Association between the assessment of endurance of deep neck flexors and motivation for exercise Dimitriadis Z.1,2, Fragkakis V.1, Kapreli E.2, Strimpakos N.2, Tziouma M.3, Petta G.1 1Technological Education Institute of Athens, 2Technological Education Institute of Sterea Ellada, 3Clinical Physiotherapist Introduction The Chin Tuck Neck Flexion Test (CTNFT)1 and the Craniocervical Flexion Test (CCFT)2 are two well-known tests for the assessment of endurance of deep neck flexors. Evidence suggests that although both tests provide reproducible estimates of endurance of deep neck flexors, the CCFT is a test of smaller measurement error and better face validity3. The CCFT has also been proposed to be less affected by the motivation of participants to perform and complete the test3. It has been suggested that the CCFT can be affected less than the CTNFT by such motivation as the test is separated in 10-sec blocks instead of keeping the activation of muscles as much as possible3. Methods The participants were initially asked to complete: a generic health questionnaire. the Assessment Scale for Completion of Usual Physical Activities (ASCUPA)4. the Short Scale of Physical Activity Motives (SSPAM)4. a Visual Analogue Scale for their motivation to begin and complete a physical activity (VAS motivation)4. After the completion of these scales, the participants were examined for the endurance of their deep neck flexors. Participants initially performed the CCFT and then the CTNFT (Fig. 1). After the completion of each clinical test, the participants had to answer in a set of six questions regarding their experience with the test. Correlations between the performance in the two clinical tests and the scales were examined with Spearman r. Significance level was set at P = 0.05. Discussion & Conclusions The performance in CTNFT is associated with the motivation of participants to complete a physical activity, something which was not observed for the CCFT. Furthermore, in contrast to CCFT, the performance in CTNFT was associated with the motives of participants for physical activity as well as the number of their motives. The study also shows that the two clinical tests present with low concurrent validity. Recommendations The results clearly demonstrate that the CTNFT is a tiring test dependent on the motivation of participants to complete an activity. Furthermore, the test seems to assess a different dimension of cervical muscle function in comparison with the CCFT. This suggests clinicians and researchers the CCFT as a better choice for the assessment of endurance of deep neck flexors because its selection could provide not only more valid and reliable recordings3, but also recordings which are only minimally influenced but the psychological dimensions of endurance of deep cervical muscles. Harris, K.D., Heer, D.M., Roy, T.C., Santos, D.M., Whitman, J.M., Wainner, R.S. (2005). Reliability of a measurement of neck flexor muscle endurance. Physical Therapy 85(12): 1349-1355. Jull G.A., O’Leary S.P. and Falla D.L. (2008). Clinical assessment of the deep cervical flexor muscles: the craniocervical flexion test. Journal of Manipulative and Physiological Therapeutics 31(7):525-533. Dimitriadis Z., Kapreli E., Strimpakos N., Oldham J. (2015). Clinical assessment of deep neck flexors: which test is best? International Journal of Therapy and Rehabilitation 22(10):458-459. Dimitriadis Z., Koustravas M. (2016). Development and reliability of a battery of clinical scales for the assessment of motives for physical activity. In proceedings of 30th Conference of Hellenic Scientific Society of Physical Therapy: Spine Symposium. Marousi: Greece. Table 1: Correlations between the motivation for completing a physical activity and the performance in the two clinical tests for the endurance of deep neck flexors. VAS Motivation ASCUPA CCFT rs = 0.33 rs = 0.12 CTNFT rs = 0.23 rs = 0.58** **p < 0.01 Participants considered CTNFT to be a more tiring and difficult test than what it was expected from the instructions in comparison with the CCFT (p < 0.05). Concurrent validity of the two clinical tests was very low as CTNFT was not significantly correlated with CCFT (rs = 0.16, p > 0.05). The association of the performance in each of the two clinical tests with each physical activity motive is analytically presented in Table 2. Purpose The examination of the association between the performance in two clinical tests for the endurance of deep neck flexors (CCFT and CTNFT) and the motivation and motives of participants to continue and complete physical activities. Table 2: Correlations between the physical activity motives and performance in Craniocervical Flexion Test (CCFT) and Chin Tuck Neck Flexion Test (CTNFT). a Motive CCFT CTNFT Ego / Competition rs = -0.33 rs = 0.16 Appearance rs = -0.12 rs = 0.12 Enjoyment rs = 0.07 rs = 0.32 Skill Improvement rs = -0.06 rs = 0.44* Affiliation rs = 0.007 rs = 0.37 Physical Condition rs = -0.02 rs = 0.20 Psychological Condition rs = -0.002 rs = 0.33 Economical/Professional rs = 0.08 rs = 0.48* Medical Condition rs = 0.01 rs = 0.62** Number of motives rs = 0.002 rs = 0.64** Participants A convenience sample of 21 healthy participants was recruited (males/females 13/8, age 21.1±1.37 years, height 1.74±0.08 metres, weight 69.76±12.55 kg, BMI 22.95±2.99 kg/m2). The participants were included if they a) were between 18-39 year old, b) did not have current neck pain or neck pain history the last year, c) did not have undergo surgeries of their spine or thorax, d) did not have known neuromusculoskeletal, cardiopulmonary, neurological, psychiatric conditions which could affect the measurements. The sample was recruited from the students of the Technological Education Institute of Athens and the local community in 2016. The study was approved by the Ethics Committee of the Technological Education Institute of Athens, Athens, Greece. References Figure 1: Two clinical tests for the endurance of deep neck flexors a) Craniocervical Flexion Test, b) Chin Tuck Neck Flexion Test b Results The correlations between the performance in the two clinical tests (CCFT and CTNFT) and the VAS motivation and ASCUPA are presented in Table 1. Participants reported 5.2±1.25 motives for physical activity (agree or highly agree), whereas their main motive for physical activity was their physical condition. VAS motivation was found equal to 7.17±1.81 mm. Participants’ recordings in VAS motivation and ASCUPA did not change after the completion of the study (p > 0.05). Contact details Dr Zacharias Dimitriadis ZachariasD@hotmail.com *p < 0.05, **p < 0.01