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Measurement properties of instruments for assessment of cervical spine function in infants with torticollis: a systematic review

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Abstract

The aim of this study was to systematically review the measurement properties of instruments which assess cervical spine function in infants with torticollis. Electronic searches were performed in MEDLINE, CINAHL, Embase, Web of Science and the Cochrane Library, combining three constructs (‘torticollis’, ‘cervical spine assessment’ and ‘measurement properties’). Two reviewers independently rated the methodological quality and the quality of measurement properties of identified articles, using both the COSMIN (COnsensus-based Standards for the selection of health status Measurement INstruments) checklist and quality criteria for measurement properties. Five studies, using six instruments, met the inclusion criteria and were analysed. Included instruments were the goniometer, electronic pendular goniometer, protractor, still photography, Muscle Function Scale and a range of motion limitation scale. All studies assessed reliability, and one study also assessed content validity and hypothesis testing. The methodological quality of the studies varied from poor to excellent according to the COSMIN checklist. Two instruments were found to have good measurement properties from high-quality studies: still photography for the assessment of habitual head tilt in supine and the Muscle Function Scale for the assessment of side-flexor muscle function in lateral head righting.

Conclusion: This systematic review identified two reliable tools for the assessment of cervical spine function in infants with torticollis. Further research is required to assess the measurement properties of tools already described in the literature and to develop further tools for use in this population.

What is known?

• A thorough assessment of the infant presenting with torticollis is essential, in order to correctly diagnose, rule out ‘red flags’ and manage appropriately

• Assessment tools need to have robust measurement properties in order to be of value for clinical practice and research

What is new?

• This systematic review identified two valid and reliable tools for the assessment of cervical spine function in infants with torticollis

• Further research is required to assess the measurement properties of tools already described in the literature and to develop further tools for use in infants with torticollis

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Abbreviations

CMT:

Congenital muscular torticollis

COSMIN:

COnsensus-based Standards for the selection of health status Measurement INstruments

CSp:

Cervical spine

HRPRO:

Health-related patient-reported outcomes

MIC:

Minimal important change

PoT:

Postural torticollis

ROM:

Range of motion

Rot :

Rotation

SCM:

Sternocleidomastoid muscle

SDC:

Smallest detectable change

SEM:

Standard error of measurement

SF:

Side flexion

References

  1. Aarnivala HE, Valkama AM, Pirttiniemi PM (2014) Cranial shape, size and cervical motion in normal new-borns. Early Hum Dev 90:425–430

    Article  PubMed  Google Scholar 

  2. Aarnivala H, Vuollo V, Harila V, Heikkinen T, Pirttiniemi P, Holmström L, Valkama AM (2016) The course of positional cranial deformation from 3 to 12 months of age and associated risk factors: a follow-up with 3D imaging. Eur J Pediatr 175:1893–1903

    Article  PubMed  Google Scholar 

  3. Antonaci F, Ghirmai S, Bono G, Nappi G (2000) Current methods for cervical spine movement evaluation: a review. Clin Exp Rheumatol 18:S-45

    CAS  Google Scholar 

  4. Arbogast KB, Gholve PA, Friedman JE, Maltese MR, Tomasello MF, Dormans JP (2007) Normal cervical spine range of motion in children 3–12 years old. Spine 32:E309–E315

    Article  PubMed  Google Scholar 

  5. Barske E, Draeger D, Keck K (2014) Comparison of 2-dimensonal and 3-dimensional motion analysis to measure infant cervical range of motion. Wisconsin physical therapy association, Wisconsin, USA

    Google Scholar 

  6. Bartels B, De Groot JF, Terwee CB (2013) The six-minute walk test in chronic paediatric conditions: a systematic review of measurement properties. Phys Ther 93:529–541

    Article  PubMed  Google Scholar 

  7. Captier G, Dessauge D, Picot MC, Bigorre M, Gossard C, El Ammar J, Leboucq N (2011) Classification and pathogenic models of unintentional postural cranial deformities in infants: plagiocephalies and brachycephalies. J Craniofac Surg 22:33–41

    Article  PubMed  Google Scholar 

  8. de Chalain TM, Park S (2005) Torticollis associated with positional plagiocephaly: a growing epidemic. J Craniofac Surg 16:411–418

    Article  PubMed  Google Scholar 

  9. Chen TMK (1995) Infantile muscular torticollis: efficacy of conservative treatment with active programme and manual stretching. Chapter 4: pilot study on the measurement of passive rotation of the neck. Master of Philosophy Dissertation, Chinese University of Hong Kong (personal communication)

  10. Chen MM, Chang HC, Hsieh CF, Yen MF, Chen TH (2005) Predictive model for congenital muscular torticollis: analysis of 1021 infants with sonography. Arch Phys Med Rehabil 86:2199–2203

    Article  PubMed  Google Scholar 

  11. Cheng JC, Au AW (1994) Infantile torticollis: a review of 624 cases. J Pediatr Orthop 14:802–808

    Article  CAS  PubMed  Google Scholar 

  12. Cheng JC, Tang SP, Chen TMK (1999) Sternocleidomastoid pseudotumor and congenital muscular torticollis in infants: a prospective study of 510 cases. J Pediatr 134:712–716

    Article  CAS  PubMed  Google Scholar 

  13. Cheng J, Tang S, Chen TMK, Wong E (2000) The clinical presentation and outcome of treatment of congenital muscular torticollis in infants—1086 cases. J Pediatr Surg 35:1091–1096

    Article  CAS  PubMed  Google Scholar 

  14. Cheng JC, Wong MW, Tang SP, Chen TMK, Shum SL, Wong EM (2001) Clinical determinants of the outcome of manual stretching in the treatment of congenital muscular torticollis in infants: a prospective study of 821 cases. J Bone Joint Surg Am 83:679–687

    Article  CAS  PubMed  Google Scholar 

  15. Christensen C, Landsettle A, Antoszewski S, Ballard B, Carey H, Pax Lowes L (2013) ConservaPhys Occup Ther Pediatrtive management of congenital muscular torticollis: an evidence-based algorithm and preliminary treatment parameter recommendations. 33:453–466

  16. Christensen E, Castle KB, Hussey E (2015) Clinical feasibility of 2-dimensional video analysis of active cervical motion in congenital muscular torticollis. Pediatr Phys Ther 27:276–283

    Article  PubMed  Google Scholar 

  17. Cooperman D (1997) The differential diagnosis of torticollis in children. Phys Occup Ther Paediatr 17:1–11

    Article  Google Scholar 

  18. Dobson F, Hinman RS, Hall M, Terwee CB, Roos EM, Bennell KL (2012) Measurement properties of performance-based measures to assess physical function in hip and knee osteoarthritis: a systematic review. Osteoarthr Cartil 20:1548–1562

    Article  CAS  Google Scholar 

  19. Emery C (1994) The determinants of treatment duration for congenital muscular torticollis. Phys Ther 74:921–928

    Article  CAS  PubMed  Google Scholar 

  20. Feipel V, Rondelet B, Le Pallec JP, Rooze M (1999) Normal global motion of the cervical spine: an electrogoniometric study. Clin Biomech 14:462–470

    Article  CAS  Google Scholar 

  21. Fortin C, Ehrmann Feldman D, Cheriet F, Labelle H (2011) Clinical methods for quantifying body segment posture: a literature review. Disabil Rehabil 33:367–383

    Article  PubMed  Google Scholar 

  22. Fradette J, Gagnon I, Kennedy E, Snider L, Majnemer A (2011) Clinical decision-making regarding intervention needs of infants with torticollis. Pediatr Phys Ther 23:249–256

    Article  PubMed  Google Scholar 

  23. Giray E, Karadag-Saygi E, Mansiz-Kaplan B, Tokgoz D, Bayindir O, Kayhan O (2017) A randomised, single-blinded pilot study evaluating the effects of kinesiology taping and the tape application techniques in addition to therapeutic exercises in the treatment of congenital muscular torticollis. Clin Rehabil 31:1098–1106

    Article  PubMed  Google Scholar 

  24. Hald ES, Hertle RW, Yang D (2011) Application of a digital head-posture measuring system in children. Am J Ophthalmol 151:66–70, 70.e2

  25. Hautopp L, Wester S, Bang B, Buus L, Grindsted J, Christensen K, Vinther A (2014) Benefit of physiotherapeutic treatment in children with torticollis. Dan Med J 61:A4970

    PubMed  Google Scholar 

  26. He L, Yan X, Li J, Guan B, Ma L, Chen Y, Xu K (2017) Comparison of two dosages of stretching treatment in infants with congenital muscular torticollis: a randomised trial. Am J Phys Med Rehabil 96:333–340

    Article  PubMed  Google Scholar 

  27. Herman MJ (2006) Torticollis in infants and children: common and unusual causes. Instr Course Lect 55:647–653

    PubMed  Google Scholar 

  28. Hylton N (1997) Infants with torticollis: the relationship between asymmetric head and neck positioning and postural development. Phys Occ Ther Ped 17:91–117

    Google Scholar 

  29. Jordan K (2000) Assessment of published reliability studies for cervical spine range-of-motion measurement tools. J Manip Physiol Ther 23:180–195

    Article  CAS  Google Scholar 

  30. Jung AY, Kang EY, Lee SH, Nam DH, Cheon JH, Kim HJ (2015) Factors that affect the rehabilitation duration in patients with congenital muscular torticollis. Ann Rehabil Med 39:18–24

  31. Kaplan S, Coulter C, Fetters L (2013) Physical therapy management of congenital muscular torticollis: an evidence-based clinical practice guideline. Pediatr Phys Ther 25:348–394

    Article  PubMed  Google Scholar 

  32. Kiwak KJ (1984) Establishing an etiology for torticollis. Postgrad Med 75:126–134

    Article  CAS  PubMed  Google Scholar 

  33. Klackenberg E, Elfving B, Haglund-Akerlind Y, Brogren Carlberg E (2005) Intra-rater reliability in measuring range of motion in infants with congenital muscular torticollis. Adv Phys 7:84–91. https://doi.org/10.1080/14038190510010331

    Article  Google Scholar 

  34. de Koning CH, van den Heuvel SP, Staal JB, Smits-Engelsman BC, Hendriks EJ (2008) Clinimetric evaluation of active range of motion measures in patients with non-specific neck pain: a systematic review. Eur Spine J 17:905–921

    Article  PubMed  PubMed Central  Google Scholar 

  35. Kwon DR, Park Y (2014) Efficacy of microcurrent therapy in infants with congenital muscular torticollis involving the entire sternocleidomastoid muscle: a randomized placebo-controlled trial. Clin Rehabil 28:983–991

    Article  PubMed  Google Scholar 

  36. Lal S, Abbasi AS, Jamro S (2011) Response of primary torticollis to physiotherapy. J Surg Pak (Intl) 16:153–156

    Google Scholar 

  37. Laughlin J, Luerssen TG, Dias MS (2011) Prevention and management of positional skull deformities in infants. Pediatrics 128:1236–1241

    Article  PubMed  Google Scholar 

  38. Lee YT, Yoon K, Kim YB, Chung PW, Hwang JH, Park YS, Han BH (2011) Clinical features and outcome of physiotherapy in early presenting congenital muscular torticollis with severe fibrosis on ultrasonography: a prospective study. J Pediatr Surg 46:1526–1531

    Article  PubMed  Google Scholar 

  39. Lee JY, Koh SE, Lee IS, Jung H, Lee J, Kang JI, Bang H (2013) The cervical range of motion as a factor affecting outcome in patients with congenital muscular torticollis. Ann Rehabil Med 37:183–90

  40. Leung AY, Mandrusiak A, Watter P, Gavranich J, Johnston LM (2016) Clinical assessment of head orientation profile development and its relationship with positional plagiocephaly in healthy term infants—a prospective study. Early Hum Dev 96:31–38

    Article  PubMed  Google Scholar 

  41. Lewandowski J, Szulc P (2003) The range of motion of the cervical spine in children aged from 3 to 7 years-an electrogoniometric study. Folia Morphol (Warsz) 62:459–461

    Google Scholar 

  42. Luxford B, Hale L, Piggott J (2009) The physiotherapy management of infants with congenital muscular torticollis: a survey of current practice in New Zealand. N Z J Physiother 37:127–135

    Google Scholar 

  43. Lynch-Caris T, Majeske KD, Brelin-Fornari J, Nashi S (2008) Establishing reference values for cervical spine range of motion in pre-pubescent children. J Biomech 41:2714–2719

    Article  PubMed  Google Scholar 

  44. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6:e1000097

    Article  PubMed  PubMed Central  Google Scholar 

  45. Mokkink LB, Terwee CB, Patrick DL, Alonso J, Stratford PW, Knol DL, De Vet HC (2010) The COSMIN checklist for assessing the methodological quality of studies on measurement properties of health status measurement instruments: an international Delphi study. Qual Life Res 19:539–549

    Article  PubMed  PubMed Central  Google Scholar 

  46. Murgia M, Venditto T, Paoloni M, Hodo B, Alcuri R, Bernetti A, Mangone M (2016) Assessing the cervical range of motion in infants with positional plagiocephaly. J Craniofac Surg 27:1060–1064. https://doi.org/10.1097/SCS.0000000000002644

    Article  PubMed  Google Scholar 

  47. Nucci P, Kushner BJ, Seragino M (2005) A multi-disciplinary study of the ocular, orthopaedic and neurological causes of abnormal head postures. Am J Opthalmol 140:65–68

    Article  Google Scholar 

  48. Nuysink J, van Haastert IC, Takken T, Helders P (2008) Symptomatic asymmetry in the first six months of life: differential diagnosis. Eur J Pediatr 167:613–619

    Article  PubMed  PubMed Central  Google Scholar 

  49. Nuysink J, van Haastert IC, Takken T, Helders PJ (2011) Symptomatic asymmetry in very young infants: a Delphi study on the development of a screening instrument. Physiother Theory Pract 27:194–212

    Article  CAS  PubMed  Google Scholar 

  50. Öhman AM (2009) Are infants with torticollis at risk of a delay in early motor milestones compared with a control group of healthy infants? Dev Med Child Neurol 51:545–550

    Article  PubMed  Google Scholar 

  51. Öhman A (2012) The inter-rater and intra-rater reliability of a modified “severity scale for assessment of plagiocephaly” among physical therapists. Physiother Theory Pract 28:402–406

    Article  PubMed  Google Scholar 

  52. Öhman AM, Beckung E (2008) Reference values for range of motion and muscle function of the neck in infants. Pediatr Phys Ther 20:53–57

    Article  PubMed  Google Scholar 

  53. Öhman AM, Nilsson S, Beckung E (2009) Validity and reliability of muscle function scale, aimed to assess the lateral flexors of the neck in infants. Physiother Theory Pract 25:129–137. https://doi.org/10.1080/09593980802686904

    Article  PubMed  Google Scholar 

  54. Öhman AM, Nilsson S, Beckung E (2010) Stretching treatment for infants with congenital muscular torticollis: physiotherapist or parents? A randomised pilot study. Phys Med Rehabil 2:1073–1079

    Google Scholar 

  55. Öhman AM, Mårdbrink EL, Stensby J, Beckung E (2011) Evaluation of treatment strategies for muscle function in infants with congenital muscular torticollis. Physiother Theory Pract 27:463–470

    Article  PubMed  Google Scholar 

  56. Öhman AM, Mårdbrink EL, Orefelt C, Seager A, Tell L, Klackenberg E (2013) The physical therapy assessment and management of infants with congenital muscular torticollis: a survey and suggested assessment protocol for congenital muscular torticollis. J Nov Physiother 3:165

    Google Scholar 

  57. Oledzka MM, Kaplan SL, Sweeney JK, Coulter C, Evans-Rogers DL (2018) Interrater and intrarater reliability of the congenital muscular torticollis severity classification system. Pediatr Phys Ther 30:176–182

    PubMed  Google Scholar 

  58. Oleszek JL, Chang N, Apkon SD, Wilson PE (2005) Botulinum toxin type a in the treatment of children with congenital muscular torticollis. Am J Phys Med Rehabil 84:813–816

    Article  PubMed  Google Scholar 

  59. Persing J, James H, Swanson J, Kattwinkel J (2003) Prevention and management of positional skull deformities in infants. Pediatrics 112:199–202

    Article  PubMed  Google Scholar 

  60. Petronic I, Brdar R, Cirovic D, Nikolic D, Lukac M, Janic D, Pavicevic P, Golubovic Z, Knezevic T (2010) Congenital muscular torticollis in children: distribution, treatment duration and outcome, Eur J Phys Rehabil Med 46:153–158

  61. Philippi H, Faldum A, Bergmann H, Jung T, Pabst B, Schleupen A (2004) Idiopathic infantile asymmetry, proposal of a measurement scale. Early Hum Dev 80:79–90

    Article  PubMed  Google Scholar 

  62. Rahlin M, Sarmiento B (2010) Reliability of still photography measuring habitual head deviation from midline in infants with congenital muscular torticollis. Pediatr Phys Ther 22:399–406. https://doi.org/10.1097/PEP.0b013e3181f9d72d

    Article  PubMed  Google Scholar 

  63. Rogers GF, Oh AK, Mulliken JB (2009) The role of congenital muscular torticollis in the development of deformational plagiocephaly. Plast Reconstr Surg 123:643–652

    Article  CAS  PubMed  Google Scholar 

  64. Rubio AS, Griffet JR, Caci H, Bérard E, El Hayek T, Boutté P (2009) The moulded baby syndrome: incidence and risk factors regarding 1,001 neonates. Eur Journal Ped 168:605–611

    Article  Google Scholar 

  65. Schaufele MK, Boden SD (2003) Physical function measurements in neck pain. Phys Med Rehabil Clin N Am 14:569–588

    Article  PubMed  Google Scholar 

  66. Schertz M, Luk L, Green D (2013) Long term neurodevelopmental follow up of children with congenital muscular torticollis. J Child Neurol 28:1215–1221

    Article  PubMed  Google Scholar 

  67. Seager A (2017) Assessment and management of torticollis in infancy: a survey of current physiotherapy practice. Physiother Prac Res 38:59–66

    Google Scholar 

  68. Sforza C, Grassi G, Fragnito N, Turci M, Ferrario VF (2002) Three-dimensional analysis of active head and cervical spine range of motion: effect of age in healthy male subjects. Clin Biomech 17:611–614

    Article  Google Scholar 

  69. Stellwagen L, Hubbard E (2008) Torticollis, facial asymmetry and plagiocephaly in normal new-borns. Arch Dis Child 93:827–831

    Article  CAS  PubMed  Google Scholar 

  70. Tatli B, Aydinli N, Çalıskan M, Ozmen M, Bılır F, Acar G (2006) Congenital muscular tortıcollis: evaluation and classification. Pediatr Neurol 34:41–44

    Article  PubMed  Google Scholar 

  71. Terwee CB, Bot SD, de Boer MR, van der Windt DA, Knol DL, Dekker J, de Vet HC (2007) Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol 60:34–42

    Article  PubMed  Google Scholar 

  72. Terwee CB, Mokkink LB, Knol DL, Ostelo RW, Bouter LM, de Vet HC (2012) Rating the methodological quality in systematic reviews of studies on measurement properties: a scoring system for the COSMIN checklist. Qual Life Res 21:651–657

    Article  PubMed  Google Scholar 

  73. Tessner A, Mooney P, Pellard L (2010) A developmental perspective on congenital muscular torticollis: a critical appraisal of the evidence. Pediatr Phys Ther 22:378–383

    Article  Google Scholar 

  74. Tyson S (2003) A systematic review of methods to measure posture. Phys Ther Rev 8:45–50

    Article  Google Scholar 

  75. Viikari-Juntura E (1987) Inter-examiner reliability of observations in physical examinations of the neck. Phys Ther 67:1526–1532

    Article  CAS  PubMed  Google Scholar 

  76. van Vlimmeren LA, Helders PJ, van Adrichem LN, Engelbert RH (2004) Diagnostic strategies for the evaluation of asymmetry in infancy—a review. Eur J Pediatr 163:185–191

    Article  PubMed  Google Scholar 

  77. van Vlimmeren LA, Helders PJ, van Adrichem LN, Engelbert RH (2006) Torticollis and plagiocephaly in infancy: therapeutic strategies. Pediatr Rehabil 9:40–46

    Article  PubMed  Google Scholar 

  78. Whitcroft KL, Massouh L, Amirfeyz R, Bannister G (2010) Comparison of methods of measuring active cervical range of motion. Spine 35:E976–E980

    Article  PubMed  Google Scholar 

  79. Youdas JW, Carey JR, Garrett TR (1991) Reliability of measurements of cervical spine range of motion—comparison of three methods. Phys Ther 71:98–104

    Article  CAS  PubMed  Google Scholar 

  80. Yu C, Wong F, Lo L, Chen Y (2004) Cranio-facial deformities in patients with uncorrected congenital muscular torticollis—an assessment from 3D imaging. Plast Reconstr Surg 113:24–33

    Article  PubMed  Google Scholar 

  81. Zachman ZJ, Traina AD, Keating JJ, Bolles ST, Braun-Porter L (1989) Inter-examiner reliability and concurrent validity of two instruments for the measurement of cervical ranges of motion. J Manip Physiol Ther 12:205–210

    CAS  Google Scholar 

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Funding

This study was funded by the Temple Street Foundation (grant number 13.032).

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Authors and Affiliations

  1. Department of Physiotherapy, Temple Street Children’s University Hospital, Dublin 1, Ireland

    Anthea Seager

  2. Department of Physiotherapy, Royal College of Surgeons in Ireland, St Stephen’s Green, Dublin 2, Ireland

    Helen French

  3. Department of Physiotherapy, Trinity College, Dublin University, Dublin 2, Ireland

    Dara Meldrum

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  1. Anthea Seager
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  2. Helen French
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  3. Dara Meldrum
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Contributions

AS, HF and DM conceived the research idea and developed the protocol; AS did the database searches; AS and HF screened studies for eligibility; AS performed data extraction; AS and HF performed COSMIN assessment and DM arbitrated in the case of disagreement; AS drafted the manuscript; All authors contributed to the manuscript and approved the final version for publication.

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Correspondence to Anthea Seager.

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Communicated by Mario Bianchetti

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Appendix

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Table 5 Search strategy for systematic review using three groups of keywords, ‘torticollis’, ‘cervical spine assessment’ and ‘measurement properties’
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Seager, A., French, H. & Meldrum, D. Measurement properties of instruments for assessment of cervical spine function in infants with torticollis: a systematic review. Eur J Pediatr 178, 657–671 (2019). https://doi.org/10.1007/s00431-019-03338-3

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