A clinical test to assess isometric cervical strength in chronic whiplash associated disorder (WAD): a reliability study
Bibliographic record
Abstract
BACKGROUND: Cervical spine muscle weakness is well demonstrated in individuals with chronic neck pain. There is a lack of literature evaluating clinically applicable means of assessing isometric cervical strength in chronic whiplash associated disorder (WAD). This study assessed the reliability of self-resisted isometric cervical strength testing using a handheld dynamometer. The relationship between strength and neck pain-related disability and kinesiophobia was also investigated. METHODS: Twenty subjects with chronic WAD performed maximum-effort isometric cervical flexion, extension, side flexion, and rotation against a hand held dynamometer. The dynamometer was held by the subject, who provided self-resistance. Subjects completed two sessions of testing on one day with two different examiners, and one session on a subsequent day with one of the original examiners. Subjects completed the Neck Disability Index (NDI) and Tampa Scale for Kinesiophobia (TSK) prior to the first testing session. RESULTS: Intraclass correlation coefficients (ICC) for directional strength measures were fair to high (0.71-0.88 for intra-rater and 0.79-0.91 for inter-rater). Total strength (sum of all directional strengths) ICCs were high for both intra-rater (ICC = 0.91) and inter-rater (ICC = 0.94) measures. All statistical tests for ICCs demonstrated significance (α < 0.05). Agreement was assessed using Bland Altman (BA) analysis with 95% limits of agreement. BA analysis demonstrated difference scores between the two testing sessions that ranged from 3.0-17.3% and 4.5-28.5% of the mean score for intra and inter-rater measures, respectively. Most measures did not meet the a priori standard for agreement. A moderate to good inverse relationship was demonstrated between kinesiophobia (TSK score) and six out of seven strength measures (α < .05). No significant correlation was found between neck disability (NDI) and cervical strength in any direction. CONCLUSION: This study demonstrated fair to high reliability of self resisted isometric cervical strength testing in the chronic WAD population. All directional strength measures except flexion demonstrated a significant inverse relationship with kinesiophobia. No cervical strength measures were correlated with neck disability. These results support testing cervical strength in this manner to reliably assess change over time within individual patients. The value of such measurement requires further consideration given the lack of correlation between cervical strength and disability. Further research is required to establish normative values and enhance clinical utility.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.012 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.005 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.002 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".