Gait Asymmetry And Its Relationship With Neck Pain And Muscles Strength In Patients With Cervical Radiculopathy

Primary outcomes

1. Pain Assessment

   Time frame: 1 day

   The level of upper limb and neck pain will be captured separately with the Numeric Pain Rating Scale (NPRS). Using an 11-point scale, ranging from 0 (no pain) to 10 (worst pain imaginable), participants will be asked to answer the following question: "On a scale of 0 to 10, where 0 = no pain and 10 = worst pain, evaluate the intensity of your neck pain at this moment ". The same question will be asked for the upper limb. The NPRS is frequently used in clinical studies in association with the neck disability index.

2. Assessment of function and disability

   Time frame: 1 day

   Arabic version of Neck Disability Index (NDI) will be used to assess disability and function limitation caused by neck pain. It has demonstrated excellent internal consistency (Cronbach's alpha between 0.88 and 0.94) and test-retest reliability (ICC = 0.90-0.98). It includes 10 items, each scored on a 0-5 scale, about: personal care, lifting, reading, concentration, work, driving, and sleeping. The total maximum score is 50 and categorize disability from none to complete , The Arabic version of NDI is a strong valid method for assessing self-rated disability in patients with neck pain with excellent "test-retest" reliability. Based on the total score (out of 50), disability will be categorized as:

   0-4 = no disability, 5-14 = mild, 15-24 = moderate, 25-34 = severe, >34 = complete disability

3. strength of deep neck flexors

   Time frame: 1 day

   Pressure Biofeedback Unit (PBU) will be used to assess deep neck flexor strength.

   From a supine position and both knees bent in flexion and arms relaxed at the sides. The PBU cuff will be placed under the suboccipital region of his neck and then inflated to a baseline pressure of 20 mmHg. Patients will be instructed to perform a gentle chin in motion without lifting their heads off the surface or activating superficial muscles. The patient will then be guided to increase the pressure in 2 mmHg stages to a maximum of 30 mmHg, and to hold each stage for 10 seconds taking no rest intervals between his attempts. The maximum pressure which he achieves and holds correctly without compensatory strategies will be recorded. 3 trials will be conducted.

4. Upper limb strength assessment

   Time frame: 1 day

   Upper limb strength will be measured using a hand-held dynamometer. Participants will be seated in upright posture, with their shoulders adducted and neutrally rotated, and their elbows will be flexed at 90 degrees, their forearms will be placed in a neutral position, and their wrists extended between 0-30 degrees, testing protocol. Each participant will be instructed to grip the dynamometer with his maximum effort for about 3-5 seconds. The participant will receive consistent verbal encouragement from the assessor to ensure maximal voluntary contraction is achieved. Each participant will perform 3 trials on their affected side, with a one-minute rest between his attempts to avoid muscle fatigue.

5. Cadence

   Time frame: 1 day

   The Tekscan Strideway™ system will be used to objectively assess spatiotemporal gait parameters for all participants with cervical radiculopathy. Cadence is the number of steps taken per minute (steps/minutes).

6. Gait Velocity

   Time frame: 1 day

   The Tekscan Strideway™ system will be used to objectively assess spatiotemporal gait parameters for all participants with cervical radiculopathy. Gait Velocity is the average walking speed, calculated as Gait Distance divided by Gait Time (centimeter/second).

7. Symmetry Index (SI)

   Time frame: 1 day

   The Tekscan Strideway™ system will be used to objectively assess spatiotemporal gait parameters for all participants with cervical radiculopathy. Symmetry Index (SI) is a calculated percentage representing the degree of asymmetry between the right and left sides for any given gait parameter (%).

   Formula used:

   SI = [(Right - Left) / 0.5 * (Right + Left)] * 100.

8. Step Time symmetry index

   Time frame: 1 day

   The Tekscan Strideway™ system will be used to objectively assess spatiotemporal gait parameters for all participants with cervical radiculopathy. Step time is the percentage of asymmetry between the right step time and the left step time (%).

9. Step Length symmetry index

   Time frame: 1 day

   The Tekscan Strideway™ system will be used to objectively assess spatiotemporal gait parameters for all participants with cervical radiculopathy. Step Length is a percentage of asymmetry between the right step length and the left step length (%).

10. Single Support Time symmetry index

    Time frame: 1 day

    The Tekscan Strideway™ system will be used to objectively assess spatiotemporal gait parameters for all participants with cervical radiculopathy. Single Support Time is the percentage of asymmetry between the average right single support time and the average left single support time (%).

11. Double Support Time symmetry index

    Time frame: 1 day

    The Tekscan Strideway™ system will be used to objectively assess spatiotemporal gait parameters for all participants with cervical radiculopathy. Double Support Time is the percentage of asymmetry between the average right total double support time and the average left total double support time (%).