Mechanical Neck Pain Research Articles

Programa rehabilitador integral del raquis cervical. Descripción, resultados y análisis de costes

Introduction Chronic mechanical neck pain is the second cause of consultation in our primary care centers. The high demand for resources generated for it, leading us introduce management strategies that are effective and efficient. For this reason, we designed an integral neck program (PIR), which optimizes available resources, and the aim of this study is demonstrate their effectiveness. Material and methods Prospective and cost analysis study of patients who have participated in the PIR cervical, from September 2008 to January 2009. Are 208 patients, 33 men and 175 women aged 25 to 89 years. The program is multidisciplinary and consists of 14 group sessions of 1 h, including 2 educational lectures (psychologist and rehabilitation physician). As variables are set age, sex, pain Visual Analog Scale (VAS) pre-and post-treatment and Northwick Pack Neck Pain Questionnaire before and after treatment. Results We have decreased visits by 50% and 40% the hours of physiotherapy, but has needed a single initial investment in equipment. The decrease in pain by VAS and improved functionality through the Northwik Park Neck Pain Questionnaire have been highly significant statistically. Conclusion The integral rehabilitation Neck Program is useful in the management of the resources available for the treatment of chronic neck pain.

Validity of the Posterior-Anterior Middle Cervical Spine Gliding Test for the Examination of Intervertebral Joint Hypomobility in Mechanical Neck Pain

Objective The purpose of this study was to determine if the posterior-anterior cervical gliding test is a valid test as compared with dynamic radiographic assessment in flexion/extension as tool for the manual diagnosis of intervertebral joint hypomobility in the midcervical spine in patients with mechanical neck pain. Methods The study was done according to Standards for Reporting of Diagnostic Accuracy guidelines. Fifty patients with mechanical neck pain participated. An examiner performed a posterior-anterior cervical spine gliding to determine the presence of joint hypomobility over the C3-C4, C4-C5, and C5-C6 levels. Two dynamic radiographs in flexion/extension of the neck were obtained from each patient. The angle resulting from the intersection of 2 lines traced between 2 consecutive vertebrae was considered the degree of intersegmental motion of flexion-extension between those vertebrae. Intersegmental motion showing radiographic data below mean − SD from normative data was considered to reflect hypomobility. Differences between hypomobile and not hypomobile segments were assessed with the 2-tailed unpaired Student t test. Sensitivity, specificity, positive predictive value, and negative predictive value were also obtained. Results At all cervical segments, those patients diagnosed with hypomobility showed significantly ( P < .001) lower radiographic motion (C3-C4: 12.4° ± 2.7°, C4-C5: 14.5° ± 2.6°, C5-C6: 15.0° ± 4.8°) compared with those patients not diagnosed with hypomobility (C3-C4: 17.6° ± 3.8°, C4-C5: 19.4° ± 3.4°, C5-C6: 21.0° ± 3.8°). The C3-C4 and C4-C5 levels had high sensitivity (>80%) and specificity (>70%), whereas C5-C6 showed high sensitivity (100%) but low specificity (41%). Conclusions The posterior-anterior cervical gliding test was as good as dynamic radiographic assessment for the diagnosis of intervertebral hypomobility in the midcervical spine in this group of subjects.

The Addition of Cervical Thrust Manipulations to a Manual Physical Therapy Approach in Patients Treated for Mechanical Neck Pain: A Secondary Analysis

Secondary analysis of a randomized clinical trial (RCT). To perform a secondary analysis on the treatment arm of a larger RCT to determine differences in treatment outcomes, adverse reactions, and effect sizes between patients who received cervical thrust manipulation and those who received only nonthrust manipulation as part of an impairment-based, multimodal treatment program of manual physical therapy (MPT) and exercise for patients with mechanical neck pain. A treatment regimen of MPT and exercise has been effective in patients with mechanical neck pain. Limited research has compared the effectiveness of cervical thrust manipulations and nonthrust mobilizations for this patient population, and no studies have investigated the added benefit of cervical thrust manipulations as part of an overall MPT treatment plan. Treatment outcomes from 47 patients in the treatment arm of a larger RCT, with a primary complaint of mechanical neck pain, were analyzed. Twenty-three patients (49%) received cervical thrust manipulations as part of their MPT treatment, and 24 patients (51%) received only cervical nonthrust mobilizations. All patients received up to 6 clinic sessions, twice weekly for 3 weeks, and a home exercise program. Primary outcome measures were the Neck Disability Index (NDI), 2 visual analog scales for cervical and upper extremity pain, and a 15-point global rating of change scale. Blinded outcome measurements were collected at baseline and at 3-, 6- and 52-week follow-ups. Consistent with the larger RCT, both subgroups in this secondary analysis demonstrated improvement in short- and long-term pain and disability scores. Low statistical power (beta< or =.28) and the resultant small effect size indices (-0.21 to 0.17) preclude the identification of any between-group differences. No serious adverse reactions were reported by patients in either subgroup. Clinically meaningful and statistically significant improvements in both subgroups of patients over time suggest that cervical thrust manipulation, as part of the MPT treatment plan, did not influence the results of the treatment arm of the larger RCT from which this study was drawn. Although no between-group differences can be identified, the small observed effect sizes in this study may benefit future studies with sample size estimation for larger RCTs and indicate the need to incorporate clinical prediction rule criteria as a means to improve statistical power. Therapy, level 4.

Exercise for healthy necks

The mobile cervical spine is highly dependent on muscles for its physical support and there is irrefutable evidence of an association between muscle dysfunction and mechanical neck pain. This workshop will draw on applied anatomy, research evidence from mechanistic and interventional studies, and clinical expertise, to outline a systematic approach to the assessment and training of cervical motor function. In particular an emphasis will be placed on establishing the relationship between an individual’s functional demands, active control of posture and movement of the cervical spine, specific muscle tests of the cervical and axio-scapular muscle groups, and requirements of functionally interrelated regions such as the thoracic spine and shoulder girdle.

Measurement of craniovertebral angle with Electronic Head Posture Instrument: Criterion validity

This study evaluated the criterion-related validity of the Electronic Head Posture Instrument (EHPI) in measuring the craniovertebral (CV) angle by correlating the measurements of CV angle with anterior head translation (AHT) in lateral cervical radiographs. It also investigated the correlation of AHT and CV angle with the Chinese version of the Northwick Park Questionnaire (NPQ) and Numeric Pain Rating Scale (NPRS). Thirty patients with diagnosis of mechanical neck pain for at least 3 months without referred symptoms were recruited in an outpatient physiotherapy clinic. The results showed that AHT measured with X-ray correlated negatively with CV angle measured with EHPI (r = -0.71, p < 0.001). CV angle also correlated negatively with NPQ (r = -0.67, p < 0.001) and NPRS (r = -0.70, p < 0.001), while AHT positively correlated with NPQ (r = 0.390, p = 0.033) and NPRS (r = 0.49, p = 0.006). We found a negative correlation between CV angle measured with the EHPI and AHT measured with the X-ray lateral film as well as with NPQ and NPRS in patients with chronic mechanical neck pain. EHPI is a valid tool in clinically assessing and evaluating cervical posture of patients with chronic mechanical neck pain.

Metastasis to the occipitocervical junction: A case report and review of the literature

BackgroundThe management of metastatic spinal disease is generally considered palliative, as the progression of systemic disease is likely to hinder survival. Although the occurrence of C1-C2 instability due to metastatic disease is not uncommon and thus treatment options have been well-defined, craniocervical instability due to lesions occurring at the junction of the occiput and atlas is more rare, and treatment for metastasis to this region is less well-defined. Case DescriptionWe present a patient with non-small-cell lung cancer metastatic to the atlanto-occipital facet joint complex. A drastic improvement in the presenting debilitating mechanical neck pain was noted following an occipitocervical fusion. A literature review of published cases of metastases to the occipitocervical junction was conducted along with treatment options. ConclusionsThe atlanto-occipital facet joint is a rare site of metastatic disease. Destruction of this joint can lead to significant neck pain secondary to instability. Spinal fusion may afford significant and rapid resolution of these symptoms, and should be considered in the management of patients—even those with end-stage oncologic disease.

Bilateral Mechanical-Pain Sensitivity Over the Trigeminal Region in Patients With Chronic Mechanical Neck Pain

The aim of this study was to investigate bilateral pressure-pain sensitivity over the trigeminal region, the cervical spine, and the tibialis anterior muscle in patients with mechanical chronic neck pain. Twenty-three patients with neck pain (56% women), aged 20 to 37 years old, and 23 matched controls (aged 20 to 38 years) were included. Pressure pain thresholds (PPTs) were bilaterally assessed over masseter, temporalis, and upper trapezius muscles, the C5-C6 zygapophyseal joint, and the tibialis anterior muscle in a blinded design. The results showed that PPT levels were significantly decreased bilaterally over the masseter, temporalis, and upper trapezius muscles, and also the C5-C6 zygapophyseal joint (P < .001), but not over the tibialis anterior muscle (P = .4) in patients with mechanical chronic neck pain when compared to controls. The magnitude of PPT decreases was greater in the cervical region as compared to the trigeminal region (P < .01). PPTs over the masseter muscles were negatively correlated to both duration of pain symptoms and neck-pain intensity (P < .001). Our findings revealed pressure-pain hyperalgesia in the trigeminal region in patients with mechanical chronic neck pain, suggesting spreading of sensitization to the trigeminal region in this patient population. This article reveals the presence of bilateral pressure-pain hypersensitivity in the trigeminal region in patients with idiopathic neck pain, suggesting a sensitization process of the trigemino-cervical nucleus caudalis in this population. This finding has implications for development of management strategies.

Immediate effects of the central posteroanterior mobilization technique on pain and range of motion in patients with mechanical neck pain

Purpose. To determine the immediate effects of the central posteroanterior (PA) mobilization technique on both pain and active cervical range of motion in patients with mechanical neck pain presenting with central or bilateral symptoms.Methods. A randomized controlled trial was conducted in 60 patients who were randomly allocated into either ‘central PA’ or ‘random’ mobilization group. Two physical therapists and one assessor participated. Outcome measures included neck pain at rest, pain on the most painful movement, and active cervical range of motion taken before and immediately 5 min after the mobilization treatment.Results. Significant reductions in pain at rest and on the most painful movement were noted within-group comparisons (p < 0.001). However, the ‘central PA’ mobilization group obtained a significantly greater reduction in pain on the most painful movement than the ‘random’ mobilization group (p < 0.05). Both mobilization techniques had no effects on the active cervical range of motion. However, the differences in the means of pain reduction between both mobilization techniques were modest (<10 mm).Conclusion. The clinical recommendation regarding the selection of the central PA mobilization technique for treating patients with central or bilateral mechanical neck pain is therefore arguably.

Repeated Applications of Thoracic Spine Thrust Manipulation do not Lead to Tolerance in Patients Presenting with Acute Mechanical Neck Pain: A Secondary Analysis

It has been demonstrated that patients receiving mobilization techniques do not exhibit tolerance to repeated applications. However, this phenomenon has not been investigated for thoracic manipulation. Our aim was to determine if patients receiving thoracic thrust manipulation exhibit tolerance to repeated applications in acute mechanical neck pain. Forty-five patients were randomly assigned to two groups. The control group received electro- and thermotherapy for 5 sessions, and the experimental group received the same program and also received a thoracic thrust manipulation once a week for 3 consecutive weeks. Outcome measures included neck pain and cervical mobility. Within-session change scores for pain and mobility during treatment sessions #1, 3, and 5 were examined with a one-way repeated measured ANOVA. A 2-way ANOVA with session as within-subject variable and group as between-subject variable was used to compare change scores for each visit between groups to ascertain if there were significant between-group differences in within-session changes for the experimental versus the control group. The ANOVA showed that for either group the 3 within-session change scores were not significantly different (P > 0.1). The 2-way ANOVA revealed significant differences between groups for both pain and neck mobility in within-session change scores (all, P < 0.001). Change scores in each session were superior in the experimental group as compared to those in the control group. The results suggest that patients receiving thoracic manipulation do not exhibit tolerance to repeated applications with regard to pain and mobility measures in acute mechanical neck pain. Further studies should investigate the dose-response relationship of thoracic thrust manipulation in this population.

Muscle Dysfunction in Cervical Spine Pain: Implications for Assessment and Management

There is irrefutable evidence of an association between mechanical neck pain (MNP) and dysfunction of the muscles of the cervical spine. A myriad of impairments have been demonstrated that include changes in the physical structure (cross-sectional area, fatty infiltration, fiber type), as well as changes in behavior (timing and activation level), of the cervical muscles. Such changes suggest an impaired capacity of the cervical muscles to generate, sustain, and maintain precision of the required levels of torque needed for optimal function. In the context of physical support, these changes potentially have deleterious consequences for the cervical region, which relies heavily on its muscles for mechanical stability. While interventions focused on the retraining of cervical muscle function have shown favorable responses in alleviating MNP, the development of best practice strategies for the assessment and management of cervical muscle dysfunction is still a work in progress. One obstacle in researching the efficacy of cervical muscle training is that, as yet, we do not possess the capacity to optimally measure and classify those patients most likely to respond to different methods of training that would enrich clinical practice. While gains in this area are emerging, the ability of a clinician to best identify the need and implement the most appropriate method of training cervical muscle function is still largely dependent on a comprehensive examination of the patient that considers all aspects of the patient's disorder and functional requirements. Level 5.

Immediate Effects of Atlanto-Occipital Joint Manipulation on Active Mouth Opening and Pressure Pain Sensitivity in Women With Mechanical Neck Pain

Objective The purpose of this study was to investigate the effects of a spinal thrust manipulation directed to the upper cervical segments (atlanto-occipital joint) on active mouth opening and pressure pain sensitivity in a trigeminal nerve innervated region (sphenoid bone) in women with mechanical neck pain. Methods Thirty-seven women, ages 21 to 50 years old (mean age, 35 ± 8 years) with mechanical neck pain were recruited for this study. Participants were randomly assigned into 1 of 2 groups as follows: an experimental group that received a spinal manipulation of the atlanto-occipital joint and a control group that received a manual contact placebo intervention. Outcomes collected were assessed pretreatment and 5 minutes posttreatment by an assessor blinded to the treatment allocation and included active mouth opening and pressure pain thresholds (PPTs) over both sides of the sphenoid bone. A 2-way repeated measures analysis of variance (ANOVA) with time (pre-post) as the within subjects variable and group (control, experimental) as the between subjects variable was used to examine the effects of the intervention. The hypothesis of interest was group-time interaction. Results The ANOVA showed a significant effect for time (F = 23.1; P < .001) and an interaction between group and time (F = 37.7; P < .001) for active mouth opening as follows: the experimental group showed a greater improvement when compared to the control group. A large positive within-group effect size ( d > 1.5) for the experimental group, whereas a negative medium within-group effect size ( d = −0.5) for the control group were identified. The ANOVA showed a significant interaction between group and time (F = 14.4; P < .001) for PPT levels at the sphenoid bone as follows: the experimental group showed a greater improvement when compared to the control group. A medium positive within-group effect size ( d = −0.5) for the experimental group, whereas a negative medium within-group effect size ( d = −0.5) for the control group was found. Conclusions Our findings suggest that the application of an atlantoaxial joint thrust manipulation resulted in an increase in active mouth opening and PPT over a trigeminal nerve distribution area (sphenoid bone) in women with mechanical neck pain.

The Immediate Effects of Mobilization Technique on Pain and Range of Motion in Patients Presenting With Unilateral Neck Pain: A Randomized Controlled Trial

Kanlayanaphotporn R, Chiradejnant A, Vachalathiti R. The immediate effects of mobilization technique on pain and range of motion in patients presenting with unilateral neck pain: a randomized controlled trial. Objective To determine the immediate effects on both pain and active range of motion (ROM) of the unilateral posteroanterior (PA) mobilization technique on the painful side in mechanical neck pain patients presenting with unilateral symptoms. Design Triple-blind, randomized controlled trial. Setting Outpatient physical therapy, institutional clinic. Participants Patients (N=60), 2 physical therapists, and 1 assessor involved in this study. Interventions The patients were randomly allocated into either preferred or random mobilization group by using an opaque concealed envelope. The first therapist performed the screening, assessing, prescribing the spinal level(s), and the grade of mobilization. The second therapist performed the mobilization treatment according to their allocated group stated in an envelope. The assessor who was blind to the group allocation conducted the measurements of pain and active cervical ROM. Main Outcome Measures Pain intensity, active cervical ROM, and global perceived effect were measured at baseline and 5 minutes posttreatment. Results After mobilization, there were no apparent differences in pain and active cervical ROM between groups. However, within-group changes showed significant decreases in neck pain at rest and pain on most painful movement ( P<0.001) with a significant increase in active cervical ROM after mobilization on most painful movement ( P=0.002). Conclusions The results of this study did not provide support for the preference of the unilateral PA mobilization on the painful side to the random mobilization.

Thoracic Spine Manipulation for the Management of Patients With Neck Pain: A Randomized Clinical Trial

Randomized clinical trial. To investigate if patients with mechanical neck pain receiving thoracic spine thrust manipulation would experience superior outcomes compared to a group not receiving thrust manipulation. Evidence has begun to emerge in support of thoracic thrust manipulation as an intervention n the management of mechanical neck pain. However, to make a strong recommendation for a clinical technique it is necessary to have multiple studies with convergent findings. Forty-five patients (21 females) were randomly assigned to 1 of 2 groups: a control group, which received electro-thermal therapy for 5 treatment sessions, and the experimental group, which received the same electro/thermal therapy program in addition to a thoracic spine thrust manipulation once a week for 3 consecutive weeks. Mixed-model analyses of variance (ANOVAs) were used to examine the effects of treatment on pain (100-mm visual analogue scale), disability (100-point disability scale), and cervical range of motion, with group as the between-subjects variable and time as the within-subjects variable. The primary analysis was the group-by-time interaction for pain. The group-by-time interaction effects for the ANOVA models were statistically significant for pain, mobility, and disability (P< .05), indicating greater improvements in the manipulation group for all the outcome measures. Patients receiving thoracic manipulation experienced greater improvements in pain at the fifth (final) treatment session and at the 2-week and 4-week follow-up periods (P< .001), with pain improvement scores in the manipulation group of 16.8 mm and 26.6 mm greater than those in the comparison group at the 2- and 4-week follow-up periods, respectively. The experimental group also experienced significantly greater improvements in disability with a between-group difference of 8.8 points (95% confidence interval [CI]: 7.5, 10.1; P< .001) at the fifth visit and 8.0 points (95% CI: 5.8, 10.2; P< .001) at the 2-week follow-up. The results of our study suggest that thoracic spine thrust manipulation results in superior clinical benefits that persist beyond the 1-mont follow-up period for patients with acute neck pain. Future studies should continue to investigate the effects of thoracic spine thrust manipulation, as compared to other physical therapy interventions, in a population with mechanical neck pain.

Calidad percibida en la fisioterapia de atención primaria: situación y oportunidades de mejora en la atención a la cervicalgia

Objectives To describe and compare how frequently patients with neck pain perceive different aspects related with the quality of physical therapy care of several health care centers. Material and Methods A descriptive, cross-sectional and analytic study was conducted. Patients with mechanical and non-traumatic neck pain were included. Information was collected using a self-report and previously validated questionnaire. Rate of answer and non- answer bias were analyzed. An adjusted descriptive analysis was performed, using indicators and the perceived quality was compared among centers based on indicators in each center, and the value average and percentiles of all centers. Results A total of 111 out of 162 questionnaires were collected. No significant differences were detected among those who responded and those who did respond to the questionnaire in relationship to gender and study level, but there were significant differences for age and previous physical therapy use. The dimensions of Waiting Time and Professional Competence are those that present the higher percentage of problems of perceived quality, 61.4% (52.4-70.4) and 51.7% (42.4-61.0), respectively. The dimension Organization has the lowest percentage of problems, 24.4 % (16.4-32.4). There are differences in the levels of quality perceived between most of the centers regarding the dimensions of Information and Professional Competence, and only between some centers regarding Time of wait and Organization. Conclusions The areas of Information and Professional Competence are those that accumulate the most problems of perceived quality. There is variability in the levels of perceived quality among the participant centers of health care.

The Effectiveness of Manual Physical Therapy and Exercise for Mechanical Neck Pain

Randomized clinical trial. To assess the effectiveness of manual physical therapy and exercise (MTE) for mechanical neck pain with or without unilateral upper extremity (UE) symptoms, as compared to a minimal intervention (MIN) approach. Mounting evidence supports the use of manual therapy and exercise for mechanical neck pain, but no studies have directly assessed its effectiveness for UE symptoms. A total of 94 patients referred to 3 physical therapy clinics with a primary complaint of mechanical neck pain, with or without unilateral UE symptoms, were randomized to receive MTE or a MIN approach of advice, motion exercise, and subtherapeutic ultrasound. Primary outcomes were the neck disability index, cervical and UE pain visual analog scales (VAS), and patient-perceived global rating of change assessed at 3-, 6-, and 52-weeks. Secondary measures included treatment success rates and post-treatment healthcare utilization. The MTE group demonstrated significantly larger reductions in short- and long-term neck disability index scores (mean 1-year difference -5.1, 95% confidence intervals (CI) -8.1 to -2.1; P = 0.001) and short-term cervical VAS scores (mean 6-week difference -14.2, 95% CI -22.7 to -5.6; P = 0.001) as compared to the MIN group. The MTE group also demonstrated significant within group reductions in short- and long-term UE VAS scores at all time periods (mean 1-year difference -16.3, 95% CI -23.1 to -9.5; P = 0.000). At 1-year, patient perceived treatment success was reported by 62% (29 of 47) of the MTE group and 32% (15 of 47) of the MIN group (P = 0.004). An impairment-based MTE program resulted in clinically and statistically significant short- and long-term improvements in pain, disability, and patient-perceived recovery in patients with mechanical neck pain when compared to a program comprising advice, a mobility exercise, and subtherapeutic ultrasound.

Multimodal Management of Mechanical Neck Pain Using a Treatment Based Classification System

The purpose of this case study was twofold: 1) to illustrate the use of a treatment-based classification (TBC) system to direct the early intervention of a patient with mechanical neck pain, and 2) to show the progression of this patient with multimodal-modal intervention. The patient exhibited axial neck pain with referral into her upper extremity. Her pain peripheralized with cervical range of motion and centralized with joint mobilization placing her primarily in the centralization category. Her poor posture and associated muscle weakness along with the chronicity of symptoms placed her secondarily into the exercise and conditioning group resulting in a multi-modal treatment as the patient progressed. Although the design of this case report prevents wide applicability, this study does illustrate the effective use of the TBC system for the cervical spine as captured by accepted outcomes measures.

Inclusion of thoracic spine thrust manipulation into an electro-therapy/thermal program for the management of patients with acute mechanical neck pain: A randomized clinical trial

Our aim was to examine the effects of a seated thoracic spine distraction thrust manipulation included in an electrotherapy/thermal program on pain, disability, and cervical range of motion in patients with acute neck pain. This randomized controlled trial included 45 patients (20 males, 25 females) between 23 and 44 years of age presenting with acute neck pain. Patients were randomly divided into 2 groups: an experimental group which received a thoracic manipulation, and a control group which did not receive the manipulative procedure. Both groups received an electrotherapy program consisting of 6 sessions of TENS (frequency 100 Hz; 20 min), superficial thermo-therapy (15 min) and soft tissue massage. The experimental group also received a thoracic manipulation once a week for 3 consecutive weeks. Outcome measures included neck pain (numerical pain rate scale; NPRS), level of disability (Northwick Park Neck Pain Questionnaire; NPQ) and neck mobility. These outcomes were assessed at baseline and 1 week after discharge. A 2-way repeated-measures ANOVA with group as between-subject variable and time as within-subject variable was used. Patients receiving thoracic manipulation experienced greater reductions in both neck pain, with between-group difference of 2.3 (95% CI 2–2.7) points on a 11-NPRS, and perceived disability with between-group differences 8.5 (95% CI 7.2–9.8) points. Further, patients receiving thoracic manipulation experienced greater increases in all cervical motions with between-group differences of 10.6° (95% CI 8.8–12.5°) for flexion; 9.9° (95% CI 8.1–11.7°) for extension; 9.5° (95% CI 7.6–11.4°) for right lateral-flexion; 8° (95% CI 6.2–9.8°) for left lateral-flexion; 9.6° (95% CI 7.7–11.6°) for right rotation; and 8.4° (95% CI 6.5–10.3°) for left rotation. We found that the inclusion of a thoracic manipulation into an electrotherapy/thermal program was effective in reducing neck pain and disability, and in increasing active cervical mobility in patients with acute neck pain.

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.

Chronic Mechanical Neck Pain in Adults Treated by Manual Therapy: A Systematic Review of Change Scores in Randomized Controlled Trials of a Single Session

We report a systematic analysis of group change scores of subjects with chronic neck pain not due to whiplash and without headache or arm pain, in randomized clinical trials of a single session of manual therapy. A comprehensive literature search of clinical trials of chronic neck pain treated with manual therapies up to December 2006 was conducted. Trials that scored above 60% on the PEDro Scale were included. Change scores that scored above 60% on the PEDro Scale were included. Change scores were analyzed for absolute, percentage change and e ect size (ES) whenever possible. Nine trials were identi ed: 6 for spinal manipulation, 4 for spinal mobilization or non-manipulative manual therapy (2 overlapping trials), and 1 trial using ischemic compression. No trials were identi ed for massage therapy or manual traction. Four manipulation trials (Five groups) reported mean immediate changes in 100-mm VAS of –18.94 (9.28) mm. ES for these changes ranged from .33 to 2.3. Two mobilization trials reported immediate VAS changes of –11.5 and –4 mm (ES of .36 and .22, respectively); one trial reported no difference in immediate pain scores versus sham mobilization. e ischemic compression study showed statistically signi cant immediate decreases in 100-mm pain VAS (average = –14.6 mm). There is moderate-to-high quality evidence that immediate clinically important improvements are obtained from a single session of spinal manipulation. e evidence for mobilization is less substantial, with fewer studies reporting smaller immediate changes. ere is insu cient evidence for ischemic compression to draw conclusions. There is no evidence for a single session of massage or manual traction for chronic neck pain.

Psychometric Properties of the Fear-Avoidance Beliefs Questionnaire and Tampa Scale of Kinesiophobia in Patients with Neck Pain

To examine selected psychometric properties of these instruments in a cohort of patients with mechanical neck pain. Cohort design of 78 subjects completing self-report measures of pain, disability, and the Fear-Avoidance Beliefs Questionnaire Work (FABQW) and Physical Activity (FABQPA) subscales, as well as the Tampa Scale of Kinesiophobia (TSK) at baseline and a 2-day follow-up. Intraclass correlation coefficients were used to calculate test-retest reliability, and Cronbach's alpha was used to calculate internal consistency. Concurrent validity was analyzed between the FABQPA, FABQW, TSK, pain, and disability using Pearson correlation coefficients and hierarchical linear regression modeling. The FABQPA and FABQW subscales exhibited substantial test-retest reliability, whereas the TSK exhibited moderate reliability. Internal consistency was high for all measures. The FABQW subscale was the only measure that significantly contributed to the regression model for both pain and disability in this group of patients with neck pain. Whereas the reliability and internal consistency of all measures ranged between moderate and substantial, the results of this study suggest weaker relationships between measures of fear and avoidance beliefs and pain/disability among patients with mechanical neck pain than has been reported among patients with low-back pain.