Background & Aims

Physical therapists (PTs) play a large role in the conservative management of neck pain. Cervical motor control exercises are an important tool used by PTs in addressing cervical motor control impairment (CMCI) and management of neck pain symptoms. Currently CMCI is most often assessed using the craniocervical flexion test (CCFT), and recommended treatment progressions for CMCI focus on endurance exercises for deep neck flexor muscles. However, the CCFT assessment is uniplanar and does not take into consideration the multiplanar and nuanced nature of cervical movement. The Neckcare System (NCS) is a new tool with great potential to improve the understanding and management of neck pain by providing novel, and multiplanar, data on movement control. The purpose of this study was to describe changes in PTs management of neck pain as they integrated the NCS into clinical practice.

Methods

A focus group, comprised of the same 8 PTs from two outpatient clinics, met every 2-weeks for a total of 8 sessions to track the integration and use of the NCS in their practice. Given that this study was associated with the clinical integration of new technology, a generic qualitative design was employed to maximize flexibility and practical application of study activities. Rapid analysis was used to explore their current practices, how they used assessment results to guide treatment, and perceived barriers to integrating the NCS into practice.

Results

PTs initially expressed that the CCFT was the most useful tool to diagnose CMCI, they relied on qualitative visual assessment, and their treatment focused on endurance exercises for deep neck flexor muscles. Midway through the study, PTs showed evidence of integrating the NCS data into their clinical reasoning as demonstrated by raising new hypotheses for the underlying mechanisms of CMCI. They described more varied treatment approaches that incorporated dynamic head movements (i.e., using a head mounted laser pointer). At the end of the study, PTs began using NCS data to generate CMCI hypotheses for complex patients and develop more nuanced treatment approaches. One PT states “ it was informative of what we’re doing and how that fits in…improving her midrange control now that we’ve been more focused.” PT’s also began to incorporate patient perspective into their rationale for using the NCS data, stating “that was a change for me…because people were actually almost requesting it.”

Conclusions

In this study, we explored how PTs integrated the NCS and outcomes into their clinical reasoning and treatment approaches and found that treatment approaches evolved as the integration of novel NCS data progressed. As PTs began to incorporate NCS data more consistently into their hypotheses regarding CMCI, they reported greater variation of dynamic treatment progressions. Late in the study, PTs highlighted using more longitudinal NCS data, NCS data for more complex patients, and integration of patient perspective of NCS. PTs described treatment approaches that were more nuanced based on NCS data.

References

Blanpied, P. R., Gross, A. R., Elliott, J. M., Devaney, L. L., Clewley, D., Walton, D. M., … & Torburn, L. (2017). Neck pain: revision 2017: clinical practice guidelines linked to the international classification of functioning, disability and health from the orthopaedic section of the American Physical Therapy Association. Journal of Orthopaedic & Sports Physical Therapy, 47(7), A1-A83.

Christensen, N., Black, L., Gilliland, S., Huhn, K., & Wainwright, S. (2023). The Role of Movement in Physical Therapist Clinical Reasoning. Physical Therapy, pzad085.

Elvén, M., & Dean, E. (2017). Factors influencing physical therapists’ clinical reasoning: qualitative systematic review and meta-synthesis. Physical Therapy Reviews, 22(1-2), 60-75.

Karen Huhn and others, Clinical Reasoning in Physical Therapy: A Concept Analysis, Physical Therapy, Volume 99, Issue 4, April 2019, Pages 440–456, https://doi.org/10.1093/ptj/pzy148

Martin-Gomez, C., Sestelo-Diaz, R., Carrillo-Sanjuan, V., Navarro-Santana, M. J., Bardon-Romero, J., & Plaza-Manzano, G. (2019). Motor control using cranio-cervical flexion exercises versus other treatments for non-specific chronic neck pain: a systematic review and meta-analysis. Musculoskeletal Science and Practice, 42, 52-59.

Owens, J. G., Rauzi, M. R., Kittelson, A., Graber, J., Bade, M. J., Johnson, J., & Nabhan, D. (2020). How new technology is improving physical therapy. Current reviews in musculoskeletal medicine, 13, 200-211

Vindrola-Padros, C., & Johnson, G. A. (2020). Rapid techniques in qualitative research: a critical review of the literature. Qualitative health research, 30(10), 1596-1604.

Presenting Author

Chelsea Miller

Poster Authors

Chelsea Miller

PT

University of Miami

Lead Author

Marlon Wong

PT

University of Miami

Lead Author

Topics

  • Treatment/Management: Interventional Therapies – Other