Measurement properties of the measure of cervical joint position error in people with and without chronic neck pain

AlDahas, Ahmad (2024). Measurement properties of the measure of cervical joint position error in people with and without chronic neck pain. University of Birmingham. Ph.D.

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Abstract

Neck pain is a common musculoskeletal condition that affects people’s quality of life, physical level, emotional well-being, and daily functioning. It is ranked as the fourth cause of disability worldwide. People with chronic neck pain (CNP) often show proprioceptive deficits, which is commonly quantified by assessing cervical joint position error (JPE). Measurement properties encompass the qualities or attributes inherent in a measurement instrument or tool that dictate its capacity to gauge the intended construct or concept precisely and consistently. These properties play a vital role in guaranteeing that the measurement tool/measure yield results that are both valid and significant. The aim of this thesis was to assess the measurement properties of the measure of JPE in people with and without CNP.
In this thesis, one systematic review and two empirical studies have been carried out. The first study summarised and appraised the literature of the measurement properties of the measure of JPE in people with and without neck pain. Both absolute error (AE) and constant error (CE) were considered. The systematic review revealed that the reliability and validity of the measure of JPE showed sufficient results, but the levels of evidence were low/very low due to extreme risk of bias, imprecision, and inconsistency in the results. The results of this systematic review highlighted gaps in testing the reliability and validity of JPE using a laser pointer after returning from neck flexion, extension, right and left rotation. Moreover, the review revealed that the responsiveness of this measure has not been investigated. The second study in this thesis investigated the reliability, measurement error, and validity of JPE when assessed in sitting and standing in people with and without CNP. Tests of relocation accuracy to a neutral head position (NHP) and target head position (THP) tasks were tested. This study revealed that the JPE is a reliable and valid measure but not for all neck movements. In this study, differences in repositioning errors in people with and without CNP were also evaluated; people with CNP showed significantly greater JPE than the asymptomatic participants, but mainly when the absolute JPE was assessed. Differences in JPE between testing positions (sitting versus standing) in both groups (asymptomatic and CNP) were also tested. There were no significant differences between testing positions, apart from the constant JPE in people with CNP after returning from left rotation. In the third study, the responsiveness of the measure of JPE was investigated. JPE was assessed before and after four weeks of home-based proprioception training. Proprioception training comprised of repositioning errors tasks (NHP, THP) as well as movement sense tasks which included tracing a double ZZ bands and different circular shapes and arrows. The study showed that the measure of JPE was able to detect a change (internal responsiveness) after 4-weeks of home-based proprioception training intervention, but this was mainly so for the measure of absolute JPE. The correlation of change of scores (external responsiveness) obtained from the laser pointer and inertial measurement units (IMUs) was weak. Findings of this thesis indicates that the JPE test, using a laser pointer, is a reliable, valid measure. It also showed that the measure of JPE is responsive, however, further research, addressing the limitations identified in Chapter 4, is required. Overall, the findings of this thesis support the use of JPE, in assessing proprioception in research and clinical settings.

Type of Work:

Thesis (Doctorates > Ph.D.)

Award Type:

Doctorates > Ph.D.

Supervisor(s):