Objective The primary aim of this prospective observational study is to investigate whether
the presence or absence of directional preference impacts movement coordination impairments
as measured at the start of care, during care, discharge, and at 3 month follow up. It is
hypothesized that the presence of directional preference in patients with WADs may be
associated with more favorable improvements in the specific outcome measures as compared to
the group without the presence of directional preference.
Design: Prospective Observation Cohort Design
Background: Neck pain ranks 19th in global disability-adjusted life years with an overall
prevalence of 27 per 1000 population with variation based on geographic location amongst
other factors. The clinical course of neck pain is variable and not always favorable. A
research dearth remains in whiplash associated disorders (WAD) and movement coordination
issues for the cervical spine.
Movement coordination impairments are commonly associated with whiplash associated disorders.
Poorer prognosis is associated with older age, higher initial neck disability index, high
initial pain intensity. Recovery slows down after the first 6-12 weeks, and some patients
have with persistent pain and disability even 1 year after the whiplash associated disorder.
However, the prognostic value of limited cervical mobility and altered motor control has also
been questioned. The use of mechanical diagnosis and therapy (MDT) has been associated with
better function, range of motion, and overall lower costs in whiplash associated disorders at
both the 6 and 36 month mark but whether the results differ from natural history or other
approaches is debatable.
Setting:
The settings for subject recruitment and all data collection are two outpatient physical
therapy clinics located in the southeastern United States during the period of September 2023
to September 2024. Prior approval for data collection will be obtained in writing from the
clinic directors of both sites.
Sample and Population:
Convenience sampling will be utilized for this study. A G-power a priori power analysis with
a medium effect size determined that a sample size of 55 is required to achieve a statistical
power of .80 with an alpha level of .05. A total of 65 subjects will be recruited between the
two data collection sites to account for an expected 20% attrition rate on follow up.
Procedures: Subjects referred to one of two out-patient physical therapy clinics meeting
inclusion criteria will be evaluated, classified using a Mechanical Diagnosis and Treatment
(MDT) approach. Those patients demonstrating a directional preference will be managed using
an MDT approach while those not demonstration a directional preference will be managed using
published clinical practice guidelines for patients with Movement Coordination Deficits
(WADs). Outcome measures will be taken at baseline, visit 5, visit 10 or discharge (whichever
comes first) and 3 month follow up.
Data Analyses:
Descriptive statistics will be used to assess patient baseline and change scores on the
dependent variables of interest. Inferential statistics (linear regression) will be utilized
to assess for statistically significant changes over time and between groups for the
variables of interest.