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ORIGINAL ARTICLE
Ahead of print publication  

Measuring cervical range of motion with gyroscope/accelerometer eyeglasses (JINS MEME) in persons with and without neck pain


1 Department of Rehabilitation Medicine, Akita University Hospital, Akita, Japan
2 Orthopaedic Trauma Institute, University of California, San Francisco, CA, USA
3 Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Japan
4 Department of Rehabilitation Medicine, Akita University Hospital, Akita; Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Japan

Date of Submission22-Nov-2020
Date of Decision09-Mar-2021
Date of Acceptance10-Mar-2021
Date of Web Publication08-Jun-2021

Correspondence Address:
Saitoh Kimio,
Orthopaedics Department Office, 44-2, Hiroomote Hasunuma, Akita-Shi, Akita
Japan
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/JISPRM-000121

  Abstract 


Context: Neck pain is common in the general population. Active cervical spine range of motion (ACROM) is often measured in the diagnosis, evaluation, and treatment of neck pain. However, commonly used measurement tools have been deemed inaccurate or impractical. The Cervical Range of Motion (CROM) Instrument, which uses inclinometers and a magnetic reference, has demonstrated high reproducibility and validity in the measurement of ACROM, however, its practicable use is suboptimal due to its large dimensions. The JINS MEME eyeglass is a lightweight and compact wearable device that contains gyroscope and accelerometer electrodes capable of detecting body motion offering an alternative means of measuring ACROM. Aims: The primary aim of this study is to validate ACROM measurements using the JINS MEME eyeglasses in comparison to the CROM Instrument. The secondary aim is to investigate the variable range of motion patterns between individuals with neck pain (NP group) versus asymptomatic individuals (AS group). Settings and Design: This was a cross-sectional, clinical measurement, and reliability study. Subjects and Methods: Seven neck pain and 14 asymptomatic individuals underwent ACROM measurements with the JINS MEME and CROM Instrument concurrently. Statistical Analysis Used: Intraclass correlation coefficient was used to determine inter- and intra-rater reliability of the JINS MEME and CROM Instrument. Mann–Whitney's U-test was used to assess differences between the two groups (NP group vs. AS group) in ACROM. Results: Using the JINS MEME eyeglasses, we observed excellent intra- and inter-rater reliability for nearly all ACROM directions (cervical spine flexion, extension, and lateral bending) except for rotation which was considered poor. ACROM was decreased in all directions for neck pain patients when measured by both devices. Conclusions: The JINS MEME eyeglasses showed excellent intra- and inter-rater reliability for all ACROM movements except for cervical rotation. Comparing the AS group and NP group, the ACROM of the NP group was significantly decreased compared to that of the AS group in all cervical spine directions, similar to findings in previous studies. With the exception of the measurement of cervical rotation, the JINS MEME eyeglasses demonstrated similar accuracy to the CROM Instrument in the assessment of ACROM in both the NP and AS groups.

Keywords: Cervical range of motion, cervical spine range of motion, JINS MEME, neck pain



How to cite this URL:
Kimio S, Rosario KD, Masato N, Pascual L, Morshed S, Naohisa M, Yoichi S. Measuring cervical range of motion with gyroscope/accelerometer eyeglasses (JINS MEME) in persons with and without neck pain. J Int Soc Phys Rehabil Med [Epub ahead of print] [cited 2021 Oct 24]. Available from: https://www.jisprm.org/preprintarticle.asp?id=318017




  Introduction Top


Neck pain is common in the general population. The overall prevalence of neck pain ranges from 0.4% to 86.8% (mean: 23.1%)[1] with the incidence of neck pain increasing in recent years.[2] Active cervical spine range of motion (ACROM) has been used in the evaluation of individuals with neck pain.[3]

ACROM is often measured in the clinical diagnosis, evaluation, and treatment of individuals with neck pain.[4] Typical ACROM assessments include cervical spine flexion and extension in the sagittal plane, lateral flexion in the frontal plane, and rotation in the transverse plane. ACROM has been assessed by various modalities such as a rangiometer, tape measure, electromagnetic motion analysis, ultrasound motion analysis, smartphone, and so on.[5]

The most commonly used measurement tools for ACROM in the studies reviewed were the goniometer, inclinometer, and Cervical Range of Motion (CROM) Instrument (CROM; Performance Attainment Associates, St. Paul, MN, USA) [Figure 1].[6] The CROM Instrument consists of 3 fluid-dampened inclinometers (1 for each plane of motion) secured to a lightweight plastic frame. The CROM Instrument has demonstrated high reproducibility and validity in the measurement of ACROM, however, its practicable use has remained suboptimal due to its large dimensions.
Figure 1: CROM (Cervical Range of Motion Instrument)

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The JINS MEME ES_R eyeglasses (JINS, Tokyo) is a lightweight wearable device that contains gyroscope and accelerometer electrodes [Figure 2]. The six-axis motion sensors mounted in the device (three-axis accelerometer and three-axis gyroscope) allow for the detection of body movement and collection of data in real time.[7],[8],[9] This device has the potential to measure ACROM more precisely and easily for clinicians. To date, there are no studies measuring ACROM using gyroscope/accelerometer eyeglasses.
Figure 2: Eyeglass type wearable sensor (JINS MEME ES_R)

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The primary aim of the study is to validate ACROM measurements using the JINS MEME eyeglasses in comparison to the CROM Instrument. The secondary aim is to investigate variable ACROM patterns between individuals with neck pain versus individuals without neck pain.


  Subjects and Methods Top


Design

This was a cross-sectional, clinical measurement, and reliability study.

Participants

Twenty-four individuals participated in the study, 9 individuals with neck pain (6 female and 3 male) (NP group) and 15 asymptomatic individuals without neck pain (9 female and 6 male) (AS group). Individuals with axial neck pain were recruited out of the outpatient Zuckerberg San Francisco General Hospital Spine and General Physiatry clinics. Asymptomatic individuals to serve as controls were recruited from the local community.

Individuals with neck pain were recruited according to the following inclusion criteria: men and women between the ages of 18–70 years with nontraumatic axial neck pain, with or without radicular arm pain, and with moderate pain intensity of at least 4 on a 10-cm Visual Analog Scale (VAS). Inclusion criteria for the control group were that individuals could not endorse current neck pain or neck pain within the last 6 months. Exclusion criteria included the following: Inflammatory arthritis and congenital spinal deformities involving the cervical spine (e.g., rheumatoid arthritis and ankylosing spondylitis), signs of cervical nerve root compression (e.g., paresthesia, numbness, or weakness in the upper extremity), and neurological and orthopedic disorders that may affect the cervical spine (e.g., cervical myelopathy, polio, multiple sclerosis, and hypermobility syndrome). A total of seven patients met the criteria of the study in the NP group and 15 individuals in the AS group [Figure 3]. Before data collection, ethical approval for this study and written consent of all participants to the experimental procedures were obtained, and participants were informed of any potential risks. Participant demographics are presented in [Table 1].
Figure 3: Criteria flowchart

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Table 1: Participant demographics

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Outcome measures

ACROM measurements using the JINS MEME eyeglasses and CROM Instrument were obtained simultaneously. Participants were asked to perform active maximal (end-range) cervical flexion, extension, right/left lateral bending, and right/left rotation. All goniometric measurements were performed by two independent examiners. The examiners of the study were physical medicine and rehabilitation specialists with experience in assessing ACROM.

Neck pain intensity was measured using the VAS for the NP group and the Oswestry Neck Disability Index was used to establish the level of disability.

Experimental procedure

Participants were seated upright on a stool with their backs against the wall to maintain a neutral head-and-neck posture at the start of the motion assessment. Modifications were made to ensure standardized measurements for each participant such as positioning the mid and low back regions to contact the wall, feet flat on the floor, and upper extremities positioned at the sides. To standardize head posture, a visual target was adjusted to eye level in front of the participants.

A 30-s warm-up period was implemented to allow the participants' familiarity with the range of motion maneuvers. ACROM in flexion, extension, right/left lateral bending, and right/left rotation was measured for each participant with their eyes open. Each participant performed these measurements two times for each examiner, for a total of four times. For each set with one examiner, the six cervical motions were measured once, with no rest time between each cervical motion. A 2-min rest break occurred between set 2 and set 3 between examiner 1 and examiner 2. Verbal cues were provided by examiners to encourage the participants to make maximum effort to reach the end of the available range. For all measurements, the angles were read to the nearest 1°.

Statistical analysis

Description of mean angles and standard deviations was measured to the nearest whole number. Intraclass correlation coefficient (ICC) was utilized to determine inter- and intra-rater reliability of both the JINS MEME eyeglasses and CROM Instrument. This study interpreted the correlation results by the categorization used by Koo and Li[10] (correlations of below 0.50, poor; between 0.50 and 0.75, moderate; between 0.75 and 0.90, good; and above 0.90, excellent relationship). To assess differences between the two groups (neck pain patient vs. control), we used the Mann–Whitney's U-test. The significance level used was P < 0.05.

Ethics

The study was approved by the Institutional Review Board of University of California San Francisco, registration number 17-23873.


  Results Top


There were 15 controls, but 1 individual was excluded because of measurement error. The final study sample for the control AS group was 14 individuals [Figure 1].

Using the CROM Instrument, we observed excellent intra-rater reliability (ICC [1.2] = 0.92–0.98) in all directions [Table 2].
Table 2: Intra-rater reliability of CROM and JINS MEME eyeglass

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Using the JINS MEME eyeglasses, we observed excellent intra-rater reliability (ICC [1.2] = 0.92–0.95) for measuring cervical flexion, extension, and lateral bending but poor intra-rater reliability (ICC [1.2] <0.5) for rotation [Table 2].

Inter-rater reliability of the CROM Instrument ICC (2.1) was excellent in all directions. Inter-rater reliability of the JINS MEME eyeglasses was excellent for cervical flexion, extension, and lateral bending (ICC [2.1] = 0.90–0.98) but poor for rotation (ICC [2.1] <0.5) [Table 3].
Table 3: Inter-rater reliability of CROM and JINS MEME eyeglass

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There were seven individuals in the neck pain group after excluding two neck pain patients with suspected hypermobility syndrome [Figure 1]. ACROM in neck pain patients was significantly reduced (P < 0.05) in all movements except for flexion compared to controls when measured by the CROM Instrument [Table 4].
Table 4: Comparison of cervical range of motion between Asymptomatic group and Neck pain group

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  Discussion Top


The CROM Instrument is a validated tool that provides accurate ACROM measurements.[4],[5],[6] In the literature, the ICC of CROM Instrument was reported to range from 0.75 to 0.92.[11] In our study, intra-rater reliability and inter-rater reliability of CROM Instrument were both excellent in all directions (ICC = 0.92–0.99). Results of this study were consistent with previous reports.

Intra-rater reliability and inter-rater reliability of the lightweight JINS MEME eyeglasses demonstrated excellent reliability for cervical flexion, extension, and lateral bending (ICC = 0.90–0.98) but poor reliability (ICC <0.50) for cervical rotation.

There have been previous validation studies performed measuring ACROM with a smartphone.[12],[13] One of the studies showed moderate intra-rater reliability for each movement (ICC = 0.65–0.85) but poor inter-rater reliability (ICC <0.50). In this study, ICC was moderate to good for movements of cervical spine flexion, extension, lateral bending, and right rotation but poor for left rotation.[14] This result shows a tendency similar to ours where inter-rater reliability of the JINS MEME eyeglasses was excellent for flexion, extension, and lateral bending but poor for rotation.

One of the reasons for poor reliability in cervical spine rotation may be related to the gyroscope sensor drift which can indicate ongoing sensor readings even after the sensor has stopped moving. We measured first cervical flexion, extension, and lateral bending and then finally evaluated rotation. Given the order of our measurements, it is possible that the gyroscope sensor accumulated drift error over time.[15] During this study, no filter was employed to avoid sensor drift.[16] Additional studies are needed to assess the presence of this drift and its significance.

ACROM in the NP group was decreased in all directions which is consistent with previous studies.[3],[17] The JINS MEME eyeglasses could detect decreasing ACROM in the NP group in a similar manner as the CROM Instrument, except for the cervical rotation measurement.

Limitations

The sample size of the current study was small which may limit the ability to generalize these findings to the entire population with neck pain. Second, a significant reduction of ACROM in cervical flexion for neck pain patients was absent when measured by the CROM Instrument, which was an interesting and unexpected finding. This may represent a limitation in establishing stable positioning of the upper thoracic spine during cervical flexion testing that would ensure the reliability of the measurement.


  Conclusions Top


The JINS MEME eyeglasses showed excellent intra- and inter-rater reliability for all ACROM movements except for rotation. Consistent with previous studies, the JINS MEME eyeglasses detected a significant loss of ACROM in the NP group compared to the AS group. With the exception of the measurement of cervical rotation, the JINS MEME eyeglasses may be a lightweight and compact alternative to the CROM Instrument in assessing loss of ACROM in NP patients.

Acknowledgment

We would like to thank Theodore Miclau, Eleni Berhaneselase, and Belaye Tigist.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Figures

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