THE BACK PAGE Exclusion criteria for the neck pain group: • Visual impairment not corrected by prescriptive lenses • Trauma-induced NP such as whiplash • Orthopaedic surgery of the lower limb within the past year • Diabetes or uncontrolled cardiorespi-ratory problems • Known ongoing neurological or ves-tibular pathology • Arthritis requiring active manage-ment, or • Any acute musculoskeletal injury. Questionnaires completed by participants • Activities-Specific Balance (ABC) scale to assess falls-related self-effi-cacy • NDI to assess self-reported neck disability • VAS to assess NP intensity • Dizziness handicap assessed via Diz-ziness Handicap Inventory (DHI) Lower limb function: Ankle ROM was assessed using a standard goniom-eter. Sensory testing evaluated both light touch and vibration sense at the lateral malleolus of the dominant foot. Vestibular function tests: Participants were screened for vestibular hypofunc-tion via a Dynamic Visual Acuity (DVA) test with a Snellen chart and the head 30 Canadian Chiropractor July/August 2019 impulse test (HIT) (this combination has been previously validated). Active Benign Paroxysmal Positional Vertigo (BPPV) was screened for via the Dix-Hallpike manoeuvre. Visual contrast sensitivity: Visual contrast sensitivity evaluated using the Melbourne Edge Test (MET). Balance: Dynamic balance was as-sessed using the Dynamic Gait Index (DGI); static balance was evaluated using the Nintendo Wii Balance Board. Strengths: • Clinically relevant evaluative tests were utilized • Comprehensive study design mini-mizes sources of confounding factors • Participants suitably represented the relevant patient population that many of us see in practice Weaknesses: • Vestibular tests may lack precision to detect subtle deficits in eye move-ment, which may result in underre-porting of vestibular deficits • Dizziness Handicap Inventory (DHI) scores may be misinterpreted as neck pain as opposed to dizziness • Balance tests performed in multiple settings (laboratory, patient’s home) may lead to inconsistency in the results Strengths/weaknesses: Additional references 1. Treleaven J. Sensorimotor distur-bances in neck disorders affecting postural stability, head and eye movement control. Man Ther 2008; 13: 2–11. 2. Quek J, Brauer S, Clark R, Treleaven J. New insights into neck-pain-re-lated postural control using measures of signal frequency and complexity in older adults. Gait & Posture 2014; 39: 1069–1073. 3. DiPietro L. Physical activity in aging changes in patterns and their rela-tionship to health and function. Journals Gerontol Series A: Biol Sci Med Sci 2011; 56: 13–22. 4. Mickle KJ, Munro BJ, Lord SR et al. ISB Clinical Biomechanics Award 2009: toe weakness and deformity increase the risk of falls in older peo-ple. Clin Biomech 2009; 24:787–791. 5. Mecagni C, Smith JP, Roberts KE, O'Sullivan SB. Balance and ankle range of motion in communi-ty-dwelling women aged 64 to 87 years: a correlational study. Phys Ther 2000; 80: 1004–1011. 6. Herdman SJ, Blatt P, Schubert MC, Tusa RJ. Falls in patients with vestib-ular deficits. Otol Neurotol 2000; 21: 847–851. 7. Lord SR, Clark RD, Webster I. Visual acuity and contrast sensitivity in rela-tion to falls in an elderly population. Age Ageing 1991; 20: 175–181. www.canadianchiropractor.ca
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