Jørgensen René, Ris Inge, Juhl Carsten, Falla Deborah, Juul-Kristensen Birgit
Department of Physiotherapy, University College South, Degnevej 16, 6705, Esbjerg Ø, Denmark.
Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark.
BMC Musculoskelet Disord. 2017 Dec 28;18(1):548. doi: 10.1186/s12891-017-1918-1.
Responsiveness of a clinical test is highly relevant in order to evaluate the effect of a given intervention. However, the responsiveness of clinical tests for people with neck pain has not been adequately evaluated. The objective of the present study was to examine the responsiveness of four clinical tests which are low cost and easy to perform in a clinical setting, including the craniocervical flexion test, cervical active range of movement, test for the cervical extensors and pressure pain threshold testing.
This study is a secondary analysis of data collected in a previously published randomised controlled trial. Participants were randomized to either physical training, exercises and pain education combined or pain education only. Participants were tested on the clinical tests at baseline and at 4-month follow-up. An anchor-based approach using Receiver Operator Characteristics (ROC) curves was used to evaluate responsiveness of the clinical tests. The Neck Disability Index was used to discriminate between those who had improved and those who were unchanged at the 4-month follow-up. Minimum Clinically Important Difference (MCID), together with sensitivity, specificity, positive and negative predictive values, in addition to positive and negative likelihood ratios were calculated.
In total, 164 participants completed the 4 month follow up. One-hundred forty four participants were classified as unchanged whereas 20 patients were considered to be improved. Twenty-six participants didn't complete all of the clinical tests, leaving a total of 138 to be included for analyses. Area Under Curve (AUC) ranged from 0.50-0.62 for the clinical tests, and were all below an acceptable level. MCID was generally large, and the corresponding sensitivity and specificity was low with sensitivity ranging from 20 to 60%, and specificity from 54 to 86%. LR+ (0.8-2.07) and LR- (0.7-1.1) showed low diagnostic value for all variables, with PPV ranging from 12.1 to 26.1 and NPV ranging from 84.7 to 89.2.
Responsiveness of the included clinical tests was generally low when using change in NDI score as the anchor from baseline to the 4-month follow up. Further investigations of responsiveness are warranted, possibly using other anchors, which to a higher degree resemble similar dimensions as the clinical tests.
为评估特定干预措施的效果，临床测试的反应性至关重要。然而，针对颈部疼痛患者的临床测试反应性尚未得到充分评估。本研究的目的是检验四种在临床环境中成本低且易于实施的临床测试的反应性，包括颅颈屈曲试验、颈椎主动活动范围、颈椎伸肌测试和压痛阈值测试。
本研究是对先前发表的一项随机对照试验中收集的数据进行的二次分析。参与者被随机分为接受体育训练、运动和疼痛教育组合或仅接受疼痛教育两组。在基线和4个月随访时对参与者进行临床测试。采用基于接受者操作特征（ROC）曲线的锚定法来评估临床测试的反应性。使用颈部残疾指数来区分在4个月随访时改善的参与者和未改善的参与者。计算最小临床重要差异（MCID）以及敏感性、特异性、阳性和阴性预测值，以及阳性和阴性似然比。
共有164名参与者完成了4个月的随访。144名参与者被归类为未改善，而20名患者被认为有所改善。26名参与者未完成所有临床测试，因此共有138名参与者纳入分析。临床测试的曲线下面积（AUC）范围为0.50 - 0.62，均低于可接受水平。MCID通常较大，相应的敏感性和特异性较低，敏感性范围为20%至60%，特异性范围为54%至86%。所有变量的阳性似然比（LR +，0.8 - 2.07）和阴性似然比（LR -，0.7 - 1.1）显示出较低的诊断价值，阳性预测值范围为12.1%至26.1%，阴性预测值范围为84.7%至89.2%。
以颈部残疾指数（NDI）评分从基线到4个月随访的变化作为锚定指标时，所纳入临床测试的反应性总体较低。有必要进一步研究反应性，可能使用其他更类似于临床测试相似维度的锚定指标。
