Award Date

5-11-2018

Degree Type

Dissertation

Degree Name

Doctor of Physical Therapy (DPT)

Department

Physical Therapy

Advisor 1

Daniel Young

First Committee Member

Merrill Landers

Second Committee Member

Emilio Puentedura

Number of Pages

42

Abstract

Purpose/Hypotheses: 1. To investigate for any change in gait parameters in individuals with neck pain while walking with different functional neck conditions immediately following cervical thrust joint manipulation (TJM) versus a sham intervention. 2. To investigate any association between Global Rating of Change (GROC) scores and gait parameters immediately following cervical thrust joint manipulation versus a sham intervention. The hypotheses were that, a) cervical TJM would have an immediate effect on gait parameters during walking with the neck in at least one of three conditions (neutral, flexion/extension and rotation) among individuals with neck pain; and b) higher scores on the GROC would be associated with improved gait parameters post-intervention. Subjects: Convenience sample of 40 individuals (30 female; mean age 24.5 ± 6.78 years) with neck pain. To qualify, subjects had to have a score >0 on the question of pain intensity in the neck on the Neck Disability Index (NDI) questionnaire and have no contraindications or precautions for cervical TJM. Materials/Methods: Subjects walked on a Zeno Walkway under the following conditions: 1) head in neutral; 2) head rotating from side-to-side, and 3) head nodding up and down. After completing 30 practice trials (10 in each condition), pre-intervention trial 1 gait parameters were recorded for each of the three neck conditions in a randomized order. After a 5-minute rest period, pre-intervention trial 2 was conducted for each condition in same order as trial 1. Subjects then received one of two randomly assigned interventions: cervical spine TJM or active cervical rotation. Immediately after the intervention, the subject returned to the Zeno Walkway for the post-intervention trial 3 in each of the three conditions, in the same order as their previous trials. Gait parameters of average step length, stride length, stride width, velocity, and cadence were analyzed using a 2x2 repeated measures ANOVA (of trials 2 and 3), as well as independent and paired t-tests, to determine if there were any significant changes based on intervention when comparing TJM to sham groups. Results: The results of the 2x2 ANOVA revealed significant interactions between group and time on average gait velocity (p=0.008), step length (p=<0.001), and stride length (p=0.009) when the head was in a neutral position. The TJM group experienced significant increases from pre to post-intervention as shown by paired samples t-test for average gait velocity (p=0.003), step length (p<0.001), and stride length (p=0.008). The sham group however, experienced no significant change in gait velocity (p = 0.290), average step length (p = 0.299), and stride length (p = 0.292). There was also a significant decrease in the Numeric Pain Rating Scale (NPRS) (mean decrease of 1.25; p=0.003) and the group that received cervical TJM reported an improved perception of change demonstrated by an average increase in GROC score by 2.85 (p=0.001). Conclusions: Although our results demonstrate a statistically significant improvement in three gait parameters following TJM while walking with the neck in a neutral position, the improvements are not clinically significant. At this time, there is no evidence-based indication for the clinical use of cervical TJM to improve gait parameters in individuals with neck pain. Our findings cannot confirm clinical significance for reduction of neck pain with cervical TJM based on NDI, NPRS, or GROC questionnaires.

Keywords

Neck pain; Gait; Cervical thrust joint manipulation; Manipulation; Physical therapy; Gait parameters

Disciplines

Physical Therapy

File Format

pdf

File Size

3.010 Kb

Degree Grantor

University of Nevada, Las Vegas

Language

English


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