Head-Eye Movement Control Tests in Chronic Neck Pain
Head-Eye Movement Control Tests in Chronic Neck Pain
Patient characteristics (gender, age, NDI score) are described in Table 1. There was no significant difference in age between patients and healthy controls (p-value 0.939).
Included patients had an NDI score of 10 to 62/100, which implies an inhomogeneous representation of symptoms.
The results of the inter-observer reliability analysis (weighted kappa coefficient and 95% confidence interval) are presented in Table 5. The weighted kappa coefficient was almost perfect (wK > 0.8) in three tests, substantial (wK 0.69 – 0.79) in five tests and moderate in two tests (wK 0.54 and 0.59). The 95% confidence interval was >0.2 in all tests (0.29 to 0.97). Excellent inter-tester reliability was found for gaze stability and sequential head and eye movements in sitting position, and eye movements in 45° relative neck rotation to the right side in standing position.
On average, three out of five tests in sitting and in standing positions were positive for participants with chronic neck pain. On average, only one test was positive for healthy controls. Results were comparable in the sitting and standing positions.
Figures 7 and 8 display the distribution of the numbers of positive tests for the tests in sitting and standing. There was no significant difference between the two positions, or between raters.
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Figure 7.
Distribution of positive tests in sitting. The red line displays the mean number of positive tests. Results were comparable for Rater 1 and Rater 2.
(Enlarge Image)
Figure 8.
Distribution of positive tests in standing. The red line displays the mean number of positive tests. Results were comparable for Rater 1 and Rater 2.
The receiver operating characteristic (ROC) curves with the area under curve AUC (95% CI) show a distribution of the numbers of positive tests in sitting (Figure 9) of 83–85% and in standing (Figure 10) of 85–87%
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Figure 9.
Receiver operating characteristic (ROC) curves. Sitting position, Rater 1 and Rater 2 with estimated area under curve AUC (95% CI). The optimal cut-off points for AUC are 1.5 and 2.5.
(Enlarge Image)
Figure 10.
Receiver operating characteristic (ROC) curves. Standing position, Rater 1 and Rater 2 with estimated area under curve AUC (95% CI). The optimal cut-off points for AUC are 1.5 and 0.5.
The Diagnostic Odds Ratio (DOR), test in sitting, of Rater 1 and Rater 2 are 18.6 and 13.3 respectively, using 2 positive tests as the cut-off point.
For the clinical diagnosis of head-eye movement control impairment, a cut-off point of 2 positive ratings out of 5 is recommended. (Table 6 and Table 7)
Results
Subjects
Patient characteristics (gender, age, NDI score) are described in Table 1. There was no significant difference in age between patients and healthy controls (p-value 0.939).
Included patients had an NDI score of 10 to 62/100, which implies an inhomogeneous representation of symptoms.
Inter-observer Reliability
The results of the inter-observer reliability analysis (weighted kappa coefficient and 95% confidence interval) are presented in Table 5. The weighted kappa coefficient was almost perfect (wK > 0.8) in three tests, substantial (wK 0.69 – 0.79) in five tests and moderate in two tests (wK 0.54 and 0.59). The 95% confidence interval was >0.2 in all tests (0.29 to 0.97). Excellent inter-tester reliability was found for gaze stability and sequential head and eye movements in sitting position, and eye movements in 45° relative neck rotation to the right side in standing position.
Discriminative Validity
On average, three out of five tests in sitting and in standing positions were positive for participants with chronic neck pain. On average, only one test was positive for healthy controls. Results were comparable in the sitting and standing positions.
Figures 7 and 8 display the distribution of the numbers of positive tests for the tests in sitting and standing. There was no significant difference between the two positions, or between raters.
(Enlarge Image)
Figure 7.
Distribution of positive tests in sitting. The red line displays the mean number of positive tests. Results were comparable for Rater 1 and Rater 2.
(Enlarge Image)
Figure 8.
Distribution of positive tests in standing. The red line displays the mean number of positive tests. Results were comparable for Rater 1 and Rater 2.
The receiver operating characteristic (ROC) curves with the area under curve AUC (95% CI) show a distribution of the numbers of positive tests in sitting (Figure 9) of 83–85% and in standing (Figure 10) of 85–87%
(Enlarge Image)
Figure 9.
Receiver operating characteristic (ROC) curves. Sitting position, Rater 1 and Rater 2 with estimated area under curve AUC (95% CI). The optimal cut-off points for AUC are 1.5 and 2.5.
(Enlarge Image)
Figure 10.
Receiver operating characteristic (ROC) curves. Standing position, Rater 1 and Rater 2 with estimated area under curve AUC (95% CI). The optimal cut-off points for AUC are 1.5 and 0.5.
The Diagnostic Odds Ratio (DOR), test in sitting, of Rater 1 and Rater 2 are 18.6 and 13.3 respectively, using 2 positive tests as the cut-off point.
For the clinical diagnosis of head-eye movement control impairment, a cut-off point of 2 positive ratings out of 5 is recommended. (Table 6 and Table 7)
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