Shaun O’Leary

The effect of a scapular postural correction strategy on trapezius activity in patients with neck pain

Extensive computer use amongst office workers has lead to an increase in work-related neck pain. Aberrant activity within the three portions of the trapezius muscle and associated changes in scapular posture have been identified as potential contributing factors. This study compared the activity (surface electromyography) of the three portions of the trapezius in healthy controls (n = 20) to a neck pain group with poor scapular posture (n = 18) during the performance of a functional typing task. A scapular postural correction strategy was used to correct scapular orientation in the neck pain group and electromyographic recordings were repeated. During the typing task, the neck pain group generated greater activity in the middle trapezius (MT) (p = 0.02) and less activity in the lower trapezius (LT) (p = 0.03) than the control group. Following correction of the scapula, activity recorded by the neck pain group was similar to the control group for the middle and lower portions (p = 0.09; p = 0.91). These findings indicate that a scapular postural correction exercise may be effective in altering the distribution of activity in the trapezius to better reflect that displayed by healthy individuals.

The relationship between superficial muscle activity during the cranio-cervical flexion test and clinical features in patients with chronic neck pain

Changes in motor behavior are a known feature of chronic mechanical neck pain disorders. This study examined the strength of the association between reported levels of pain and disability from 84 individuals (63 women, 21 men) with chronic mechanical neck pain and levels of electromyographic activity recorded from superficial cervical flexor (sternocleidomastoid; SCM and anterior scalene; AS) muscles during progressive stages of the cranio-cervical flexion muscle test. A significant positive association was observed between superficial muscle activity and pain intensity (P < 0.003), but not pain duration (P > 0.5) or perceived disability (P > 0.21). The strongest relationship between pain intensity and superficial muscle activity occurred at the final increment of the cranio-cervical flexion test (inner-range test position) for both the SCM and AS muscles (R(2) = 0.16). Although a positive and significant relationship between pain intensity and superficial muscle activity was shown, the relationship was only modest (16% explained variance), indicating that multiple factors contribute to the altered motor function observed in individuals with chronic mechanical neck pain.

Real-time telerehabilitation for the treatment of musculoskeletal conditions is effective and comparable to standard practice: a systematic review and meta-analysis:

Objective: To evaluate the effectiveness of treatment delivered via real-time telerehabilitation for the management of musculoskeletal conditions, and to determine if real-time telerehabilitation is comparable to conventional methods of delivery within this population. Data sources: Six databases (Medline, Embase, Cochrane CENTRAL, PEDro, psycINFO, CINAHL) were searched from inception to November 2015 for literature which reported on the outcomes of real-time telerehabilitation for musculoskeletal conditions. Review methods: Two reviewers screened 5913 abstracts where 13 studies (n = 1520) met the eligibility criteria. Methodological quality was assessed using the Downs & Black ‘Checklist for Measuring Quality’ tool. Results were pooled for meta-analysis based upon primary outcome measures and reported as standardised mean differences and 95% confidence intervals (CI). Results: Aggregate results suggest that telerehabilitation is effective in the improvement of physical function (SMD 1.63, 95%CI 0.92-2.33, I2=93%), whilst being slightly more favourable (SMD 0.44, 95%CI 0.19-0.69, I2=58%) than the control cohort following intervention. Sub-group analyses reveals that telerehabilitation in addition to usual care is more favourable (SMD 0.64, 95%CI 0.43-0.85, I2=10%) than usual care alone, whilst treatment delivered solely via telerehabilitation is equivalent to face-to-face intervention (SMD MD 0.14, 95% CI −0.10–0.37, I2 = 0%) for the improvement of physical function. The improvement of pain was also seen to be comparable between cohorts (SMD 0.66, 95%CI −0.27–1.60, I2=96%) following intervention. Conclusions: Real-time telerehabilitation appears to be effective and comparable to conventional methods of healthcare delivery for the improvement of physical function and pain in a variety of musculoskeletal conditions.

Pitfalls in the use of kappa when interpreting agreement between multiple raters in reliability studies

OBJECTIVE To compare different reliability coefficients (exact agreement, and variations of the kappa (generalised, Cohens and Prevalence Adjusted and Biased Adjusted (PABAK))) for four physiotherapists conducting visual assessments of scapulae. DESIGN Inter-therapist reliability study. SETTING Research laboratory. PARTICIPANTS 30 individuals with no history of neck or shoulder pain were recruited with no obvious significant postural abnormalities. MAIN OUTCOME MEASURES Ratings of scapular posture were recorded in multiple biomechanical planes under four test conditions (at rest, and while under three isometric conditions) by four physiotherapists. RESULTS The magnitude of discrepancy between the two therapist pairs was 0.04 to 0.76 for Cohens kappa, and 0.00 to 0.86 for PABAK. In comparison, the generalised kappa provided a score between the two paired kappa coefficients. The difference between mean generalised kappa coefficients and mean Cohens kappa (0.02) and between mean generalised kappa and PABAK (0.02) were negligible, but the magnitude of difference between the generalised kappa and paired kappa within each plane and condition was substantial; 0.02 to 0.57 for Cohens kappa and 0.02 to 0.63 for PABAK, respectively. CONCLUSIONS Calculating coefficients for therapist pairs alone may result in inconsistent findings. In contrast, the generalised kappa provided a coefficient close to the mean of the paired kappa coefficients. These findings support an assertion that generalised kappa may lead to a better representation of reliability between three or more raters and that reliability studies only calculating agreement between two raters should be interpreted with caution. However, generalised kappa may mask more extreme cases of agreement (or disagreement) that paired comparisons may reveal.

Physical risk factors for developing non-specific neck pain in office workers: a systematic review and meta-analysis

IntroductionIdentifying risk factors associated with the development of work-related neck pain in office workers is necessary to facilitate the development of prevention strategies that aim to minimise this prevalent and costly health problem. The aim of this systematic review is to identify individual worker (e.g., lifestyle activity, muscular strength, and posture) and workplace (e.g., ergonomics and work environment) physical factors associated with the development of non-specific neck pain in office workers.MethodsStudies from 1980 to 2016 were identified by an electronic search of Pubmed, CINAHL, EMBASE, Psychlnfo and Proquest databases. Two authors independently screened search results, extracted data, and assessed risk of bias using the epidemiological appraisal instrument (EAI). A random effect model was used to estimate the risk of physical factors for neck pain.ResultsTwenty papers described the findings of ten prospective cohort studies and two randomized controlled trials. Low satisfaction with the workplace environment (pooled RR 1.28; CI 1.07–1.55), keyboard position close to the body [pooled RR 1.46; (CI 1.07–1.99)], low work task variation [RR 1.27; CI (1.08–1.50)] and self-perceived medium/high muscular tension (pooled RR 2.75/1.82; CI 1.60 /1.14–4.72/2.90) were found to be risk factors for the development of neck pain.ConclusionsThis review found evidence for a few number of physical risk factors for the development of neck pain, however, there was also either limited or conflicting factors. Recommendations for future studies evaluating risk factors are reported and how these may contribute to the prevention of neck pain in office workers.

Modifiable individual and work-related factors associated with neck pain in 740 office workers: a cross-sectional study

BACKGROUND Office workers have the highest incidence of neck pain of all occupations. However, the relationship between symptoms and the risk factors is unclear. OBJECTIVE To examine the relationship between self-reported neck pain with a comprehensive range of individual and work-related risk factors. METHODS This study utilised a cross-sectional study design. Office workers with and without neck pain (n=763) were recruited. Participants completed a survey which included a Pain Numerical Rating Scale (dependent variable), and measures of independent variables including demographic, individual, work-related factors, neck/shoulder muscle strength, endurance, and range of motion (ROM). The relationships between the independent and dependent variables were analysed in a logistic regression model. RESULTS Neck pain was significantly associated with more senior occupational categories, working more than six hours per day on the computer, female sex, greater fear avoidance beliefs for work, greater psychological distress, and reduced cervical flexion ROM. The low severity of neck pain of the participants in this study may limit a robust determination of their association with the risk factor variables, but the studied sample is a realistic representation of the office worker population. CONCLUSION Several potentially modifiable individual and work-related factors were identified to be associated with the presence of self-reported neck pain in office workers. Future studies will be needed to investigate whether strategies to alter these modifiable risk factors translate to changes in neck pain. TRIAL REGISTRATION ACTRN12612001154897 (https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=363209).

Neck and Upper Limb Dysfunction in Patients following Neck Dissection: Looking beyond the Shoulder

Objective To measure patient-perceived upper limb and neck function following neck dissection and to investigate potential associations between clinical factors, symptoms, and function. Study Design Cross-sectional. Setting Two tertiary hospitals in Brisbane, Australia. Subjects and Methods Inclusion criteria: patients treated with neck dissection (2009-2014). Exclusion criteria: aged <18 years, accessory nerve or sternocleidomastoid sacrifice, previous neck dissection, preexisting shoulder/neck injury, and inability to provide informed consent (cognition, insufficient English). Primary outcomes were self-reported function of the upper limb (Quick Disabilities of the Arm, Shoulder, and Hand) and neck (Neck Disability Index). Secondary outcomes included demographics, oncological management, self-efficacy, and pain. Generalized linear models were prepared to examine relationships between explanatory variables and self-reported function. Results Eighty-nine participants (male n = 63, 71%; median age, 62 years; median 3 years since surgery) reported mild upper limb and neck dysfunction (median [quartile 1, quartile 3] scores of 11 [3, 32] and 12 [4, 28], respectively). Significant associations were found between worse upper limb function and longer time since surgery (coefficient, 1.76; 95% confidence interval [CI], 0.01-3.51), having disease within the thyroid (17.40; 2.37-32.44), postoperative radiation therapy (vs surgery only) (13.90; 6.67-21.14), and shoulder pain (0.65; 0.44-0.85). Worse neck function was associated with metastatic cervical lymph nodes (coefficient, 6.61; 95% CI, 1.14-12.08), shoulder pain (0.19; 0.04-0.34), neck pain (0.34; 0.21-0.47), and symptoms of neuropathic pain (0.61; 0.25-0.98). Conclusion Patients can experience upper limb and neck dysfunction following nerve-preserving neck dissection. The upper quadrant as a whole should be considered when assessing rehabilitation priorities after neck dissection.

Patients are willing to use telehealth for the multidisciplinary management of chronic musculoskeletal conditions: A cross-sectional survey:

Introduction Access to specialised multidisciplinary healthcare services is difficult for many patients with chronic musculoskeletal conditions. A possible solution could be delivery of care via telehealth. This study aims to identify current barriers in accessing healthcare services, and to determine if telehealth is an acceptable mode of healthcare delivery, from the perspective of patients with chronic musculoskeletal conditions. Methods Surveys were distributed to current patients receiving care within the Neurosurgical and Orthopaedic Physiotherapy Screening Clinic and Multidisciplinary Service (N/OPSC & MDS) at six facilities throughout Queensland, Australia. The 48-item survey evaluated five key areas including demographics; current barriers to attendance; satisfaction with current management provided by the N/OPSC & MDS; technology access and literacy; and attitudes and preference towards telehealth. Results In total, 85 patients (71%) completed the survey. The majority of patients were satisfied overall with the N/OPSC & MDS, but almost one-quarter of the patients reported ceasing treatment due to difficulty accessing services. Over half of the respondents were willing to use telehealth if it reduced the costs (53%) and time (57%) associated with attending appointments. Patients in paid employment were more likely (65%) to use telehealth if it reduced work absenteeism. Overall, 78% of patients were identified as having appropriate technology access to enable home telehealth. Specifically, 43% of patients would prefer home telehealth over having to travel to attend their appointments. Discussion The majority of N/OPSC & MDS patients are willing to engage in telehealth for the management of their chronic musculoskeletal condition. These findings justify consideration of telehealth as an additional method of service delivery within the existing N/OPSC & MD service.

Differential Strength and Endurance Parameters of the Craniocervical and Cervicothoracic Extensors and Flexors in Healthy Individuals

This study examined isometric strength (maximal voluntary contraction [MVC]) and endurance of cervical flexor and extensor muscles in healthy individuals at the craniocervical (CC) and cervicothoracic (CT) axes. MVC and endurance measures (time to task failure in seconds [s]) at 50% MVC were recorded in 4 directions (CC flexion, CC extension, CT flexion, and CT extension) in 20 males and 20 females, and 6 strength and endurance ratios were calculated. The findings showed that the cervical extensor muscles are not only much stronger than the flexors (1.3-2 times greater MVC), but also have greater capacity for endurance (2-2.4 times greater). While males produced significantly greater MVC recordings than females (P < .003), strength ratios (P > .06) and endurance measures (P > .11) were similar. Endurance ratios were also similar except the CT extension to CC flexion ratio, which was significantly larger in females compared with males (P = .03). These findings demonstrate that substantial but normal variation exists in strength and endurance parameters between cervical flexor and extensor muscles. This is informative to clinicians when evaluating the performance of these neck muscles or when deciding on exercise parameters (eg, load, duration) when training their performance.

Cross-cultural adaptation and validation of the Depression, Anxiety and Stress Scale-21 (DASS-21) in the Korean working population

BACKGROUND In this study, we developed a new Korean translation for the shortened version of the Depression, Anxiety, and Stress Scale (DASS-21) and examined its psychometric properties in a Korean working population. OBJECTIVE To develop a new Korean version of the DASS-21 and test its psychometric properties specific to the Korean working population. METHODS The DASS-21 was translated to the Korean language in accordance with scientific guidelines for cross-cultural adaptation. A total of 228 general workers from Korea then completed the newly translated version of the DAS S-21 and its psychometric properties were evaluated. RESULTS Most of the questionnaire items were correctly loaded on the proposed scales of the original questionnaire. Excellent internal consistency and measurement consistency over a one week interval were obtained for all scales (Cronbachs alpha; 0.87, 83, and 83, and ICC (2, 1); 0.84, 0.94, and 0.89 for depression, anxiety and stress scales, respectively). All three scales were negatively associated with the level of life satisfaction (p < 0.05). CONCLUSIONS The new Korean version of DASS-21 has shown excellent validity and reliability of measurement in the Korean working population. Organizations investigating the prominent health issue of affective disorders in Korean workers can use this instrument with confidence.