Does inter-vertebral range of motion increase after spinal manipulation? A prospective cohort study
TL;DR: There was a modest dose-response relationship between the number of manipulations given and number of levels increasing IV-RoM - providing evidence that neck manipulation has a mechanical effect at segmental levels, however, patient-reported outcomes were not related to this.
Abstract: Background: Spinal manipulation for nonspecific neck pain is thought to work in part by improving inter-vertebral range of motion (IV-RoM), but it is difficult to measure this or determine whether it is related to clinical outcomes. Objectives: This study undertook to determine whether cervical spine flexion and extension IV-RoM increases after a course of spinal manipulation, to explore relationships between any IV-RoM increases and clinical outcomes and to compare palpation with objective measurement in the detection of hypo-mobile segments. Method: Thirty patients with nonspecific neck pain and 30 healthy controls matched for age and gender received quantitative fluoroscopy (QF) screenings to measure flexion and extension IV-RoM (C1-C6) at baseline and 4-week follow-up between September 2012-13. Patients received up to 12 neck manipulations and completed NRS, NDI and Euroqol 5D-5L at baseline, plus PGIC and satisfaction questionnaires at follow-up. IV-RoM accuracy, repeatability and hypo-mobility cut-offs were determined. Minimal detectable changes (MDC) over 4 weeks were calculated from controls. Patients and control IV-RoMs were compared at baseline as well as changes in patients over 4 weeks. Correlations between outcomes and the number of manipulations received and the agreement (Kappa) between palpated and QF-detected of hypo-mobile segments were calculated. Results: QF had high accuracy (worst RMS error 0.5o) and repeatability (highest SEM 1.1o, lowest ICC 0.90) for IV-RoM measurement. Hypo-mobility cut offs ranged from 0.8o to 3.5o. No outcome was significantly correlated with increased IV-RoM above MDC and there was no significant difference between the number of hypo-mobile segments in patients and controls at baseline or significant increases in IV-RoMs in patients. However, there was a modest and significant correlation between the number of manipulations received and the number of levels and directions whose IV-RoM increased beyond MDC (Rho=0.39, p=0.043). There was also no agreement between palpation and QF in identifying hypo-mobile segments (Kappa 0.04-0.06). Conclusions: This study found no differences in cervical sagittal IV-RoM between patients with non-specific neck pain and matched controls. There was a modest dose-response relationship between the number of manipulations given and number of levels increasing IV-RoM - providing evidence that neck manipulation has a mechanical effect at segmental levels. However, patient-reported outcomes were not related to this.
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TL;DR: General osteopathic treatment is associated with reduced sagittal imbalance and apical deviation and increased lordotic apex position, but this effect is demonstrable only in persons whose sagittal balance ranks in the lower or median tertile.
Abstract: Aim: To investigate whether standard general osteopathic treatment can influence the static configuration of the vertebral column or pelvis. Material and Methods: One hundred thirteen persons, 72 females and 41 males, either symptomfree volunteers or patients with mild idiopathic back pain, were investigated using the DIERS formetric® system, before and immediately after a single session of general osteopathic treatment. Variables of static assessment of the thoraco-lumbar vertebral column and of the pelvis were compared before and after treatment, using paired statistics. Results: There was no difference between observations in the healthy controls and the symptomatic patients. The sagittal imbalance decreased significantly (two sided student’s t-test: P=0.034), apical deviation diminished (one sided student’s t-test: P= 0.047) after treatment and lordotic apex position increased (one sided student’s t-test: P=0.028). Since such changes have not been observed in a previous trial of repeat measurements without treatment, the observations in the present study suggest an effect of treatment. This effect was, however, limited to persons Short Research Article Comhaire et al.; BJMMR, 6(7): 709-714, 2015; Article no.BJMMR.2015.247 710 with sagittal imbalance not exceeding the 62 percentile. Conclusion: General osteopathic treatment is associated with reduced sagittal imbalance and apical deviation and increased lordotic apex position, but this effect is demonstrable only in persons whose sagittal imbalance ranks in the lower or median tertile.
5 citations
Cites background from "Does inter-vertebral range of motio..."
...cervical hysteresis [10] and inter-vertebral range of motion [11] has been reported....
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TL;DR: The results imply that a neutral cervical spine position during an impaction can be beneficial, and even if a vertebral fracture occurs, the generated injury patterns are expected to be mild or moderate.
3 citations
TL;DR: While overall the neck pain participant’s symptoms improved, there was no correlation between increase in IV-RoM and patient reported outcomes after the course of manipulations, and the results confirmed the high accuracy and repeatability of QF for the measurement of IV- RoM.
2 citations
TL;DR: In this article, the difference between maximum joint motion and joint end-range in healthy subjects was quantified and the proportions of these joint types were classified according to the type of motion.
Abstract: In clinical diagnosis, the maximum motion of a cervical joint is thought to be found at the joint’s end-range and it is this perception that forms the basis for the interpretation of flexion/extension imaging studies. There have however, been representative cases of joints producing their maximum motion before end-range, but this phenomenon is yet to be quantified. To provide a quantitative assessment of the difference between maximum joint motion and joint end-range in healthy subjects. Secondarily to classify joints into type based on their motion and to assess the proportions of these joint types. This is an observational study. Thirty-three healthy subjects participated in the study. Maximum motion, end-range motion and surplus motion (the difference between maximum motion and end-range) in degrees were extracted from each cervical joint. Thirty-three subjects performed one flexion and one extension motion excursion under video fluoroscopy. The motion excursions were divided into 10% epochs, from which maximum motion, end-range and surplus motion were extracted. Surplus motion was then assessed in quartiles and joints were classified into type according to end-range. For flexion 48.9% and for extension 47.2% of joints produced maximum motion before joint end-range (type S). For flexion 45.9% and for extension 46.8% of joints produced maximum motion at joint end-range (type C). For flexion 5.2% of joints and for extension 6.1% of joints concluded their motion anti-directionally (type A). Significant differences were found for C2/C3 (P = 0.000), C3/C4 (P = 0.001) and C4/C5 (P = 0.005) in flexion and C1/C2 (P = 0.004), C3/C4 (P = 0.013) and C6/C7 (P = 0.013) in extension when comparing the joint end- range of type C and type S. The average pro-directional (motion in the direction of neck motion) surplus motion was 2.41° ± 2.12° with a range of (0.07° -14.23°) for flexion and 2.02° ± 1.70° with a range of (0.04°-6.97°) for extension. This is the first study to categorise joints by type of motion. It cannot be assumed that end-range is a demonstration of a joint’s maximum motion, as type S constituted approximately half of the joints analysed in this study.
1 citations
01 Jan 2018
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Cites background or methods from "Does inter-vertebral range of motio..."
...To address this problem, video fluoroscopy was developed for the analysis of dynamic cervical joint motion (Branney and Breen 2014; Reinartz et al. 2009; Wu et al. 2010)....
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...Branney et al. assessed cervical joint motion from C1 to C6 (Branney and Breen 2014)....
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...Individual joint motion has provoked greater interest in order to detect potential clinical associations with diagnosis and rehabilitation (Anderst et al. 2013a; Branney and Breen 2014; Bogduk et al. 1995; Dvorak et al. 1988)....
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...Dynamic joint motions have been assessed with automated analysis, which 8 allowed analysis of all images in a video (Anderst et al. 2013b; Branney and Breen 2014; Reinartz et al. 2009)....
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...A pivot arm has been used to control cervical movements (Branney and Breen 2014)....
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References
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TL;DR: In this article, the authors present a procedure for having two or more judges independently categorize a sample of units and determine the degree, significance, and significance of the units. But they do not discuss the extent to which these judgments are reproducible, i.e., reliable.
Abstract: CONSIDER Table 1. It represents in its formal characteristics a situation which arises in the clinical-social-personality areas of psychology, where it frequently occurs that the only useful level of measurement obtainable is nominal scaling (Stevens, 1951, pp. 2526), i.e. placement in a set of k unordered categories. Because the categorizing of the units is a consequence of some complex judgment process performed by a &dquo;two-legged meter&dquo; (Stevens, 1958), it becomes important to determine the extent to which these judgments are reproducible, i.e., reliable. The procedure which suggests itself is that of having two (or more) judges independently categorize a sample of units and determine the degree, significance, and
34,965 citations
"Does inter-vertebral range of motio..." refers methods in this paper
...Analysis of proportions of dichotomous variables was by 2-way Fisher Exact tests for comparison of cohorts and by Cohen’s Kappa statistic [41] for agreement between palpated and measured hypo-mobility....
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01 Jan 2000
TL;DR: Suitable for those new to statistics as well as students on intermediate and more advanced courses, the book walks students through from basic to advanced level concepts, all the while reinforcing knowledge through the use of SAS(R).
Abstract: Hot on the heels of the 3rd edition of Andy Field's award-winning Discovering Statistics Using SPSS comes this brand new version for students using SAS(R). Andy has teamed up with a co-author, Jeremy Miles, to adapt the book with all the most up-to-date commands and programming language from SAS(R) 9.2. If you're using SAS(R), this is the only book on statistics that you will need! The book provides a comprehensive collection of statistical methods, tests and procedures, covering everything you're likely to need to know for your course, all presented in Andy's accessible and humourous writing style. Suitable for those new to statistics as well as students on intermediate and more advanced courses, the book walks students through from basic to advanced level concepts, all the while reinforcing knowledge through the use of SAS(R). A 'cast of characters' supports the learning process throughout the book, from providing tips on how to enter data in SAS(R) properly to testing knowledge covered in chapters interactively, and 'real world' and invented examples illustrate the concepts and make the techniques come alive. The book's companion website (see link above) provides students with a wide range of invented and real published research datasets. Lecturers can find multiple choice questions and PowerPoint slides for each chapter to support their teaching.
25,020 citations
"Does inter-vertebral range of motio..." refers background in this paper
...A sample size of 30 participants in each group would allow adequate opportunity for normal distributions of interval data if present [24] with a realistic recruitment target given the time and resources available....
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TL;DR: In this article, the authors present guidelines for choosing among six different forms of the intraclass correlation for reliability studies in which n target are rated by k judges, and the confidence intervals for each of the forms are reviewed.
Abstract: Reliability coefficients often take the form of intraclass correlation coefficients. In this article, guidelines are given for choosing among six different forms of the intraclass correlation for reliability studies in which n target are rated by k judges. Relevant to the choice of the coefficient are the appropriate statistical model for the reliability and the application to be made of the reliability results. Confidence intervals for each of the forms are reviewed.
21,185 citations
"Does inter-vertebral range of motio..." refers methods in this paper
...Agreement was calculated for both tests as standard errors of measurement (SEM) [33] and intraclass correlation coefficients (ICC 2C,1 and 3C,1) for reliability [34]....
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TL;DR: A 5-level version of the EQ-5D has been developed by the EuroQol Group and further testing is required to determine whether the new version improves sensitivity and reduces ceiling effects.
Abstract: This article introduces the new 5-level EQ-5D (EQ-5D-5L) health status measure. EQ-5D currently measures health using three levels of severity in five dimensions. A EuroQol Group task force was established to find ways of improving the instrument's sensitivity and reducing ceiling effects by increasing the number of severity levels. The study was performed in the United Kingdom and Spain. Severity labels for 5 levels in each dimension were identified using response scaling. Focus groups were used to investigate the face and content validity of the new versions, including hypothetical health states generated from those versions. Selecting labels at approximately the 25th, 50th, and 75th centiles produced two alternative 5-level versions. Focus group work showed a slight preference for the wording 'slight-moderate-severe' problems, with anchors of 'no problems' and 'unable to do' in the EQ-5D functional dimensions. Similar wording was used in the Pain/Discomfort and Anxiety/Depression dimensions. Hypothetical health states were well understood though participants stressed the need for the internal coherence of health states. A 5-level version of the EQ-5D has been developed by the EuroQol Group. Further testing is required to determine whether the new version improves sensitivity and reduces ceiling effects.
5,345 citations
"Does inter-vertebral range of motio..." refers methods in this paper
...Patients completed an 11-point numerical rating scale for pain (NRS), the Neck Disability Index (NDI) [26], and the EuroQol EQ-5 L [27]....
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TL;DR: Using a standard outcome across chronic pain studies would greatly enhance the comparability, validity, and clinical applicability of these studies, and the application of these results to future studies may provide a standard definition of clinically important improvement in clinical trials of chronic pain therapies.
Abstract: Pain intensity is frequently measured on an 11-point pain intensity numerical rating scale (PI-NRS), where 0=no pain and 10=worst possible pain. However, it is difficult to interpret the clinical importance of changes from baseline on this scale (such as a 1- or 2-point change). To date, there are no data driven estimates for clinically important differences in pain intensity scales used for chronic pain studies. We have estimated a clinically important difference on this scale by relating it to global assessments of change in multiple studies of chronic pain. Data on 2724 subjects from 10 recently completed placebo-controlled clinical trials of pregabalin in diabetic neuropathy, postherpetic neuralgia, chronic low back pain, fibromyalgia, and osteoarthritis were used. The studies had similar designs and measurement instruments, including the PI-NRS, collected in a daily diary, and the standard seven-point patient global impression of change (PGIC), collected at the endpoint. The changes in the PI-NRS from baseline to the endpoint were compared to the PGIC for each subject. Categories of "much improved" and "very much improved" were used as determinants of a clinically important difference and the relationship to the PI-NRS was explored using graphs, box plots, and sensitivity/specificity analyses. A consistent relationship between the change in PI-NRS and the PGIC was demonstrated regardless of study, disease type, age, sex, study result, or treatment group. On average, a reduction of approximately two points or a reduction of approximately 30% in the PI-NRS represented a clinically important difference. The relationship between percent change and the PGIC was also consistent regardless of baseline pain, while higher baseline scores required larger raw changes to represent a clinically important difference. The application of these results to future studies may provide a standard definition of clinically important improvement in clinical trials of chronic pain therapies. Use of a standard outcome across chronic pain studies would greatly enhance the comparability, validity, and clinical applicability of these studies.
4,568 citations