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Langenfeld A.1,2, Bastiaenen C.1,3, Sieben J.1,4, Swanenburg J.2,5
1Maastricht University, CAPHRI School for Public Health and Primary Care, Maastricht, Netherlands, 2University of Zurich and Balgrist University Hospital, Department of Chiropractic Medicine, Zurich, Switzerland, 3Maastricht University, Department of Epidemiology, Maastricht, Netherlands, 4Maastricht University, Department of Anatomy & Embryology, Maastricht, Netherlands, 5University Hospital Zurich, Physiotherapy Occupational Therapy Research Centre, Directorate of Research and Education, Zurich, Switzerland
Background: Cervical range of motion is a frequently used assessment in physiotherapy and is the most commonly applied measure in assessing the status of patients with neck pain. Measurements are usually conducted by the clinician but the patient`s point of view is not often incorporated. However, patient perception is an important component of the initial assessment to specify the treatment. Self-reported range of motion measures exist for other joints but not for the cervical spine.
Purpose: To develop a measure that assesses the patient`s cervical range of motion from the patient´s perspective.
Methods: A prospective cohort was conducted. Eligible patients were > = 18 years of age, duration of complaints > 90 days and able to speak, read and write German. Patients were excluded if they had any signs of Red Flags e.g. fractures of the cervical spine. The S-ROM-Neck is a self-administered questionnaire incorporating six questions, based on a visual analogue rating scale, targeting the primary movements of the cervical spine: flexion, extension, rotation to both sides and lateral flexion to both sides. A total score is calculated; min. score (60) = no restrictions and max. score (0) = total restriction. Additionally, the Visual Analogue Rating Scale (VAS) and the German Version of the Neck Disability Index (NDI-G) were assed. All questionnaires were answered twice within seven days. Relative reliability of the S-ROM-Neck was assessed using intraclass correlation coefficient (ICC) and 95% confidence intervals. To evaluate internal consistency we used Cronbach`s alpha. Standard Error of Measurement (SEM) and Smallest Detectable Change (SDC) were used to determine absolute reliability. Additionally, Bland-Altman Plots were generated. To establish criterion validity the total score of the S-ROM-Neck was correlated with the VAS and NDI-G.
Results: 50 patients, 35 female (mean=43.62 years, SD 14.94), were included. Mean overall score of the S-ROM-Neck was 42,57mm (SD= 10,66mm). Mean overall VAS score was 3.57 (SD=2.28) and mean NDI score was 13.16 (SD 5.92). With a value of ICC 0,718, the S-ROM-Neck showed good reliability. Cronbach`s alpha was 0,83. The SEM was 3,17 and the SDC 8,79. The Bland-Altman plot indicated, that all points apart from two were located within the 95% limits of agreement for test-retest and visual inspection showed no tendency towards heteroscedasticity. Spearman´s rho between VAS and S-ROM-Neck showed a moderate negative correlation (rs=-0,30, p= 0,030) as well as for the NDI and S-ROM-Neck (rs= -0,40, p= 0,003).
Conclusion(s): The S-ROM-Neck shows good reliability and internal consistency. Negative correlations of VAS and S-ROM-Neck as well as NDI and S-ROM-Neck suggest that if the VAS scores reduce the S-ROM-Neck scores increase, which is as expected regarding the NDI. This indicates that people who have a larger cervical range of motion also have less pain. Furthermore people having a better cervical spine movement have a lower NDI score.
Implications: The S-ROM-Neck is a new measure, which seems to be promising for the use in daily practice to assess cervical range of motion in neck pain patients incorporating patient perception. Additional research is needed to assess further psychometric properties of the measurement.
Funding acknowledgements: None
Topic: Outcome measurement
Ethics approval: Ethics Commission Canton of Zurich
All authors, affiliations and abstracts have been published as submitted.
