Abstract
BackgroundClinicians frequently rely on subjective categorization of impairments in mobility, strength, and endurance for clinical decision-making; however, these assessments are often unreliable and lack sensitivity to change. The objective of this study was to determine the inter-rater reliability, minimum detectable change (MDC), and group differences in quantitative cervicothoracic measures for individuals with and without chronic neck pain (NP).MethodsNineteen individuals with NP and 20 healthy controls participated in this case control study. Two physical therapists performed a 30-minute examination on separate days. A handheld dynamometer, gravity inclinometer, ruler, and stopwatch were used to quantify cervical range of motion (ROM), cervical muscle strength and endurance, and scapulothoracic muscle length and strength, respectively.ResultsIntraclass correlation coefficients for inter-rater reliability were significantly greater than zero for most impairment measures, with point estimates ranging from 0.45 to 0.93. The NP group exhibited reduced cervical ROM (P ≤ 0.012) and muscle strength (P ≤ 0.038) in most movement directions, reduced cervical extensor endurance (P = 0.029), and reduced rhomboid and middle trapezius muscle strength (P ≤ 0.049).ConclusionsResults demonstrate the feasibility of obtaining objective cervicothoracic impairment measures with acceptable inter-rater agreement across time. The clinical utility of these measures is supported by evidence of impaired mobility, strength, and endurance among patients with NP, with corresponding MDC values that can help establish benchmarks for clinically significant change.
Highlights
Clinicians frequently rely on subjective categorization of impairments in mobility, strength, and endurance for clinical decision-making; these assessments are often unreliable and lack sensitivity to change
Given that chronic symptoms tend to fluctuate over time, it is important to establish the betweenday reliability and minimum detectable change (MDC) for cervical impairment measures so that clinicians can identify meaningful improvement in patients treated for chronic neck pain
There were no significant differences between the neck pain and healthy control groups, with the exception of Neck Disability Index (NDI) scores which were significantly greater for individuals with neck pain (P
Summary
Clinicians frequently rely on subjective categorization of impairments in mobility, strength, and endurance for clinical decision-making; these assessments are often unreliable and lack sensitivity to change. Several studies have investigated the reliability of cervical impairment measures such as strength [5,6], endurance [5,6], and range of motion [6,7] among individuals with neck pain. The natural time course of symptom resolution is more predictable in patients with acute compared to chronic neck pain [3], which limits the ability to generalize findings from an acute pain population to patients who are experiencing chronic symptoms. Given that chronic symptoms tend to fluctuate over time, it is important to establish the betweenday reliability and minimum detectable change (MDC) for cervical impairment measures so that clinicians can identify meaningful improvement in patients treated for chronic neck pain. The reliability of cervical impairment measures has most often been examined within a single session [8,9,10,11] limiting the ability to generalize these findings to a clinical setting where impairments are typically reassessed days or weeks apart, often by different therapists
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