Intra and interrater reliability and clinical feasibility of a simple measure of cervical movement sense in patients with neck pain

Abstract

BackgroundPattern tracing tasks can be used to assess cervical spine movement sense (CMS). A simple clinical measure of CMS (tracing fixed figure-of-eight (F8) and zigzag (ZZ) patterns with a head mounted laser) has been proposed and assessed in asymptomatic subjects. It is important to determine if examiner ratings of the traces are reliable and feasible for clinical use in those with neck pain. We therefore examined the intra- and inter-rater reliability of rating video recordings of the CMS tasks, and the feasibility of undertaking the tests in clinic by comparing slow motion versus real-time video ratings.MethodsCross-sectional study examining neck pain subjects from a physiotherapy clinic. F8 and ZZ patterns traced with a head-mounted laser pointer at two velocities (accurate; accurate & fast) were videoed and later examined. Time (total time taken to complete the pattern), error frequency (number of deviations) and error magnitude (sum of deviations multiplied by distance from the central line) were measured. Two assessors independently evaluated the laser tracing videos in slow motion; a third rated the videos in real time. Intraclass correlation coefficients (ICC) and standard error of measurements (SEM) were calculated for intra- and inter-tester reliability, and feasibility.ResultsTwenty neck pain patient (13 women) videos were assessed. Intra-and inter-rater reliability was substantial to almost-perfect (ICC 0.76–1.00; SEM < 0.01–2.50). Feasibility was moderate to almost-perfect (ICC 0.54–1; SEM < 0.01–2.98).ConclusionsVideo (slow motion) ratings of time and errors for F8 and ZZ movement patterns in neck pain subjects showed high intra and inter-rater reliability. Achieving reliable ratings in clinic (real-time) appears feasible. Synthesising our results, the most reliable and feasible CMS ratings appear to be when the subject uses accurate rather than accurate and fast execution. The ZZ movement pattern may be superior to F8 in terms of rating. Time and error frequency for tracing F8 and ZZ as accurately as possible in determining CMS appears promising for use in clinic. Future research directions were identified.

Clinical assessment of cervical movement sense in those with neck pain compared to asymptomatic individuals

“…Subjects completed the questionnaires and then performed CMS testing in random order and according to an established method (Werner et al, 2018). Briefly, subjects sat on a chair with backrest, one metre away from a board where the F8 or ZZ pattern was attached.…”

“…A cost-effective and simple clinical alternative, where time and number of errors are recorded while tracing zigzag (ZZ) and figure of eight (F8) patterns with a head-affixed laser has been investigated in healthy asymptomatic and individuals with NP and shown to be reliable (Pereira et al , 2013, Werner et al , 2018. First indications of clinical feasibility were demonstrated but elaboration is needed (Werner et al, 2018). Accordingly, the primary aim of this study was to examine differences in CMS between age-and gender-matched individuals with NP and asymptomatic controls to determine suitable cut-off measures for clinical interpretation.…”

Age-related kinematic performance must be considered during fast head-neck rotation target task in individuals aged from 8 to 85 years old

“…In light of the foregoing, we showed that Seniors and Children needed to be slower (TT, Mean S, Acc, Dec) 5,14,32,33 to become as precise as Young and Old people (no significant differences for OS in all age-groups). The validity and reliability of the OS seems to be good when comparing patients with WAD with controls 21 and with patients with non-traumatic neck pain 30 . Even if we have calculated OS differently than Kristjansson et al (2004), this concept of analyzed is representative of the quality of the cervical sensorimotor status.…”

“…Because of their reliability, sensitivity and specificity 4,23 , the following specific parameters were computed for each kinematics variable: maximum/minimum rotational speed (Max S, Min S, in °s -1 ); average rotational speed (Mean S, in °s -1 ) and average rotational acceleration/deceleration (Acc, Dec, in °s -2 ). To assess the accuracy, we calculated overshoot (OS, in °) ( Fig.3) 30 . It was computed as the difference between peak rotation amplitude and stabilized mean rotation amplitude.…”

Concurrent validity and reliability of a mobile tracking technology to measure angular and linear movements of the neck

“…For start and end positions, 50 frames were considered, 150 since the subjects were told to hold the position for two seconds. For following the Zigzag pattern (ZIZA) (Werner et al, 2018), data of the helmet without 162 differential signal to the trunk were considered, since the trunk sensors were hidden behind 163 the pattern for lighthouse visibility. Generalizability theory (G-theory) was applied to assess reliability, (Brennan, 2001).…”