Measuring pressure pain threshold in the cervical region of dizzy patients-The reliability of a pressure algometer

Objectives: A tool for measuring neck pain in patients with dizziness is needed to further investigate the relationship between the two symptoms. The objective of this study was to examine the reliability and validity of a hand‐held pressure algometer in measuring pressure pain threshold (PPT) in different cervical regions of dizzy patients. Methods: PPT was measured at two bilateral standardized sites of the neck by a trained physiotherapist in 50 patients with dizziness. Intraclass correlation coefficients (ICC) were calculated for intrarater and test–retest reliability. Concurrent validity was assessed by measuring the association between PPT and the American College of Rheumatology (ACR) tender points at each site and with the numeric pain rating scale (NPRS). Results: Almost perfect intrarater (ICC = 0.815–0.940) and within‐session test–retest (ICC = 0.854–0.906) reliability was found between the measures. On each site, a low PPT predicted a positive ACR tender point at each site (OR = 0.864–0.922). Last, we found a statistical inverse relationship between the PPT and the NPRS (R = −0.52 to −0.66). Conclusion: The study shows that a pressure algometer is a reliable tool for measuring PPT in the neck of dizzy patients. Further, the PPT correlates significantly with other subjective measures of pain indicating that it may be a useful tool for further research.publishedVersio

Functional evaluation and work participation in health care workers with musculoskeletal disorders

Background: In Norway and other western countries, musculoskeletal disorders (MSDs) are the most frequent reasons for sick leave and disability pensions, and particularly employees in the health and social sector have a high sick leave level. Purpose: The main purpose of the project was to gain more knowledge regarding the functional level of employees with MSDs, whether on sick leave (less than 4 months’ full sick leave) or in work despite having pain, and to gain experience with a functional evaluation tool. In addition, we aimed to have close cooperation with the workplace to increase our understanding of employers’ perspectives and experiences in preventing or reducing sickness absence. Methods: Health care workers were recruited from the Department of Health- and Social Service in the municipality of Bergen from January 2012 to December 2014. Data from the functional evaluation were compared between those on full sick leave, partial sick leave and those staying in work, and factors associated with being on sick leave were examined (Study I). Participants with low back pain that met the inclusion criteria were invited to a randomised controlled trial (RCT) (not part of our study). All who were not included in the RCT, received advice and a report and verbal feedback from the functional evaluation tool, and four weeks later they were asked to return a short questionnaire about the usefulness of the brief functional evaluation (Study II). Focus group interviews were also conducted: three focus groups with employees (11 participants), and five with their supervisors (26 participants). Through the interviews we explored the employees’ and supervisors’ experiences with the brief functional evaluation (Study II), and we also explored the supervisors’ strategies when following up employees with MSDs (Study III). Results: A total of 250 employees (92.4 % women) underwent a functional evaluation. We found that participants on full sick leave had statistically significant poorer physical function compared to those working and to those on partial sick leave. Logistic regression showed that a reduced level for the physical dimension of the Short-Form 12 Health Survey (SF-12) and a high lift test were significantly related to full sick leave (OR 0.86, p < 0.001) (OR 0.79, p = 0.002). The physical dimension of SF-12 was the only variable that was associated to partial sick leave (OR 0.91, p = 0.005). Of the 194 employees who received a written evaluation report, three- quarters completed the questionnaire, and about 70% found the evaluation useful. Three main themes relating to its usefulness emerged from the qualitative data analyses: 1) Clarification and raising awareness, 2) The functional evaluation report as a tool for communication, and 3) Increased knowledge - altered behavior. In Study III, the supervisors described different strategies related to three phases in sick leave management and five corresponding themes: Phase 1) Promoting well-being and a healthy working environment, Phase 2) Providing early support and adjustments, and Phase 3) Making employees more responsible, using confrontational strategies in relation to employees on long-term sick leave, and cooperation with general practitioners (GPs). Conclusions: Reduced physical function can be measured in an early phase of sickness absence in employees with MSDs. Health care workers on full sick leave due to MSDs, who underwent a functional evaluation, had lower (worse) scores on selfreported and directly measured physical function compared to a working group with MSD and those on partial sick leave. Both employees and supervisors found the brief functional evaluation useful for clarifying the employees’ functional level and for obtaining advice to improve employees’ health and work functioning. At the workplace, the supervisors applied strategies to support as well as make demands on, and confront the employees. Moreover, the supervisors requested a closer cooperation with the GPs, which they believed could facilitate a faster return to work

Supervisors' Strategies to Facilitate Work Functioning among Employees with Musculoskeletal Complaints: A Focus Group Study

Aim. To explore what strategies the supervisors found beneficial to prevent or reduce sickness absence among employees with musculoskeletal complaints. Methods. Five focus groups were conducted and 26 supervisors from health and social sector participated. Commonly used strategies to prevent sickness absence and interdisciplinary cooperation in this work were discussed in the focus groups. Systematic text condensation was used to analyse the data. Results. The supervisors described five strategies for sick leave management: (1) promoting well-being and a healthy working environment, (2) providing early support and adjustments, (3) making employees more responsible, (4) using confrontational strategies in relation to employees on long-term sick leave, and (5) cooperation with general practitioners (GPs). Conclusions. Strategies of promoting a healthy working environment and facilitating early return to work were utilised in the follow-up of employees with musculoskeletal complaints. Supportive strategies were found most useful especially in the early phases, while finding a balance between being supportive, on one side, and confronting the employee, on the other, was endeavoured in cases of recurrent or long-term sick leave. Further, the supervisors requested a closer cooperation with the GPs, which they believed would facilitate return to work

Testing og trening av dype nakkefleksorer

Research has shown reduced activity in the deep cervical flexors in patients with neck pain and cervicogen headache. The muscles Longus colli and Longus capitis, are the most important deep flexors in the neck. An indirect test, the cranio- cervical flexion (CCF) test, has been developed to assess these muscles. The CCF test assess the individuals ability to perform an accurate flexion movement in the upper part of the neck, without voluntary flexion of the middle or the lower part of the cervical column. An inflatable air-filled pressure sensor is placed suboccipitally to monitor the flattening of the cervical lordosis. Recent research using a specially developed electromyography, have confirmed that the CCF test is an adequate indirect measure of the activation of the deep neck flexors. The training program emphasises specific exercises including re- educating the neuromuscular control and stimulating the interaction between the deep and superficial muscles in the neck. The aim is to facilitate a coordinated movement pattern which integrates work and daily activities

Self-Reported and Tested Function in Health Care Workers with Musculoskeletal Disorders on Full, Partial or Not on Sick Leave

Purpose The aim of this study was to describe self-reported and physically tested function in health care workers with musculoskeletal disorders (MSDs) and to examine how function was associated with work participation. Methods A cross-sectional study was conducted. 250 health care workers attended an evaluation where self-reported and physical function were measured. Differences between groups (full sick leave, partial sick leave, not on sick leave/working) were analyzed for categorical data (Chi square exact test) and continuous variables (Kruskal–Wallis and Mann–Whitney U tests). Logistic regression analysis was performed to examine which factors were associated with being on sick leave. Results Participants on full sick leave had statistically significant poorer function compared to those working and the group on partial sick leave. Logistic regression showed that a reduced level of the physical dimension of SF-12 and a high lift test were significantly related to full sick leave (OR 0.86, p < 0.001) (OR 0.79, p = 0.002). The physical dimension of SF-12 was the only variable that was associated to partial sick leave (OR 0.91, p = 0.005). Conclusion Health care workers on full sick leave due to MSDs have reduced function on self-reported and physically tested function, compared to those working despite MSDs, as well as when compared to those on partial sick leave. More knowledge about work ability in occupational sub-groups is needed

Physiotherapists' engagement in work ability and return to work issues of patients with musculoskeletal disorders. A cross-sectional survey in Norway

Background Work and health are a national priority in Norway, and leading health authorities call for treatment approaches that incorporate these perspectives. We have little knowledge of how physiotherapists in private practice integrate the work perspective during the treatment of patients with musculoskeletal disorders. Thus, the purpose of this study was to gain more insight into the way physiotherapists in Norway integrate the aspect of work. Methods In 2021, all 2650 privately practising members of the Norwegian Physiotherapist Association received a web-based survey that was answered by 514 physiotherapists. The survey included questions about treatment approaches, competencies, and collaboration with other health professionals in the context of promoting work participation. Results 91% of the physiotherapists reported that they play an important role in assessing work ability. 75% were confident in assessing the patients' work ability, while 25% stated that they have little or some competence. 49% of the physiotherapists often contacted the general practitioner (GP) to discuss patients' ability to work, and 19% were often contacted by the GP. Only 14% stated that they were invited to participate in dialogue meetings with the Norwegian Labour and Welfare Administration. 28% of the physiotherapists reported that insufficient knowledge about social security issues was an obstacle in promoting the patient's work participation. The physiotherapists believed that increased use of standardised assessment tools, better knowledge of social security issues, and closer collaboration with other professionals may strengthen their role in promoting work participation. Discussion and Conclusion Although physiotherapists promote work participation when treating patients on sick leave, limited communication with the stakeholders, and inadequate knowledge of social security issues pose an obstacle. To strengthen the physiotherapist's role in the return-to-work facilitation, work and health should become a separate subject in basic and advanced education programmes for physiotherapists.publishedVersio

Associations between pressure pain threshold in the neck and postural control in patients with dizziness or neck pain - a cross-sectional study

Background It is theorized that neck pain may cause reduced postural control due to the known physiological connection between the receptors in the cervical spine and the vestibular system. The purpose of this study was to examine whether the pressure pain threshold in the neck is associated with postural sway in patients with dizziness or neck pain. Methods Consecutive patients with dizziness (n = 243) and neck pain (n = 129) were recruited from an otorhinolaryngological department and an outpatient spine clinic, respectively. All subjects underwent static posturography. Pressure pain thresholds were measured at four standardized points in the neck, and generalized pain was assessed using the American College of Rheumatology tender points. The relationship between postural sway and pressure pain threshold was analyzed by linear regression, and the covariates included age, sex, and generalized pain. Results In the dizzy group, there was a small, inverse relationship between pressure pain thresholds and sway area with eyes closed, after adjusting for age, sex, and generalized pain (bare platform; lower neck, p = 0.002, R2 = 0.068; upper neck, p = 0.038, R2 = 0.047; foam rubber mat; lower neck, p = 0.014, R2 = 0.085). The same inverse relationship was found between pressure pain thresholds in the neck and the Romberg ratio on a bare platform after adjusting for age, sex and generalized pain (upper neck, p = 0.15, R2 = 0.053; lower neck, p = 0.002, R2 = 0.069). Neither of these relationships were present in the neck pain group. Conclusion Our findings indicate that the pressure pain threshold in the neck is associated with postural sway in patients suffering from dizziness after adjusting for age, sex, and generalized pain, but only with closed eyes. The association was small and should be interpreted with caution

Neck pain associated with clinical symptoms in dizzy patients- A cross-sectional study

Objective: Many patients suffer from concurrent neck pain and dizziness. The aim of this study was to describe the clinical symptoms and physical findings in patients with concurrent neck pain and dizziness and to examine whether they differ from patients with dizziness alone. Methods: Consecutive patients with dizziness and neck pain were recruited from an ear–nose–throat department and a spine clinic. They were divided into three groups: patients with dizziness only (n = 100), patients with dizziness as their primary complaint and additional neck pain (n = 138) and finally, patients with neck pain as their primary complaint accompanied by additional dizziness (n = 55). The patients filled in questionnaires regarding their symptom quality, time‐course, triggers of dizziness and the Vertigo Symptom Scale Short Form. The physical examination included Cervical Range of Motion, American College of Rheumatology (ACR) Tender Points, Cervical Pressure Pain Thresholds and Global Physiotherapy Examination 52‐Flexibility. Results: Both neck pain groups were more likely to have a gradual onset of dizziness symptoms, more light‐headedness, visual disturbances, autonomic/anxiety symptoms, decreased cervical range of motion, decreased neck and shoulder flexibility and increased number of ACR tender points compared with patients with dizziness alone. The group having dizziness as their primary complaint and also reporting neck pain had the highest symptom severity and tended to report rocking vertigo and increased neck tenderness. The group with neck pain as their primary complaint was more likely to report headache. Conclusion: Neck pain is associated with certain dizziness characteristics, increased severity of dizziness and increased physical impairment when compared with dizzy patients without neck pain

Associations between pressure pain threshold in the neck and postural control in patients with dizziness or neck pain - a cross-sectional study

Background: It is theorized that neck pain may cause reduced postural control due to the known physiological connection between the receptors in the cervical spine and the vestibular system. The purpose of this study was to examine whether the pressure pain threshold in the neck is associated with postural sway in patients with dizziness or neck pain. Methods: Consecutive patients with dizziness (n = 243) and neck pain (n = 129) were recruited from an otorhinolaryngological department and an outpatient spine clinic, respectively. All subjects underwent static posturography. Pressure pain thresholds were measured at four standardized points in the neck, and generalized pain was assessed using the American College of Rheumatology tender points. The relationship between postural sway and pressure pain threshold was analyzed by linear regression, and the covariates included age, sex, and generalized pain. Results: In the dizzy group, there was a small, inverse relationship between pressure pain thresholds and sway area with eyes closed, after adjusting for age, sex, and generalized pain (bare platform; lower neck, p = 0.002, R2 = 0.068; upper neck, p = 0.038, R2 = 0.047; foam rubber mat; lower neck, p = 0.014, R2 = 0.085). The same inverse relationship was found between pressure pain thresholds in the neck and the Romberg ratio on a bare platform after adjusting for age, sex and generalized pain (upper neck, p = 0.15, R2 = 0.053; lower neck, p = 0.002, R2 = 0.069). Neither of these relationships were present in the neck pain group. Conclusion: Our findings indicate that the pressure pain threshold in the neck is associated with postural sway in patients suffering from dizziness after adjusting for age, sex, and generalized pain, but only with closed eyes. The association was small and should be interpreted with caution