| 1. |
- Chen, Kenneth, et al.
(författare)
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Recommendations for Core Outcome Domain Set for Whiplash Associated Disorders (CATWAD)
- 2019
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Ingår i: Clinical Journal of Pain. - : Lippincott Williams & Wilkins. - 0749-8047 .- 1536-5409. ; 35:9, s. 727-736
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Inconsistent reporting of outcomes in clinical trials of treatments for Whiplash Associated Disorders (WAD) hinders effective data pooling and conclusions that can be drawn about the effectiveness of tested treatments. The aim of this study was to provide recommendations for core outcome domains that should be included in clinical trials of WAD. Methods: A three-step process was used. 1) A list of potential core outcome domains were identified from the published literature; 2) Researchers, health care providers, patients and insurance personnel participated and rated the importance of each domain via a three round Delphi survey. A priori criteria for consensus were established; 3) Experts comprising researchers, health care providers and a consumer representative participated in a multidisciplinary consensus meeting that made final decisions on the recommended core outcome domains. Results: The literature search identified 63 potential core domains. 223 participants were invited to partake in the Delphi surveys with 41.7% completing Round 1, 45.3% Round 2 and 51.4% Round 3. Eleven core domains met the criteria for inclusion across the entire sample. After the expert consensus meeting, six core domains were recommended: Physical Functioning, Perceived Recovery, Work and Social Functioning, Psychological Functioning, Quality of Life and Pain. Discussion: A 3-step process was used to recommend core outcome domains for clinical trials in WAD. Six core domains were recommended: Physical Functioning, Perceived Recovery, Work and Social Functioning, Psychological Functioning, Quality of Life and Pain. The next step is to determine the outcome measurement instruments for each of these domains.
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| 2. |
- Clark, Nicholas C., et al.
(författare)
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Proprioception in Musculoskeletal Rehabilitation : Part 2: Clinical Assessment and Intervention
- 2015
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Ingår i: Manual Therapy. - : Elsevier BV. - 1356-689X .- 1532-2769. ; 20:3, s. 378-387
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Tidskriftsartikel (refereegranskat)abstract
- IntroductionProprioception can be impaired in gradual-onset musculoskeletal pain disorders and following trauma. Understanding of the role of proprioception in sensorimotor dysfunction and methods for assessment and interventions is of vital importance in musculoskeletal rehabilitation. In Part 1 of this two-part Masterclass we presented a theory-based overview of the role of proprioception in sensorimotor control, causes and findings of altered proprioception in musculoskeletal conditions, and general principles of assessment and interventions.PurposeThe aim of this second part is to present specific methods for clinical assessment and interventions to improve proprioception in the spine and extremities.ImplicationsClinical assessment of proprioception can be performed using goniometers, inclinometers, laser-pointers, and pressure sensors. Manual therapy, taping, and bracing can immediately enhance proprioception and should be used to prepare for exercise interventions. Various types of exercise (active joint repositioning, force sense, co-ordination, muscle performance, balance/unstable surface, plyometric, and vibration training) should be employed for long-term enhancement of proprioception.
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| 3. |
- Grip, Helena, et al.
(författare)
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Head eye co-ordination using simultaneous measurement of eye in head and head in space movements : potential for use in subjects with a whiplash injury.
- 2009
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Ingår i: Journal of clinical monitoring and computing. - : Springer. - 1387-1307 .- 1573-2614. ; 23:1, s. 31-40
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Tidskriftsartikel (refereegranskat)abstract
- Objective. Describe reproducibility of a measurement method to investigate deficits in eye-head co-ordination. Methods. Combined recordings of head and eye rotation using wireless motion sensors and electro-oculography (EOG) were used as an initial step towards a method to quantify eye-head co-ordination deficits. Head rotation to the side during gaze fixation and sequential head and eye movements were studied on 20 asymptomatic control subjects and six subjects with chronic whiplash disorders. All included whiplash subjects reported eye disturbances according to a vision symptom questionnaire. Results. The trial-to-trial reproducibility was moderate to high for 24 of 28 variables (Intraclass Correlation Coefficient 0.44 to 0.87). Velocity gain (ratio of eye and head velocities) was on average close to unity in both groups. Head stability was high in control subjects, while three of six whiplash subjects demonstrated head instability during eye movement. Whiplash subjects also demonstrated a decreased range of head movement during gaze fixation and lower head velocities as compared with the asymptomatics. Conclusions. The method of combined head and eye motion appears to give accurate, repeatable measurements. Case studies of whiplash subjects indicated deficits in head eye co-ordination. The method could be useful in further clinical research into eye and head movement in those with neck disorders.
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| 4. |
- Jull, Gwendolen A, et al.
(författare)
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Toward optimal early management after whiplash injury to lessen the rate of transition to chronicity
- 2011
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Ingår i: Spine. - 0362-2436 .- 1528-1159. ; 36:25 Suppl, s. S335-S342
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: Expert debate and synthesis of research to inform future management approaches for acute whiplash disorders.OBJECTIVE: To identify a research agenda toward improving outcomes for acute whiplash-injured individuals to lessen the incidence of transition to chronicity.SUMMARY OF BACKGROUND DATA: International figures are concordant, estimating that 50% of individuals recover from pain and disability within 3 to 6 months of a whiplash injury. The remainder report continuing symptoms up to 1 to 2 years or longer postinjury. As no management approach to date has improved recovery rates, new clinical/research directions are required for early management of whiplash-injured patients.METHODS: A group of multidisciplinary researchers critically debated evidence and current research concerning whiplash from biological, psychological, and social perspectives toward informing future research directions for management of acute whiplash.RESULTS: It was recognized that effective treatments for acute whiplash are constrained by a limited understanding of causes of whiplash-associated disorders. Acute whiplash presentations are heterogeneous leading to the proposal that a research priority was development of a triage system based on modifiable prognostic indicators and clinical features to better inform individualized early management decisions. Other priorities identified included researching effective early pain management for individuals presenting with moderate to high levels of pain; development of best education/information for acute whiplash; testing the efficacy of stratified and individualized rehabilitation, researching modes of delivery considering psychosocial modulators of pain and disability; and the timing, nature, and mode of delivery of cognitive-behavioral therapies. Directions were highlighted for future biomechanical research into injury prevention.CONCLUSION: The burden of whiplash injuries, the high rate of transition to chronicity, and evidence of limited effects of current management on transition rates demand new directions in evaluation and management. Several directions have been proposed for future research, which reflect the potential multifaceted dimensions of an acute whiplash disorder.
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| 5. |
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| 6. |
- Röijezon, Ulrik, et al.
(författare)
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Proprioception in Musculoskeletal Rehabilitation : Part 1: Basic Science and Principles of Assessment and Clinical Interventions
- 2015
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Ingår i: Manual Therapy. - : Elsevier BV. - 1356-689X .- 1532-2769. ; 20:3, s. 368-377
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Tidskriftsartikel (refereegranskat)abstract
- IntroductionImpaired proprioception has been reported as a feature in a number of musculoskeletal disorders of various body parts, from the cervical spine to the ankle. Proprioception deficits can occur as a result of traumatic damage, e.g., to ligaments and muscles, but can also occur in association with painful disorders of a gradual-onset nature. Muscle fatigue can also adversely affect proprioception and this has implications for both symptomatic and asymptomatic individuals. Due to the importance of proprioception for sensorimotor control, specific methods for assessment and training of proprioception have been developed for both the spine and the extremities.PurposeThe aim of this first part of a two part series on proprioception in musculoskeletal rehabilitation is to present a theory based overview of the role of proprioception in sensorimotor control, assessment, causes and findings of altered proprioception in musculoskeletal disorders and general principles of interventions targeting proprioception.ImplicationsAn understanding of the basic science of proprioception, consequences of disturbances and theories behind assessment and interventions is vital for the clinical management of musculoskeletal disorders. Part one of this series supplies a theoretical base for part two which is more practically and clinically orientated, covering specific examples of methods for clinical assessment and interventions to improve proprioception in the spine and the extremities.
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| 7. |
- Röijezon, Ulrik, et al.
(författare)
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Proprioceptive Disturbance in Chronic Neck Pain: Discriminate Validity and Reliability of Performance of the Clinical Cervical Movement Sense Test
- 2022
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Ingår i: Frontiers in Pain Research. - : Frontiers Media S.A.. - 2673-561X. ; 3
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Tidskriftsartikel (refereegranskat)abstract
- Chronic neck pain is associated with sensorimotor dysfunctions, which may develop symptoms, affect daily activities, and prevent recovery. Feasible, reliable, and valid objective methods for the assessment of sensorimotor functions are important to identify movement impairments and guide interventions. The aim of this study was to investigate the discriminative validity of a clinical cervical movement sense test, using a laser pointer and an automatic video-based scoring system. Individuals with chronic neck pain of idiopathic onset (INP), traumatic onset (TNP), and healthy controls (CON) were tested. Associations between movement sense and neck disability were examined and the repeatability of the test was investigated. A total of 106 participants (26 INP, 28 TNP, and 52 CON) were included in a cross-sectional study. Acuity, Speed, Time, and NormAcuity (i.e., normalized acuity by dividing acuity with movement time) were used as outcome measures. ANOVAs were used for group comparisons and Pearson correlations for associations between movement sense variables and neck disability index (NDI). Notably, 60 of the participants (30 CON, 17 INP, and 13 TNP) performed the test on a second occasion to explore test-retest reliability. Results revealed a reduced NormAcuity for both INP and TNP compared with CON (p < 0.05). The neck pain groups had similar Acuity but longer Time compared with CON. Among TNP, there was a fair positive correlation between Acuity and NDI, while there was a negative correlation between Acuity and NDI among INP. Reliability measures showed good to excellent ICC values between tests, but standard error of measurements (SEM) and minimal detectable change (MDC) scores were high. The results showed that NormAcuity is a valuable measure to identify disturbed cervical movement sense among INP and TNP. While Acuity was similar between the groups, different strategies, such as longer Time, to perform the task among neck patient groups were used. Few differences were identified between the neck pain groups, but altered strategies may exist. Reliability was acceptable, and the test is feasible to perform in the clinic. However, the technical complexity of the automated image analysis is a concern. Future developments will provide more feasible solutions.
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| 8. |
- Treleaven, Julia, et al.
(författare)
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Altered trunk head co-ordination in those with persistent neck pain
- 2019
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Ingår i: Musculoskeletal Science and Practice. - : Elsevier. - 2468-7812. ; 39, s. 45-50
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Tidskriftsartikel (refereegranskat)abstract
- Background: Decreased neck motion and sensorimotor deficits have been identified in those with neck pain. It is thought that these might be related to altered reflex mechanisms between the neck, eyes and the vestibular system. Trunk, head co-ordination might also be altered in neck pain.Objectives: This study investigated trunk head co-ordination ability in subjects with neck pain compared to asymptomatic controls.Method: Twenty-four subjects with persistent neck pain and twenty-six age and gender matched healthy controls performed 3 trials of 3 trunk movements whilst trying to keep the head still - (1) alternate trunk movement to the left and right (2) trunk movement to the left (3) trunk movement to the right. Wireless motion sensors positioned over the sternum and the forehead measured trunk and head range and velocity of motion.Analysis: ANOVA was used to compare trunk and head range and velocity of motion during the 3 tasks.Results: Neck pain subjects had significantly less trunk movement (p < 0.05) and velocity (p = < 0.02) as well as significantly increased head movement (p = < 0.03) during most tasks compared to control subjects.Discussion: The results of the study suggest that neck pain subjects have difficulty moving their trunk independently of their head. They are less able to keep the head still while moving the trunk and perform the tasks more slowly. These findings might be related to altered reflex activity of the cervico-collic reflex and sensorimotor control. Further research is required.
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| 9. |
- Treleaven, Julia, et al.
(författare)
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Balance, dizziness and proprioception in patients with chronic whiplash associated disorders complaining of dizziness : A prospective randomized study comparing three exercise programs
- 2016
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Ingår i: Manual Therapy. - : Elsevier BV. - 1356-689X .- 1532-2769. ; 22, s. 122-130
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Tidskriftsartikel (refereegranskat)abstract
- Background: Dizziness and unsteadiness are common symptoms following a whiplash injury. Objective: To compare the effect of 3 exercise programs on balance, dizziness, proprioception and pain in patients with chronic whiplash complaining of dizziness.Design: A sub-analysis of a randomized study.Methods: One hundred and forty subjects were randomized to either a physiotherapist-guided neck-specific exercise (NSE), physiotherapist-guided neck-specific exercise, with a behavioural approach (NSEB) or prescription of general physical activity (PPA) group. Pre intervention, 3, 6 and 12 months post baseline they completed the University of California Los Angeles Dizziness Questionnaire (UCLA-DQ), Visual Analogue Scales (VAS) for, dizziness at rest and during activity and physical measures (static and dynamic clinical balance tests and head repositioning accuracy (HRA)).Results: There were significant time by group differences with respect to dizziness during activity and UCLA-Q favouring the physiotherapy led neck specific exercise group with a behavioural approach. Within group analysis of changes over time also revealed significant changes in most variables apart from static balance. Conclusion: Between and within group comparisons suggest that physiotherapist led neck exercise groups including a behavioural approach had advantages in improving measures of dizziness compared with the general physical activity group, although many still complained of dizziness and balance impairment. Future studies should consider exercises specifically designed to address balance, dizziness and cervical proprioception in those with persistent whiplash.
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| 10. |
- Treleaven, Julia, et al.
(författare)
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Cervical musculoskeletal, physical and psychological factors associated with ongoing dizziness in patients with whiplash associated disorder, 12 months after undertaking a neck specific or general exercise intervention
- 2022
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Ingår i: BMC Musculoskeletal Disorders. - : Springer Nature. - 1471-2474. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- Background Exercise in the management of persistent whiplash often doesn't specifically address dizziness. This study aimed to determine cervical musculoskeletal and sensorimotor measures, quality of life and psychological factors associated with the presence of dizziness in individuals with persistent whiplash 12 months post exercise intervention commencement. Methods A retrospective cross sectional review of questionnaires on dizziness, physical and psychological disability, quality of life and physical measures prospectively collected from 172 individuals during a randomised controlled trial. Associations between dizziness at 12 months post intervention and possible predictors was analysed with simple and multiple logistic regression models. Results Sixty-three % reported dizziness with a mean University of California Los Angeles dizziness score of 9 (SD 5) and dizziness intensity during activity of 26 mm (SD 24). They had poorer performance on sharpened Rhomberg, Neck muscle endurance (NME), and range of motion, elevated scores on pain, Neck disability index (NDI) and psychological and quality of life measures compared to those without dizziness. Less improvement in NDI and NME flexion from baseline to 12 months post exercise commencement, along with some baseline covariates were related to persistent dizziness and explained 50% of the variance. Conclusion Dizziness following exercise at 12 months post follow-up was associated with lack of improvement in NDI and NME flexion suggesting a cervicogenic role. Alternatively, the presence of dizziness may inhibit exercise response. Additional causes or contributing factors of dizziness should be investigated in those with persistent whiplash to improve quality of life.
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| 11. |
- Treleaven, Julia, et al.
(författare)
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Nacken : proprioception
- 2019. - 1
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Ingår i: Motorisk kontroll och inlärning. - Lund : Studentlitteratur AB. - 9789144074177 ; , s. 203-214
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- Besvärstillstånd med nacksmärta är heterogena och därför varierar symtom och avvikelser i motoriska kontrollfunktioner betydligt mellan individer. Vägledning om och i så fall vilken typ av träning av cervikal proprioception som bör inkluderas i rehabiliteringsregimen för den enskilde erhålls via anamnes och klinisk undersökning. I detta kapitel beskrivs först specifika symtom, följt av avvikelser i proprioception och sensomotoriska funktioner som kan vara relaterade till störningar i cervikal proprioception. Slutligen beskrivs kliniska metoder för undersökning och träning av nackens proprioception, okulomotorisk kontroll, öga–huvud–kroppkoordination och postural kontroll hos personer med nackbesvär.
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| 12. |
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