Proprioceptive Disturbance in Chronic Neck Pain: Discriminate Validity and Reliability of Performance of the Clinical Cervical Movement Sense Test

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.

Cervicocephalic kinaesthesia reveals novel subgroups of motor control impairments in patients with neck pain

“…Recent systematic literature review reports diverse results in various aspects of cervical motor control in patients with neck pain depicted by changes in many different parameters 8 . While position sense tests commonly apply parameters of variable, constant and absolute error 9 , 10 movement sense tests apply more diverse parameters such as smoothness of movement 11 , accuracy of head and neck movement 2 , 12 , 13 directional accuracy 14 , mean and peak velocity of head movement 12 , 13 , 15 time to peak velocity 12 , 16 and others, although all these are not consistently applied throughout the literature. Some studies apply limited amount of parameters 11 , 13 , 17 , while other studies apply numerous parameters simultaneously 18 – 20 which raises the concern of addressing different characteristics of kinaesthetic sensibility, however to our knowledge this has not yet been addressed.…”

Is Thoracic Kyphosis Relevant to Pain, Autonomic Nervous System Function, Disability, and Cervical Sensorimotor Control in Patients with Chronic Nonspecific Neck Pain?

“…Since changes in sagittal thoracic alignment have been reported to alter the mechanical loading of the cervical spine [14,15], this may subtly or overtly impair proprioceptive afferentation from spine ligaments, muscles, and discs, which are considered to be major components of sensorimotor control supplying the essential neurophysiological information for feedforward and feedback responses via linkages to the vestibular, visual, and central nervous systems [16][17][18]. Sensorimotor control is altered in neck pain populations compared to healthy controls, where slower reaction times in visual acuity, cervical movement, and inefficient motor control in general has been reported [19,20]. It is unclear if the altered sensorimotor control is causative of neck pain and disability or a result due to kinesiophobia (fear-based movement variables) [21]; however, it is clear that inefficient sensorimotor control is part of the cycle of chronicity and likely influences recovery [16][17][18][19][20][21].…”

“…Sensorimotor control is altered in neck pain populations compared to healthy controls, where slower reaction times in visual acuity, cervical movement, and inefficient motor control in general has been reported [19,20]. It is unclear if the altered sensorimotor control is causative of neck pain and disability or a result due to kinesiophobia (fear-based movement variables) [21]; however, it is clear that inefficient sensorimotor control is part of the cycle of chronicity and likely influences recovery [16][17][18][19][20][21]. In addition to sensorimotor control influences, several studies show that the cervical receptors and the sympathetic nervous system have direct interactions [22][23][24].…”