أحمد محمد عمر العلوي

البحوث المنشورة

Are physical factors associated with poor prognosis following a whiplash trauma?: a protocol for a systematic review and data synthesis

https://bmjopen.bmj.com/content/9/11/e033298

16/10/2019

Introduction: Mitigating the transition from acute to chronic Whiplash Associated Disorders (WAD) is fundamental, and this could be achieved through early identification of individuals at risk. Several physical factors such as angular velocity, smoothness of neck movement, and co-activation of neck flexors and extensors, have been observed in patients with WAD, but their predictive ability after a whiplash injury have not been considered in previous reviews. Therefore, the aim of the current protocol is to outline a strategy for a systematic review that synthesises the current evidence of which physical factors can predict ongoing pain and disability following whiplash trauma.

Methods and analysis: Two independent reviewers will search for studies in several electronic databases including Medline, EMBASE, CINAHL, PsycINFO, Scopus, and Web of Science as well as grey literature. Observational cohort studies will be considered if they involve participants with acute WAD followed for at least 3 months post-injury. Studies will be required to assess the prognostic ability of one or more physical factors that directly involve a body function and/or structure and can be measured objectively. Further, patient-reported outcomes of physical function will be considered. The primary outcome for this review is Neck Disability Index, while all other validated measures will be considered as secondary outcomes. Risk of bias across individual studies is assessed using the Quality In Prognostic Studies tool along with the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) method to assess the quality of evidence. A meta-analysis will be planned depending on heterogeneity and the number of available studies. If appropriate, data will be pooled and presented as odd ratios, otherwise, a qualitative synthesis will be conducted.

Ethics and dissemination: Ethical approval is not required for this systematic review. The result from this review will be published in peer-reviewed journals.

PROSPERO registration number: CRD42019122559

Do measures of physical function enhance the prediction of persistent pain and disability following a whiplash injury? Protocol for a prospective observational study in Spain

https://bmjopen.bmj.com/content/10/10/e035736

07/10/2020

Introduction: Not all factors that predict persistent pain and disability following whiplash injury are known. In particular, few physical factors, such as changes in motor function and muscle behaviour have been investigated.

Aims and objectives: The aim of this study is to identify predictive factors that are associated with the development of persistent pain and disability following a whiplash injury by combining contemporary measures of physical function together with established psychological and pain-related predictive factors.

Methods and analysis: A prospective observational study will recruit 150 consecutive eligible patients experiencing whiplash-related symptoms, admitted to a private physiotherapy clinic in Spain within 15 days of their whiplash injury. The absolute risk of poor outcome will be measured using the Neck Disability Index (NDI). Poor outcome is defined as an NDI absolute score of 30% or greater at 6 months post-injury. Candidate predictors, including demographic characteristics, injury characteristics, pain characteristics, self-reported psychosocial factors and physical factors will be collected at baseline (within 15 days of inception). Regression analyses will be performed to identify factors that are associated with persistent neck pain and disability over the 12-month study period.

Ethics and dissemination: The project has been approved by the University of Birmingham Research Ethics Committee and the Ethics Committee of the province of Malaga, Spain (#30052019). The results of this study will be published in peer-reviewed journals.

المؤتمرات العلمية

Physiotherapy UK 2020

13/11/2020

Birmingham, UK

Poster presentation

People with acute neck pain following a whiplash trauma, present with reduced range, velocity and smoothness of neck movement

Purpose: To evaluate cervical kinematics in patients with acute Whiplash Associated Disorders (WAD) compared to asymptomatic participants using objective and quantitative methods.

Methods: Participants with acute WAD who admitted to a private physiotherapy clinic within 14 days after a vehicle collision were recruited and compared to asymptomatic participants. Participants performed 5 repetitive maximal cervical movements of active flexion-extension, axial rotations, and lateral bending at a self-determined velocity. A wearable sensor system was utilized to assess cervical kinematics during each movement including maximal range of motion (ROM), peak and mean velocity of movement, smoothness of movement, and neck joint position error. In addition, self-reported measures of Neck Disability Index (NDI) and Numeric Rating Scale (NRS) of pain intensity were collected. Kinematic differences between groups were investigated using either the independent t-test or Wilcoxon signed-rank test if data were not normally distributed.

Results: In total, 32 subjects participated in this study; 16 with acute WAD (mean age (SD) 36.4 (10.5); 81% women) and another 16 as asymptomatic controls (mean age (SD) 31.3 (5.3); 50% women). No significant differences in age (p=0.1) or gender (p=0.14) were found between groups. The average baseline NDI and NRS for those with acute WAD were 32.8 (7.9) and 6.9 (2.0), respectively. In comparison to the control group, participants with acute WAD showed significantly decreased maximal ROM in neck flexion, extension, right and left rotation (p<0.0001). All participants with acute WAD showed a reduction in mean and peak velocity in all directions (p<0.0001), except for right and left lateral flexion of which the reduction was not significantly different. The number of velocity peaks was significantly lower in patients in all directions indicating reduced smoothness of movement of participants with acute WAD (p<0.0001). Repositioning acuity after cervical rotations was not statistically different between groups.

Conclusion: Participants with acute WAD presented with altered cervical kinematics compared to asymptomatic participants including restricted neck range, and reduced velocity and irregular cervical movements.

Impact: Dynamic cervical variables such as motion velocity and smoothness of movement should be considered and monitored using objective and quantitative methods in patients with acute WAD, in addition to ROM. Assessing such measures could contribute to a better understanding of cervical impairments associated with acute neck trauma, leading to the development of specific rehabilitation programs to address impaired cervical kinematics and improve recovery following a whiplash injury.

https://physiotherapyuk2020.abstractserver.com/program/#/details/presentations/555

Physiotherapy UK 2020

13/11/2020

Birmingham, UK

Poster presentation

Are physical factors associated with poor prognosis following a whiplash trauma?: a systematic review

Purpose: The aim of this systematic review was to summarise and synthesis the current evidence regarding the predictive ability of physical factors in individuals with acute whiplash Associated Disorders (WAD) transitioning to chronic WAD.

Methods: Several electronic databases were searched by two independent reviewers including MEDLINE, Embase, CINAHL, PsycINFO, Scopus and Web of Science as well as grey literature. Observational cohort studies were included if they involved participants with acute WAD followed for at least 3 months post-injury. Cohort studies were also required to assess the predictive ability of one or more physical factors that directly involve a body function and/or structure that can be measured objectively. Patient-reported outcomes of physical function were also considered as physical factors. Neck Disability Index was considered as the primary outcome while all other validated measures were considered as secondary outcomes. Two independent reviewers extracted the data and assessed the risk bias across individual studies using the Quality In Prognostic Studies tool.

Results: The literature search revealed 12774 potential studies, of which 12 studies (11 cohorts) were included in this review. Three studies were assessed as having low risk of bias, three studies as moderate risk of bias, and six studies as high risk of bias, mainly due to limitations in study attrition domain, not adjusting for important confounders, insufficient details for the statistical analysis, and/or poor reporting. Meta-analysis was not feasible due to the small number of included studies and the heterogeneity in the prognostic factors and outcomes, and therefore a qualitative synthesised was adopted. Several physical factors were considered by eligible studies including, neck range of motion, joint position error, neck pain and disability, muscle strength/endurance, superficial neck flexor muscle activity, physical function, and WAD classification. Four studies showed that WAD grade II and grade III were significantly predictive of poor outcomes 6 months after injury, when compared grade I or grade 0. Other physical factors such as neck joint position error, neck muscle strength/endurance,   neck flexor muscle activity and functional status at baseline were not associated with poor outcomes 6 months after injury. Conflicting evidence was found with the regards to the predictive ability of baseline neck range of motion on poor outcomes following injury.

Conclusions: There was limited evidence of low quality showing that higher WAD classification could predict poor outcome in patients with acute WAD. Most of the eligible studies were high risk of bias.

Impact: Patients with acute WAD could be categorised based on WAD grade into low risk and high risk of developing persistent symptoms. Intervention should be aimed at people with high WAD grade which could reduce their risk of experiencing chronic symptoms, informing health policy and clinical management.

https://physiotherapyuk2020.abstractserver.com/program/#/details/presentations/183

IASP 2021 VIRTUAL WORLD CONGRESS ON PAIN

9-11/06/2021  & 16-18/06/2021

Virtual (online)

Poster presentation

Assessment of Neuromuscular and Psychological Features in People with Recurrent Neck Pain During a Period of Remission

Background and Aims: Very little is known about the neuromuscular or psychological status of people who are in remission from pain following a whiplash injury. This study aimed to examine whether people with Recurrent Neck Pain (RNP) following a whiplash injury, during a period of remission, present with altered neuromuscular control and psychological function compared to asymptomatic people or people Chronic Neck Pain (CNP).

Methods: Three groups of participants were recruited into this study, including people with RNP, CNP, and asymptomatic controls. Participants in the RNP group were included if they experienced two or more neck pain episodes separated by a period of remission lasting at least 10 days during the previous 12 months and experienced pain of at least two on the Numeric Rating Scale during an episode. Self-reporting questionnaires of Neck Disability Index (NDI), Tampa Scale for Kinesiophobia (TSK), and European Quality of life (EQ-5D) were assessed. Kinematic features were evaluated including neck range of motion (RoM), mean velocity of movement, smoothness of movement, and joint position error (JPE). Superficial neck flexor activity was assessed using Electromyography (EMG) during the craniocervical ?exion test (CCFT). Maximum neck flexion and extension strength following isometric contractions, and perceived exertion (by Borg scale 6-20) during submaximal contractions were assessed. Differences among groups were investigated using either one-way ANOVA or Kruskal-Wallis ANOVA followed by post-hoc analysis using Tukey’s HSD or Dunne’s test.

Results: In total, 45 subjects participated in this study; 22 with RNP (mean age (SD) 31 (11.8); 64% women), 8 with CNP (mean age (SD) 33.6 (8.7); 88% women), and 15 asymptomatic control (mean age (SD) 31.1 (5.7); 60% women). Differences among groups were not statistically significant with regards to age (p=0.24) and gender (p=0.38). People with RNP presented with significant differences in NDI (p< 0.001) and EQ-5D (p< 0.05) when compared to asymptomatic and CNP groups. Significant differences were also observed in TSK between RNP and controls (p< 0.001), and CNP and controls (p< 0.0001), but not between RNP and CNP. People with RNP showed no significant differences when compared to asymptomatic or CNP groups in RoM, but significant differences were observed between CNP and asymptomatic controls in combined flexion and extension RoM (p< 0.05), and combined right and left rotation (p< 0.05). JPE following right and left rotation were not significantly different among groups. Further, mean velocity was significantly lower in those with RNP than controls in all directions (p< 0.05), except in extension. People with RNP and people CNP did not show any significant difference in mean velocity of neck movement. The number of velocity peaks were higher (less smooth movement) in all directions in those with RNP compared to asymptomatic controls. However, significant differences were only observed during flexion and left rotation (p>0.5). The RNP group and CNP group showed similar NVP with no significant differences. The activity of superficial neck flexors during the 60% level of the CCFT task was only significantly different between people with CNP and RNP (p< 0.001) and between CNP and asymptomatic controls (p< 0.001). People with RNP displayed lower strength in flexion and extension (p< 0.05), with higher perceived exertion in flexion (p< 0.001) and extension than asymptomatic controls. No significant differences were observed between RNP and CNP in neck strength or perceived exertion.

Conclusions: Participants with RNP, during a period of remission, presented with impaired neuromuscular features and poorer psychological function, similar to those with CNP. These features include higher disability, higher fear of movement, and lower quality of life. They also move their neck slowly with irregular movement in most directions and displayed lower neck strength in extension and higher perceived fatigue in flexion. These features could be targeted to prevent recurrent episodes of neck pain.

https://iaspvirtualcongress.evareg.com/poster/assessment-of-neuromuscular-and-psychological-features-in-people-with-recurrent-neck-pain-during-a-period-of-remission