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Sensorimotor characteristics in chronic neck pain: Possible pathophysiological mechanisms and implications for rehabilitation
Högskolan i Gävle, Belastningsskadecentrum.
2004 (Engelska)Doktorsavhandling, monografi (Övrigt vetenskapligt)
Abstract [en]

The general aims of this thesis was to investigate the predictive value of physical, sociodemographic, and psychosocial-behavioural variables for pain reduction arter multimodal rehabilitation in patients with chronic low back or neck pain, and to develop and evaluate tests for objective and quantitative evaluation of characteristic sensorimotor disturbances in chronic neck pain.

Logistic regression ffiodels revealed that unchanged pain intensity could be predicted with good precision while reduced pain intensity arter rehabilitation was poorly predicted by the baseline variables. Altered pain intensity in chronic low back pain was predicted by high pain intensity, low levels of pain severity and high affective distress, while reduced pain intensity for patients with chronic neck pain were predicted by high endurance, low age, high pain intensity, low need ofbeing social along with optirnistic attitudes on how the pain will interfere with daily life, and few vegetative symptorns. One of the conclusions was that objective measures of specific sensorimotor disturbances should improve the precision by which treatment-induced effects can be assessed and predicted.

A study was designed to objectively and quantitatively evaluate a large numbers of different sensorimotor characteristics in a small group of patients with chronic neck pain of different aetiology (whiplash-related and insidious). Kinernatic data was recorded during different motor tasks, involving cervical rotations, arm ffiovements and standing. In comparison to a group of asymptomatic control subjects, patients with chronic neck pain was characterised by slower ffiovements, poor balance, reduced cervical stability during perturbations, altered smoothness of ffiovement (jerk index), and reduced ffiovement precision (variable error and variability in range of motion). The sensorimotor variables velocity ofarm ffiovements and cervical stability, could correctly classified nearly 90% of the subjects as having chronic neck pain or being asymptomatic.

There was a large diversity of sensorimotor disturbances among the individual patients. This was conflrmed in a regression ffiodel that failed to separate the groups insidious neck pain (sensitivity 44%) and WAD (sensitivity 67%).

By investigating associations between the different sensorimotor variables, close relations was found between the repositioning acuity and variability in range of motion, and between standing balance and cervical stability! standing balance during perturbation. These two groups of variables were only weakly related to each other and to smoothness offfiovement and ffiovement velocity.

The results indicate that chronic neck pain is characterised by specific sensorimotor deficits, and that there are common pathophysiological mechanisrns in chronic neck pain of different aetiology. However, the lack of associations between several sensorimotor disturbances indicates that different mechanisrns are involved. The thesis indicates that objective sensorimotor tests should be used to improve the quaIity of functional assessments in chronic neck pain. Methods that objectively and quantitatively measure e.g. ffiovement precision, balance and cervical stability are also needed in order to evaluate current treatment methods and to develop new rehabilitation prograrns for specific sensorimotor deficits.

Ort, förlag, år, upplaga, sidor
Grafiska enheten, SLU, Umeå , 2004.
Serie
Umeå University Medical Dissertations, ISSN 0346-6612 ; 924
Nyckelord [en]
Outcome prediction, Pain intensity, Neck Pain, WAD, Motor control, Proprioception, Balance, Cervical stabililty, Jerk, Neck Kinematics
Identifikatorer
URN: urn:nbn:se:hig:diva-2848ISBN: 91-7305-744-4 (tryckt)OAI: oai:DiVA.org:hig-2848DiVA, id: diva2:119510
Tillgänglig från: 2007-11-05 Skapad: 2007-11-05

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