Introduction: Manual joint mobilization and manipulation are recommended therapeutic interventions for people with neck pain. High-velocity thrust and sustained techniques have an uncertain association with serious arterial trauma. The validity of pre-manipulative tests of the cervical spine is often questioned, and the understanding of the effect of head/neck position on blood flow is still incomplete. Most of the evidence concerning hemodynamics in this area relates to extracranial flow (vertebral and carotid artery). Less is understood about the effects on intracranial flow while performing pre-manipulative tests and sustained positions like end of range cervical rotation mobilization. The aim of the study was to assess the influence of commonly used evaluation and treatment positions on intracranial hemodynamic
parameters.
Method: A randomized, cross-over observational study using ultrasonography on healthy subjects (n = 19) was conducted to measure hemodynamic parameters (peak systolic velocity and end diastolic maximum) of intracranial arterial systems. Two test positions (sustained premanipulative thrust C0-1 and sustained cervical end of range rotation) were compared with a sham position for each test position.
Results: Neither the sequence of tests performed nor an independent variable (the two positions) had a significant effect (p < 0.05) on peak systolic velocity (PSV) or end diastolic maximum (EDM).
Discussion: No effects from commonly used assessment and treatment of neck positions on hemodynamic parameters were found. This is consistent with previous studies. Further study is indicated on people with symptoms and known pathologies.

Background: Neck pain (NP) is a significant health problem that can lead to pain persistence. Identifying predictive variables in acute NP might assist in alleviating persistent pain and disability. Psychosocial factors appear to be adverse solid prognostic factors. Among them, avoidance and overactivity mediated pain persistence and disability. Stress takes a central role in the context of persistent pain. Pain and stress are intricately interconnected processes, both adaptive mechanisms for protecting the organism from harm. In cases of chronic pain, it can be seen as a form of stress overload, indicating a close relationship between the two and the potential for allostatic overload of the body and brain. However, stress and activity patterns have yet to be studied as predictors of pain persistence states over one year in subjects with acute NP.
Methods: This longitudinal inception cohort study recruits subjects with acute NP (< 4 weeks since the onset of pain) aged 18-65 years in clinical praxis, hospitals, and universities. Activity patterns (Avoidance-Endurance-Fast Screening (AE-FS)) and stress (Stress and Coping Inventory (SCI)) are collected at four different time points. Additionally, Hair cortisol concentrations (HCC) are measured to assess stress levels objectively. An online pain diary is maintained, providing information on the progression of pain over a year. In the initial phase, the prevalence of baseline activity patterns and HCC levels are determined using a cross-sectional design. As a subsequent step, the pain course over one year is observed. A linear mixed regression model calculates the time at which activity patterns, stress, and pain demonstrate the best predictive value for persistent pain and disability.
Discussion: To the best of our knowledge, this study represents the first investigation of activity patterns in acute NP and the predictive power of activity patterns, stress, and pain for the persistence of pain and disability in acute NP at different time points over one year.
Trial registration: Registration published 07/22, identifiers: NCT05468684
Keywords: Neck pain, activity patterns, stress, pain, disability

Introduction: Clinicians commonly assess cervical range of motion (ROM) in patients with neck pain. Recently, a new instrument has been developed, the Senscoordination 3D Cervical Trainer (SCT), designed to measure neck ROM in addition to joint position error, static and dynamic balance performance, and performance on a ‘neuro muscular control test’. The SCT incorporates a 9 degrees of freedom sensor which combines signals from a 3-axis accelerometer, a 3-axis gyroscope and a 3-axis magnetometer and then translates the 9 separate data points to an orientation vector in x, y and z coordinates and an angle of rotation around the direction of the vector. The sensor communicates with the computer and automatically displays the results on the screen after assessment.
This study aims to assess the interrater reliability, concurrent validity, and responsiveness of the SCT using the CROM device as a comparator.
Methods: One hundred patients with non-specific neck pain were included and their active cervical ROM was measured in a random order by two raters in succession using both devices simultaneously at baseline and after personalised physiotherapy management, at 12 week follow up. Convergent validity and responsiveness were quantified by a Pearson correlation coefficient. The intraclass correlation coefficient (ICC) was used to calculate the test–retest reliability of the SCT. The smallest
detectable change (SDC) was calculated per movement direction and for the total range of motion.
Results: The correlation between the measures obtained with the CROM device and the SCT was high (0.97 or 0.98 depending on direction of movement). Interrater reliability was high for all directions (ICC ranging from 0.81 to 0.97). The SDC ranged from 6.9 for left cervical rotation to 12.2 for right cervical rotation. At the follow up, correlation between the change score on the CROM device and the SCT was high (0.86–0.94 depending on the direction of movement).
Conclusion: The SCT is a valid, reliable and responsive instrument for measuring cervical ROM.

Background
The symptoms of hypermobility vary widely and can change across the lifespan. Whilst pain, joint instability and soft tissue injury are most commonly reported, many individuals report manifestations extending beyond the musculoskeletal system. Without routine screening, these multisystemic symptoms may go undetected and, if suboptimally managed, can significantly impact quality of life. The Spider, a 31-item self-report questionnaire, was developed to identify the presence and impact of the symptoms of hypermobility across eight domains: pain, fatigue, neuromusculoskeletal, cardiac dysautonomia, gastrointestinal, urogenital, depression and anxiety. Face and content validity of this new screening tool have been tested, and construct validity of the individual Spider domains has been established in adolescents.

Purpose
The aim of this study was to determine if the total Spider score, aggregated across all domains, provides a valid measure of the magnitude of symptom impact in adolescents and to explore which symptoms have the strongest associations with perceived functional ability in daily life. Convergent validity of the Spider’s total score was examined using an established measure of daily functional ability, the Paediatric Quality of Life Inventory (PedsQL). Known group validity testing determined whether the total score could differentiate between those with and without hypermobility. Finally, the strength with which each multisystemic manifestation (Spider domains) were associated with poorer functional ability relative to one another were explored.

Methods
This was an observational, cross-sectional study. Ethical approval was granted by the UCL Research Ethics Committee. Participants aged 13 to 18 years with and without symptomatic hypermobility were invited to complete the Spider and PedsQL questionnaires online via advertisement through 3 hypermobility charities (EDS UK, The ED Society, HMSA) and a private physiotherapy hypermobility unit. Data was analysed using descriptive and inferential statistics in SPSS.

Results
441 adolescents completed the study. Convergent validity testing, using Pearson’s correlation coefficient, demonstrated a strong inverse correlation between the Spider and PedsQL scores. As Spider scores increased, indicative of greater symptom impact, PedsQL scores decreased accordingly (r=-0.750, p < 0.001). Known-groups validity was evidenced by the significant between-group differences in Spider scores for those without and without hypermobility (median difference 42.34, p < 0.001). Multiple linear regression analysis of the domain scores revealed that the fatigue, cardiac dysautonomia and depression domains were the mostly strongly associated with poorer functional ability in adolescents.

Conclusion(s)
Results support the aggregation of scores from the eight Spider domains as a valid measure of the overall impact of hypermobility on functional ability in daily life in adolescents. Prioritising the management of fatigue, cardiac dysautonomia and depression, where present, may alleviate more of the burden associated with this condition.

Implications
The total Spider score can be used by clinicians to indicate the magnitude of symptom burden of hypermobility in adolescents, whilst the domain scores detail how a person is impacted to facilitate more directed management. Where fatigue, cardiac dysautonomia and depression predominate, clinicians may anticipate a greater level of disability in daily life and prioritise interventions accordingly to prevent further decline.

Background
Restoring agility post lower limb injury is pivotal in facilitating safe direction changes during sports activities, thereby minimizing the risk of re-injury. Standardized return-to-sport tests, including agility assessments such as the modified agility t-test (MAT), are commonly recommended. However, the psychometric properties of the MAT remain unestablished.

Purpose
This study aimed to ascertain the construct validity and test-retest reliability of the MAT.

Methods
In a single-center, cross-sectional study, we recruited 30 participants with an equal gender distribution and a mean age of 25.7 ± 1.5 years. We compared MAT performance against the Illinois agility test (IAT) to assess MAT’s construct validity by calculating Pearson’s correlation coefficient. The absolute and relative were gauged through the standard error of measurement, the 95% limits of agreement, the smallest detectable change and the intraclass correlation coefficient 2,1 (ICC 2,1) derived from test-retest results, setting statistical significance at α = 0.05.

Results
Pearson’s correlation coefficient revealed a substantial correlation between MAT and IAT performances (r = 0.89). Moreover, MAT demonstrated good test-retest reliability with a standard error of measurement of 0.18 seconds and an intraclass correlation coefficient 2,1 (ICC 2,1) of 0.84. The IAT mirrored this reliability with respective scores of 0.19 seconds and 0.97. Furthermore, we identified the smallest detectable change in MAT to be 0.71 seconds.

Conclusions
The study corroborates the construct validity and test-retest reliability of MAT as a credible agility assessment tool, thereby positing it as a viable alternative to IAT.

Implications
The MAT more accurately mirrors agility demands in sports with short displacements like tennis and basketball compared to the IAT and the standard T-test. However, for sports requiring longer sprints, the standard T-test remains more suitable. Moreover, it is recommended to compare an athlete’s MAT scores during the Return-to-Sport (RTS) process to those of healthy participants, using data from this study as a reference.