Accessory Movements and Associated Factors During Active Cervical Range of Motion

NCT07267507 | Active Not Recruiting

• 1 other identifier: Atılım University-25
• Study Type: observational
• Target: 180
• Locations: 1 country
• Sites: 1

Brief Summary

This project aims to quantify accessory movements that occur during cervical range of motion (ROM) assessment in young adults and to examine their relationship with functional and psychological factors. Although cervical ROM is widely used in clinical practice, accurate measurement is challenged by the complex anatomy of the cervical spine and coupled movements, which may alter true motion values. Despite their clinical relevance, accessory movements have been largely overlooked in both research and routine assessment. This cross-sectional observational study will include volunteers aged 18-30 years, recruited between January and August 2025 following ethical approval. Individuals with cervical trauma or surgery, neurological disease, recent treatment, musculoskeletal injury, or medications affecting movement will be excluded. Accessory movements will be measured using the CROM device while participants perform flexion-extension, lateral flexion, and rotation, maintaining end-range for 20 seconds to record primary and accessory motions. Clinical outcomes will include cervical disability (Neck Disability Index), pain intensity (Visual Analog Scale), cervical mechanosensitivity (pressure algometry at the upper trapezius and C2-C7 regions), psychological status (Depression, Anxiety, Stress Scale-21), and sleep quality (Pittsburgh Sleep Quality Index).

Conditions

Asymptomatic Condition; Neck Pain

Keywords

Cervical Vertebrae; Range of Motion; Pain; Sleep; Depression

Outcome Measures

Primary Outcomes (6)

• Assessment of Accessory Movements

  Accessory movements occurring during active cervical ROM will be evaluated using the Cervical Range of Motion (CROM) device. In a seated position, the participant's neutral resting posture will first be recorded. Subsequently, they will be instructed to perform flexion, extension, right lateral flexion, left lateral flexion, right rotation, and left rotation in sequence. At the end of each movement, participants will hold the end position for 20 seconds, during which the primary movement and the accessory movements occurring in the other two planes will be recorded.

  0-18 months

• Assessment of Cervical Disability

  Cervical disability will be assessed using the Neck Disability Index (NDI), a widely used instrument for evaluating cervical spine dysfunction. The NDI consists of 10 items that measure the impact of neck-related problems on daily activities, including pain intensity, personal care, lifting, reading, headaches, concentration, work status, driving, sleep, and recreational activities. Each item is scored on a scale from 0 to 5, resulting in a total score ranging from 0 to 50. A score of 0 indicates no disability or functional limitation, whereas a score of 50 reflects severe functional impairment. It is recommended that the total score be converted into a percentage, interpreted as follows: 0-4 (no disability), 5-14 (mild disability), 15-24 (moderate disability), 25-34 (severe disability), and 35-50 (complete or very severe disability).

  0-18 months

• Assessment of Pain Intensity

  Pain intensity will be assessed using the Visual Analog Scale (VAS). The VAS consists of a 10-cm (100-mm) horizontal line anchored by the descriptors "no pain" at one end and "worst imaginable pain" at the other. Participants will mark the point on the line that represents the intensity of pain they experience, and the distance in millimeters from the "no pain" anchor to the marked point will be recorded as the pain score.

  0-18 months

• Assessment of Cervical Mechanosensitivity

  Cervical muscle mechanosensitivity will be evaluated using a pressure algometer (Baseline Force Gauge Model 12-0304; Baseline, NY, USA). The device applies force perpendicular to the tissue through a 0.5 cm² probe at an approximate rate of 3 N/s. With the participant seated, pressure will be applied bilaterally to the midpoint of the upper trapezius muscle and to points located 2 cm lateral to the C2 and C7 articular pillars. Pressure algometry has demonstrated high intra-rater (ICC = 0.94-0.97) and inter-rater reliability (ICC = 0.79-0.90) in individuals with neck pain. Participants will be instructed to indicate the moment when the pressure sensation first becomes uncomfortable. This value, defined as the pressure pain threshold (PPT), will be recorded twice with at least 30 seconds between trials, and the mean of the two measurements will be used for analysis.

  0-18 months

• Assessment of Depression, Anxiety, and Stress:

  Depression, anxiety, and stress levels will be assessed using the Depression, Anxiety, and Stress Scale-21 (DASS-21). The DASS-21 consists of three subscales-depression, anxiety, and stress-each comprising 7 items. Scores for each subscale are summed and then multiplied by two, yielding a maximum possible score of 42 per domain. Higher scores indicate greater symptom severity. Recommended cut-off ranges vary for each construct: for depression, 0-9 (normal) to ≥28 (extremely severe); for anxiety, 0-7 (normal) to ≥20 (extremely severe); and for stress, 0-14 (normal) to ≥34 (extremely severe).

  0-18 months

• Assessment of Sleep Disturbances

  Sleep disturbances will be assessed using the Pittsburgh Sleep Quality Index (PSQI). The PSQI is a 19-item questionnaire designed to evaluate sleep habits over the past month and comprises seven components. The total score ranges from 0 to 21, with higher scores indicating poorer sleep quality. A global score of 5 or above is considered indicative of sleep disturbance.

  0-18 months

Study Arms (2)

Proprioceptive Dysfunction Group

Individuals with proprioceptive error (more than 4 degree)

Non-Error Group

Individuals without proprioceptive error-less than 4 degree

Eligibility Criteria

• Age: 18 Years - 35 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64)
• Sampling Method: Non-Probability Sample

Study Population

The study population will consist of young adults aged 18-30 years who volunteer to participate and meet the inclusion criteria. Only individuals without cervical trauma, surgery, neurological disorders, recent treatment, musculoskeletal injuries, or medication use affecting cervical movement will be included, ensuring a homogeneous non-clinical sample suitable for accurately evaluating accessory cervical movements.

You may qualify if:

• Are between 18 and 30 years of age
• Volunteer to participate in the study
• Provide written informed consent.

You may not qualify if:

• A history of cervical trauma
• A history of cervical spine surgery
• Any neurological disorder
• Received treatment related to the cervical region within the past 6 months
• Any musculoskeletal injury that may affect cervical movement
• Use of medications that could influence movement or neuromuscular function.

Sponsors & Collaborators

• Atılım University: lead

Study Sites (1)

Atılım University

Ankara, Ankara, 06830, Turkey (Türkiye)

Location

Related Publications (20)

• Ağargün, M.Y., H. Kara, and Ö. Anlar, The validity and reliability of the Pittsburgh Sleep Quality Index. Turk Psikiyatri Derg, 1996. 7(2): p. 107-15.

  BACKGROUND

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  PMID: 2748771 BACKGROUND

• Sariçam, H., The psychometric properties of Turkish version of Depression Anxiety Stress Scale-21 (DASS-21) in health control and clinical samples. Journal of Cognitive Behavioral Psychotherapies and Research, 2018. 7(1): p. 19.

  BACKGROUND

• Lovibond, S.H., Manual for the depression anxiety stress scales. Sydney psychology foundation, 1995.

  BACKGROUND

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  PMID: 3078045 BACKGROUND

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  PMID: 1834753 BACKGROUND

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• Law EY, Chiu TT. Measurement of cervical range of motion (CROM) by electronic CROM goniometer: a test of reliability and validity. J Back Musculoskelet Rehabil. 2013;26(2):141-8. doi: 10.3233/BMR-2012-00358.

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  PMID: 10771122 BACKGROUND

• Boussion, L. and L. Chèze, Étude cinématique tridimensionnelle du rachis cervical: Comparaison entre sujets asymptomatiques et "pathologiques". Kinésithérapie, la Revue, 2011. 11(109-110): p. 36-37.

  BACKGROUND

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  PMID: 29751851 BACKGROUND

• Cuesta-Vargas AI, Galan-Mercant A, Williams JM. The use of inertial sensors system for human motion analysis. Phys Ther Rev. 2010 Dec;15(6):462-473. doi: 10.1179/1743288X11Y.0000000006.

  PMID: 23565045 BACKGROUND

• Tucci SM, Hicks JE, Gross EG, Campbell W, Danoff J. Cervical motion assessment: a new, simple and accurate method. Arch Phys Med Rehabil. 1986 Apr;67(4):225-30.

  PMID: 3964055 BACKGROUND

• Frost M, Stuckey S, Smalley LA, Dorman G. Reliability of measuring trunk motions in centimeters. Phys Ther. 1982 Oct;62(10):1431-7. doi: 10.1093/ptj/62.10.1431.

  PMID: 7122701 BACKGROUND

• Sukari AAA, Singh S, Bohari MH, Idris Z, Ghani ARI, Abdullah JM. Examining the Range of Motion of the Cervical Spine: Utilising Different Bedside Instruments. Malays J Med Sci. 2021 Apr;28(2):100-105. doi: 10.21315/mjms2021.28.2.9. Epub 2021 Apr 21.

  PMID: 33958964 BACKGROUND

• Audette I, Dumas JP, Cote JN, De Serres SJ. Validity and between-day reliability of the cervical range of motion (CROM) device. J Orthop Sports Phys Ther. 2010 May;40(5):318-23. doi: 10.2519/jospt.2010.3180.

  PMID: 20436238 BACKGROUND

• Yoon TL, Kim HN, Min JH. Validity and Reliability of an Inertial Measurement Unit-based 3-Dimensional Angular Measurement of Cervical Range of Motion. J Manipulative Physiol Ther. 2019 Jan;42(1):75-81. doi: 10.1016/j.jmpt.2018.06.001.

  PMID: 31054596 BACKGROUND

• Jonas R, Demmelmaier R, Hacker SP, Wilke HJ. Comparison of three-dimensional helical axes of the cervical spine between in vitro and in vivo testing. Spine J. 2018 Mar;18(3):515-524. doi: 10.1016/j.spinee.2017.10.065. Epub 2017 Oct 23.

  PMID: 29074465 BACKGROUND

• de Koning CH, van den Heuvel SP, Staal JB, Smits-Engelsman BC, Hendriks EJ. Clinimetric evaluation of active range of motion measures in patients with non-specific neck pain: a systematic review. Eur Spine J. 2008 Jul;17(7):905-21. doi: 10.1007/s00586-008-0656-3. Epub 2008 Apr 22.

  PMID: 18427843 BACKGROUND

MeSH Terms

Conditions

Asymptomatic Diseases; Neck Pain; Pain; Depression

Condition Hierarchy (Ancestors)

Disease Attributes; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Neurologic Manifestations; Signs and Symptoms; Behavioral Symptoms; Behavior

Study Design

• Study Type: observational
• Observational Model: OTHER
• Time Perspective: CROSS SECTIONAL
• Target Duration: 1 Day
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Asst. Prof.

Study Record Dates

• First Submitted: November 25, 2025
• First Posted: December 5, 2025
• Study Start: April 30, 2024
• Primary Completion: December 31, 2025
• Study Completion: January 15, 2026
• Last Updated: December 5, 2025

Record last verified: 2025-11

Locations

TU (1)