Neck Pain Disorders Research Articles

Identification of Factors Associated with Nonspecific Neck Pain in Working Women

Abstract Objectives Neck pain is a broad term that encompasses both nonspecific neck pain and neck pain-related disorders. It causes discomfort, impaired quality of life, disability, and affects workability alike in men as well as women. This study was designed to determine prevalence and evaluate the association of different factors with the occurrence of nonspecific neck pain in working women. Materials and Methods A cross-sectional study was performed on working women (n = 196) age group between 25 and 53 years. A Google Form of the Questionnaire for the Evaluation of Risk Factors Associated With Non-Specific Neck Pain scale and Neck Disability Index (NDI) scale was given to individuals and further objective assessment of physical factors was conducted. Statistical Analysis The association between individual, workplace, lifestyle, physical and psychological factors, and NDI levels of disability was also investigated using Pearson's correlation test and the chi-squared test using SPSS version 28.0. Results Frequency of nonspecific neck pain in working women was 47.55%. Marital status was a significant (χ2 = 8.89) factor toward occurrence of neck pain in working women. Number of working hours/week (χ2 = 19.97), number of hours spend for entertainment on the computer (χ2 = 41.84), and height of keyboard & mouse (χ2 = 18.52) were significant factors leading to neck pain at workplace. Lifestyle factors such as mobile phones usage (p-value = 0.02) and posture assumed while using them (χ2 = 19.56) were significantly associated with neck disability. Levels of disability were significantly influenced by physical factors like tragus-to-wall tests (r = 0.33) and cervical flexion and extension ranges (r = 0.41 and r = 0.31). Importantly, psychological factors were strongly associated with neck pain and disability. Conclusion Factors under psychological, workplace, and lifestyle domains were found significantly associated with nonspecific neck pain in working women.

A systematic review and meta-analysis of randomized controlled trials on the effectiveness of high-intensity laser therapy in the management of neck pain.

The purpose of this systematic review was to evaluate the effects of high-intensity laser therapy (HILT) on pain, disability, and range of movement in patients with neck pain. Randomized controlled trials (RCTs) of HILT for neck pain disorders were searched across databases such as PubMed, Web of Science, Scopus, CINAHL, Science Direct, Cochrane Library, the PEDro database, and Google Scholar (updated January 7, 2024). The main outcome was pain intensity, with neck disability and cervical range of motion as secondary outcomes. Researchers reviewed article titles and abstracts from different databases using the Rayyan web app. Study quality was assessed using the Cochrane risk of bias tool, and evidence-based recommendations were developed using the GRADE approach. A meta-analysis was conducted to calculate the pooled effect in terms of mean differences (MD) for the outcomes of interest, along with a 95% confidence interval (95% CI). Twenty studies met the selection criteria and were potentially eligible for inclusion in the meta-analysis. At the end of the treatment, there was a statistically significant (p < 0.01) pooled MD of -14.1mm for pain intensity (17 RCTs) with the VAS (95% CI:-18.4,-9.7), 3.9° (95% CI:1.9,6.7) for cervical extension (9 RCTs), and -8.3% (95% CI:-14.1,-4.1) for disability diminish (12 RCTs) with the neck disability index in favor of HILT. Only the results for pain intensity are in line with the minimal clinically important differences (MCID) reported in the literature. Overall, the evidence was deemed significant but with low certainty, attributed to observed heterogeneity and some risk of bias among the RCTs. HILT demonstrates effectiveness in reducing neck pain and disability while enhancing cervical extension when added to other physical therapy interventions, especially therapeutic exercise, based on a moderate level of evidence. This review highlights that the most favorable results are obtained when HILT is employed to address myofascial pain, cervical radiculopathy and chronic neck pain.PROSPERO registration number: CRD42023387394 (Registration date, 14/01/2023).

THE RELATIONSHIP OF GADGET ADDICTION ON MENTAL HEALTH IN MEDICAL STUDENTS

Smartphone, is a term to distinguish advanced feature phones from basic feature phones. Excessive smartphone use or addiction can lead to negative health consequences such as neck pain, accidents, anxiety, depression, and sleep disorders. This study aims to determine how the influence of gadget use addiction on mental health in medical students. Method used (narrative review/systematic review with PRISMA 2020). Research was collected through searches on Google Scholar from 2019 to 2023, Ebscho from 2019 to 2023 with full text limits and PubMed from 2019 to 2023. The keyword searches used are smartphone addiction, mental health, and medical student. 210 results were found from Google Scholar, 15 results were found on Ebscho, 31 results were found on PubMed, and 21 studies were included in the study. Results of the 256 journals netted, there are 21 journals that match the category of literature review titles. There is a significant relationship between gadget addiction to mental health in medical students, especially in women.

Sleep Quality, and Fatigue As Predictive Factors For Mechanical Neck Pain

Aims: The purpose of our study was to investigate the relationship between mechanical neck pain and sleep disorders, mental and physical fatigue, and the rising expectations of people in modern societies regarding their work, families, and social lives. Mechanical neck pain is a common problem that can result in disability. Methods: We included 230 patients with mechanical neck discomfort, with a mean age of 25.62 ± 9.25years, in our study. The Neck Disability Index, Chalder Fatigue Scale, and Pitssburg Sleep Quality Index was applied to all participant. Results: Multiple linear regression analysis revealed that the overall model explained 22% of the variance of NDI score. Both sleep quality scale and fatigue scale were significantly associated and can predict NDI score (p &lt; 001). Conclusion: sleep quality and fatigue were found among the independent determinants of neck disability. Therefore, physiotherapists who treat patients with mechanical neck pain should advise them to get enough sleep and teach them relaxation techniques to help them feel less stressed and exhausted, which will lower their neck discomfort

A Study of 45 Patients with Chronic Neck Pain to Compare the Effects on Pain and Disability of 4 Weeks of Physical Therapy with the Active Release Technique and Strain-Counterstrain Manipulation with Massage Alone, Before and After Treatment.

BACKGROUND Active release technique (ART) and strain-counterstrain (SCS) have been reported to be beneficial for patients with trigger point pain. Therefore, this study of 45 patients with chronic neck pain aimed to compare the effects of 4 weeks of physical therapy with the ART and SCS manipulation with massage alone, evaluated before and after treatment, using the visual analog scale (VAS) for pain, the neck disability index (NDI), and the pressure pain threshold (PPT). MATERIAL AND METHODS The participants were 45 adults with neck pain lasting >12 weeks, divided into the ART group (n=15), SCS group (n=15), and control group (n=15). All groups received clinical massage (CM) for 15 min twice a week for 4 weeks. The control group received only CM, the ART group received CM and ART for 15 min twice a week for 4 weeks, and the SCS group received CM and SCS for 15 min twice a week for 4 weeks. VAS, NDI, and PPT were measured before and after the interventions. RESULTS In all groups, there were significant changes in VAS, NDI, and PPT after the interventions (P<0.05), and there was a significant difference among groups in the difference before and after intervention (P<0.05). VAS and NDI showed the greatest difference among before and after intervention in the ART group (VAS pre-post 3.38±0.76, NDI pre-post 5.69±2.78). PPT showed the greatest difference among before and after intervention in the SCS group (PPT pre-post 1.75±0.62). CONCLUSIONS The ART technique and the SCS technique effectively reduced neck pain and neck disorders in adults with chronic neck pain.

Pupillometric parameters of alertness during unpredictable but not predictable smooth pursuit neck torsion test are altered in patients with neck pain disorders: a cross-sectional study

Despite commonly investigated predictable smooth-pursuit neck-torsion tasks (SPNT) in neck pain patients, unpredictable conditions have been seldom investigated but are indicative of preserved oculomotor functions during neck torsion. Although not previously studied, some speculations about compensatory cognitive mechanisms such as increased phasic alertness during unpredictable tasks were suggested. The aim of this study was to investigate eye movement accuracy and pupillometric responses during predictable and unpredictable SPNT test in neck pain patients and asymptomatic controls. Eye movements (gain and SPNT-difference) and pupillometry indicative of tonic (average and relative pupil diameter) and phasic (index of cognitive activity-ICA) alertness were measured in 28 idiopathic neck pain patients and 30 asymptomatic individuals using infrared video-oculography during predictable and unpredictable SPNT test. Gain in unpredictable SPNT test was lower as compared to predictable tasks and presented with similar levels in neutral and neck torsion positions, but not in the predictable SPNT test. ICA was lower during neutral position in all tasks in patients as compared to control group but increased during neck torsion positions in unpredictable tasks. Relative pupil diameters presented with no differences between the groups or neck positions, but the opposite was observed for average pupil diameter. Higher ICA indicates an increase in phasic alertness in neck pain patients despite no alterations in oculomotor control during SPNT test. This is the first study to indicate cognitive deficits in oculomotor task in neck pain patients. The latter could negatively affect other tasks where additional cognitive resources must be involved.

Could Vulnerability to Motion Sickness and Chronic Pain Coexist within a Sensorimotor Phenotype? Insights from over 500 Pre-Pain Motion Sickness Reports.

The sensorimotor incongruence theory proposes that certain instances of pain result from conflicts in the brain's sensorimotor networks. Indeed, injuries may cause abnormalities in afferent and cortical signaling resulting in such conflicts. Motion sickness also occurs in instances of incongruent sensorimotor data. It is possible that a sensory processing phenotype exists that predisposes people to both conditions. The aim of this study was to investigate whether participants with chronic pain recall greater susceptibility to motion sickness before chronic pain onset. Data were collected via an online LimeSurvey. A self-report tendency toward motion sickness was measured using the Motion Sickness Susceptibility Questionnaire. Group differences were analysed using analysis of covariance methods. 530 patients (low back pain, n = 198; neck pain, n = 59; whiplash-associated disorder, n = 72; fibromyalgia syndrome, n = 114; Migraine, n = 41) and 165 pain-free controls were surveyed. ANCOVA analysis, using sex and anxiety as covariates, suggested that childhood motion sickness susceptibility scores differed by group (F = 2.55 (6, 615), p = 0.019, (ηp2) = 0.024). Planned comparisons, with corrected p-values, suggested that childhood motion sickness was not statistically greater for low back pain, rheumatoid arthritis, migraine, neck pain or whiplash-associated disorder (ps > 0.05), although scores were on average 27%, 42%, 47%, 48% and 58% higher, respectively. Childhood susceptibility was statistically higher in people with FMS (p = 0.018), with scores on average 83% higher than controls. ANCOVA analysis, using sex and anxiety as covariates, suggested that adult motion sickness susceptibility scores did not differ by group (F = 1.86 (6, 613), p = 0.086), although average scores were, on average, at least 33% higher in persistent pain groups. According to retrospective reporting, greater susceptibility to motion sickness appears to pre-date persistent pain in some conditions. This supports the possibility that motion sickness and chronic pain may, in some cases, have overlapping mechanisms related to the handling of incongruent sensorimotor data.

Cervicogenic headache

IntroductionCervicogenic headache, first proposed as a distinct headache in 1983, is a secondary headache to a primary cervical musculoskeletal disorder. Research into physical impairments was integral to clinical diagnosis and to develop and test research informed conservative management as the first line approach. PurposeThis narrative presents an overview of the body of cervicogenic headache research from our laboratory which was undertaken in the context of a broad program of research into neck pain disorders. ImplicationsEarly research validated manual examination of the upper cervical segments against anaesthetic nerve blocks, which was vital to clinical diagnosis of cervicogenic headache. Further studies identified reduced cervical motion, altered motor control of the neck flexors, reduced strength of flexor and extensor muscles, and occasional presentation of mechanosensitivity of the upper cervical dura. Single measures are variable and not reliable in diagnosis. We proved that a pattern of reduced motion, upper cervical joint signs and impaired deep neck flexor function accurately identified cervicogenic headache and differentiated it from migraine and tension-type headache. The pattern was validated against placebo controlled diagnostic nerve blocks. A large multicentre clinical trial determined that a combined program of manipulative therapy and motor control exercise is effective in the management of cervicogenic headache and outcomes are maintained in the long term.More specific research into cervical related sensorimotor controlled is warranted in cervicogenic headache. Further adequately powered clinical trials of current research informed multimodal programs are advocated to further strengthen the evidence base for conservative management of cervicogenic headache.

Oxygen-ozone therapy in musculoskeletal disorders: a narrative review

Oxygen-ozone (O2O3) therapy is a spreading intervention proposed to reduce pain intensity and improve physical function in patients with musculoskeletal conditions. The biological effects of O2O3 are strictly related to its biochemical properties. It induces moderate oxidative stress and promotes the activation of specific transcriptional pathways related to endogenous radical scavengers. In this context, O2O3 therapy promotes immune modulation and inflammatory regulation that might potentially have a key role in the management of patients with musculoskeletal disorders. Interestingly, in recent years a growing number of studies have been showing promising results of O2O3 local therapy in different conditions, including low back pain, neck pain, knee osteoarthritis, and temporomandibular disorders. Due to its positive effects in terms of not only pain management but also functional improvement, it has been suggested that this promising therapy might be effectively integrated into a comprehensive rehabilitation approach to musculoskeletal disorders. Despite these considerations, several questions remain open about the effects of O2O3 combined with other conventional approaches. The aim of this narrative review was therefore to summarize the state of the art of O2O3 local therapy from a rehabilitation perspective, underlining its potential synergisms with other techniques in a multitarget rehabilitation approach to musculoskeletal disorders.

Virtual reality in the management of patients with low back and neck pain: a retrospective analysis of 82 people treated solely in the metaverse

BackgroundClinically, neck pain disorders (NPD) and non-specific low back pain (NS-LBP) are respectively the fourth and first most common conditions associated with the greatest number of years lived with disability. Remote delivery of care may benefit healthcare sustainability, reduce environmental pollution, and free up space for those requiring care non-virtual care.MethodsA retrospective analysis was performed on 82 participants with NS-LBP and/or NPD who received exercise therapy delivered solely in the metaverse using virtually reality. The study was to determine if this was achievable, safe, had appropriate outcome measures that could be collected, and if there was any early evidence of beneficial effects.ResultsThe study demonstrated that virtual reality treatment delivered via the metaverse appears to be safe (no adverse events or side effects). Data for more than 40 outcome measures were collected. Disability from NS-LBP was significantly reduced (Modified Oswestry Low Back Pain Disability Index) by 17.8% (p < 0.001) and from NPD (Neck Disability Index) by 23.2% (p = 0.02).ConclusionsThe data suggest that this method of providing exercise therapy was feasible, and safe (no adverse events reported), that complete reports were obtained from a large selection of patients, and that software acquired outcomes were obtainable over a range of time points. Further prospective research is necessary to better understand our clinical findings.

How well can we detect cervical driven sensorimotor dysfunction in concussion patients? An observational study comparing patients with idiopathic neck pain, whiplash associated disorders and concussion

BackgroundPatients with mild traumatic brain injury (mTBI) suffer from sensorimotor impairments. Evidence is emerging that cervical spine plays an important role in mTBI, but it is not known how cervicocephalic kinaesthetic sensibility measured during dynamic unpredictable head movements and measures of position sense, cervical induced postural balance and eye movement control differ between mTBI, whiplash associated disorders (WAD) patients, idiopathic neck pain patients and healthy controls. Research questionAre cervical sensorimotor deficits present in mTBI patients and do they differ from sensorimotor deficits found in traumatic and nontraumatic neck pain patients and whether they differ from healthy controls. MethodsTwenty idiopathic neck pain patients, 18 WAD, 17 mTBI and 20 healthy controls were enroled in the study. Frequency and velocity of centre of pressure movements were measured during parallel stance in the neutral and neck torsion positions, gain and smooth pursuit neck torsion difference of eye movements during smooth pursuit neck torsion test (SPNTT) and cervicocephalic kinaesthesia using Butterfly and head-to-neutral relocation test. ResultsStatistically significant differences in postural balance, both tests of cervicocephalic kinaesthesia and SPNTT were observed between healthy controls and all patient groups. No differences were observed between patient groups for SPNTT, Butterfly and head-to-neutral relocation test, but differences were present in postural balance between mTBI and both groups of patients with neck pain disorders. Differences were found in the ML direction for mTBI, but not differences were found for AP direction. SignificanceResults of our study show that mTBI present with similar impairment in cervical driven sensorimotor deficits as patients with neck pain disorders, but they differ from healthy individuals. Clinical practice would benefit from identifying cervical spine related sensorimotor impairments in patients with mTBI. This could enable to design more targeted prevention and rehabilitation programs to minimise cervical spine related disorders in concussion patients.

An Investigation of temporomandibular pain, headache, and fatigue in relation with long-term mask use during the COVID-19 pandemic period

ABSTRACT Objective To investigate the effects of long-term mask use on temporomandibular pain, headache, and fatigue during the COVID-19 pandemic period via a survey. Methods The survey was sent online, and symptoms associated with mask use, perception of mask discomfort, temporomandibular dysfunction, fatigue, headache, and trigger points of temporomandibular joint were evaluated. Results For the study, 909 people were screened. Head, neck, face, throat, ear, and jaw pain, cheek tension, teeth clamping, acne, mask trace, palpitation, and voice and sleep disorders were different between groups (p < 0.05). The individuals’ temporomandibular dysfunction and fatigue were different between groups (p < 0.05). Conclusion Long-term mask use can cause many symptoms, such as headache, jaw pain, and fatigue. Furthermore, increased mask-wearing time can trigger all these symptoms. The authors recommend relaxing breaks and exercises for neck, jaw, and face muscles along with the use of appropriate masks to minimize negative symptoms.

Low Sleep Satisfaction Is Related to High Disease Burden in Tinnitus.

Previous studies have shown a high prevalence of sleep disturbances in tinnitus patients. However, no study has yet evaluated subjective sleep satisfaction. The present study aimed to investigate associations of self-reported sleep satisfaction with sociodemographic factors, tinnitus-related distress, depression, and self-reported quality of life. This is a retrospective analysis of 2344 outpatients with tinnitus presenting at a tertiary German tinnitus clinic from 2010 to 2020. Patients who filled in five questionnaires (Tinnitus Handicap Inventory (THI), Tinnitus Questionnaire (TQ), Major Depression Inventory (MDI), Tinnitus Sample Case History Questionnaire (TSCHQ), and the World Health Organization Quality of Life Brief Version (WHOQOL-Bref)) were included. Based on the question about sleep satisfaction in the WHOQOL-Bref, group classification into (I) sleep-satisfied, (II) neither satisfied or dissatisfied, and (III) sleep-dissatisfied patients was performed. Associations between sleep satisfaction and quality of life, depression, tinnitus distress, and tinnitus characteristics were analyzed by group differences and a multinomial regression model with elastic net penalization. A total of 42.38% of patients were satisfied or very satisfied with sleep, whereas 40.91% of patients were dissatisfied or very dissatisfied with sleep. The remaining patients reported being neither satisfied nor dissatisfied with sleep. Sleep-dissatisfied patients were significantly more burdened in questionnaires on depressive symptoms (MDI), tinnitus distress (TQ, THI), and quality of life (WHOQOL-Bref). In addition, they suffered significantly more often from comorbidities such as headache, neck pain, or temporomandibular joint disorder (TMJ). The elastic net regression based on sum scores of THI, TQ, MDI, the four domains of WHOQOL-Bref, as well as all individual questions from the TSCHQ was able to classify patients satisfied with their sleep with an accuracy of 79%, 87.8% sensitivity, and 70.4% specificity. The model could not identify patients indifferent with the quality of their sleep (neither satisfied nor dissatisfied) (sensitivity: 0%; specificity: 100%). The accuracy of the model to predict patients dissatisfied with their sleep was 80.7%, with 83% sensitivity and 78.4% specificity. Poor physical and mental health (Domain I/II WHOQOL-Bref) as well as tinnitus distress were the strongest predictors of sleep dissatisfaction. Conversely, for sleep satisfaction, good physical and mental health as well as low tinnitus distress were the strongest predictors. The division into sleep-satisfied and sleep-dissatisfied tinnitus patients allows a very good discrimination regarding disease burden as indicated by depression, tinnitus distress, quality of life, and pain-related comorbidities. Physical and mental health as well as tinnitus distress seem to be strongly related to sleep satisfaction underscoring the concept of “tinnitus” versus “tinnitus disorder”, but also the importance of sleep satisfaction as a global health indicator. Moreover, these data indicate the relevance of addressing sleep disorders in the therapeutic management of chronic tinnitus patients.

Conventional Cupping Therapy: Clinical Concerns

Cupping therapy is a customary medical innovation for a great many years. It is a critical segment of reciprocal and alternative medicine in the universe as needle therapy. It is mainstream in numerous nations, particularly in China, Korea, Japan, Saudi Arabia, and even Sudan [1]. Cupping therapy can be employed in spacious curable disease, and a few enhancements in the technical research of cupping therapy has been Made [2]. More heeds are intensive on the adverse event statement and exhorted proposal or standard. Cupping therapy is compelling in numerous sorts of sicknesses. It is reported that Persian Cupping therapy can be applied in 1001 sorts of ailments. Latterly, cupping therapy is regularly exercising for pain, cardiovascular diseases, immune system anomalies and metabolic diseases, migraine, low back pain, fibromyalgia, shoulder pain, chronic non-specific neck pain, angina, arthritis, hypertension, ischemic and inflammatory myocardial disorders, herpes zoster infection, secondary amenorrhea, depression and anxiety, fatigue, and acne vulgaris [3].

The Relationship between Cellphone Usage on the Physical and Mental Wellbeing of University Students: A Cross-Sectional Study.

(1) Background: The study aims to examine the use of cell phones on physical and mental health status and their impact on personality among university students. (2) Methods: A cross-sectional study was conducted using a semi-structured questionnaire. The association of physical and mental health variables with the demographic variables was examined using Pearson’s correlation and χ2-test. The binary logistic regression model was further used to predict the probabilities of negative impact on personality due to excessive use of cell phones. (3) Results: A total of 400 participants participated with a mean age of 24.45 ± 3.45 years. The average eye strain was more in High cell phone users HCPU than in LCPU and that difference was significant p = 0.000. The average neck pain was more in (HCPU) than Low cell phone users (LCPU) and there was a significant difference between the two groups with p = 0.006. The average weight gain was more in HCPU than LCPU and that difference was significant p = 0.000. Considering back pain, back pain was found more in HCPU as compared to LCPU with a statistical difference at p = 0.027. Cell phone usage significantly correlated with eye strain (r = 0.577, p = 0.000), neck pain (r = 0.543, p = 0.000), back pain (r = 0.611, p = 0.000), weight gain (r = 0.423, p = 0.000), depression (r = 0.430, p = 0.000), loneliness (r = −0.276, p = 0.002), and mood disorder (r = 0.608, p = 0.000). Eye strain, neck pain, and back pain was observed more in HCPU than in LCPU. HCPU felt they gained more weight when compared to the respondents in the LCPU group. HCPU felt more changes in mood and feeling low when compared to the LCPU, while LCPU group felt more lonelier when compared to the HCPU group. (4) Conclusions: The study highlights a significant association between excess use of cell phones and negative effects on physical and mental health wellbeing. Based on the results, it is recommended that more physical activities and alternative to minimize cell phone usage should be planned for the students. Public health policy makers and stakeholder need to address the ill effects of excessive use of cell phones through novel policies., especially young students, and alternatives to reduce their cell phone activities.

Evaluation of implementation and effectiveness of neck-specific exercise for persistent disability and pain after whiplash injury: study protocol for a randomized controlled study using a hybrid 2 design

BackgroundPersistent pain and disability in whiplash-associated disorders (WAD) grades II and III are common. In two randomized controlled trials (RCTs) of neck-specific exercises (NSE), we have seen promising results in chronic WAD, with a sustained clinically important reduction in pain and disability. NSE can also be delivered through internet support (NSEIT) and a few visits to a physiotherapist, saving time and cost for both patients and providers. NSE have been shown to have positive effects in other neck pain disorders and we will evaluate the diffusion of the exercises to other patients. The aims of the proposed study are to evaluate an implementation strategy for NSEIT and NSE in primary health care and to evaluate the effectiveness of NSEIT and NSE in clinical practice.MethodsThe proposed study is a prospective cluster-randomized mixed-design study with hybrid 2 trial design. Reg. physiotherapists working in twenty physiotherapy clinics will be included. The primary implementation outcome is proportion of patients with neck pain receiving neck-specific exercise. Secondary outcomes are; physiotherapists attitudes to implementation of evidence-based practice, their self-efficacy and confidence in performing NSEIT/NSE, number of patients visits, and use of additional or other exercises or treatment. To further evaluate the implementation strategy, two qualitative studies will be performed with a sample of the physiotherapists. The primary outcome in the patient effectiveness evaluation is self-reported neck disability according to the Neck Disability Index (NDI). Secondary outcomes are pain intensity in the neck, arm, and head; dizziness; work- and health-related issues; and patient’s improvement or deterioration over time. All measurements will be conducted at baseline and at 3 and 12 months. Physiotherapists´ self-efficacy and confidence in diagnosing and treating patients with neck pain will also be evaluated directly after their instruction in NSEIT/NSE.DiscussionThis trial will evaluate the implementation strategy in terms of adoption of and adherence to NSEIT and NSE in clinical primary health care, and measure diffusion of the method to other patients. In parallel, the effectiveness of the method will be evaluated. The results may guide physiotherapists and health care providers to sustainable and effective implementation of effective exercise programs.Trial registrationThe randomized trial is registered on ClinicalTrials.gov, NCT05198258, initial release date January 20, 2022.

Video-oculographic measures of eye movement control in the smooth pursuit neck torsion test can classify idiopathic neck pain patients from healthy individuals: A datamining based diagnostic accuracy study

BackgroundIdiopathic neck pain patients frequently experience oculomotor disfunctions with deficits in eye movement control between neutral and neck torsion position (SPNT test) being commonly investigated in clinical and research settings. ObjectivesThe aim of the study was to determine accuracy of SPNT test in classifying idiopathic neck pain patients. Designa datamining based diagnostic accuracy study. MethodsThe study was conducted on a referred sample of 38 chronic neck pain patients from orthopaedic outpatient clinic and 40 healthy controls. Video-oculography was used to study gain and SPNTdiff during SPNT test under three target movement velocities and amplitudes and two different angles of neck torsion. A Naïve Bayesian predictive model was used to classify neck pain patients based on gain or SPNTdiff. ResultsGain during two target movement profiles at velocities of 30°s−1 and amplitudes of 30° and 40° under 45° of neck torsion presented with highest area under the curve (0.837), specificity (92%), sensitivity (94%), highest true positive and lowest false negative predicted value. Highest area under the curve (0.760), specificity (50%), sensitivity (71%), highest true positive and lowest false negative values were observed for SPNTdiff at velocities of 30°s−1 and amplitude of 30° applying 45° of neck torsion. ConclusionSPNT test provides useful diagnostic tool for classifying neck pain patients when using single or combination of two target movement profiles. Neck torsion of 45° as opposed to 30° should be used during SPNT test when investigating patients with neck pain disorders.

Tele-Yoga for the Management of Cervical Dystonia: A Safety and Feasibility Trial

Background: Cervical dystonia impacts quality of life and activities of daily living. Botulinum toxin injections, the standard treatment, are not effective for all and often include bouts of recurring symptoms between injections. There is a need for supplementary treatments such as yoga, which has been shown to be beneficial for individuals with chronic neck pain and movement disorders. However, individuals with cervical dystonia experience barriers impeding access to in-person yoga. Thus, alternative delivery methods that can optimize access while maintaining safety must be investigated. The purpose of this study is to investigate the feasibility and safety of a synchronous one-on-one tele-yoga intervention for individuals with cervical dystonia.Methods: Individuals with cervical dystonia were enrolled in a single group pilot feasibility study consisting of a 6-weeks tele-yoga intervention bookended by two assessment sessions, ending with a 6-weeks follow-up period and associated final assessment session. The live one-on-one tele-yoga intervention consisted of breathing, postures, and relaxation and was delivered for 30 min twice weekly. Primary outcomes included adherence, adverse events, technological challenges, and usability. Secondary outcomes included enjoyment, yoga status at follow-up, clinically relevant questionnaires, and functional measures.Results: Of the fifteen individuals enrolled, one did not complete the follow-up assessment. Intervention adherence was 93%. No significant adverse events related to the intervention occurred. Manageable technological challenges occurred. Mean usability and enjoyment were high.Conclusions: The implementation of a one-on-one tele-yoga intervention for individuals with cervical dystonia is safe and feasible thus, efficacy trials should be initiated.Clinical Trial Registration:https://www.clinicaltrials.gov/ct2/show/NCT04348669, NCT04348669

Machine learning versus logistic regression for prognostic modelling in individuals with non-specific neck pain

PurposePrognostic models play an important clinical role in the clinical management of neck pain disorders. No study has compared the performance of modern machine learning (ML) techniques, against more traditional regression techniques, when developing prognostic models in individuals with neck pain.MethodsA total of 3001 participants suffering from neck pain were included into a clinical registry database. Three dichotomous outcomes of a clinically meaningful improvement in neck pain, arm pain, and disability at 3 months follow-up were used. There were 26 predictors included, five numeric and 21 categorical. Seven modelling techniques were used (logistic regression, least absolute shrinkage and selection operator [LASSO], gradient boosting [Xgboost], K nearest neighbours [KNN], support vector machine [SVM], random forest [RF], and artificial neural networks [ANN]). The primary measure of model performance was the area under the receiver operator curve (AUC) of the validation set.ResultsThe ML algorithm with the greatest AUC for predicting arm pain (AUC = 0.765), neck pain (AUC = 0.726), and disability (AUC = 0.703) was Xgboost. The improvement in classification AUC from stepwise logistic regression to the best performing machine learning algorithms was 0.081, 0.103, and 0.077 for predicting arm pain, neck pain, and disability, respectively.ConclusionThe improvement in prediction performance between ML and logistic regression methods in the present study, could be due to the potential greater nonlinearity between baseline predictors and clinical outcome. The benefit of machine learning in prognostic modelling may be dependent on factors like sample size, variable type, and disease investigated.

Is Altered Oculomotor Control during Smooth Pursuit Neck Torsion Test Related to Subjective Visual Complaints in Patients with Neck Pain Disorders?

Subjective visual complaints are commonly reported in patients with neck pain, but their relation to objectively measured oculomotor functions during smooth pursuit neck torsion tests (SPNTs) has not yet been investigated. The aim of the study was to analyse classification accuracy of visual symptom intensity and frequency based on SPNT results. Forty-three patients with neck pain were referred by orthopaedic outpatient clinics where they were required to fill out 16-item proformas of visual complaints. Infrared video-oculography was used to measure smooth pursuit eye movements during neutral and neck torsion positions. Parameters of gain and SPNT difference (SPNTdiff) were taken into the Naïve Bayes model as classifiers, while intensity and frequency of visual symptoms were taken as predicted class. Intensity and, to a lesser degree, frequency of visual symptoms previously associated with neck pain or focal vision disorders (computer vision syndrome) showed better classification accuracy using gain at neck torsion position, indicating cervical driven visual disturbances. Moreover, SPNTdiff presented with slightly lower classification accuracy as compared to gain at neck torsion position. Our study confirmed the relationship between cervical driven oculomotor deficits and some visual complaints (concentrating to read, words moving on page, blurred vision, difficulty judging distance, sore eyes, heavy eyes, red eyes, and eyes strain).