Clinical Management and Measurement of Upper Limb Disability in Neck Pain Patients

There is a strong relationship between non-specific neck pain (NS-NP) and upper limb disability (ULD). Optimal management of NS-NP should incorporate upper limb (UL) rehabilitation and therefore include evaluation of ULD using suitable UL outcome measure (OM) in the assessment and during the management process. However, there is no clear guidance regarding the suitability of available measures alongside a lack of information on how physiotherapists in the United Kingdom (UK) measure and rehabilitate their patients with NS-NP. The purpose of this thesis was to explore the clinical measurement and management of ULD in patients with NS-NP. The quantitative research approach adopted by this thesis enabled the researcher to gain a deeper understanding of the clinical measurement and in turn rehabilitation of ULD in patients with NS-NP, and build on knowledge acquired throughout the period of study. In order to support this methodology, a positivist philosophical stance was adopted. A systematic review was completed to identify all available UL OMs that were used for patients with neck pain (NP) and to make recommendations about those that are suitable for use in clinical practice and research. A survey with a national sample of physiotherapists was completed to establish current physiotherapeutic management of NS-NP and ULD in the UK. This was followed by a validation study aimed at exploring the acceptability and feasibility of the Single Arm Military Press (SAMP) test. Subsequently, a second validation study was completed to explore the reliability and validity of the SAMP test in female patients with NS-NP and healthy subjects. The systematic review identified five measures but quality issues prevented a clear recommendation for any of the identified instruments. The survey highlighted substantial gaps in current evidence-based practice of UK physiotherapists regarding the measurement of patients with NS-NP and associated deficits in the measurement and management of ULD in this population. Subsequently, a validation study established the acceptability and feasibility of the SAMP test using a 1-kg hand weight in female patients with NS-NP. In the second validation study, the SAMP test was found to be a reliable and valid UL instrument for female patients with NS-NP. This thesis provided preliminary evidence that the SAMP test is an acceptable, feasible, valid and reliable measure of ULD for female patients with NS-NP and of its suitability for use in clinical practice and research. The SAMP test can be used by clinicians to improve their assessment of UL functional capacity and to suggest management strategies for patients with NS-NP. Further longitudinal studies are required to evaluate the further validity and reliability of the SAMP test in older and younger female patients, and male patients using additional examiners and additional populations. Further studies are required to establish the responsiveness of the SAMP test in patient populations with all types of NP.