The assessment of cervical sensory motor control: a systematic review focusing on measuring methods and their clinicmetric characteristics

Purpose: The aim of this review is twofold: first to describe
commonly used measuring methods and second to compare
their clinimetric properties.
Relevance: Cervical sensorimotor control is increasingly
important in the assessment and treatment of patients with
neck pain. Various measuring methods are used. These measuring
methods vary in the required task, which makes it hard
to compare their results. Moreover, it is unclear whether the
different measuring methods are equally reliable and valid.
Participants: Since this text is the abstract of a review, no
participants were included.
Methods: Two independent researchers performed a systematic
review, screening online databases (Medline and Science
Direct, publication years: 1990–2009). Based on title and
abstract, 56 articles were detected of which 33 were withhold
based on predefined in- and exclusion criteria. The methodological
quality of the selected articles was scored according
to CBO guidelines.
Analysis: Since this text is the abstract of a review, statistical
analysis was not used.
Results: Three cervical sensory motor measuring methods
were found. The most commonly used procedure is the head
repositioning accuracy (HRA) to the neutral head position
(NHP) whereby subjects have to relocate their heads as accurately
as possible to a self-determined NHP. The subject is
blindfolded to exclude visual input. The repositioning error
was measured and is the criterion for the HRA measurements.
This repositioning error is measured using laser pointer or
more sophisticated measurement techniques such as electromagnetic
tracking devices. Reliability of this procedure
appears to be good (ICC 0.75–0.93). A second method is
similar to the abovementioned but the head is now relocated
to a predefined target position (e.g. 30◦ rotation). Reliability
of this procedure was moderate to good (ICC 0.8–0.82).
A more dynamic method (The Fly) concentrates on cervical
motion sense instead of position sense. The entire motion
trajectory is registered and movement parameters are calculated.
The Jerk index, a rate for the smoothness of the
movement, is used as the main outcome for this analysis.
Reliability of this movement analysis is very good (ICC 0.90).
For all three measuring methods mainly discriminant validity
has been investigated. The HRA (NHP and target position)
was able to make the distinction between various populations
such as between patients with whiplash associated disorders
(WAD) and asymptomatic controls. The Fly also makes the
distinction between WAD and controls.
Conclusions: The currently used HRA techniques for measuring
cervical position sense can be used in clinical practice
and for research purposes as they have a good reliability.
The same accounts for the Fly which has shown to have an
excellent reliability.
Implications: The HRA techniques as well as The Fly can
be used in research purposes.
Keywords: Cervical sensory motor control; Assessment;
Clinimetrics
Funding acknowledgements: This research was funded by
the Artesis Hogeschool Antwerpen, grant nr. G850.
Ethics approval: Since this text is the abstract of a review,
no ethics approval was needed.