Physical Performance Tests in Adult Neck Pain Patients with and without Clinical Myelopathic Signs: A Matched Case-Control Study

Abstract

Patients with neck pain may experience cervical myelopathy, this may be detected by clinical myelopathic signs, although they did not have any symptom of myelopathy, except having neck pain. Decreasing physical performance is one symptom of cervical myelopathy that can lead to reduced quality of life in the elderly, however, in adult neck pain with clinical myelopathic signs have not been evaluated. Therefore, this research aimed to compare physical performance in two groups of adult patients with neck pain: those with and without clinical myelopathic signs. A total of 52 participants, gender, age, and body mass index (BMI) matched were allocated into 2 groups of 26 subjects with neck pain, those with, and without, clinical myelopathic signs. The grip and release test, nine-hole peg test, ten second step test and foot-tapping test were evaluated. The group of neck pain participants with clinical myelopathic signs exhibited greater impairment in all the tests than the group without clinical myelopathic signs (p < 0.001). Effect sizes (Cohen’s d) were grip and release test: 2.031, nine-hole peg test: 1.143, ten second step test: 1.329, and foot-tapping test: 0.798. Neck pain participants with clinical myelopathic signs demonstrated reduced physical performance. Physical performance tests may need to assessed in adult patients with neck pain who had clinical myelopathic signs.

Prevalence and Associated Factors of Clinical Myelopathy Signs in Smartphone-Using University Students with Neck Pain

“…The prevalence of finger escape signs was 28.27%, which conflicts with the study of Hnin Lwin et al [26], who reported the prevalence at 10% [26]. This difference may be because the current study included younger participants.…”

“…Participants were eligible for inclusion if they (i) were university students, (ii) had reported neck pain for more than three months [29], (iii) had reported daily smartphone use of at least two hours per day for more than six months [30], and (iv) had a pain score between 3-7 on the visual analog scale (VAS) [31]. Participants were excluded if they (i) had a positive jaw jerk; (ii) had a positive Spurling test; (iii) had a history of previous cervical spine surgery; (iv) were concurrently suffering from other locomotor disorders; (v) had a history of brain trauma; (vi) had comorbid neurological diseases, such as cerebral infarction or neuropathy; (vii) had consumed any sedative drugs or alcohol within the past 48 h; or (viii) were pregnant [26].…”

“…A clinical myelopathy sign is a term used to describe the presence of Hoffmann's sign, the inverted supinator sign [11,[18][19][20], the Babinski sign [11,[18][19][20][21][22], the Trömner sign [16], the finger escape sign [22,23], or the Clonus sign [10,20]. A study reported that clinical myelopathic signs were sensitive to the detection of cervical myelopathy [11,[18][19][20]22,[24][25][26]. Furthermore, research by Nagata et al (2014) showed that clinical myelopathic signs are associated with a decrease in cervical spinal cord diameter (OR = 2.73, 95% CI = 1.83-4.23, p < 0.001) [27].…”

“…The authors explained that cervical myelopathy may have been due to spinal cord ischemia [28]. Hnin Lwin et al reported that smartphone usage of ≥four h per day, an education at university or postgraduate level, and neck pain scores of >seven on a numerical rating scale are associated with clinical myelopathic signs with an adjusted OR (95% CI) of 2.57 (1.52 to 4.36), 3.35 (1.14 to 9.89), and 2.31 (1.07 to 4.99), respectively [26]. However, their study conducted on adults did not focus specifically on university students who had the highest rates of addiction to smartphone use [23].…”

“…A few studies have reported the prevalence of clinical myelopathy signs; one is hospital based [20] and another is community based [23], and all of them focus on those of adult age, including the elderly [20,26]. There is limited evidence of the prevalence and factors associated with clinical myelopathic signs in smartphone-using university students with neck pain.…”