A clinical test to assess isometric cervical strength in chronic whiplash associated disorder (WAD): a reliability study
Abstract Background Cervical spine muscle weakness is well demonstrated in individuals with chronic neck pain. There is a lack of literature evaluating clinically applicable means of assessing isometric cervical strength in chronic whiplash associated disorder (WAD). This study assessed the reliabil...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-08-01
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| Series: | BMC Musculoskeletal Disorders |
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| Online Access: | https://doi.org/10.1186/s12891-022-05703-0 |
| _version_ | 1798037979342569472 |
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| author | Jeff Habberfield Geoff Schneider Kathryn Schneider Sozina Katuli Lee Olson |
| author_facet | Jeff Habberfield Geoff Schneider Kathryn Schneider Sozina Katuli Lee Olson |
| author_sort | Jeff Habberfield |
| collection | DOAJ |
| description | Abstract Background Cervical spine muscle weakness is well demonstrated in individuals with chronic neck pain. There is a lack of literature evaluating clinically applicable means of assessing isometric cervical strength in chronic whiplash associated disorder (WAD). This study assessed the reliability of self-resisted isometric cervical strength testing using a handheld dynamometer. The relationship between strength and neck pain-related disability and kinesiophobia was also investigated. Methods Twenty subjects with chronic WAD performed maximum-effort isometric cervical flexion, extension, side flexion, and rotation against a hand held dynamometer. The dynamometer was held by the subject, who provided self-resistance. Subjects completed two sessions of testing on one day with two different examiners, and one session on a subsequent day with one of the original examiners. Subjects completed the Neck Disability Index (NDI) and Tampa Scale for Kinesiophobia (TSK) prior to the first testing session. Results Intraclass correlation coefficients (ICC) for directional strength measures were fair to high (0.71–0.88 for intra-rater and 0.79–0.91 for inter-rater). Total strength (sum of all directional strengths) ICCs were high for both intra-rater (ICC = 0.91) and inter-rater (ICC = 0.94) measures. All statistical tests for ICCs demonstrated significance (α < 0.05). Agreement was assessed using Bland Altman (BA) analysis with 95% limits of agreement. BA analysis demonstrated difference scores between the two testing sessions that ranged from 3.0—17.3% and 4.5—28.5% of the mean score for intra and inter-rater measures, respectively. Most measures did not meet the a priori standard for agreement. A moderate to good inverse relationship was demonstrated between kinesiophobia (TSK score) and six out of seven strength measures (α < .05). No significant correlation was found between neck disability (NDI) and cervical strength in any direction. Conclusion This study demonstrated fair to high reliability of self resisted isometric cervical strength testing in the chronic WAD population. All directional strength measures except flexion demonstrated a significant inverse relationship with kinesiophobia. No cervical strength measures were correlated with neck disability. These results support testing cervical strength in this manner to reliably assess change over time within individual patients. The value of such measurement requires further consideration given the lack of correlation between cervical strength and disability. Further research is required to establish normative values and enhance clinical utility. |
| first_indexed | 2024-04-11T21:33:57Z |
| format | Article |
| id | doaj.art-7347213d502d40f29bafa052476405cb |
| institution | Directory Open Access Journal |
| issn | 1471-2474 |
| language | English |
| last_indexed | 2024-04-11T21:33:57Z |
| publishDate | 2022-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Musculoskeletal Disorders |
| spelling | doaj.art-7347213d502d40f29bafa052476405cb2022-12-22T04:01:48ZengBMCBMC Musculoskeletal Disorders1471-24742022-08-0123111210.1186/s12891-022-05703-0A clinical test to assess isometric cervical strength in chronic whiplash associated disorder (WAD): a reliability studyJeff Habberfield0Geoff Schneider1Kathryn Schneider2Sozina Katuli3Lee Olson4Evidence Sport and Spinal TherapyEvidence Sport and Spinal TherapyEvidence Sport and Spinal TherapyAndrews University School of Rehabilitation Sciences. School of Rehabilitation Sciences Building 131Andrews University School of Rehabilitation Sciences. School of Rehabilitation Sciences Building 131Abstract Background Cervical spine muscle weakness is well demonstrated in individuals with chronic neck pain. There is a lack of literature evaluating clinically applicable means of assessing isometric cervical strength in chronic whiplash associated disorder (WAD). This study assessed the reliability of self-resisted isometric cervical strength testing using a handheld dynamometer. The relationship between strength and neck pain-related disability and kinesiophobia was also investigated. Methods Twenty subjects with chronic WAD performed maximum-effort isometric cervical flexion, extension, side flexion, and rotation against a hand held dynamometer. The dynamometer was held by the subject, who provided self-resistance. Subjects completed two sessions of testing on one day with two different examiners, and one session on a subsequent day with one of the original examiners. Subjects completed the Neck Disability Index (NDI) and Tampa Scale for Kinesiophobia (TSK) prior to the first testing session. Results Intraclass correlation coefficients (ICC) for directional strength measures were fair to high (0.71–0.88 for intra-rater and 0.79–0.91 for inter-rater). Total strength (sum of all directional strengths) ICCs were high for both intra-rater (ICC = 0.91) and inter-rater (ICC = 0.94) measures. All statistical tests for ICCs demonstrated significance (α < 0.05). Agreement was assessed using Bland Altman (BA) analysis with 95% limits of agreement. BA analysis demonstrated difference scores between the two testing sessions that ranged from 3.0—17.3% and 4.5—28.5% of the mean score for intra and inter-rater measures, respectively. Most measures did not meet the a priori standard for agreement. A moderate to good inverse relationship was demonstrated between kinesiophobia (TSK score) and six out of seven strength measures (α < .05). No significant correlation was found between neck disability (NDI) and cervical strength in any direction. Conclusion This study demonstrated fair to high reliability of self resisted isometric cervical strength testing in the chronic WAD population. All directional strength measures except flexion demonstrated a significant inverse relationship with kinesiophobia. No cervical strength measures were correlated with neck disability. These results support testing cervical strength in this manner to reliably assess change over time within individual patients. The value of such measurement requires further consideration given the lack of correlation between cervical strength and disability. Further research is required to establish normative values and enhance clinical utility.https://doi.org/10.1186/s12891-022-05703-0Neck strengthCervical strengthWhiplash associated disorderTest–retest reliabilityTest–retest agreementKinesiophobia |
| spellingShingle | Jeff Habberfield Geoff Schneider Kathryn Schneider Sozina Katuli Lee Olson A clinical test to assess isometric cervical strength in chronic whiplash associated disorder (WAD): a reliability study BMC Musculoskeletal Disorders Neck strength Cervical strength Whiplash associated disorder Test–retest reliability Test–retest agreement Kinesiophobia |
| title | A clinical test to assess isometric cervical strength in chronic whiplash associated disorder (WAD): a reliability study |
| title_full | A clinical test to assess isometric cervical strength in chronic whiplash associated disorder (WAD): a reliability study |
| title_fullStr | A clinical test to assess isometric cervical strength in chronic whiplash associated disorder (WAD): a reliability study |
| title_full_unstemmed | A clinical test to assess isometric cervical strength in chronic whiplash associated disorder (WAD): a reliability study |
| title_short | A clinical test to assess isometric cervical strength in chronic whiplash associated disorder (WAD): a reliability study |
| title_sort | clinical test to assess isometric cervical strength in chronic whiplash associated disorder wad a reliability study |
| topic | Neck strength Cervical strength Whiplash associated disorder Test–retest reliability Test–retest agreement Kinesiophobia |
| url | https://doi.org/10.1186/s12891-022-05703-0 |
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