Perceived pain and disability but not fear of movement are associated with altered cervical kinematics in people with acute neck pain following a whiplash injury.

OBJECTIVES: To determine if measures of cervical kinematics are altered in people with acute whiplash associated disorders (WAD) and secondarily, to examine whether kinematic variables are associated with self-reported outcomes. METHODS: We recruited people with acute WAD within 15 days after a motor vehicle collision and asymptomatic control participants. All participants performed active neck movements at a self-determined velocity. Maximal range of motion (ROM), peak and mean velocity of movement, smoothness of movement, and cervical joint position error were assessed. Moreover, self-reported measures of perceived pain and disability, pain catastrophising, and fear of movement were obtained. RESULTS: Sixty people participated: 18 with acute WAD (mean age [SD] 38.7 [12.0]) and 42 as asymptomatic controls (mean age [SD] 38.4 [10.2]). Participants with acute WAD showed significantly decreased ROM in all movement directions (p < 0.0001). All participants with acute WAD showed a reduction in the mean and peak velocity of movement in all directions (p < 0.0001) and the number of velocity peaks was significantly higher (i.e., reduced smoothness of movement) in those with acute WAD in all directions (p < 0.0001). Repositioning acuity following cervical rotation was not significantly different between groups. Neck pain-related disability showed the largest number of significant associations with kinematic features, while fear of movement was not associated with measures of cervical kinematics. CONCLUSIONS: Participants with acute WAD presented with altered cervical kinematics compared to asymptomatic participants. Several measures of cervical kinematics were associated with the level of pain and disability in people with acute WAD but not their fear of movement.

A network analysis reveals the interaction between fear and physical features in people with neck pain.

Although neck pain is known to be a complex and multifactorial condition characterised by the interplay between physical and psychological domains, a comprehensive investigation examining the interactions across multiple features is still lacking. In this study, we aimed to unravel the structure of associations between physical measures of neuromuscular function and fear of movement in people with a history of neck pain. One hundred participants (mean age 33.3 ± 9.4) were assessed for this cross-sectional study, and the neuromuscular and kinematic features investigated were the range of motion, velocity of neck movement, smoothness of neck movement, neck proprioception (measured as the joint reposition error), and neck flexion and extension strength. The Tampa Scale for Kinesiophobia was used to assess fear of movement. A network analysis was conducted to estimate the associations across features, as well as the role of each feature in the network. The estimated network revealed that fear of movement and neuromuscular/kinematic features were conditionally dependent. Higher fear of movement was associated with a lower range of motion, velocity, smoothness of neck movement, neck muscle strength, and proprioception (partial correlations between - 0.05 and - 0.12). Strong interactions were also found between kinematics features, with partial correlations of 0.39 and 0.58 between the range of motion and velocity, and between velocity and smoothness, respectively. The velocity of neck movement was the most important feature in the network since it showed the highest strength value. Using a novel approach to analysis, this study revealed that fear of movement can be associated with a spectrum of neuromuscular/kinematic adaptations in people with a history of neck pain.

Assessment of Neuromuscular and Psychological Function in People with Recurrent Neck Pain during a Period of Remission: Cross-Sectional and Longitudinal Analyses.

The aim of this study was to examine for the presence of differences in neuromuscular and psychological function in individuals with recurrent neck pain (RNP) or chronic neck pain (CNP) following a whiplash trauma compared to healthy controls. A secondary aim was to examine whether neuromuscular characteristics together with psychological features in people with RNP were predictive of future painful episodes. Multiple features were assessed including neck disability, kinesiophobia, quality of life, cervical kinematics, proprioception, activity of superficial neck flexor muscles, maximum neck flexion and extension strength, and perceived exertion during submaximal contractions. Overall, those with RNP (n = 22) and CNP (n = 8) presented with higher neck disability, greater kinesiophobia, lower quality of life, slower and irregular neck movements, and less neck strength compared to controls (n = 15). Prediction analysis in the RNP group revealed that a higher number of previous pain episodes within the last 12 months along with lower neck flexion strength were predictors of higher neck disability at a 6-month follow-up. This preliminary study shows that participants with RNP presented with some degree of altered neuromuscular features and poorer psychological function with respect to healthy controls and these features were similar to those with CNP. Neck flexor weakness was predictive of future neck disability.

Does Pain Extent Predict Ongoing Pain and Disability in Patients with Chronic Whiplash-Associated Disorders?

This study investigates whether baseline pain extent, extracted from an electronic pain drawing, is an independent predictive factor of pain and disability measured 1 year and 2 years later in people with chronic WAD. Participants completed questionnaires assessing neck pain intensity, disability via the Neck Disability Index (NDI), psychological features, and work ability. Participants also completed electronic pain drawings from which their pain extent was extracted. A two-step modelling approach was undertaken to identify the crude and adjusted association between pain extent and NDI measured at 1-year and 2-year follow-ups. A total of 205 participants were included in the analysis. The univariate analysis showed that pain extent was significantly associated with the NDI score at the 1-year (p = 0.006, 95% CI: 0.159-0.909) and 2-year (p = 0.029, 0.057-0.914) follow-ups. These associations were not maintained when we introduced perceived disability, psychological health, and work ability into the model after 1 year (p = 0.56, 95%CI: -0.28-0.499) and 2 years (p = 0.401, -0.226-0.544). Pain extent, as an independent factor, was significantly associated with perceived pain and disability in patients with chronic WAD for up to 2 years. This association was masked by neck disability, psychological health, and work ability.

Are Measures of Physical Function of the Neck Region Associated With Poor Prognosis Following a Whiplash Trauma?: A Systematic Review.

OBJECTIVE: The objective of this study was to synthesize the current evidence regarding the predictive ability of measures of physical function (PF) of the neck region and perceived PF on prognosis following a whiplash injury. MATERIALS AND METHODS: Electronic databases were searched by 2 independent reviewers up to July 2020, including MEDLINE, EMBASE, CINAHL, PsycINFO, Scopus, and Web of Science as well as gray literature. Eligible studies were selected by 2 reviewers who then extracted and assessed the quality of evidence. Observational cohort studies were included if they involved participants with acute whiplash-associated disorders (WAD), followed for at least 3 months postinjury, and included objective measures of neck PF or self-reported measures of PF as prognostic factors. Data could not be pooled and therefore were synthesized qualitatively. RESULTS: Fourteen studies (13 cohorts) were included in this review. Low to very low quality of evidence indicated that initial higher pain-related disability and higher WAD grade were associated with poor outcome, while there was inconclusive evidence that neck range of motion, joint position error, activity of the superficial neck muscles, muscle strength/endurance, and perceived functional capacity are not predictive of outcome. The predictive ability of more contemporary measures of neck PF such as the smoothness of neck movement, variability of neck motion, and coactivation of neck muscles have not been assessed. DISCUSSION: Although initial higher pain-related disability and higher WAD grade are associated with poor outcome, there is little evidence available investigating the role of neck PF on prognosis following a whiplash injury.

Screening for depression, anxiety, and obsessive-compulsive disorders among secondary school students in Al-Hasa Region, Saudi Arabia.

BACKGROUND: The purpose of this study was to determine the prevalence of anxiety, depression, and obsessive-compulsive disorder (OCD) and assess their severity in both male and female secondary school students. MATERIALS AND METHODS: This cross-sectional study was conducted among secondary school students in Al Hasa region. A sample of student was selected using multi-stage sampling technique. Data were collected using valid self administered questionnaires (Patient Health Questionnaire 9, Anxiety Disorder 7, and Yale-Brown Obsessive-Compulsive scale). Study was approved by institutional ethical review committee, and informed consent was obtained from each participant. SPSS used for data entry and analysis. Chi-square test was used to test for statistical significance. RESULTS: A total of 1783 of students, 930 males and 853 females, were enrolled in the study. The prevalence of depression, anxiety, and OCD was 76.2%, 49.9%, and 61.6%, respectively. Most of the diagnosed students had mild forms of the diseases, fewer had moderate form, and very few had severe forms. The most significant risk factor was gender, but other risk factors were significant for some of the diseases. CONCLUSION: The prevalence of the three diseases is high and significantly associated with gender. Further work is needed to evaluate this high prevalence and assess the severity of the diseases and other risk factors.

Do measures of physical function enhance the prediction of persistent pain and disability following a whiplash injury? Protocol for a prospective observational study in Spain.

INTRODUCTION: Not all factors that predict persistent pain and disability following whiplash injury are known. In particular, few physical factors, such as changes in movement and muscle behaviour, have been investigated. The aim of this study is to identify predictive factors that are associated with the development of persistent pain and disability following a whiplash injury by combining contemporary measures of physical function together with established psychological and pain-related predictive factors. METHODS AND ANALYSIS: A prospective observational study will recruit 150 consecutive eligible patients experiencing whiplash-related symptoms, admitted to a private physiotherapy clinic in Spain within 15 days of their whiplash injury. Poor outcome will be measured using the Neck Disability Index (NDI), defined as an NDI score of 30% or greater at 6 months post injury. Candidate predictors, including demographic characteristics, injury characteristics, pain characteristics, self-reported psychosocial factors and physical factors, will be collected at baseline (within 15 days of inception). Regression analyses will be performed to identify factors that are associated with persistent neck pain and disability over the study period. ETHICS AND DISSEMINATION: The project has been approved by the Ethics Committee of the province of Malaga, Spain (#30052019). The results of this study will be published in peer-reviewed journals.

Are physical factors associated with poor prognosis following a whiplash trauma?: a protocol for a systematic review and data synthesis.

INTRODUCTION: Mitigating the transition from acute to chronic whiplash-associated disorders (WAD) is fundamental, and this could be achieved through early identification of individuals at risk. Several physical factors such as angular velocity, smoothness of neck movement and coactivation of neck flexors and extensors, have been observed in patients with WAD, but their predictive ability after a whiplash injury have not been considered in previous reviews. Therefore, the aim of the current protocol is to outline the protocol for a systematic review that synthesises the current evidence of which physical factors can predict ongoing pain and disability following a whiplash trauma. METHODS AND ANALYSIS: Two independent reviewers will search for studies in several electronic databases including MEDLINE, Embase, CINAHL, PsycINFO, Scopus and Web of Science as well as grey literature. Observational cohort studies will be considered if they involve participants with acute WAD followed for at least 3 months post-injury. Studies will be required to assess the prognostic ability of one or more physical factors that directly involve a body function and/or structure and can be measured objectively. Further, patient-reported outcomes of physical function will be considered. The primary outcome for this review is Neck Disability Index, while all other validated measures will be considered as secondary outcomes. Risk of bias across individual studies will be assessed using the Quality In Prognostic Studies tool along with the Grades of Recommendation, Assessment, Development and Evaluation method to assess the quality of evidence. A meta-analysis will be conducted depending on homogeneity and the number of available studies. If appropriate, data will be pooled and presented as odds ratios, otherwise, a qualitative synthesis will be conducted. ETHICS AND DISSEMINATION: Ethical approval is not required for this systematic review. The result from this review will be published in peer-reviewed journals. PROSPERO REGISTRATION NUMBER: CRD42019122559.

The effectiveness of physiotherapy interventions for sacroiliac joint dysfunction: a systematic review.

[Purpose] The aim of this study is to investigate the effectiveness of physical therapy interventions in the treatment of sacroiliac joint dysfunction (SIJD). [Subjects and Methods] MEDLINE, PUBMED, CINAHL, AMED, PEDro, and CIRRIE databases were searched and only relevant data from studies that matched the inclusion criteria were included. CASP tools for critical appraisal were used to assess the quality of studies included. [Results] Nine articles met the inclusion criteria, of which, three examined the effect of exercise on SIJD, three used kinesio tape and four studies examined the effect of manipulation. Various outcomes were used including the visual analogue pain scale (VAS), Oswestry disability questionnaire (ODQ), numerical pain rating scale (NPRS) and pelvic position measurement (PALM, pelvimeter and photogrammetry). The quality of included studies ranged from low to average as the CASP tools revealed several limitations that affect the validity of the studies. The results showed that physiotherapy interventions are effective in reducing pain and disability associated with SIJD, with manipulation being the most effective approach and most commonly used within physical therapy clinics. [Conclusion] Manipulation, exercise and kinesio tape are effective in the treatment of pain, disability and pelvic asymmetry in SIJD.

Physiotherapists' behaviour, attitudes, awareness, knowledge and barriers in relation to evidence-based practice implementation in Saudi Arabia: a cross-sectional study.

AIM: The implementation of evidence-based practice (EBP) is extremely important and plays a vital role in healthcare practice. There have been few studies concerning the level of healthcare provided to patients in Saudi Arabia, using EBP as an indicator. This study is aimed at investigating physiotherapists' behaviour, attitudes, awareness and knowledge about EBP, along with barriers that curb the implementation of EBP. METHODS: A sample of convenience was used and an online survey consisting of 14 closed-ended questions was given to both clinical and academic physiotherapists in Saudi Arabia from May to October 2016. Data regarding demographics, behaviour, attitudes, awareness, knowledge, previous formal training and barriers to implementation of EBP were recorded. The data were analysed using IBM SPSS version 19. RESULTS: A total of 604 physiotherapists participated in the survey, out of which 385 respondents provided complete data. Nine participants were undergraduate physiotherapy students or not physiotherapists and their responses were excluded. The final number of participants included in data analysis was 376. The majority of the participants were men (60.4%) and most of them had completed their bachelor degree (66.2%). Although most physiotherapists reported a positive attitude towards the use of research in practice, there were many who were unfamiliar with the terms and implementation of EBP. The majority of physiotherapists had no formal EBP training (70.2%) in universities or any authorized training centres. According to the responses collected, the most important barrier to the implementation of EBP was insufficient teaching in previous education (43.1%), followed by lack of research knowledge and skills (36.4%). The study revealed that there was a significant association between physiotherapists' attitude and their education level, while no significant associations were identified based on other demographic data. In addition, there were significant associations between physiotherapists' awareness and knowledge and demographics such as education level, work setting, job title and previous training in EBP. CONCLUSION: There is a prominent gap in terms of understanding and applying the concept of EBP among physiotherapists in Saudi Arabia. Given that the majority of practicing physiotherapists reported no formal training in EBP, there is a need to integrate concepts related to EBP into the undergraduate and graduate curriculum. In addition, strategies must be developed and implemented to encourage practicing physiotherapists for gaining knowledge and proficiency in EBP.