Dimitriadis Z.1, Fragkakis V.1, Kapreli E.2, Strimpakos N.2,3, Tziouma M.4, Petta G.1
1Technological Educational Institution of Athens, Physiotherapy, Athens, Greece, 2Technological Educational Institution of Sterea Ellada, Physiotherapy, Lamia, Greece, 3University of Manchester, Manchester, United Kingdom, 4Physiotherapy Center, Athens, Greece

Background: The assessment of deep neck flexors is an important part of physiotherapeutic management especially in patients with neck pain or in risk of developing neck pain. In clinical practice the two most usual clinical tests for their endurance are the craniocervical flexion test (CCFT) and the chin tuck neck flexion test (CTNFT). Although the reliability of both tests has been examined, specific characteristics such as the degree at which they are affected by the motive or motivation of the participants to continue the trial have never been examined.

Purpose: The main aim of the study was to investigate the association between the performance in these two clinical tests for the endurance of deep neck flexors (CCFT and CTNFT) and the motives and motivation of participants to engage in and complete the tests.

Methods: Twenty one young healthy volunteers participated (men/women 13/8, age 21.1±1.37 years). Participants were asked to complete a general health questionnaire, a scale for the assessment of their motivation to continue physical activities (ASCUPA scale), a scale for the recording of motives for physical activity (SSPAM scale), a visual analog scale for the recording of their motivation to complete a physical activity/exercise (VAS motivation) and then they performed the CCFT and CTNFT. After the completion of each clinical test the participants completed a 6-item questionnaire relative to specific characteristics of the test (difficulty, dependence on their motivation to complete it etc).

Results: The CCFT did not present any significant correlation with either VAS mood or ASCUPA scale. In contrast, although the CTNFT was not significantly associated with ASCUPA scale, it was significantly associated with VAS motivation (rs = 0.58, p 0.01). In contrast again with CCFT, the CTNFT was significantly associated with the total number of motives for physical activity (rs = 0.64). The participants additionally considered that the CTNFT was tiring in contrast to CCFT which was not (p=0.001). The CTNFT seemed to be more difficult than what it was believed based on the initial instructions, something which was less apparent for the CCFT (p 0.01). The participants believed that both tests are equally affected by their motivation to complete the tests (p>0.05).

Conclusion(s): CTNFT is generally a more tiring test for the assessment of endurance of deep neck flexors and in spite of the subjective opinions of participants the other findings suggest that it is affected by their motives and motivation. Furthermore, the low concurrent validity of the two tests potentially suggests that they do not assess the same neck muscle parameter something which might be attributed to the fact that the CTNFT does not isolate the activation of deep neck flexors.

Implications: The findings of the study complement the previous studies regarding the validity and reliability of the tests and reveal the superiority of the CCFT which not only is not affected by participants’ motives and motivation to complete the test, but also it might be the only test which assess the endurance of deep neck flexors without influences from the large neck flexors.

Funding acknowledgements: The study was self-funded

Topic: Musculoskeletal: spine

Ethics approval: The study was approved by the Ethics Committee of the Technological Educational Institute of Athens, Athens, Greece.

All authors, affiliations and abstracts have been published as submitted.

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