Reduced cervical range of motion (ROM) and movement velocity are often seen in people with neck pain. Objective assessment of movement characteristics is important to identify dysfunction, to inform tailored interventions, and for the evaluation of the treatment effect. The purpose of this study was to investigate the concurrent validity of a newly developed VR technology for the assessment of cervical ROM and movement velocity. VR technology was compared against a gold-standard three-dimensional optical motion capture system. Consequently, 20 people, 13 without and 7 with neck pain, participated in this quantitative cross-sectional study. ROM was assessed according to right/left rotation, flexion, extension, right/left lateral flexion, and four diagonal directions. Velocity was assessed according to fast cervical rotation to the right and left. The correlations between VR and the optical system for cervical ROM and velocity were excellent, with intraclass correlation coefficient (ICC) values > 0.95. The mean biases between VR and the optical system were ≤ 2.1° for the ROM variables, <12°/s for maximum velocity, and ≤3.0°/s for mean velocity. In conclusion, VR is a useful assessment device for ROM and velocity measurements with clinically acceptable biases. It is a feasible tool for the objective measurement of cervical kinematics in the clinic.

Sensorimotor disturbances such as disturbed cervical joint position sense (JPS) and reduced reaction time and velocity in fast cervical movements have been demonstrated in people with neck pain. While these sensorimotor functions have been assessed mainly in movement science laboratories, new sensor technology enables objective assessments in the clinic. The aim was to investigate concurrent validity of a VR-based JPS test and a new cervical reaction acuity (CRA) test. Twenty participants, thirteen asymptomatic and seven with neck pain, participated in this cross-sectional study. The JPS test, including outcome measures of absolute error (AE), constant error (CE), and variable error (VE), and the CRA test, including outcome measures of reaction time and maximum velocity, were performed using a VR headset and compared to a gold standard optical motion capture system. The mean bias (assessed with the Bland–Altman method) between VR and the gold standard system ranged from 0.0° to 2.4° for the JPS test variables. For the CRA test, reaction times demonstrated a mean bias of −19.9 milliseconds (ms), and maximum velocity a mean bias of −6.5 degrees per seconds (°/s). The intraclass correlation coefficients (ICCs) between VR and gold standard were good to excellent (ICC 0.835–0.998) for the JPS test, and excellent (ICC 0.931–0.954) for reaction time and maximum velocity for the CRA test. The results show acceptable concurrent validity for the VR technology for assessment of JPS and CRA. A slightly larger bias was observed in JPS left rotation which should be considered in future research.

Background

Traumatic neck pain is prevalent and often linked to sensorimotor impairments, including reduced cervical movement velocity, prolonged task completion time and delayed reaction times. The cervical reaction acuity (CRA) test provides a virtual reality (VR) based objective assessment of a combination of these deficits.

Objectives

To evaluate the CRA test in terms of discriminant and construct validity, associations among CRA-variables, and test-retest reliability.

Design

Cross-sectional and test-retest reliability study.

Method

Adults aged 18–65 years with chronic traumatic neck pain (CTNP) (n = 42) and asymptomatic controls (CON) (n = 38) completed the VR-based CRA test (measuring peak velocity, reaction time, and task completion time) twice, one week apart. Discriminant validity was examined through group comparisons and sensitivity and specificity analyses. Construct validity was examined through correlations with patient-reported outcomes. Associations among CRA variables were examined using correlational analyses. Test-retest reliability (CTNP n = 41, CON n = 29) was examined via intraclass correlation coefficients (ICC), standard error of measurement and minimal detectable change.

Results

Participants with CTNP showed significantly lower peak velocity and longer task completion times than CON. Reaction time did not differ between groups. Peak velocity had the best discriminative ability (sensitivity 83%, specificity 71%), while task completion time showed lower sensitivity (45%) but higher specificity (90%). Correlations with self-reported measures were low to moderate. ICC ranged from 0.54 to 0.94 (95% CI 0.23–0.97).

Conclusion

The CRA test assesses cervical movement performance, with reliability ranging from poor to excellent. Individuals with CTNP demonstrate slower cervical movement velocity and prolonged task completion times than CON.