title: Comparison of Cervical Range-of-Motion Restriction and Craniofacial Tissue-Interface Pressure With 2 Adjustable and 2 Standard Cervical Collars.
abstract: METHODS
  Randomized controlled trial.
  
  
  OBJECTIVE
  The aim of the study was to compare and contrast the restrictiveness and tissue-interface pressure (TIP) characteristics of 2 standard and 2 adjustable cervical collars.
  
  
  BACKGROUND
  This study compared the restrictiveness and TIP of 4 commercially available cervical collars (2 standard and 2 adjustable). Adjustable collars offer potential advantages of individualized fit for patients and decreased inventory for institutions. The overall goal was to determine whether the adjustable collars provided the same benefits of cervical range-of-motion (CROM) restriction as the standard collars without increasing TIP and risk of pressure-related complications.
  
  
  METHODS
  A total of 48 adult volunteer subjects (24 men and 24 women) were fitted with 4 collars (Aspen, Aspen Vista, Miami J, and Miami J Advanced) in random order. Data collection included assessment of CROM restrictiveness and measurement of TIP on the mandible and occiput in upright and supine positions. The experimental, repeated measures design stratified the sample by body mass index (BMI) and sex.
  
  
  RESULTS
  All collars restricted CROM as compared with no collar (P ≤ 0.001 each). Aspen was more restrictive than Aspen Vista and Miami J in 4 movement planes (P ≤ 0.003 each), but not significantly different from Miami J Advanced. The Miami J standard collar was associated with significantly lower peak TIPs on all sites and in all positions compared with Aspen (P ≤ 0.001), Miami J Advanced (P < 0.001), and Aspen Vista (P = 0.01 for mandible site and upright position, P < 0.001 for remaining sites and positions). Increased peak TIP correlated with high BMI across all collar types, but was significantly lower for the Miami J collar than the Aspen collar.
  
  
  CONCLUSIONS
  All collars, compared with no collar, significantly restricted CROM. Although the collar-to-collar comparisons were statistically significant, the differences may have little clinical significance in the acutely injured trauma patient. The Miami J standard collar had the lowest overall TIP in both sites and positions. Ongoing effort should be devoted to staff education in proper sizing and fit, particularly for patients with high BMI.
authors.affiliation: *Department of Nursing, Mayo Clinic, Rochester, Minnesota†Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota‡Division of Trauma, Critical Care and General Surgery, Mayo Clinic, Rochester, Minnesota§Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota¶Mayo School of Health Sciences, Physical Therapy Program, College of Medicine, Mayo Clinic, Jacksonville, Florida||Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida**Prosthetic Laboratories Inc., Rochester, Minnesota.
authors.forename: Ann N
authors.initials: AN
authors.lastname: Tescher
authors.forename: Aaron B
authors.initials: AB
authors.lastname: Rindflesch
authors.forename: James W
authors.initials: JW
authors.lastname: Youdas
authors.forename: Ross W
authors.initials: RW
authors.lastname: Terman
authors.forename: Therese M
authors.initials: TM
authors.lastname: Jacobson
authors.forename: Lisa L
authors.initials: LL
authors.lastname: Douglas
authors.forename: Anne G
authors.initials: AG
authors.lastname: Miers
authors.forename: Christine M
authors.initials: CM
authors.lastname: Austin
authors.forename: Adriana M
authors.initials: AM
authors.lastname: Delgado
authors.forename: Savannah M
authors.initials: SM
authors.lastname: Zins
authors.forename: Brian D
authors.initials: BD
authors.lastname: Lahr
authors.forename: Mark A
authors.initials: MA
authors.lastname: Pichelmann
authors.forename: Stephanie F
authors.initials: SF
authors.lastname: Heller
authors.forename: Paul M
authors.initials: PM
authors.lastname: Huddleston
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000503:physiopathology*; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009989:Orthotic Devices / Q000009:adverse effects* / Q000706:statistics & numerical data*; D003668:Pressure Ulcer; D016059:Range of Motion, Articular / Q000502:physiology*; D055815:Young Adult