Reliability and agreement of FCE for patients with chronic nonspecific nek pain

Neck pain is, after low back pain and shoulder complaints, the most common
musculoskeletal complaint and has a major impact on society because of the
reduced working capacity. The prognosis of recovery from non-specific neck
pain is positive; 50-70% recovers
within a few months. Neck pain, however, can also persist for an extended
period or be recurrent. Incidence of neck pain in the general medical practice
is around 16 per 1000 patients (Bot et al, 2005, Feleus et al. 2008). About 1.2
per 1000 patients a year will visit a
hospital for neck pain (Verhagen et al. 2009). Main factors negatively
influencing recovery are higher age, higher pain intensity, longer duration of
pain and previous episode(s) with non-specific neck pain.
Performing repetitive movements, forceful movements, unusual positions and
static contraction of neck and/or shoulder musculature are physical risk
factors for developing chronic non-specific neck pain (Reesink et al. 2007). To
determine the capacity to perform physical work a Functional Capacity
evaluation (FCE) is used. The FCE is a standardized set of tests that each
represents a work-related activity (Isernhagen, 1997). The FCE for neck pain
(neck-FCE) consists of 6 tests. This neck-FCE is considered to be a valid
representation of the capacity to perform physical work specific for people
with neck pain (Reneman et al, 1997; Reneman et al., 2005b; Reesink et al 2007;
Soer et al, 2009). The neck-FCE has been proven to be reliable in healthy
subjects. The full FCE, wrom which is is derived, has demonstrated reliability
in in patients with chronic non-specific low back pain and in patients with
osteoarthritis in knees and hips (Brouwer et al, 2003; Gross et al, 2002;
Reneman et al 2002a; 2004; 2005a; Soer et al, 2006; van Ittersum et al. 2009).
Construct validity is good in healthy subjects and in patients with chronic
low back pain
(Gross & Battie, 2003; Reneman et al, 2002b; Reneman et al, 2003). The safety
of the FCE is good in patients with chronic low back pain and healthy subjects
(Reneman et al. 2006; Kuijer et al, 2006; Soer et al. 2008). The reliability of
the neck-FCE has not yet been studied.

To determine the test-retest reliability and agreement of the neck-FCE in
patients with
chronic non-specific neck pain.

Test-retest design. The neck-FCE is performed twice with a two week interval,
by the same tester. . At session 2 (T1) the tester and patient are blinded for
the results of session 1 (T0). The researcher has no contact with the
patients.

- When a patient is diagnosed with chronic non-specific neck pain and is
enrolled for outpatient pain rehabilitation at the Centre for Rehabilitation
(CvR) UMCG, location Beatrixoord, the rehabilitation physician will assess
whether the patient is suitable for participation in this study. The
rehabilitation physician will ask whether the patient will consider
participation. The patient will than receive the brochure 'information for
patients' and a sign-up form with a postage free return envelope.
- When the patient wants to participate he sends the sign-up form to the CvR
secretary of Pain Rehabilitation. By telephone two appointments will be
arranged for both sessions. The patient will receive a confirmation letter with
the appointments and a consent form at his / her home address.
- T0: Prior to the first test session patient will fill in a questionnaire and
read the consent form. Before starting the first session the tester will ask
whether the information is understood and if there are any questions pending,
if necessary, there will be additional explanation/information. The tester will
take in the completed questionnaire. After signing the consent form T0 is
performed. After the first test the patient receives a questionnaire to fill in
at home 24-hours after the test (T0+) and a travel allowance form (travel
expense reimbursement ¤ 0.19 per km for the second visit).
- T0+: Patient fills in questionnaire T0+ about the experienced pain 24 hrs
after completion of T0 (duration 5 min).
- T1: Retest after 2 weeks. Patient takes along the completed questionnaire
T0+ and the form for the travel allowance. Patient fills in questionnaire T1
(10 min). The test leader takes completed questionnaires and checks the
completeness. Performing T1.
- Test leader hand over the gift voucher (¤ 20).
- Within 1 month travel expenses will be paid to the participant.

Patients voluntarily participate in this research. There is an Informed Consent
procedure followed as written above. Patients will be invited in the CvR UMCG,
location Beatrixoord (Dilgtweg 5). Questionnaires will be used to check if the
self-reported functional status of patients is equal on T0 and T1.

Patients will be invited to come twice to the CvR. The sessions will take about
1.5 hours the first time and approximately 1 hour the second session. The first
visit is similar to "Care as Usual". For the second session travel expenses
will be reimbursed (19 euro cents per km) because it is an additional test.
After performing the second test patients get a gift voucher (20 euros) for
their participation in het research.
Both sessions enclose filling in questionnaires and conducting tests. It is to
be expected that patients will experience muscular pain and / or a temporary
increase of already existing neck pain as a result of each test session. This,
however is considered a normal reaction to effort (Reneman et al, soer et al).
The risk that healthy patients will suffer injury during this research is
minimal, because of the safety procedures and also based on previous research.
In studies with healthy subjects and in patients with low back pain it has been
demonstrated that risks are very low (Matheson et al (1995), Reneman et al
(2006), ,(Soer et al. 2008).