The Measurement Methods And Influencing Factors Of Head-cervical Spine Motion In Healthy Population

BackgroundAssessment of head-cervical spine motion(HCSM)is an essential part of routine physical examination,and a vital index of functional evaluation for cervical surgery as well.However,whether the patient’s symptoms are relieved is the primary standard to evaluate the treatment effect of neck diseases.HCSM with high accuracy is not popular in clinical practice,as the CROM apparatus,the golden standard for measuring HCSM,is rarely available for physicians.As an essential tool in nowadays daily life and work,smartphone with gravity and angle sensors,could be an alternative to CROM.At the same time,the emergence of wearable and precise sensors also make it possible to dynamically record HCSM and analyze movement features of common activities in daily life.ObjectThe objects of this study are:(1)Obtain the reference values of HCSM for healthy population of different genders and age-groups;(2)Test the reliability and validity of the smartphone software "G-Plus" as a tool for accurate measurement of HCSM;(3)Analyze the influencing factors of HCSM;(4)Dynamically record HCSM and analyze movement features of common activities in daily life.Method(1)Measuring HCSM in six directions(flexion,extension,left lateral flexion,right lateral flexion,left rotation,right rotation)of 500 healthy volunteers(divided into 5 groups according to 20-29 years old,30-39 years old,40-49 years old,50-59 years old and ≥60years old,100 people in each group)with CROM device and "G-Plus".(2)Intraclass Correlation Coefficient(ICC)was used to test the reliability of CROM device and "G-Plus".The validity of "G-Plus" measurement as compared to CROM device was tested by Pearson correlation coefficient and Bland-Altman statistics.(3)Using multiple linear regression analysis to test the correlation between age,gender,BMI,neck configuration(ratio of cervical circumference to cervical length)and HCSM.(4)The wearable sensors were used to dynamically record the HCSM of 14 common activities in daily life(Lie down and get up;Cross the road;Go up and down stairs;Drive a car;Wear a coat;Wear pants;Wear shoes and tie shoelaces;Eat and drink water;Wash your hands and face;Brush your teeth;Wash your hair;Use a toilet;Make a phone call;Read)and analyze movement features.Results(1)The CROM device was used to obtain the reference values in six directions of different genders and age-groups of healthy population.The reference values of HC-SM for men of all age-groups(20-29y;30-39y;40-49y;50-59y;>60y)are as follows:Flexion: 52.35(5.19),50.83(5.91),49.19(5.97),45.45(5.17),45.22(4.17);Extension: 73.21(6.17),64.54(7.39),60.03(8.01),56.91(7.12),54.32(7.48);Left lateral flexion: 44.05(4.37),42.48(4.81),40.45(5.31),39.26(4.42),37.00(4.86);Right lateral flexion: 42.18(3.58),39.16(4.35),37.55(4.02),35.29(4.82),33.45(4.34);Left rotation: 70.51(4.29),69.23(4.72),66.19(5.56),64.69(5.32),62.21(6.39);Right rotation: 70.05(4.87),68.67(4.53),66.74(4.69),63.30(5.38),61.42(5.98).Female: Flexion: 54.52(5.49),52.09(5.56),48.53(5.98),47.30(4.26),45.69(3.81);Extension: 74.51(5.46),71.59(7.59),64.19(7.41),58.61(6.29),55.97(7.94);Left lateral flexion: 47.50(4.50),44.16(4.79),42.32(3.94),39.17(4.56),36.82(5.22);Right lateral flexion: 43.27(6.11),40.79(4.46),38.31(4.21),35.20(5.22),34.38(5.72);Left rotation: 71.95(4.79),71.91(5.14),68.03(5.26),65.89(5.30),62.84(6.41);Right rotation: 71.58(3.97),71.97(5.13),67.67(4.79),65.31(5.95),62.29(6.36).(2)Excellent inter-rater and intra-rater reliability was demonstrated for CROM(ICC:0.929-0.993)and "G-Plus"(ICC:0.898-0.991).Pearson correlation coefficient(r:0.934-0.974)and Bland-Altman plots demonstrated an acceptable agreement between CROM device and "G-Plus" in HCSM measurement.(3)Multiple linear regression analysis was used to analyze the correlation between age,gender,BMI,neck configuration and HCSM.The results showed that in terms of age,HCSM showed a downward trend with the increase of age(P < 0.001).In terms of gender,female had better HCSM than male in all directions except flexion(flexion: P = 0.125 > 0.05;P values in the other directions were all less than 0.05).In terms of neck configuration,the subjects with slender neck had greater HCSM than those with dumpy neck in extension,right lateral flexion,left rotation and right rotation(flexion: P=0.359 > 0.05;left lateral flexion:P=0.134 > 0.05;P values in the other directions were all less than 0.05).In terms of BMI,the higher the BMI,the smaller the HCSM in flexion and extension(flexion: P < 0.001;extension:P < 0.001;P values in the other directions less than 0.05).(4)Analysis of dynamic measurement data of HCSM showed that: Among the 14 common activities of daily life,the total range of motion of head-cervical spine in the sagittal plane(flexion to extension)required the participation of 16.60%(cross the road)-44.16%(wash hair)of the available HCSM,in the coronal plane(left lateral flexion to right lateral flexion)required the participation of 14.04%(go up and down stairs)-35.09%(brush teeth)of the available HCSM and in the cross section(left rotation to right rotation)required the participation of 12.66%(make a phone call)to 91.96%(drive a car)of the available HCSM.Conclusion(1)This study collected the reference values of HCSM in different genders and agegroups.The presentation of the data of HCSM in healthy population provides an important reference for the evaluation of cervical spine function.(2)Smartphone application "G-Plus" is a reliable and convenient tool for HCSM measurement in clinical practice.(3)Age,gender,BMI and neck configuration are significantly correlated to HCSM.(4)For the common activities of daily life,except driving a car and crossing the road,which required the participation of the transverse(left rotation to right rotation)HCSM near the limit value,the rest of the movements could be completed only by using within 50% of the available HCSM.