Mechanical Neck Disorders Research Articles

Efficacy of Manual Therapy and Transcutaneous Electrical Nerve Stimulation in Cervical Mobility and Endurance in Subacute and Chronic Neck Pain: A Randomized Clinical Trial.

Neck pain is a frequent health problem. Manual therapy (MT) and transcutaneous electrical nerve stimulation (TENS) are recommended techniques for treatment of mechanical neck disorders (MND) in Spanish Public Primary Care Physiotherapy Services. The aim of this study was to compare the efficacy of MT versus TENS in active mobility and endurance in cervical subacute or chronic neck pain. Ninety patients with MND were randomly allocated to receive ten 30-min sessions of either MT or TENS, in a multi-centered study through 12 Primary Care Physiotherapy Units in the Madrid community. Active cervical range of motion (CD-ROM) and endurance (Palmer and Epler test) were evaluated pre- and post-intervention and at 6-month follow-up. A generalized linear model of repeated measures was constructed for the analysis of differences. Post-intervention MT yielded a significant improvement in active mobility and endurance in patients with subacute or chronic MND, and at 6-month follow-up the differences were only significant in endurance and in sagittal plane active mobility. In the TENS group, no significant improvement was detected. With regard to other variables, MT improved mobility and endurance more effectively than TENS at post-intervention and at 6-month follow-up in the sagittal plane. Only MT generated significant improvements in cervical mobility and endurance in the three movement planes.

Effects of Sling Exercise for Neck Pain: A Systematic Review and Meta-Analysis.

The purpose of this review was to evaluate the effects of sling exercise on pain intensity, disability, and health-related quality of life in adults with neck pain. The Cochrane Central Register of Controlled Trials, EMBASE, Physiotherapy Evidence Database (PEDro), and 6 other databases were searched from inception to July 2020. The reference lists of relevant articles to identify additional trials were also screened. Randomized controlled trials were included if they investigated the effects of sling suspension therapy in patients with neck pain, including mechanical neck disorders, cervicogenic headache, and neck disorders with radicular findings. Studies were required to be published in English or Chinese. The methodological quality and levels of evidence of studies were assessed using the PEDro scale and the Grading of Recommendations Assessment, Development and Evaluation approach, respectively. The random-effects model was used to perform meta-analyses. Eleven randomized controlled trials were included (n = 595). The mean total PEDro score was 4.64 (SD = 1.21) of 10, which indicated a fair methodological quality. The intervention groups showed significant improvements in pain intensity (SMD = -1.23; 95% CI = -1.88 to -0.58) immediately postintervention compared with the control groups. No significant effects were found for disability, cervical range of motion, and health-related quality of life. However, sensitivity analyses revealed significant short-term improvements in pain intensity, disability, and cervical range of motion and sustained effects on disability at intermediate-term follow-up. Sling exercise appears to be beneficial for improvements in pain intensity (moderate- to low-level evidence) among patients with neck pain. However, no definitive conclusion could be made regarding the effect of sling exercise for neck pain due to methodological limitations and high heterogeneity in the included studies. This review provides overall moderate- to very low-level evidence for health care professionals who may consider including sling exercise in the intervention program for patients with neck pain.

The use of skeletal muscle relaxants in musculoskeletal injuries: what is the evidence?

Skeletal muscle relaxants (SMRs) consist of a heterogeneous group of medications with a side effect profile of concern. The aim of this paper was to review the evidence of use of SMRs in the treatment of sports injuries. A literature search between 2005 – 2018 (Ovid MEDLINE, SPORTDiscus and SCOPUS) were conducted. In addition, citations within articles were searched, and the most commonly prescribed SMRs in South Africa were also used to explore the literature for additional publications. Relevant studies that met the inclusion criteria were selected. Clinical recommendations for general practitioners are given based on the Strength of Recommendation Taxonomy (SORT) level of evidence. Combination drugs rather than single agents are mostly used, however the effectiveness of SMR agents, single and in combination, as well as its significance as opposed to analgesics and non-steroidal anti-inflammatory drugs, still has to be evaluated. Evidence suggest SMRs to be probably effective for use in non-specific lower back pain (acute and chronic lower back muscle strains, ligament sprains, soft tissue contusions), as well as for whiplash associated disorder, mechanical neck disorders, piriformis syndrome, lateral epicondylosis, and plantar fasciitis. It does not appear if there is a role for SMRs as part of combination management for acute cervical strains, post-exercise muscle soreness or myofacial pain syndrome. However, substantial evidence to confirm the use of SMRs in the treatment of sports injuries have not been adequately investigated and is currently largely based on case reports and general reviews.

Evidence-based mindfulness

IntroductionMindfulness is a form of meditation that cultivates present moment awareness in a non-judging way. It has a Buddhist origin but has been practiced in the last 40 years without relation to any religious belief. It has been proposed as a treatment for a variety of ailments.ObjectivesTo carry out an overview of systematic reviews of the evidence on mindfulness as a therapeutic tool.AimsTo summarize the existing evidence on the efficacy of mindfulness.MethodsWe searched for systematic reviews in the Cochrane Database of Systematic Reviews (Cochrane Library).ResultsWe found nine Cochrane reviews (for fibromyalgia, aggressiveness in intellectually disabled people, mechanical neck disorders, reducing sedentariness at work, anxiety, somatoform disorders, and post-stroke fatigue), two Cochrane review protocols (stress reduction of patients with breast cancer, and substance use disorders), 50 non-Cochrane reviews (29 provisional abstracts and 21 structured abstracts from the Centre for Reviews and Dissemination) on the efficacy of mindfulness. The Cochrane reviews showed a lack of conclusive evidence for fibromyalgia, aggressiveness in intellectually disabled people, anxiety disorders, somatoform disorders and post-stroke fatigue. Mindfulness training induced a non-significant reduction in workplace sitting time. For chronic neck pain, mindfulness exercises minimally improved function but no global effect was perceived at short term.ConclusionsAccording to the existing Cochrane reviews, there is a general lack of evidence mindfulness as an effective treatment. For chronic neck pain, mindfulness exercises minimally improved function. We have detected important areas where high quality clinical trials are needed.Disclosure of interestThe authors have not supplied their declaration of competing interest.

WITHDRAWN: Medicinal and injection therapies for mechanical neck disorders.

WITHDRAWN: Medicinal and injection therapies for mechanical neck disorders.

Exercise for mechanical neck disorders: a cochrane systematic review update

Exercise for mechanical neck disorders: a cochrane systematic review update

Exercises for mechanical neck disorders.

Neck pain is common, disabling and costly. Exercise is one treatment approach. To assess the effectiveness of exercises to improve pain, disability, function, patient satisfaction, quality of life and global perceived effect in adults with neck pain. We searched MEDLINE, MANTIS, ClinicalTrials.gov and three other computerized databases up to between January and May 2014 plus additional sources (reference checking, citation searching, contact with authors). We included randomized controlled trials (RCTs) comparing single therapeutic exercise with a control for adults suffering from neck pain with or without cervicogenic headache or radiculopathy. Two review authors independently conducted trial selection, data extraction, 'Risk of bias' assessment and clinical relevance. The quality of the evidence was assessed using GRADE. Meta-analyses were performed for relative risk and standardized mean differences (SMD) with 95% confidence intervals (CIs) after judging clinical and statistical heterogeneity. Twenty-seven trials (2485 analyzed /3005 randomized participants) met our inclusion criteria.For acute neck pain only, no evidence was found.For chronic neck pain, moderate quality evidence supports 1) cervico-scapulothoracic and upper extremity strength training to improve pain of a moderate to large amount immediately post treatment [pooled SMD (SMDp) -0.71 (95% CI: -1.33 to -0.10)] and at short-term follow-up; 2) scapulothoracic and upper extremity endurance training for slight beneficial effect on pain at immediate post treatment and short-term follow-up; 3) combined cervical, shoulder and scapulothoracic strengthening and stretching exercises varied from a small to large magnitude of beneficial effect on pain at immediate post treatment [SMDp -0.33 (95% CI: -0.55 to -0.10)] and up to long-term follow-up and a medium magnitude of effect improving function at both immediate post treatment and at short-term follow-up [SMDp -0.45 (95%CI: -0.72 to -0.18)]; 4) cervico-scapulothoracic strengthening/stabilization exercises to improve pain and function at intermediate term [SMDp -14.90 (95% CI:-22.40 to -7.39)]; 5) Mindfulness exercises (Qigong) minimally improved function but not global perceived effect at short term. Low evidence suggests 1) breathing exercises; 2) general fitness training; 3) stretching alone; and 4) feedback exercises combined with pattern synchronization may not change pain or function at immediate post treatment to short-term follow-up. Very low evidence suggests neuromuscular eye-neck co-ordination/proprioceptive exercises may improve pain and function at short-term follow-up.For chronic cervicogenic headache, moderate quality evidence supports static-dynamic cervico-scapulothoracic strengthening/endurance exercises including pressure biofeedback immediate post treatment and probably improves pain, function and global perceived effect at long-term follow-up. Low grade evidence supports sustained natural apophyseal glides (SNAG) exercises.For acute radiculopathy, low quality evidence suggests a small benefit for pain reduction at immediate post treatment with cervical stretch/strengthening/stabilization exercises. No high quality evidence was found, indicating that there is still uncertainty about the effectiveness of exercise for neck pain. Using specific strengthening exercises as a part of routine practice for chronic neck pain, cervicogenic headache and radiculopathy may be beneficial. Research showed the use of strengthening and endurance exercises for the cervico-scapulothoracic and shoulder may be beneficial in reducing pain and improving function. However, when only stretching exercises were used no beneficial effects may be expected. Future research should explore optimal dosage.

Comparative Effects of Portable and Stationary Traction in the Management of Mechanical Neck Disorders

Objective The purpose of this study was to compare the therapeutic effects of portable and stationary tractions on treatment outcomes in patients with mechanical neck disorders (MNDs). Methods Forty-one participants with MNDs were randomly assigned to either portable traction or stationary traction. Participants' pain level, activity limitation, disability, and neck range of motion were measured before and after 6 weeks of intervention. Inferential statistics for comparing the treatment outcome involved paired t-test and two-way analysis of variance at P < 0.05. Results The mean age of participants was 47.3 ± 10.5 years. After intervention, there were significant improvements in both groups. However, the portable traction group had significantly higher score on neck flexion than the stationary traction group at baseline (portable: 27.1 ± 6.0, stationary: 22.1 ± 6.8; P = 0.009) and after intervention ( F-ratio = 15.0; P = 0.001). Conclusion Inclusion of both portable and stationary tractions to usual physiotherapy provided comparable treatment outcomes in patients with MNDs.

The current perception threshold test differentiates categories of mechanical neck disorder.

Cross-sectional discriminative analysis. To determine whether current perception threshold (CPT) can differentiate between categories of patients with mechanical neck disorders (MNDs). Neck pain is the third most common musculoskeletal disorder and affects a third of all adults each year. It can present as neck pain without musculoskeletal signs, neck pain with musculoskeletal signs but no neurological signs, or neck pain with neurological signs. CPT testing can assess altered sensory perception that may reflect neurological changes. Patients with MNDs (n = 106) were classified into 3 groups, based on a standardized musculoskeletal examination process performed by an experienced physiotherapist who was blinded to CPT scores. The 3 groups were defined as neck pain without musculoskeletal signs (MND I) (n = 60), neck pain with musculoskeletal signs (MND II) (n = 29), and neck pain with neurological signs (MND III) (n = 17). A rapid protocol of CPT testing was performed at 3 frequencies (5, 250, and 2000 Hz), using 3 dermatomal locations on the hand. A 1-way analysis of variance with post hoc comparison and effect sizes was calculated to compare the mean CPT scores between the groups. A binary logistic-regression model was used to predict probability of higher CPT in MND III and to create a receiver-operating-characteristic curve. Mean CPT differed significantly across the 3 MND groups (MND I, 9.7; MND II, 10.6; and MND III, 11.8; P<.001; η(2) = 0.6). Post hoc comparisons indicated differences between MND I and MND II (P = .05) and between MND II and MND III (P = .01) that had large effect sizes (MND I versus II, d = 1 and MND II versus III, d = 2.2). CPT testing was able to distinguish between MND II and III when a threshold value of greater than 11 was used to indicate MND III. The predicted probability of abnormal CPT in MND III had an estimated 73% sensitivity and 81% specificity; the odds ratio was 11.5 (P = .001) for the differentiation capacity of CPT between MND II and III, with a cutoff of 11. The area under the receiver-operating-characteristic curve was 0.84 (95% confidence interval: 0.72, 0.96; P<.001). CPT testing has moderate discriminatory accuracy, specificity, and sensitivity for classification of MND categories into neck pain with or without neurological signs. J Orthop Sports Phys Ther 2014;44(7):532-540. Epub 10 May 2014. doi:10.2519/jospt.2014.4691.

The Current Perception Threshold Test Differentiates Categories of Mechanical Neck Disorder.

Study Design Cross-sectional discriminative analysis. Objective To determine whether current perception threshold (CPT) can differentiate between categories of patients with mechanical neck disorders (MNDs). Background Neck pain is the third most common musculoskeletal disorder, affecting a third of all adults each year. It can present as neck pain without musculoskeletal signs; neck pain with musculoskeletal signs but no neurological signs; neck pain with neurological signs. CPT testing can assess altered sensory perception that may reflect neurological changes. Methods Patients with MNDs (n=106) were classified into 3 groups based on a standardized musculoskeletal examination process performed by an experienced physiotherapist blinded to CPT scores. The 3 groups were defined as: MND-I, neck pain without musculoskeletal signs (n=60); MND-II, neck pain with musculoskeletal signs (n=29); MND-III, neck pain with neurological signs (n=17). A rapid protocol of CPT testing was performed at 3 frequencies (5, 250, 2000 Hz), using 3 dermatomal locations on the hand. A 1-way ANOVA with post hoc comparison and effect sizes were calculated to compare the mean CPT score between the groups. A binary logistic regression model was used to predict probability of higher CPT in MND-III and used to create a receiver operating characteristic (ROC) curve. Results Mean CPT differed significantly across the 3 MND groups (MND-I, 9.7; MND-II, 10.6; and MND-III, 11.8; P < .001, η2 = .6). Post hoc comparisons indicated differences between MND-I and MND-II (P = .05) and between MND-II and MND-III (P = .01), that were large effect sizes (MND I versus II, d = 1 and MND II versus III, d = 2.2). CPT testing was able to distinguish between MND II and III when a threshold value of greater than 11 was used to indicate MND-III. The predicted probability of abnormal CPT in MND-III had an estimated 73% sensitivity and 81% specificity; the odds ratio was 11.5 (P =.001) for the differentiation capacity of CPT between MND-II and III with a cut-off of 11. The area under the ROC curve (AUC) was .84 (95% CI =.72 to .96, P < .001). Conclusions CPT testing has moderate discriminatory accuracy, specificity, and sensitivity for classification of MND categories into neck pain with or without neurological signs. J Orthop Sports Phys Ther, Epub 10 May 2014. doi:10.2519/jospt.2014.5691.

Physician-Delivered Injection Therapies for Mechanical Neck Disorders: A Systematic Review Update (Non-Oral, Non-Intravenous Pharmacological Interventions for Neck Pain)

Background: Controversy persists regarding medicinal injections for mechanical neck disorders (MNDs).Objectives: To determine the effectiveness of physician-delivered injections on pain, function/disability, quality of life, global perceived effect and patient satisfaction for adults with MNDs.Search Methods: We updated our previous searches of CENTRAL, MEDLINE and EMBASE from December 2006 through to March 2012.Selection Criteria: We included randomized controlled trials of adults with neck disorders treated by physician-delivered injection therapies.Data Collection and Analysis: Two authors independently selected articles, abstracted data and assessed methodological quality. When clinical heterogeneity was absent, we combined studies using random-effects models.Results: We included 12 trials (667 participants). No high or moderate quality studies were found with evidence of benefit over control. Moderate quality evidence suggests little or no difference in pain or function/disability between nerve block injection of steroid and bupivacaine vs bupivacaine alone at short, intermediate and long-term for chronic neck pain. We found limited very low quality evidence of an effect on pain with intramuscular lidocaine vs control for chronic myofascial neck pain. Two low quality studies showed an effect on pain with anaesthetic nerve block vs saline immediately post treatment and in the short-term. All other studies were of low or very low quality with no evidence of benefit over controls.Authors' Conclusions: Current evidence does not confirm the effectiveness of IM-lidocaine injection for chronic mechanical neck pain nor anaesthetic nerve block for cervicogenic headache. There is moderate evidence of no benefit for steroid blocks vs controls for mechanical neck pain.

Exploring the Clinical Course of Neck Pain in Physical Therapy: A Longitudinal Study

ObjectiveTo investigate the short-term trajectory of recovery from mechanical neck pain, and predictors of trajectory. DesignProspective, longitudinal cohort study with 5 repeated measurements over 4 weeks. SettingCommunity-based physical therapy clinics. ParticipantsConvenience sample of community-dwelling adults (N=50) with uncomplicated mechanical neck disorders of any duration. InterventionsUsual physical therapy care. Main Outcome MeasuresNeck Disability Index (NDI), numeric rating scale (NRS) of pain intensity. ResultsA total of 50 consecutive subjects provided 5 data points over 4 weeks. Exploratory modeling using latent class growth analysis revealed a linear trend in improvement, at a mean of 1.5 NDI points and 0.5 NRS points per week. Within the NDI trajectory, 3 latent classes were identified, each with a unique trend: worsening (14.5%), rapid improvement (19.6%), and slow improvement (65.8%). Within the NRS trajectory, 2 unique trends were identified: stable (48.0%) and improving (52.0%). Predictors of trajectory class suggest that it may be possible to predict the trajectory. Results are described in view of the sample size. ConclusionsThe mean trajectory of improvement in neck pain adequately fits a linear model and suggests slow but stable improvement over the short term. However, up to 3 different trajectories have been identified that suggest neck pain, and recovery thereof, is not homogenous. This may hold value for the design of clinical trials.

A New Concept for Quantifying the Complicated Kinematics of the Cervical Spine and Its Application in Evaluating the Impairment of Clients with Mechanical Neck Disorders

Mechanical neck disorder (MND) is one of the most common health issues and is characterized by restricted cervical mobility. However, traditional kinematic information often focuses on primary movement in the cardinal plane, which seems insufficient to fully determine the kinematics of the cervical spine because of the complexity of the anatomical structures involved. Therefore, the current investigation aimed to modify the concept of the three-dimensional workspace to propose an objective mathematical model to quantify the complicated kinematics of the cervical spine. In addition, the observation evaluated the characteristics of the cervical workspace in asymptomatic and MND groups. Seventeen healthy volunteers and twenty-five individuals with MND participated in the study and executed the motion of circumduction to establish the cervical workspace using an electromagnetic tracking system. The results produced a mathematical model to successfully quantify the cervical workspace. Moreover, MND groups demonstrated significant reduction in the normalization of the cervical workspace with respect to the length of the head-cervical complex. Accordingly, the current study provided a new concept for understanding the complicated kinematics of the cervical spine. The cervical workspace could be a useful index to evaluate the extent of impairment of the cervical spine and monitor the efficacy of rehabilitation programs for patients with MND.

Massage for mechanical neck disorders.

The prevalence of mechanical neck disorders (MND) is known to be both a hindrance to individuals and costly to society. As such, massage is widely used as a form of treatment for MND. To assess the effects of massage on pain, function, patient satisfaction, global perceived effect, adverse effects and cost of care in adults with neck pain versus any comparison at immediate post-treatment to long-term follow-up. We searched The Cochrane Library (CENTRAL), MEDLINE, EMBASE, MANTIS, CINAHL, and ICL databases from date of inception to 4 Feburary 2012. Studies using random assignment were included. Two review authors independently conducted citation identification, study selection, data abstraction and methodological quality assessment. Using a random-effects model, we calculated the risk ratio and standardised mean difference. Fifteen trials met the inclusion criteria. The overall methodology of all the trials assessed was either low or very low GRADE level. None of the trials were of strong to moderate GRADE level. The results showed very low level evidence that certain massage techniques (traditional Chinese massage, classical and modified strain/counter strain technique) may have been more effective than control or placebo treatment in improving function and tenderness. There was very low level evidence that massage may have been more beneficial than education in the short term for pain bothersomeness. Along with that, there was low level evidence that ischaemic compression and passive stretch may have been more effective in combination rather than individually for pain reduction. The clinical applicability assessment showed that only 4/15 trials adequately described the massage technique. The majority of the trials assessed outcomes at immediate post-treatment, which is not an adequate time to assess clinical change. Due to the limitations in the quality of existing studies, we were unable to make any firm statement to guide clinical practice. We noted that only four of the 15 studies reported side effects. All four studies reported post-treatment pain as a side effect and one study (Irnich 2001) showed that 22% of the participants experienced low blood pressure following treatment. No recommendations for practice can be made at this time because the effectiveness of massage for neck pain remains uncertain.As a stand-alone treatment, massage for MND was found to provide an immediate or short-term effectiveness or both in pain and tenderness. Additionally, future research is needed in order to assess the long-term effects of treatment and treatments provided on more than one occasion.

PMD3 Does Current Perception Threshold Test Can Differentiate Categories of Mechanical Neck Disorder?

To differentiate three types of Mechanical Neck Disorders (MND) by Current Perception Threshold (CPT). Specific aims were to: 1) Look whether differences in CPT exist in MND categories, and 2) Estimate the predicted probability of the neurological symptoms in type-3 of MND. The study design was a laboratory based cross-sectional discriminative analysis. Patients with MND (N = 106) were assessed for CPT into three groups: MND-mixed (N=60), MND-2 (N=29), MND-3 (N=17). CPT testing was performed in a standard Quantatative Sensory Testing laboratory. A one-way ANOVA with post hoc was done for compare the mean CPT score between the groups. An independent sample t-test was done to compare the mean CPT and estimated effect size between MND-2 and MND-3 group. The discriminative analysis predicted the group membership in one of the categories. A binary logistic regression model predicted probability of higher CPT in MND-3, where CPT score counted as the risk factor to having neurological symptoms. A Receiver Operating Characteristic (ROC) curve was created from predicted probability by binary covariate. Mean CPT differed significantly across the three groups (F 2, 96 = 6.69, p = 0.002), with a significant higher preference rating in MND-3 (p = 0.004). Moderate discriminates and a small to medium effect size found between the MND-2 and MND-3. Model discrimination (between MND-2 and MND-3) showed 86.2% specificity and 64.7% sensitivity, where an area under the ROC curve was 0.836 (95% CI = 0.716 - 0.956, p = 0.000). CPT test was capable of differentiate MND categories. CPT might be a potential tool for evaluating neurological involvement or hypersensitivity in neck pain.

Upper Limb Neuromuscular Strategies are Altered in Patients with Mechanical Neck Disorders Compared with Asymptomatic Volunteers

The objective of this study was to investigate the neuromuscular strategy used during a cyclical reach and grasp test (CRGT) in patients with mechanical neck disorder. The CRGT is a paced and timed, repetitive reach and grasp task that was designed to monitor both kinematics and electromyography of the upper limb. Patients (n = 9) with moderate to severe neck pain were compared with healthy controls (n = 7). Activities from 10 muscles of the upper limb were acquired during performance of the CRGT and processed to render both temporal/spatial and amplitude indices. Cross- and Pearson correlations of selected muscle pairs were calculated. Comparisons were conducted using nonparametric statistics. All par- ticipants completed the CRGT but only patients self-reported pain after performance (visual analog scale rating of 3.9 ± 2.7 on the affected side). Modulation of activity was observed for posture (sitting vs. standing, P = 0.034) and side (affected/nondominant vs. unaffected) for controls (P = 0.005). The patient group did not demonstrate significant differences between these dependent variables. Neuromuscular strategies exhibited by patients during reaching did not alter significantly with variation in side and posture, as they did with controls, indicating the lack of a capacity to modulate muscle activity appropriate to the task. This is a significant consequence of the chronic pain experienced by patients with mechanical neck disorder and may underlie the upper limb disability reported in this patient population.

Satisfaction of patients with mechanical neck disorders attended to by primary care physical therapists

To describe the satisfaction and expectations of the patients with neck pain with relation to the physical therapy received and to analyse the relationship between the patient's characteristics and his degree of satisfaction and expectation. This study is performed in the setting of a random clinical trial. Subjects between 18 and 60 years of age with subacute mechanical neck disorders. Patient's expectations and satisfaction with the received treatment (scale similar to Likert's Scale). OTHER VARIABLES: Pain intensity, episodes of previous neck pain, depression and anxiety symptoms (Goldberg Scale), age and gender, physical disability, general state of health, duration of the present episode of neck pain, regular exercise and regular consumption of medicines. A total of 90 patients were studied. The mean age was 40.1 years and 88.9% were female. Thirteen per cent of the subjects expected partial relief, 60% expected good recovery and 27% expected complete recovery. Those patients who have not suffered previous episodes of neck pain and those who have a higher score on the Goldberg Scale have a higher expectation of recovering after the treatment. About patients' satisfaction after the intervention, 2% totally unsatisfied, 1% very unsatisfied, 2% somewhat unsatisfied, 2% indifferent, 17% somewhat satisfied, 42% very satisfied and 30% totally satisfied. Those patients who experienced a greater decrease in pain were more satisfied. It would be interesting to study in depth the measurement of patients' satisfaction with the received physical therapy and to extend it to other pathologies.

Differences in reported psychometric properties of the Neck Disability Index: patient population or choice of methods?

Young BA, Walker MJ, Strunce JB, et al. Responsiveness of the Neck Disability Index in patients with mechanical neck disorders. Spine J 2009;9:802-808 (in this issue).

Responsiveness of the Neck Disability Index in patients with mechanical neck disorders

Purpose Report the test-retest reliability, construct validity, minimum clinically important difference (MCID), and minimal detectable change (MDC) for the Neck Disability Index (NDI). Study design/setting Cohort study of patients presenting to outpatient physical therapy clinics. Patient sample Ninety-one subjects with a primary complaint of neck pain, with or without concomitant upper extremity (UE) symptoms, who were participants in a randomized clinical trial. Outcome Measures NDI and the 15-point Global Rating of Change (GRC) self-report measures. Methods All subjects completed the NDI at baseline and at a 3-week follow-up. Additionally, subjects completed the GRC scale, which was used to dichotomize patients into improved or stable groups. Changes in the NDI were used to assess test-retest reliability, construct validity, MCID, and MDC. Results Test-retest reliability was moderate for the NDI (intraclass correlation coefficient, 0.64; 95% confidence interval, 0.19–0.84). For the NDI, the MCID was 7.5 points and the MDC was 10.2 points. Conclusions The NDI appears to demonstrate adequate responsiveness based on statistical reference criteria when used in a sample that approximates the high percentage of patients with neck pain and concomitant UE referred symptoms. Because the MCID is within the bounds of measurement error, a 10-point change (the MDC) should be used as the MCID.

Physical and social predictors of partner abuse in women attending general practice: a cross-sectional study

Intimate partner abuse causes significant morbidity and mortality in women attending general practice. Currently there is insufficient evidence for screening all women but case finding of women at risk of intimate partner abuse is recommended. To develop physical symptoms and sociodemographic indicators for partner abuse for women attending general practice. Descriptive, cross-sectional survey. Thirty general practices in Victoria, Australia. A total of 1257 consecutive women attending general practice (response rate 77%) were screened for a history of partner abuse using a self-report questionnaire. The presence of partner abuse in the last 12 months was measured by the Composite Abuse Scale. Women who reported more than two physical symptoms in the last month were more likely to report experiencing partner abuse in the last 12 months (3-5 symptoms, odds ratio [OR]=2.32, 95% confidence interval [CI]=1.55 to 3.48; 6-15 symptoms OR=3.47, 95% CI=2.21 to 5.47). Many individual physical symptoms were associated with partner abuse in the bivariable analysis. Multivariable analysis showed clinical indicators of partner abuse (excluding the strong association with depression) which included sociodemographic features (age, separated/divorced, low education, low income, no private insurance) and physical symptoms (diarrhoea, tiredness, chest pain). Clinicians should be alert for current and past partner abuse in women who are separated/divorced, on low incomes, have poor education, or have multiple physical symptoms in the past month. Future research questions include what interventions would work for women who have been or are being abused once identified.