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Comparison of Cervical Range-of-Motion Restriction and Craniofacial Tissue-Interface Pressure With 2 Adjustable and 2 Standard Cervical Collars

Tescher, Ann N. RN, PhD; Rindflesch, Aaron B. PT, PhD; Youdas, James W. PT, MS; Terman, Ross W. CO; Jacobson, Therese M. RN, CNS; Douglas, Lisa L. RN, CNS; Miers, Anne G. RN, CNS; Austin, Christine M. RN; Delgado, Adriana M.; Zins, Savannah M. RN; Lahr, Brian D. MS; Pichelmann, Mark A. MD; Heller, Stephanie F. MD; Huddleston, Paul M. III MD

doi: 10.1097/BRS.0000000000001252
RANDOMIZED TRIAL
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Study Design. 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.

Summary of Background Data. 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.

Conclusion. 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.

Level of Evidence: 2

*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.

Address correspondence and reprint requests to Ann N. Tescher, RN, PhD, Department of Nursing, Mayo Clinic, 200 First St. SW, Rochester, MN 55905; E-mail: tescher.ann@mayo.edu

Received 21 July, 2014

Revised 24 August, 2015

Accepted 7 September, 2015

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

No funds were received in support of this work.

Relevant financial activities outside the submitted work: board membership, consultancy, employment.

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