Influence of Directional Preference on Movement Coordination Deficits in Individuals With Whiplash Associated Disorders

NCT06143228 | Recruiting

• 1 other identifier: 081469
• Study Type: observational
• Target: 65
• Locations: 1 country
• Sites: 2

Brief Summary

The aim of this prospective observational study is to investigate whether the presence or absence of directional preference impacts movement coordination impairments as measured in patients with Whiplash Associated Disorders (WAD). The primary research question this study aims to answer is: 1\. Is the presence of directional preference in patients with WADs associated with more favorable improvements in the specific outcome measures as compared to those patients with WADs without the presence of directional preference. Patients in this study will asked to complete the following measures at baseline, during care, discharge, and 3 month follow up.

1. 1.Numeric Pain Rating Scale (NPRS)
2. 2.Optimal Screening for Prediction and Referral and Outcome-Yellow Flag (OSPRO-YF)
3. 3.Neck Disability Index (NDI)
4. 4.Craniocervical Flexion Test (CCFT)
5. 5.Neck Flexor Endurance Test
6. 6.Cervical Range of Motion

Conditions

Whiplash Injury of Cervical Spine; Muscle Weakness

Keywords

Whiplash Associated Disorders; Movement Coordination Deficits; McKenzie; Neck Pain

Outcome Measures

Primary Outcomes (3)

• Craniocervical Flexion Test (CCFT)

  Measures the holding capacity of the deep cervical flexor muscles: longus capitis and longus coli.To measure the deficit, an inflatable pressure biofeedback device (Stabilizer, Chattanooga, Tennessee, USA) is placed behind the patient's neck while the patient is hook-lying in the supine position. The pressure sensor is inflated to a baseline pressure of 20 mmHg. The patient is then instructed to perform head nodding motions of craniocervical flexion. The patient is instructed to hold a head-nodding motion for ten seconds at a baseline of 20 mmHg. After this step, the patient's pressure is progressively increased by 2 mmHg in 10 second intervals until a maximum of 30 mmHg is achieved. If the patient failed to maintain the head-nodding position at a certain pressure, then the measurement is recorded.

  Baseline, 3 weeks, 6 weeks

• Neck Flexor Endurance Test:

  Used to measure the holding capacity of the deep cervical flexor muscles. The participant was instructed to tuck their chin, lift their head off the table, and hold that position until exhaustion, or onset of symptoms. The physical therapist administering the test used a stopwatch to assess duration of hold. The test was concluded if the patient demonstrated any of the following: protrusion, shaking, onset or worsening of symptoms, or touching the table with their head.18, neck pain versus no neck pain.

  Baseline, 3 weeks, 6 weeks

• Cervical Range of Motion (CROM)

  A standard goniometer will be used to measure patient range of motion for flexion, extension, side bending, and rotation. All measures will be completed in sitting and repeated two times in each direction. The standard error of measure for goniometry is 2.4 to 4.9 degrees

  Baseline, 3 weeks, 6 weeks

Secondary Outcomes (3)

• The Numerical Pain Rating System (NPRS)

  Baseline, 3 weeks, 6 weeks, 3 months

• Optimal Screening for Prediction of Referral and Outcome-Yellow Flag (OSPRO-YF)

  Baseline, 3 weeks, 6 weeks, 3 months

• The Neck Disability Index (NDI)

  Baseline, 3 weeks, 6 weeks, 3 months

Study Arms (2)

Whiplash Associated Disorder with Directional Preference

Movements that reduce, abolish, or centralize the patient symptoms are recognized as a directional preference. Directional preference is ultimately used to guide the treatment of neck pain related to derangement syndrome.If the patient neck impairments are related to a Derangement syndrome, the patient will be instructed to perform the movements in the identified directional preference every 2-3 hours for 10-12 repetitions or to hold the cervical spine in a sustained position for 1-2 minutes. If the response to the intervention plateaus, the exercise intensity is progressed through the application of patient self-overpressure. If warranted clinician overpressure and mobilization may be utilized as a progression beyond patient generated forces. to achieve a favorable response.

Whiplash Associated Disorder without Direction Preference

Patients with WADs that do not demonstrate directional preference will be managed based on the published Clinical Practice Guidelines (2017) for management of WADs with related movement coordination deficits. Treatment and progression of care for this group will be determined by the treating therapist but will consist of education, multimodal care inclusive of therapeutic exercise, mobilization, aerobic exercise, flexibility, and postural education. In addition, if the patient symptoms are chronic in nature treatment may include exercise progression, education and reassurance, transcutaneous nerve electrical stimulation, and cognitive behavioral therapy are recommended.

Eligibility Criteria

• Age: 19 Years - 70 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

The population of interest for this study will consist of subjects meeting inclusion criteria referred by their physician to one of two out-patient physical therapy clinics located in the southwestern United States.

You may qualify if:

• Age 19-70
• Symptom complaints are related to a motor vehicle collision or trauma.
• Pain presents as unilateral or bilateral head/neck, upper back, or arm pain and/or stiffness
• Patient has been previously screened by their MD and received appropriate imaging to rule out the possibility of cervical fracture.

You may not qualify if:

• Neck pain is determined to be of non-cervical origin
• Malignancy/infection
• Presence of progressive neurological deficits
• Cranial or cervical vascular disorder
• Substance use or withdrawal
• Acute post cervical surgery
• Psychosis/psychiatric disorder/post-traumatic stress disorder
• Vertigo with nystagmus is present

Sponsors & Collaborators

• D'Youville College: lead

Study Sites (2)

Center for Orthopedic & Sports Physical Therapy

Tallahassee, Florida, 32308, United States

RECRUITING

OrthoPT Spine & Joint Specialists Clinic

Tampa, Florida, 33613, United States

RECRUITING

Related Publications (6)

• Blanpied PR, Gross AR, Elliott JM, Devaney LL, Clewley D, Walton DM, Sparks C, Robertson EK. Neck Pain: Revision 2017. J Orthop Sports Phys Ther. 2017 Jul;47(7):A1-A83. doi: 10.2519/jospt.2017.0302.

  PMID: 28666405 RESULT

• Ritchie C, Sterling M. Recovery Pathways and Prognosis After Whiplash Injury. J Orthop Sports Phys Ther. 2016 Oct;46(10):851-861. doi: 10.2519/jospt.2016.6918. Epub 2016 Sep 3.

  PMID: 27594661 RESULT

• Ritchie C, Hendrikz J, Jull G, Elliott J, Sterling M. External validation of a clinical prediction rule to predict full recovery and ongoing moderate/severe disability following acute whiplash injury. J Orthop Sports Phys Ther. 2015 Apr;45(4):242-50. doi: 10.2519/jospt.2015.5642.

  PMID: 25827122 RESULT

• Garcia AN, Costa LDCM, de Souza FS, de Almeida MO, Araujo AC, Hancock M, Costa LOP. Reliability of the Mechanical Diagnosis and Therapy System in Patients With Spinal Pain: A Systematic Review. J Orthop Sports Phys Ther. 2018 Dec;48(12):923-933. doi: 10.2519/jospt.2018.7876. Epub 2018 Jun 22.

  PMID: 29932871 RESULT

• Jull GA, O'Leary SP, Falla DL. Clinical assessment of the deep cervical flexor muscles: the craniocervical flexion test. J Manipulative Physiol Ther. 2008 Sep;31(7):525-33. doi: 10.1016/j.jmpt.2008.08.003.

  PMID: 18804003 RESULT

• Domenech MA, Sizer PS, Dedrick GS, McGalliard MK, Brismee JM. The deep neck flexor endurance test: normative data scores in healthy adults. PM R. 2011 Feb;3(2):105-10. doi: 10.1016/j.pmrj.2010.10.023.

  PMID: 21333948 RESULT

MeSH Terms

Conditions

Muscle Weakness; Neck Pain

Condition Hierarchy (Ancestors)

Muscular Diseases; Musculoskeletal Diseases; Neuromuscular Manifestations; Neurologic Manifestations; Nervous System Diseases; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Pain

Study Officials

• Jane Borgehammar, DSc

  Midwestern University

  STUDY DIRECTOR

Central Study Contacts

Eric Miller, DSc

CONTACT

7169129046; millere@dyc.edu

Jane Borgehammar, DSc

CONTACT

6309368001; jborge@midwestern.edu

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: November 16, 2023
• First Posted: November 22, 2023
• Study Start: December 30, 2023
• Primary Completion: September 30, 2024
• Study Completion: December 30, 2024
• Last Updated: February 22, 2024

Record last verified: 2024-02

Locations

US (2)