Background & Aims

The cranio-cervical cervical flexion (CCFT) and neck flexor muscle endurance tests are currently the only tests that are widely recommended for assessing movement coordination impairments in people with neck pain. However, these tests consist solely of uniplanar motions performed in the non-functional supine position, and performance on these tests are only weakly associated with disability. Thus, there is a need for more robust functional movement evaluation tools that can better define movement coordination impairment associated with pain and disability. The aim of this study was to investigate the clinical utility of the Butterfly test (FLY), performed with the NeckcareTM system (Neckcare Inc., Iceland). The FLY is a tri-planar test that requires patients to manipulate a cursor on a screen using head and neck motions.

Methods

Twenty-four patients seeking physical therapy for neck pain at an outpatient clinic were consecutively recruited. The Neck Disability Index (NDI), Pain Catastrophizing Scale, numeric pain rating scale, CCFT, and FLY test were completed at the time of initial physical therapy examination. The CCFT was conducted using the Stabilizer Pressure Biofeedback (Chattanooga, TX). For the FLY, participants were fitted with the Neckcare headgear device and provided with warm up and practice trials prior to completion of 3 assessments at varying levels of difficulty: easy, medium, and difficult.

Results

The CCFT was not significantly correlated with performance on the FLY tests at any level of FLY difficulty (r values between -0.160 and 0.150, p > .05). NDI scores were significantly (p < 0.05) and inversely correlated with FLY scores for easy (r=-0.42), medium (r=-0.41), and difficult (r=-0.36) levels. It is known that perceived neck disability is influenced by many factors, so linear regression analysis was performed to examine the utility of combining FLY test scores with current pain intensity, Pain Catastrophizing Scale score, and CCFT to predict baseline NDI scores. The model was significant with an R2 value of 0.53, p = 0.001.

Conclusions

The lack of correlation between the CCFT and FLY suggests that the FLY may add novel and complementary information to the CCFT. Interestingly, the FLY, but not the CCFT, was correlated with NDI scores suggesting that the FLY may be more useful than the CCFT for understanding underlying neck coordination impairments that are contributing to perceived disability. These findings may allow for better targeting of exercise interventions to improve neck pain and disability.

References

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2.de Zoete RMJ, Osmotherly PG, Rivet DA, Snodgrass SJ. Cervical Sensorimotor Control Does NotChange Over Time and Is Not Related to Chronic Idiopathic Neck Pain Characteristics: A 6-MonthLongitudinal Observational Study. Phys Ther. 2020;100(2):268-282.

3.de Zoete RMJ, Osmotherly PG, Rivet DA, Snodgrass SJ. No Differences Between Individuals with Chronic Idiopathic Neck Pain and Asymptomatic??c Individuals on 7 Cervical Sensorimotor Control Tests: A Cross-sectional Study. J Orthop Sports Phys Ther. 2020;50(1):33-43.

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Presenting Author

Juan P. Gonzalez

Poster Authors

Juan Gonzalez

PT

University of Miami, Department of Physical Therapy, APReCIAT Lab

Lead Author

E-mail

Chelsea Miller

PT

University of Miami

Lead Author

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Claudia Hernandez

University of Miami

Lead Author

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Gabriel Gonzalez

The University of Miami

Lead Author

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Cindy Bailon Perez

University of Miami, Miller School of Medicine, APReCIAT Laboratory

Lead Author

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Jessica Bolanos

University of Miami

Lead Author

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Teresa Glynn

University of Miami

Lead Author

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Marlon Wong

PT

University of Miami

Lead Author

E-mail

Topics

  • Specific Pain Conditions/Pain in Specific Populations: Neck Pain

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