Thursday, February 19, 2009

Clinimetric evaluation of methods to measure muscle functioning in patients with non-specific neck pain


Panjabi et al estimated that the neck musculature contributes about 80% to the mechanical stability of the cervical spine, while the osseoligamentous system contributes the remaining 20%.
Evidences suggest that patients with neck pain have
1. Reduced maximal isometric neck strength and endurance capacity.
2. Further in patients with chronic neck pain jerky and irregular cervical movements and poor position sense acuity have been found.

Exercises are commonly used to improve neck muscle function and thereby decrease pain or other symptoms. Evaluating the progress of neck muscle function during treatment requires tests which can be carried out easily and meet certain standards for clinimetric properties.

Chantal HP de Koning et al of Netherlands did a review to provide information for researchers and clinicians to facilitate choices amongst existing instruments to measure neck muscle functioning in patients with neck pain. Following are their conclusions:

1. The choice of a test (or instrument) depends on the kind of muscle function to be evaluated.
2. The muscle endurance of the short neck flexors and the cervical PILE test were found to have sufficient reliability.

They recommend using the muscle endurance for short neck flexors, that is patients are instructed to raise their head in a crook-lying position with monitoring of the chin tuck by the musculoskeletal practitioner, and using the cervical PILE test as a performance test.

What is PILE test: PILE is the short form of progressive iso-inertial lifting evaluation (PILE) test.
About the research carried out by Chantal HP de Koning et al:
Chantal HP de Koning et al did a critical analysis of the research literature on the clinimetric properties of tests to measure neck muscle strength or endurance in patients with non-specific neck pain, which can be used in daily practice.
How they did it?
They did a literature search of Medline, CINAHL and Embase databases from 1980 to January 2007. Two reviewers independently assessed the clinimetric properties of identified measurement methods, using a checklist of generally accepted criteria for reproducibility (inter- and intra-observer reliability and agreement), construct validity, responsiveness and feasibility.
The search identified a total of 16 studies.
What are clinimetric tests: The tests that measure something in clinical settings. In this particular instance i.e. in this paper by Chantal HP de Koning et al cervical muscle function tests are discussed.
The instruments or tests included were:
1. muscle endurance tests for short neck flexors,
2. craniocervical flexion test with an inflatable pressure biofeedback unit,
3. manual muscle testing of neck musculature,
4. dynamometry
5. functional lifting tests (the cervical progressive iso-inertial lifting evaluation (PILE) test and the timed weighted overhead test).

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