A meta-analysis and systematic review of changes in joint position sense and static standing balance in patients with whiplash-associated disorder

Abstract

Objective To synthesise and analyse the current evidence regarding changes in joint position sense (JPS) and standing balance in people with whiplash-associated disorder (WAD) taking the presence or absence of dizziness into account. Data sources PubMed, CINAHL Plus, Web of Science, Embase, MEDLINE and APA PsycINFO were searched by two independent reviewers from inception until August 2020 and reference lists of all included studies were also reviewed. Study selection Only cross-sectional studies that measured JPS and/or standing balance between people with WAD vs. healthy controls (HC) or people with WAD complaining of dizziness (WADD) vs. those not complaining of dizziness (WADND) were selected. Data extraction Relevant data were extracted using specific checklists and quality assessment was performed using Downs and Black Scale (modified version). Data synthesis Twenty-six studies were included. For JPS, data were synthesized for absolute error in the primary plane of movement for separate movement directions. For standing balance, data were synthesized for traditional time- and frequency domain sway parameters considering the conditions of eyes open (EO) and eyes closed (EC) separately. For meta-analysis, reduced JPS was observed in people with WAD compared to HC when the head was repositioned to a neutral head position (NHP) from rotation (standardised mean difference [SMD] = 0.43 [95%: 0.24–0.62]) and extension (0.33 [95%CI: 0.08–0.58]) or when the head was moved toward 50° rotation from a NHP (0.50 [0.05–0.96]). Similarly, people with WADD had reduced JPS compared to people with WADND when the head was repositioned to a NHP from rotation (0.52 [0.22–0.82]). Larger sway velocity and amplitude was found in people with WAD compared to HC for both EO (0.62 [0.37–0.88] and 0.78 [0.56–0.99], respectively) and EC (0.69 [0.46–0.91] and 0.80 [0.58–1.02]) conditions. Conclusion The observed changes of JPS and standing balance confirms deficits in sensorimotor control in people with WAD and especially in those with dizziness.

A network analysis reveals the interaction between fear and physical features in people with neck pain

“…In addition to kinematic features and strength, higher fear of movement was also associated with poorer proprioception (larger joint position error). However, findings for this relationship, as well as on the clinical utility of sensorimotor tests in people with neck pain, are not consistent across the literature 17 , 45 . In this regard, the structure of a network may reveal the existence of interactions across features able to impact their assessment.…”

“…It has been shown that fear of movement mediates the relationships among catastrophizing, pain intensity, and disability in people with neck pain 8 , 9 , yet any interactions with movement avoidance and deconditioning are less clear 10 , 11 . Besides changes in physical activity levels, people with neck pain often present with several specific changes in physical function including reduced range and speed of movement 12 , 13 , altered variability and smoothness of movement 14 , 15 , impaired proprioception 16 , 17 , and reduced neck muscle strength 18 , 19 , which potentially could all be influenced by fear of movement.…”

Assessment of Neuromuscular and Psychological Function in People with Recurrent Neck Pain during a Period of Remission: Cross-Sectional and Longitudinal Analyses

“…This finding was also observed in previous studies of patients with persistent WAD, who have similar pain intensity to the cohort tested in the current study [ 92 , 93 , 94 ]. A recent meta-analysis, found that patients with chronic WAD have significant larger JPE following cervical rotation when compared to healthy controls, but there is a discrepancy between studies [ 16 ]. Such discrepancies could be attributed to various factors.…”

“…Altered neuromuscular function is a common feature in patients with acute and CNP including those that have sustained a whiplash injury [ 12 , 13 , 14 ]. These changes include disturbances in muscle strength, muscle behaviour and proprioception [ 15 , 16 , 17 , 18 ]. Additionally, restricted neck range of motion (RoM), as a static measure of movement, has been extensively documented for patients with neck pain of both traumatic and idiopathic origin [ 19 , 20 ].…”

Are Measures of Physical Function of the Neck Region Associated With Poor Prognosis Following a Whiplash Trauma?

“…15,16 This includes increased activation of the superficial neck flexors, 17 reduced maximum angular velocity of neck movements, 15,16 and reduced smoothness of neck movement. 16 Moreover, other changes such as increased repositioning error, 18 reduced conjunct motion, 19 and changes in deep neck muscle activation 20 have also been observed in patients with chronic WAD. Of relevance, studies in acute WAD have revealed early changes in motor behavior 17 that may persist even after the acute phase 17,20 suggesting that these factors could play a role in the transition to chronicity.…”