- Title
- Cervical spine sensorimotor control in individuals with chronic idiopathic neck pain
- Creator
- de Zoete, Rutger M. J.
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2018
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- The aim of this thesis was to investigate the clinical relevance of cervical sensorimotor control in individuals with chronic idiopathic neck pain. Sensorimotor control has been defined as all the afferent and efferent information streams, as well as the central integration components contributing to joint stability, and recent research has suggested that cervical sensorimotor control might be disturbed in individuals with neck pain. However, current evidence is ambiguous and different studies with varying study designs and source populations report inconsistent findings. This body of work, reporting the findings of four studies, addresses this issue by investigating cervical sensorimotor control in a homogenous sample of individuals with chronic idiopathic neck pain. Chapter 1 provides a brief introduction to neck pain and sensorimotor control and presents the research question for this thesis: (1) what is the most useful test or combination of tests for assessing cervical sensorimotor control in individuals with idiopathic neck pain, and (2) is chronic idiopathic neck pain associated with cervical sensorimotor control? Chapter 2 discusses literature on cervical sensorimotor control in individuals with neck pain in more detail, and further discusses what tests measurements have been used to assess cervical sensorimotor control. Chapter 3 reports the findings of Study 1; a systematic review of the literature with meta-analysis that identified six tests that have been used to assess cervical sensorimotor control in individuals with idiopathic neck pain. These tests included measurements of joint position error, postural balance, subjective visual vertical, smooth pursuit neck torsion, head steadiness, and The Fly®. One other outcome measure, head tilt response, although not described in this population, was deemed relevant for individuals with idiopathic neck pain. Meta-analysis demonstrated a statistically significant difference between pooled means for joint position error, however the actual magnitude of the difference was not considered clinically meaningful. In further meta-analyses for postural balance, no differences were found between individuals with chronic idiopathic neck pain and healthy individuals. Chapter 4 reports the findings of Study 2, which tested whether seven cervical sensorimotor control tests measure the same, or different, skills. The study found that different tests did not cluster together in factor analysis, indicating that all tests measure distinct skills and potentially unique characteristics of cervical sensorimotor control. Two tests, postural balance and head steadiness, were found to explain a large proportion of the variance across the variables. This study suggests that clinically not one test or test battery can be recommended, and arguably clinicians have to perform all tests to adequately assess cervical sensorimotor control or nominate which aspect of cervical sensorimotor control they are examining. Chapter 5 presents Study 3 and reports a case-control study comparing outcomes of seven cervical sensorimotor control tests in 50 individuals with chronic idiopathic neck pain and 50 sex and age matched healthy individuals. With groups being similar in terms of sex, age, BMI and physical activity levels, no differences were found for any of the cervical sensorimotor control tests. This suggests that these tests may not be clinically useful to discriminate between individuals with chronic idiopathic neck pain and healthy individuals. Additionally, correlations between cervical sensorimotor control outcomes and neck pain intensity and neck disability were weak at best, further questioning the clinical meaningfulness of these tests. Chapter 6 reports the findings of Study 4, which investigated whether changes in cervical sensorimotor control occur over time in individuals with chronic idiopathic neck pain, and what factors are associated with changes in cervical sensorimotor control. Only half of the sensorimotor control outcomes significantly changed over a six-month period. It was further found that changes in cervical sensorimotor control outcomes were not associated with characteristics of neck pain, including neck pain intensity, neck pain duration, and neck disability. Other factors, such as sex, age, BMI, and physical activity level, were not associated with changes in cervical sensorimotor control. This suggests that clinically, cervical sensorimotor control might not be a relevant assessment for individuals with chronic idiopathic neck pain. This thesis contributes to the understanding of the relevance of cervical sensorimotor control in individuals with chronic idiopathic neck pain. Based on inconsistent findings in recent literature, the clinical meaningfulness of cervical sensorimotor control has been questioned. From the current studies demonstrating that (1) seven tests appear to measure unique aspects that may address different characteristics of cervical sensorimotor control, (2) none of these tests discriminate between individuals with chronic idiopathic neck pain and healthy individuals, and (3) cervical sensorimotor control outcomes are not associated with characteristics of neck pain, it is suggested that cervical sensorimotor control may not be useful in the clinical assessment of individuals with chronic idiopathic neck pain.
- Subject
- cervical spine; sensorimotor control; neck pain; chronic pain; physiotherapy; thesis by publication
- Identifier
- http://hdl.handle.net/1959.13/1394385
- Identifier
- uon:33688
- Rights
- Copyright 2018 Rutger M. J. de Zoete
- Language
- eng
- Full Text
- Hits: 3877
- Visitors: 1650
- Downloads: 696
| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT01 | Thesis | 5 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 419 KB | Adobe Acrobat PDF | View Details Download |