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WALTER P. MAKSYMOWYCH, CATHERINE MALLON, RHONDA RICHARDSON, BARBARA CONNER-SPADY, EDWIN JAUREGUI, CECILIA CHUNG, LISA ZAPPALA, KEVIN PILE, and ANTHONY S. RUSSELL ABSTRACT. Objective. To compare a tape-based tool for measuring cervical mobility in patients with ankylosing spondylitis (AS) with the widely practiced goniometer-based approach. Methods. We developed a novel tape-based approach to measurement of lateral cervical rotation of the neck that is minimally affected by flexion/extension movements of the neck. This requires measurement of the difference between a mark at the suprasternal notch and the tragus of the ear. Rotation score is measured in centimeters and constitutes the difference in length between the 2 extremes of cervical rotation (http://www.arthritisdoctors.org/researcher.html). We assessed the tape-based and goniometer-based methods in a total of 263 patients from 3 countries, Canada (n = 205), Australia (n = 29), and Colombia (n = 29), that included patients from community and tertiary-based practice. Intra- and interobserver reliability was assessed in a subset of 44 patients by ANOVA and a 2-way mixed effects model. The Bath AS Disease Activity (BASDAI) and Function (BASFI) Indices, and the modified Stoke AS Spinal Score (mSASSS), were also recorded to assess construct validity by correlation coefficient and regression analysis. Responsiveness was assessed in a subset of 33 patients that were either randomized to anti-tumor necrosis factor-a therapy:placebo (n = 22) or received open label infliximab (n = 4) or pamidronate (n = 7) over a period of 24 weeks. Results. Scores obtained with the tape-based method were normally distributed, while those obtained using the goniometer were skewed towards normal values. Reliability for the goniometer-based approach was excellent [intraclass correlation coefficient (ICC) > 0.90] and very good for the tape-based approach (ICC > 0.80). Significant correlations were noted between age, disease duration, function and structural damage scores, and scores obtained with both methods. Responsiveness was high using raw scores obtained with the goniometer (standardized response mean > 0.80) but was not evident when the grading scheme proposed for the Bath AS Metrology Index (BASMI) was employed. Conclusion. The tape-based approach we describe provides a simple, feasible, and reliable index of cervical rotation that is comparable to the information obtained from the use of a goniometer. If the goniometer-based approach is used, raw scores should be used in the calculation of responsiveness rather than the grading scheme suggested in the BASMI. (First Release Oct 1 2006; J Rheumatol 2006;33:2242-8) Key Indexing Terms:
CERVICAL ROTATION From the Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; CAYRE Hospital for Arthritis and Rehabilitation, Bogota, Colombia; and the Department of Medicine, James Cook University, Townsville, Queensland, Australia. Dr. Maksymowych is a Senior Scholar of the Alberta Heritage Foundation for Medical Research. W.P. Maksymowych FRCPC, Professor; C. Mallon, RN, Clinical Research Associate; R. Richardson, RN, Clinical Research Associate; B. Conner-Spady, PhD, Biostatistician; C. Chung, MD; A.S. Russell FRCPC, Professor, Department of Medicine, University of Alberta; E. Jauregui, MD, CAYRE Hospital for Arthritis and Rehabilitation; L. Zappala, MB, ChB; K. Pile, MD, Department of Medicine, James Cook University. Address reprint requests to Dr. W.P. Maksymowych, 562 Heritage Medical Research Building, University of Alberta, Edmonton, Alberta T6G 2S2, Canada. E-mail: walter.maksymowych@ualberta.ca Accepted for publication May 18, 2006.
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