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Functional analysis of the cervical spine: Reliability, reference data and outcome after anterior cervical decompression and fusion
Linköping University, Department of Department of Health and Society, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.ORCID iD: 0000-0002-6075-4432
2002 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aim of the thesis was to investigate the reliability of the test procedure, and to obtain reference values for active range of motion (AROM) of the neck, neck-, and hand strength. Another aim was to perform a broad assessment of outcome in patients with cervical disc disease operated on by anterior cervical decompression and fusion (ACDF) and to identify predictive factors for a good outcome. For a broad assessment it is important to have reliable objective and subjective variables, and reference values obtained in healthy people.

Three studies concern reliability and reference values for neck AROM, neck strength, and hand strength of healthy individuals. One study concerns the outcome of 34 consecutively included patients six months and one year after ACDF, and any remaining deficits afterwards. One study is a prospective randomised study of 103 patients concerning prognostic factors (mean follow-up 19 months, SD 6, range 12-24 months) for a good outcome of ACDF, and any remaining deficits afterwards.

The intra-, and inter-tester reliability of neck AROM, neck strength, and hand strength obtained from 30-32 healthy volunteers were considered substantial to almost perfect (ICC-values 0.61-0.98) and can be used for comparisons between or within groups. The reference values obtained in 101 asymptomatic men and women aged 25-64 years showed that age was the most important factor to take into consideration when measuring neck AROM, and gender was most important for neck and hand strength measurements. The patients showed benefits from ACDF at the one-year follow-up in neck strength in lateral flexion, neck muscle endurance in flexion, pain, numbness, ADL, Neck Disability Index (NDI), sick leave, change in general health, and symptom satisfaction. Except for a deterioration in general health there were no significant differences between the six-month and the one-year followup. The most important predictor for low postoperative pain intensity was greater preoperative kyphosis.

The predictive value of segmental kyphosis is noteworthy and of potential clinical interest. Low preoperative pain intensity was the most important predictor for improved NDI. Non-smoking males with a greater segmental kyphosis at the level of surgical intervention, with less severe pain experience and better initial function, had the best prognosis for a successful outcome of ACDF. Although the patients experienced benefits from surgery in many of the variables, a large number still had remaining deficits. These studies support the need for improvements in the selection for and the treatment techniques in both surgery and physiotherapy in degenerative cervical disorders.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet , 2002. , 84 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 738
National Category
Social Sciences
Identifiers
URN: urn:nbn:se:liu:diva-26343Local ID: 10867ISBN: 91-7373-182-X (print)OAI: oai:DiVA.org:liu-26343DiVA: diva2:246891
Public defence
2002-09-06, Berzeliussalen, Universitetssjukhuset, Linköping, 09:00 (Swedish)
Opponent
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2013-09-03Bibliographically approved
List of papers
1. Intra- and inter-tester reliability and range of motion of the neck
Open this publication in new window or tab >>Intra- and inter-tester reliability and range of motion of the neck
2000 (English)In: Physiotherapy Canada, ISSN 0300-0508, E-ISSN 1708-8313, Vol. 52, 233-242 p.Article in journal (Refereed) Published
Abstract [en]

To our knowledge, neither reliability nor reference values have previously been investigated on the cervical measurement system (CMS) equipment. In this study we determined the intra- and intertester reliability of measuring active range of motion (AROM) in the three planes using the cervical measurement system (CMS) and the golden standard cervical range of motion device (CROM). Based on repeated measurements by two observers in 30 healthy volunteers, measurement of AAOM with the GMS equipment was shown to be a reliable method and nearly as good as the CROM equipment. Thus, the CMS equipment can be used for evaluating cervical AROM in clinical practice. Age- and sex-specific cervical range of motion was measured with the CMS equipment in 101 randomly selected asymptomatic men and women aged 25-64 years. The results from the reference- value study showed that age is a much more important determinant of cervical AROM than sex, body weight, or body mass index.

Keyword
Cervical Spine, Neck, Active Range of Motion, Reliability
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-27923 (URN)12684 (Local ID)12684 (Archive number)12684 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
2. Intra- and inter-tester reliability and reference values for hand strength
Open this publication in new window or tab >>Intra- and inter-tester reliability and reference values for hand strength
2001 (English)In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 33, no 1, 36-41 p.Article in journal (Refereed) Published
Abstract [en]

The intra- and inter-tester reliability for measurement of handgrip strength and indexgrip strength using the Jamar dynamometer was investigated in 32 healthy volunteers, and the intra-tester reliability in 13 patients with cervical radiculopathy. The results from the reliability studies showed that handgrip and indexgrip strength measured with the Jamar dynamometer is a reliable method (ICC values 0.85-0.98) and can be recommended for use in clinical practice. Age- and sex-specific reference values for handgrip strength and indexgrip strength were measured with the Jamar dynamometer in 101 randomly selected healthy volunteers, aged 25-64 years. The results from the reference value study showed that sex is a more important determinant of hand strength than age, height and body weight. The reference values for hand strength improve the potential for objective evaluation of patients with arm/hand disorders caused by cervical radiculopathy.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-27924 (URN)10.1080/165019701300006524 (DOI)12685 (Local ID)12685 (Archive number)12685 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
3. Intra- and inter-tester reliability and reference values for isometric neck strength
Open this publication in new window or tab >>Intra- and inter-tester reliability and reference values for isometric neck strength
2001 (English)In: Physiotherapy Research International, ISSN 1358-2267, E-ISSN 1471-2865, Vol. 6, no 1, 15-26 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND AND PURPOSE: Age- and sex-specific reference values for neck strength based on reliable measurements in the upright position are lacking. The aim of the present study was to determine intra- and inter-tester reliability and age- and sex-specific reference values for isometric neck strength in extension, flexion and lateral flexion in sitting position measured with the David Back Clinic 140 (DBC 140) equipment.

METHOD: The reliability of the DBC 140 equipment was investigated in 30 healthy volunteers and reference values were obtained from 101 healthy men and women.

RESULTS: The reliability study showed that neck strength measured with the DBC 140 equipment has almost perfect intra- and inter-tester reliability (ICC values between 0.85 and 0.97). The mean value of the first in a series of three measurements was the highest for all three test leaders and for almost all directions. Results from the reference value study showed that gender is a much more important determinant of neck strength than age, body weight or body mass index (BMI). Neck strength in women was, on average, 55% of that in men, and when adjusted for body weight or BMI, the percentages were 70% and 59%, respectively. In all directions observed, neck strength decreased by approximately 20% from age 25 to 64 years.

CONCLUSIONS: Measurements of neck strength taken in upright position with the DBC 140 equipment have almost perfect intra- and inter-tester reliability and justify the use of this test procedure. The use of the first measurement in a test series can be recommended for use in clinical practice since it was shown to be the maximal test value and thus, had a very low intra-tester difference. The use of reference values for neck strength when evaluating patients with neck disorders needs to take gender into account.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-81290 (URN)10.1002/pri.210 (DOI)
Available from: 2012-09-11 Created: 2012-09-11 Last updated: 2017-12-07Bibliographically approved
4. Disability after anterior decompression and fusion for cervical disc disease
Open this publication in new window or tab >>Disability after anterior decompression and fusion for cervical disc disease
2002 (English)In: Advances in Physiotherapy, ISSN 1403-8196, E-ISSN 1651-1948, Vol. 4, no 3, 111-124 p.Article in journal (Refereed) Published
Abstract [en]

Few prospective studies on outcome have been conducted with respect to disability after anterior cervical decompression and fusion (ACDF), and the need for further rehabilitation after surgery is unknown. Thirty-four patients with cervical disc disease verified by magnetic resonance imaging were included before ACDF with a cervical carbon fibre intervertebral fusion cage. Measurements took place the day before, 6 months and 1 year after surgery, and consisted of both objective and subjective measurements. The results showed a significant improvement from surgery in neck muscle endurance in flexion, neck strength in lateral flexion, some of the pain variables, numbness, neck specific disability, change in general health and symptom satisfaction at the 1-year follow-up. Except for worsening in general health, there were no significant differences between the 6-month and the 1-year follow-up. Despite improvement in several of the variables, about one-third of the patients had deficits in the objective measurements and about two-thirds had deficits in the subjective variables. Only five patients were without neck problems according to average pain, the Neck Disability Index and general health. This suggests that there is still a great need for improvement both of the surgical procedure and the rehabilitation afterwards.

Keyword
Cervical radiculopathy, Neck, Outcome, Rehabilitation, Spine, Surgery
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-46883 (URN)10.1080/140381902320387531 (DOI)
Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2017-12-13Bibliographically approved
5. Predictive factors for the outcome of anterior cervical decompression and fusion
Open this publication in new window or tab >>Predictive factors for the outcome of anterior cervical decompression and fusion
2003 (English)In: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 12, no 3, 274-280 p.Article in journal (Refereed) Published
Abstract [en]

In a prospective study, 103 patients were randomised to anterior cervical decompression and fusion (ACDF) with a cervical carbon-fibre intervertebral fusion cage or the Cloward procedure. Preoperative background variables, active range of neck motion, handgrip strength, radiological evaluation and subjective variables were used in a multiple regression model to find the strongest predictors of postoperative outcome as measured by current pain intensity and the Neck Disability Index (NDI). Male sex, greater kyphosis at the level operated on, non-smoking, a greater neck mobility in right rotation, low disability on NDI, and older age were predictors of pain reduction and explained 30% of current pain intensity at follow-up. Higher educational level, non-smoking, greater kyphosis at the level operated on, a greater flexion mobility, greater right handgrip strength and lower current pain intensity were predictors of improvement, and explained 28% of the postoperative outcome on NDI. The most important predictor for postoperative pain intensity was the magnitude of the preoperative kyphosis. Preoperative pain intensity was the most important predictor for improved NDI. At follow-up about 70% of the patients still had deficit based on current pain intensity and NDI, and 44% had remaining dysfunction based on Odom's criteria. In conclusion, the multivariate analysis shows that male sex, non-smoking, greater segmental kyphosis and a low pain and disability level are preoperative predictors of a good outcome in ACDF. In addition, the study suggests the importance of other predictive variables than those studied for the outcome of ACDF.

Keyword
cervical spine, intervertebral fusion, prognostic factors, outcome
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-47773 (URN)10.1007/s00586-003-0530-2 (DOI)
Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2017-12-13Bibliographically approved

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