musculoskeletal impairment (range of motion (ROM), flexion rotation test (FRT) and location of any symptomatic cervical joint dysfunction), upper limb functional limitation and self-reported disability. Manual scapular repositioning was performed on the side of neck pain. Participants were categorised as responsive or non-responsive based on a change in pain and/or cervical rotation range.ResultsA total of 219 people with neck pain responded to advertisements, of which 144 were eligible. Of the eligible participants, 107 (74.3%) demonstrated a clinically relevant improvement in either neck pain or rotation range or both following the scapular repositioning and 37 (25.7%) had no relevant improvement. The responsive group had a high incidence of scapular downward rotation, greater neck pain intensity, headache and cervical musculoskeletal impairment (reduced ROM, positive FRT and symptomatic C1-3 dysfunction) compared with the non-responsive group (pConclusionAlmost 75% of neck pain patients with altered scapular alignment responded to scapular repositioning. The predominance of upper cervical dysfunction with a downwardly rotated scapular in this group suggests a role of poor axioscapular muscle function which might benefit from rehabilitation.

IntroductionMusculoskeletal (MSK) conditions constitute the highest burden of disease globally, with healthcare services often utilised inappropriately and overburdened. The aim of this trial is to evaluate the effectiveness of a novel clinical PAthway of CarE programme (PACE programme), where care is provided based on people’s risk of poor outcome.Methods and analysisMulticentre randomised controlled trial. 716 people with MSK conditions (low back pain, neck pain or knee osteoarthritis) will be recruited in primary care. They will be stratified for risk of a poor outcome (low risk/high risk) using the Short Form Örebro Musculoskeletal Pain Screening Questionnaire (SF-ÖMSPQ) then randomised to usual care (n=358) or the PACE programme (n=358). Participants at low risk in the PACE programme will receive up to 3 sessions of guideline based care from their primary healthcare professional (HCP) supported by a custom designed website (mypainhub.com). Those at high risk will be referred to an allied health MSK specialist who will conduct a comprehensive patient-centred assessment then liaise with the primary HCP to determine further care. Primary outcome (SF 12-item PCS) and secondary outcomes (eg, pain self-efficacy, psychological health) will be collected at baseline, 3, 6 and 12 months. Cost-effectiveness will be measured as cost per quality-adjusted life-year gained. Health economic analysis will include direct and indirect costs. Analyses will be conducted on an intention-to-treat basis. Primary and secondary outcomes will be analysed independently, using generalised linear models. Qualitative and mixed-methods studies embedded within the trial will evaluate patient experience, health professional practice and interprofessional collaboration.Ethics and disseminationEthics approval has been received from the following Human Research Ethics Committees: The University of Sydney (2018/926), The University of Queensland (2019000700/2018/926), University of Melbourne (1954239), Curtin University (HRE2019-0263) and Northern Sydney Local Health District (2019/ETH03632). Dissemination of findings will occur via peer-reviewed publications, conference presentations and social media.Trial registration numberACTRN12619000871145.

Clinicians seek to identify associations between pain behaviours to understand if symptoms are related or separate conditions. This study determined whether the temporal behaviour of migraine related neck pain related to i) the presence of cervical musculoskeletal function or ii) migraine hypersensitivity.Cross-sectional study of migraineurs with neck pain (n = 110). Participants reported daily for one month via an online survey, on migraine and other headaches, neck symptoms, location of onset and self-identified triggers. Allodynia Symptom Checklist (ASC12), Pressure pain thresholds (PPTs), and presence or absence of cervical musculoskeletal dysfunction were also assessed.The temporal behaviours of neck pain in 92 participants (46 migraine only, 46 migraine plus another headache) were categorised as: i) ictal only (n = 42), ii) ictal and infrequent interictal (n = 26), iii) ictal and frequent interictal (n = 17), and iv) undecipherable (n = 7). Cervical musculoskeletal dysfunction was present in 43%. Temporal behaviours of neck pain were not associated with cervical musculoskeletal dysfunction (p = 1.00 and 0.21), nor related to ASC12, PPTs, headache triggers, neck pain, nor region of symptom onset, whether migraine only or migraine and another headache was reported (p = 0.29 to 0.97).Individuals with migraine present with varied behaviours of neck pain in relation to the headache. As temporal behaviour is not informative, a physical examination is needed to negate or confirm a cervical source of neck pain in migraine.

The pathophysiology of concussion is complex. Altered sensorimotor function post-concussion may contribute to the wide range of symptoms and impairments reported. There is currently limited evidence documenting changes in sensorimotor function during the recovery period. The aim of this study was to investigate the effect of concussion on the sensorimotor system in adolescents post-concussion using a multifaceted approach.Prospective nested case-control study.A total of 285 male adolescent rugby players underwent assessment of sensorimotor function during preseason. Players who sustained a concussion during the season and control players, matched for age and playing position, were assessed in the subacute period (3-5 days) and after return-to-sport (3 weeks). Tests of sensorimotor function included balance, cervical spine and vestibulo-ocular function, and measurement of the size and contraction of lumbopelvic muscles (ultrasound imaging).Twenty-three players (8%) sustained a concussion. Of these, 20 players were assessed during the subacute period and 17 players following return-to-sport. The prevalence of vestibulo-ocular dysfunction increased from 38.9% to 72.2% during the subacute period and dysfunction was present in 83.3% of players after return-to-sport (p = 0.01). Changes in lumbar multifidus muscle size (p = 0.002) and thickness (p = 0.05) at the L5 vertebral level were observed. No statistically significant changes in balance, cervical spine proprioception, or contraction of lumbopelvic muscles were found (p 0.05).Changes in sensorimotor function were observed in the subacute period post-concussion, with some persisting after return-to-sport. Using symptom-based criteria for return-to-sport may not adequately reflect the sequelae of concussion on the sensorimotor system.

BACKGROUND Clinically relevant scores of neck disability have been observed in adults post mild traumatic brain injury (mTBI), even in those who initially report to be recovered. Potentially cervical musculoskeletal and/or cervical sensorimotor impairments may underlie these persistent symptoms post mTBI. OBJECTIVE To determine whether cervical impairments exist beyond expected recovery times following concussion compared to healthy controls (HC). STUDY DESIGN Observational cohort study. METHODS Participants aged 18-60 years consisting of 39 HC, and 72 individuals, 4 weeks to 6 months post mTBI of which 35 considered themselves asymptomatic (Asymp), and 37 symptomatic (Symp). Cervical outcome measures included range and velocity of motion, flexor muscle endurance, presence of at least one dysfunctional cervical joint, joint position error -neutral and torsion, movement accuracy, smooth pursuit neck torsion test (SPNT) and balance. RESULTS Individuals in the Symp mTBI group demonstrated significantly reduced: flexion and rotation range, rotation velocity, flexor endurance and movement accuracy as well as increased postural sway and a higher percentage had positive cervical joint dysfunction (p

To compare neck, trunk, and lower extremity muscle activity in standing in persons with neck pain (NP) to healthy controls and determine associations with postural sway.Participants included 25 persons with NP and 25 controls. Surface electromyography was recorded bilaterally from neck (sternocleidomastoid, SCM; splenius capitis, SC; upper trapezius, UT), trunk (erector spinae, ES), and lower extremity (rectus femoris, RF; biceps femoris, BF; tibialis anterior, TA; medial gastrocnemius, GN) muscles. Postural sway was measured using a force platform in narrow stance with eyes open/closed, on firm/soft surfaces.Compared to controls, the NP group demonstrated higher activity in all muscles, except UT and had higher amplitude ratios for neck muscles (SCM, SC) for all tasks (p .05). No between-group difference was found in amplitude ratios for lower extremity muscles, except for GN. Lower extremity activity was moderately correlated with larger postural sway for both groups (r = 0.41-0.66, p .05). There were no correlations between sway and neck and trunk muscle activity (p .05).Increased muscle activity with NP is associated with increased postural sway. Both groups used similar postural control strategies, but the increased neck activity in the NP group is likely related to the NP disorder rather than postural instability.