Background: Several studies have shown that patients with non-traumatic or traumatic neck pain without vestibular pathology and visual disorder have impaired postural control compared to asymptomatic individuals. Furthermore, when disturbing the function of the cervical spine, e.g., changing the head's position seems to weaken postural control even more. Therefore, balance measurements have been considered an alternative for testing cervical sensorimotor control.

Postural stability has often been assessed with force-plate posturography. Although posturography has been reported as a reliable tool for assessing static postural control and balance performance, most studies have evaluated posturography tests' reliability with healthy subjects. According to our knowledge, the reliability of the computerised static posturographic (CSP) balance tests with or without perturbation tests, such as the balance test in the neck rotation position, has yet to be studied in patients with neck pain.

Purpose: Our study aimed to examine the inter- and intra-tester repeatability of postural stability tests in patients with whiplash-associated disorder (WAD).

Methods: Fourteen adults with chronic WAD performed in randomised order seven different balance tests with eyes open using CSP: neutral head, gaze rotated 20° (left and right), head rotated 20° (left and right), and body turned 20° (left and right). Two testers independently and blinded to all subject information performed all tests, and one of the testers on two occasions two to four weeks apart. The reliability of the balance outcomes from the sway velocity (mm/s) and velocity moment (mm2/s) was evaluated using intra- and interclass correlation and a group of means of two measurements (T-test or Wilcoxon).

Results: Six out of seven tests showed at least a strong (≥0.70) interclass correlation between the two measurements. The correlation of the body rotation to the left test was moderate (≥0.40). Furthermore, the average results of each test did not differ significantly between the testers. The intraclass correlation between the first and second test sessions was at least strong in all tests. However, the average results of the two test sessions differed significantly in the gaze rotation test.

Conclusions: Preliminary results suggest that the reproducibility of balance tests with different test variants is at least moderate in patients with WAD. However, a systematic error in the intraclass correlation may occur in the gaze rotation test.

Implications: Clinicians can reliably use these tests to assess the effects of symptoms and neck position on postural control in patients with WAD.

Background: In view of the scientific evidence that demonstrates the benefits of telerehabilitation for musculoskeletal conditions and the social impact that traumatic fractures of the lower limbs can cause, there is still no consensus on the use of telerehabilitation for this health condition.
Purpose: To sistematically review the literature regarding the effects of telerehabilitation on the physical and functional capacity of individuals with traumatic fractures of the lower limbs.
Methods: The following electronic databases were searched from the beginning of creation until July 31, 2023: MEDLINE/PubMed; EMBASE; PEDro; Cochrane; LILACS and Science Direct. Only randomized clinical trials with at least one intervention group and one comparator group were included. The intervention group should have undergone some form of telerehabilitation and the control group should have undergone conventional physical therapy or the health education strategy. Two reviewers evaluated the titles and abstracts of the initial research in isolation and independently, as well as extracted and synthesized the data.
Results: 5 randomized controlled trials were included in this systematic review. Telerehabilitation did not have favorable effects on functional capacity, with low certainty of evidence, both when measured through the Functional Independence Measure (FIM) (MD=7.35; CI95% [5.48 – 9.22]), when according to the Harris Hip Score -HHS (MD=4.98; CI95% [2.54 – 7.42]). In terms of physical capacity, telerehabilitation presents favorable results and a low level of certainty of the evidence in relation to the Time Up and Go (TUG) test (MD= -7.40; 95%CI [-9.64, – 5.16]), but not favorable and with moderate certainty of the evidence in relation to the Short Physical Performance Battery – SPPB (MD=1.17; 95%CI [0.90 – 1.43]).
Conclusions: Telerehabilitation did not have favorable effects on the physical and functional capacity of individuals with lower limb fractures, but with a low certainty of evidence in the outcomes, which shows the need for more quality clinical trials.
Implications:
In view of the results of this research, physical therapists need to be cautious in the use of telerehabilitation for this health condition, since the evidence that this technique has positive effects on the physical and functional capacity of these patients is still limited.

Background:
The use of measurement instruments (MI) is important for the practice of evidence-based physiotherapy. This is not only from the perspective of therapists and patients, but also from the perspective of other health professionals and health insurances. Standardized MI are used for diagnosis, evaluation, prognosis, and documentation. Currently, there are no data available on the use of MI by physiotherapists in Switzerland.

Objective:
The aim of this study was to evaluate the use of MI among practicing physiotherapists in Switzerland, to identify subjectively perceived facilitators and barriers and to identify predictors of MI use.

Method:
A cross-sectional study was conducted among physiotherapists in Switzerland. An online survey was used to collect data. MI use, facilitators and barriers were assessed descriptively. Relationships between possible factors of influence on the frequency of MI use were evaluated with regression analyses.

Results:
477 physiotherapists participated in the survey. Of these, 90% used MI with their patients. The three most reported MIs were the visual analogue scale or numeric rating scale (60.8%), the goniometer (36.3%) and the 6-minute walk test (19.1%). The majority of respondents (59.3%) used a maximum of five different MI. Workplace, age and education of the physiotherapists had a significant influence on the use of MI.
Positive attitudes towards MI, support in the clinical reasoning process and stronger arguments for communication with insurances were found to be the greatest facilitators. Conversely, lack of time to use and document MI and the need of many therapists to learn more about the use of MI were seen as barriers.

Conclusion:
The aim should be to increase the use of MI by physiotherapists in Switzerland, especially in private practices. The identified time factor and the need for further knowledge about MI have to be taken into account. The results of this study provide a basis for future research questions in the field of the application of MI in daily physiotherapy practice to ensure evidence-based physiotherapy.

Background: Cervical radiculopathy is characterized by pain, sensory and motor disturbance in structures innervated by the affected nerve root, and approximately 50 % of patients have headache. Between 10-25 % of all individuals with cervical radiculopathy undergo surgery to relieve the compressed nerve root, and two common techniques are anterior cervical decompression surgery (ACDF) and posterior cervical foraminotomy (PCF). However, there is a lack of knowledge about which surgical methods have the best effect on neck-related disability, headache, and neck- and arm pain, in the sub-group of individuals with cervical radiculopathy who also express headache.

Purpose: To evaluate the effect of ACDF and PCF on neck-related disability, headache, and neck- and arm pain in individuals with cervical radiculopathy combined with headache.

Methods: This is a prospective observational register-based cohort study with 2 years follow-up with data from the national Swedish Spine Register (Swespine). All individuals (n = 3106) underwent either ACDF (n = 2590) or PCF (n = 516) and were operated between 2014-2021. Patient-reported data was collected preoperatively (baseline), and at 1- and 2-year follow-ups and surgeon-reported data regarding the operation were collected after the operation. Primary outcome was self-reported neck-related disability measured with Neck Disability Index and secondary outcomes were headache, measured with an item about headache of Neck Disability Index, and neck- and arm pain, measured with a 0 to 10-point numeric rating scale.

Results: There were no between group differences at baseline in neck-related disability, headache, and neck- and pain. For primary outcome neck-related disability and secondary outcome neck pain, no significant between-group differences were found between ACDF and PCF (p > 0.05) at 12- and 24 months. Secondary outcome headache decreased more with PCF then ACDF from baseline to 2-years follow-up (p = 0.033) and arm pain decreased more with ACDF from baseline to 1-year follow-up (p = 0.048). No other between-group differences were found for headache and arm pain (p > 0.05). In all variables there were a significant within-group improvements from baseline to all follow-ups in both ACDF and PCF (p < 0.001).

Conclusion: ACDF and PCF show similar improvement in neck-related disability and neck pain in individuals with cervical radiculopathy combined with headache. Both interventions decrease headache and arm pain, but ACDF seems to decrease arm pain more the first year postoperatively and PCF seems to decrease headache more over time.

Implications: In preoperative information to individuals with headache who are undergoing ACDF and PCF due to cervical radiculopathy, clinicians can inform them that neck-related disability, headache, and neck- and arm pain may decrease after surgery although arm pain seems to decrease more the first year with ACDF and headache seems to decrease more over time with PCF.

Background: The most common type of whiplash injury is Whiplash-Associated Disorder grade 2 (WAD2), which includes pain and musculoskeletal signs without frank nerve injury. Approximately 50% of people with WAD2 develop persistent pain. However, we have limited knowledge of prognostic factors that provide pathological insights.
Purpose: To assess the temporal profile of nerve pathology using clinical, serologic, and skin testing. A secondary objective was to assess if nerve pathology can predict recovery at six-months.
Methods: Participants aged 18-85 with acute WAD2 were recruited within 4 weeks of injury and re-evaluated six-months later. Exclusion criteria included: pregnancy; previous cervical/arm pain lasting >3 months; pre-existing peripheral neuropathy. We also included 55 healthy controls without a history of whiplash or treatment for neck, spine or upper limb pain in the past 3 months.
Upper extremity neurological assessment included light touch, pin prick, thermal sensation, myotomal strength and deep-tendon reflexes (nerve roots C5-T1).
Quantitative sensory testing (QST) included sensory detection and pain thresholds over the index finger.

Serum neurofilament light chain (NfL) concentrations were measured using Simoa assay.

Intraepidermal nerve fibre density (IENFD) was evaluated from skin samples taken from the index finger.

Analysis: Neurologic examination is presented as percentages of patients with normal, loss, or gain of function. Changes in NfL and QST between acute, follow-up, and controls were assessed using ANOVA or Kruskal-Wallis with post hoc testing. Prognostic ability of NfL was assessed using linear regression controlling for age, sex, and initial Neck Disability index (NDI).
Results:
Our current cohort consists of 130 people with acute WAD2 (median age: 36 years, 58% female), 50 WAD2 follow-ups, and 55 healthy controls (median age: 31, 56% female).
Neurological assessment: Neurologic dysfunction was identified in 63% acutely and 37% at follow-up WAD2.
QST: There was a significant decrease in detection thresholds for cold (p < 0.001), warm (p < 0.001), mechanical (p < 0.001), and vibration detection (p < 0.001) in people with acute WAD2 compared to controls. At follow-up, sensory detection remained impaired for cold (p < 0.01), warm (p < 0.05), mechanical detection (p < 0.001) as well as mechanical (p < 0.01) and pressure pain thresholds (p < 0.001) compared to controls. There were no differences in any QST measures between acute and follow-up timepoints, besides reduced pressure pain at follow-up (p < 0.001).
NfL: There was significantly increased serum NfL concentrations in people with acute WAD2 (P < 0.05) but no difference at six-months compared to acute WAD2 or controls.
IENFD: There was no significant difference in nerve fibre density at the index finger in acute WAD2 compared to controls.
Prognosis: Acute serum NfL was not prognostic for neck-related disability at 6-months (adjusted r2= 0.248; coefficient estimate: 0.325, standard error: 2.96).
Conclusions: Our findings suggest clinical signs of acute nerve pathology in a subgroup of people, with the NfL resolving while functional deficits largely remain. Acute NfL did not appear prognostic for WAD2.

Implications: A comprehensive clinical neurological examination is critical for assessing signs of nerve pathology in WAD2.

Background: There is international agreement that physical functioning is the most important outcome domain to measure effectiveness of interventions for low back pain. Patient reported outcome measures (PROMs) are the norm in lumbar spinal surgery populations, but physical functioning is multidimensional and necessitates evaluation with physical measures. Physical measures are an important component of a physiotherapy assessment and inform clinical reasoning to formulate a diagnosis, prognosis and intervention plan.

Purpose: To identify outcome measures (PROMs and physical) used to evaluate physical functioning in the lumbar spinal surgery population. To assess the measurement properties of physical measures of physical functioning in this population.

Methods: Using a two-staged approach, this systematic review was conducted according to a registered and published protocol. MEDLINE, EMBASE, Health and Psychosocial Instruments, CINAHL, Web of Science, PEDro (stage one only) and ProQuest Dissertations and Theses were searched. Stage one (inception to 15 December 2021) included studies evaluating physical functioning (PROMs, physical measures) in lumbar spinal surgery populations. Stage two (inception to 10 July 2023) included studies evaluating measurement properties of stage one physical measures. Two independent reviewers determined study eligibility, extracted data and assessed risk of bias (RoB) according to COSMIN guidelines. Measurement properties were rated according to COSMIN criteria. High heterogeneity and RoB directed a narrative synthesis. Level of evidence was determined using a modified GRADE approach.

Results: Stage one included 1,101 reports using PROMs (n=70 established in literature, n=67 developed by study authors) and physical measures (n=134). The most frequently used PROM to evaluate physical functioning was the Short Form Health Survey (e.g., SF-36, SF-12) physical component score and physical functioning domain. The most frequently used physical outcome measure was range of movement for impairment-based measures, walking tests for performance-based measures and physical activity parameters for activity in a natural environment. Stage two included 43 articles evaluating measurement properties of 34 physical measures. The strongest evidence supports performance-based physical measures, with moderate-level evidence for sufficient responsiveness of 1-minute stair climb and 50-foot walk tests, insufficient responsiveness of the 5-minute walk test and sufficient reliability of distance walked during the 6-minute walk test. Very low/low-level evidence limits further understanding of measurement properties for a wide range of physical measures.

Conclusion(s): Many physical measures of physical functioning are used in lumbar spinal surgery populations. Few have investigations of measurement properties. Strongest evidence supports responsiveness of 1-minute stair climb and 50-foot walk tests and reliability of distance walked during the 6-minute walk. Further recommendations cannot be made because of very low/low-level evidence. However, results highlight promise for a range of measures.

Implications: There is promise for physical measures of physical functioning to demonstrate sufficient measurement properties, but few clear recommendations can be made. Knowledge of measurement properties is essential in establishing consensus on appropriate physical measures of physical functioning to evaluate effectiveness of interventions for lumbar spinal surgery populations and inform physiotherapy practice. Prospective low RoB studies are required owing to emerging evidence demonstrating the value of physical measures.