Accessory Movements and Associated Factors During Active Cervical Range of Motion

Condition(s) studied

Study summary

This project aims to quantify accessory movements that occur during cervical range of motion (ROM) assessment in young adults and to examine their relationship with functional and psychological factors. Although cervical ROM is widely used in clinical practice, accurate measurement is challenged by the complex anatomy of the cervical spine and coupled movements, which may alter true motion values. Despite their clinical relevance, accessory movements have been largely overlooked in both research and routine assessment.

This cross-sectional observational study will include volunteers aged 18-30 years, recruited between January and August 2025 following ethical approval. Individuals with cervical trauma or surgery, neurological disease, recent treatment, musculoskeletal injury, or medications affecting movement will be excluded. Accessory movements will be measured using the CROM device while participants perform flexion-extension, lateral flexion, and rotation, maintaining end-range for 20 seconds to record primary and accessory motions.

Clinical outcomes will include cervical disability (Neck Disability Index), pain intensity (Visual Analog Scale), cervical mechanosensitivity (pressure algometry at the upper trapezius and C2-C7 regions), psychological status (Depression, Anxiety, Stress Scale-21), and sleep quality (Pittsburgh Sleep Quality Index).

Eligibility

Primary outcome measure(s)

• Assessment of Accessory Movements — 0-18 months
  Accessory movements occurring during active cervical ROM will be evaluated using the Cervical Range of Motion (CROM) device. In a seated position, the participant's neutral resting posture will first be recorded. Subsequently, they will be instructed to perform flexion, extension, right lateral flexion, left lateral flexion, right rotation, and left rotation in sequence. At the end of each movement, participants will hold the end position for 20 seconds, during which the primary movement and the accessory movements occurring in the other two planes will be recorded.
• Assessment of Cervical Disability — 0-18 months
  Cervical disability will be assessed using the Neck Disability Index (NDI), a widely used instrument for evaluating cervical spine dysfunction. The NDI consists of 10 items that measure the impact of neck-related problems on daily activities, including pain intensity, personal care, lifting, reading, headaches, concentration, work status, driving, sleep, and recreational activities. Each item is scored on a scale from 0 to 5, resulting in a total score ranging from 0 to 50. A score of 0 indicates no disability or functional limitation, whereas a score of 50 reflects severe functional impairment. It is recommended that the total score be converted into a percentage, interpreted as follows: 0-4 (no disability), 5-14 (mild disability), 15-24 (moderate disability), 25-34 (severe disability), and 35-50 (complete or very severe disability).
• Assessment of Pain Intensity — 0-18 months
  Pain intensity will be assessed using the Visual Analog Scale (VAS). The VAS consists of a 10-cm (100-mm) horizontal line anchored by the descriptors "no pain" at one end and "worst imaginable pain" at the other. Participants will mark the point on the line that represents the intensity of pain they experience, and the distance in millimeters from the "no pain" anchor to the marked point will be recorded as the pain score.
• Assessment of Cervical Mechanosensitivity — 0-18 months
  Cervical muscle mechanosensitivity will be evaluated using a pressure algometer (Baseline Force Gauge Model 12-0304; Baseline, NY, USA). The device applies force perpendicular to the tissue through a 0.5 cm² probe at an approximate rate of 3 N/s. With the participant seated, pressure will be applied bilaterally to the midpoint of the upper trapezius muscle and to points located 2 cm lateral to the C2 and C7 articular pillars. Pressure algometry has demonstrated high intra-rater (ICC = 0.94-0.97) and inter-rater reliability (ICC = 0.79-0.90) in individuals with neck pain. Participants will be instructed to indicate the moment when the pressure sensation first becomes uncomfortable. This value, defined as the pressure pain threshold (PPT), will be recorded twice with at least 30 seconds between trials, and the mean of the two measurements will be used for analysis.
• Assessment of Depression, Anxiety, and Stress: — 0-18 months
  Depression, anxiety, and stress levels will be assessed using the Depression, Anxiety, and Stress Scale-21 (DASS-21). The DASS-21 consists of three subscales-depression, anxiety, and stress-each comprising 7 items. Scores for each subscale are summed and then multiplied by two, yielding a maximum possible score of 42 per domain. Higher scores indicate greater symptom severity. Recommended cut-off ranges vary for each construct: for depression, 0-9 (normal) to ≥28 (extremely severe); for anxiety, 0-7 (normal) to ≥20 (extremely severe); and for stress, 0-14 (normal) to ≥34 (extremely severe).
• Assessment of Sleep Disturbances — 0-18 months
  Sleep disturbances will be assessed using the Pittsburgh Sleep Quality Index (PSQI). The PSQI is a 19-item questionnaire designed to evaluate sleep habits over the past month and comprises seven components. The total score ranges from 0 to 21, with higher scores indicating poorer sleep quality. A global score of 5 or above is considered indicative of sleep disturbance.

Trial sites (1)

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