RELIABILITY, CONSTRUCT AND DISCRIMINATIVE VALIDITY OF CLINICAL TESTING IN SUBJECTS WITH AND WITHOUT CHRONIC NECK PAIN

RELIABILITY, CONSTRUCT AND DISCRIMINATIVE VALIDITY OF CLINICAL TESTING IN SUBJECTS WITH AND WITHOUT CHRONIC NECK PAIN René Jørgensen 1,2,Inge Ris 2,, Deborah Falla 3,4, Birgit Juul-Kristensen 2,5 1 University College South Denmark, Department of Physiotherapy, Esbjerg Ø, Denmark 2 Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark 3 Pain Clinic, Center for Anesthesiology, Emergency and Intensive Care Medicine, University Hospital Göttingen, Göttingen, Germany 4 Department of Neurorehabilitation Engineering, Bernstein Focus Neurotechnology Göttingen, Bernstein Center for Computational Neuroscience, University Medical Center Göttingen, Georg- August University, Göttingen, Germany 5 Bergen University College, Institute of Occupational Therapy, Physiotherapy and Radiography, Department of Health Sciences, Bergen, Norway

Baggrund Kroniske nakkepatienter symptomer: Nedsat styrke og udholdenhed i den cervikale muskulatur (Lindstrom et al. 2011, Pearson et al. 2009) Nedsat neuromuskulær kontrol (Jull et al. 2004, Falla et al. 2003) Nedsat proprioceptiv evne (Heikkila, Astrom 1996, Treleaven, Jull & Sterling 2003) Hoved/øje koordinationsbesvær (Treleaven, Jull & Grip 2011) Ændringer i smerteperception med lokal og central sensitivering (Chien, Sterling 2010, Scott, Jull & Sterling 2005)

Baggrund Tidligere studier har fundet divergerende resultater med hensyn til reliabilitet og validitet af kliniske tests (de Koning et al. 2008) Mange tests er kun undersøgt i forskningssammenhænge med avanceret og dyrt udstyr som ikke er tilgængelig i klinisk praksis Forskning Klinisk praksis

Formål Undersøge: Inter- og intra reliabiliten af seks kliniske nakketests Test-retest reliabiliteten af en test for balance/postural control og en test for smerteperception Diskriminative validitet af testene Construct validitet af testene

Design Tværsnitsstudie Studiet fulgte anbefalingerne fra International Academy of Manual/Musculoskeletal Medicine (FIMM 2004). Training phase ( Overall agreement phase ) Study phase Testerne var blindede for patientens eksponeringsstatus og de andre testeres fund To testere udførte testene i inter- og intra reliabilitetsstudiet, en tredje tester udførte testene i test-retest studiet

In og eksklusions kriterier Inklusion Cases Voksne (min. 18år) Nakkesmerter i minimum 6mdr. Nedsat nakkefunktion (Neck Disability Index >10) Dansktalende Kontroller Ingen aktuelle smerter I nakke, hoved, skulder eller arm Ingen nakkesmerter af mere end en uges varighed indenfor det sidste år Matchet på køn og alder (+/- 3 år) Dansktalende Eksklusion Neuropati/Radiculopati (spurling test, cervikal traktion, plexus brachialis test) Neurologiske udfaldssymptomer (normal klinisk undersøgelse) Ustabil arbejdssituation Graviditet Frakturer Depression ifølge Bech Depression Index (score>29)

Studiepopulationen

Kliniske tests

Selvrapporterede mål Bech Depression Index (BDI) (0-63) SF 36 (0-100) Neck Disability Index (NDI) (0-50) Numeric Rating Scale (NRS) (0-10) Global Perceived Effectiveness (GPE) (0-11)

Resultater Alle tests med undtagelse af JPE og DCE var i stand til at diskrimere mellem cases og kontroller (p<0.05) CCFT, ROM, GS og SPNTT korrelerede signifikant med NDI, NRS og SF36 PCS (p<0.05) DCE korrelerede signifikant med NDI og NRS (p<0.05)

Resultater PPT på C2/C3 og infraspinatus var i stand til at diskriminere mellem cases og controller (p<0.05) PPT på C2/C3 korrelerede signifikant med NDI, NRS og SF36-PCS (p<0.05), PPT på infraspinatus korrelerede signifikant med NDI og NRS (p<0.05) og PPT på tibialis anterior korrelerede signifikant med NRS (p<0.05) Areal, A/P, M/L i Rhomberg eyes closed og One leg stand korrelerede signifikant med NDI, NRS og SF 36-PCS (p<0.05).

Reliabilitet CCFT SWAY PPT GS ROM SPNTT DCE JPE

p-værdi Diskriminativ validitet Diskriminativ validitet 0 ROM GS SPNTT 0,05 CCFT DCE PPT SWAY 0,1 0,15 0,2 0,25 0,3 0,35 0,4 JPE 0,45

Construct Validitet CCFT ROM GS SPNTT NDI, NRS, PCS (Alle variabler) PPT SWAY NDI, NRS, PCS (Fleste variabler) DCE NDI, NRS JPE ----------------

Resultater (oversigt)

Konklusion Størstedelen af testene havde tilfredsstillende reliabilitet hos denne gruppe af kroniske nakkepatienter og asymptomatiske kontroller. Alle tests med undtagelse af JPE og til dels SWAY korrelerede signifikant med NRS, NDI og SF36 physical component score. CCFT, ROM, DCE, GS, SPNTT og PPT var alle i stand til at diskriminere mellem cases og kontroller, men den gennemsnitlige forskel lå indenfor Minimum Detectable Change (MDC)

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