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Effect of Different Pillow Designs on Promoting Sleep Comfort, Quality, & Spinal Alignment: A Systematic Review
Abstract
Introduction: Sleep is beneficial and necessary for nearly every tissue in and function of the human body. A lack of sleep can lead to many health hazards including depression, heart disease, obesity, hypertension, and diabetes. Utilizing an appropriate pillow can promote optimal spinal alignment, thus improving sleep quality and duration.
The purpose of this study was to analyze available literature and determine the level of evidence that different pillow parameters have (material, height, shape, and thermal properties) to promote and enhance sleep quality, spinal alignment, and to decrease waking symptoms.
Methods: Following detailed and systematic search in major ergonomics-related data bases (PubMed, CINAHL, Science Direct, & Google Scholar) by independent searchers applying systematized search processes, eleven articles qualified for inclusion in this review (309 participants). The methodological qualities of included articles were assessed by two independent raters utilizing the PEDro scale and the Modified PEDro Scale for Ergonomics Research (MPSER). Similarly, the authors utilized the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to evaluate the quality of evidence that these articles established.
Results: There is moderate evidence that some of the following pillow parameters could improve sleep quality/spinal alignment, and decreasing sleep-related neck pain. The parameters are; a latex pillow material, a contoured pillow design (higher sides to accommodate side sleepers and a lower, flattened middle to accommodate back sleepers), a seven to eleven centimeters height of the unloaded central part of the pillow, and a cooling surface.
Conclusion: Patients/clients are encouraged to consider as many of the above mentioned parameters as possible when choosing a new pillow that fits their individual needs of promoting sleep comfort.
... It is because of this discordance that the Modified PEDro Scale for Ergonomics Research was created. The Modified PEDro Scale for Ergonomics Research (MPSER) is an assessment tool created in order to assess more accurately the quality of research in the field of ergonomics [36]. In place of the traditional 10 score seen with the PEDro, the MPSER utilizes a seven-point scale that appraises more accurately the quality of ergonomics-based research [36]. ...
... The Modified PEDro Scale for Ergonomics Research (MPSER) is an assessment tool created in order to assess more accurately the quality of research in the field of ergonomics [36]. In place of the traditional 10 score seen with the PEDro, the MPSER utilizes a seven-point scale that appraises more accurately the quality of ergonomics-based research [36]. This is the reason why we decided to add MPSER tool to the quality assessment of our review. ...
... Each Randomized Control Trial that is included in the present systematic review was screened thoroughly to determine its methodological quality, using both the original PEDro scale and the Modified PEDro Scale for Ergonomics Research (MPSER). The utilization of both of these quality assessment tools leads to a more accurate determination of each methodological quality, as the MPSER scale assesses more accurately the quality of the selected articles in the field of ergonomics [36]. The quality scores of the included Randomized Control Trials were deemed appropriate for review. ...
Office workers often experience occupational musculoskeletal disorders. The aim of the current systematic review was to investigate the effectiveness of workplace exercise intervention on the oldest age group of office workers who have been reported in the literature so far, in terms of workability and well-being. Randomized Controlled Trials were used and the methodological guidelines of PRISMA were followed. The keywords used were: office workers, older, exercise intervention, workplace, microbreaks, workability and well-being. The databases searched were: PubMed, PEDro, ResearchGate, CINAHL, PsychINFO and Science Direct. PROSPERO ID: CRD42022329656. Five studies (total number of participants: 1190, mean age: 46,4) met the inclu-sion criteria. Their quality was deemed to be moderate to high, according to PEDro and MPSER scales. Workplace interventions of gradually increased strengthening and moderate stretching exercises, isometric positioning and postural reminders, either with or without supervision, result in decreasing musculoskeletal pain, disability, sick-leave from work and in the improvement of quality of life and physical activity of the middle-aged office workers, without negative impact on their workability. Despite the worldwide aging workforce, there is a knowledge gap due to research absence in the field of microbreak exercise interventions in the group of older office workers.
... In 2021, Radwan et al. conducted a systematic review to determine the level of evidence of different pillow parameters (material, height, shape, and thermal properties) for sleep quality, spinal alignment, and waking symptoms 14) . The review found that a latex pillow material, a contoured pillow design, a 7-11 cm pillow height, and a cooling surface had moderate evidence for improving sleep quality and spinal alignment, and decreasing sleep-related pain 14) . ...
... In 2021, Radwan et al. conducted a systematic review to determine the level of evidence of different pillow parameters (material, height, shape, and thermal properties) for sleep quality, spinal alignment, and waking symptoms 14) . The review found that a latex pillow material, a contoured pillow design, a 7-11 cm pillow height, and a cooling surface had moderate evidence for improving sleep quality and spinal alignment, and decreasing sleep-related pain 14) . In the same year, Chun-Yiu et al. published a systematic review and meta-analysis on the effects of different pillow types on neck pain, waking symptoms, neck disability, sleep quality, and spinal alignment 15) . ...
... The Japanese version of the SSS-8 has been linguistically and psychometrically validated 22) . The total SSS-8 score (0-32) was categorized, as in Gierk et al. 20) , into the following five groups: no to minimal (0-3); low (4-7); medium (8)(9)(10)(11); high (12)(13)(14)(15); and very high (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32). ...
[Purpose] The purpose of this study was to determine whether strict adjustment of the pillow height using the Set-up for Spinal Sleep method improves clinical outcomes like neck pain and somatic symptoms. [Participants and Methods] A total of 84 participants with chief complaints of stiff shoulders and neck pain were evaluated using the numerical rating scale and the Somatic Symptom Scale-8. Questionnaires were used to collect data at the baseline, after two weeks, and after three months of adjusting the pillow height. [Results] Forty-two participants (50%) achieved the minimal clinically important difference for neck pain with a decrease of three points or higher in the numerical rating scale. The baseline neck pain scores were significantly higher in the group that achieved the minimal clinically important difference. The three-month change in neck pain and the Somatic Symptom Scale-8 was significantly greater in participants who were satisfied with treatment. There was a significant positive association between improvement in the numerical rating scale score and improvement in the Somatic Symptom Scale-8 at three months. [Conclusion] Strict adjustment of the pillow height using the Set-up for the Spinal Sleep method significantly improved both physical neck pain and somatic symptoms related to psychological and social problems.
... It has been claimed by pillow manufacturers that many designrelated pillow parameters are effective in improving sleep quality and reducing neck pain. However, most of these recommendations are based on personal experience [22,32]. ...
... In our study, the support and comfort levels provided to the spine by Pillow A, which is contour designed and produced from viscose material, remained not extremely higher than those provided by conventional pillows. This result may have occurred because the spinal alignments in individuals with FHP are different from normal posture [32]. As a result, Pillow A, produced from contour designed viscose material, is insufficient in terms of head comfort and back support for individuals with FHP. ...
Based on the pressure distributions in the head, neck, and upper body and the spine support values, this study aims to recommend the most suitable pillow for those with forward head posture (FHP) according to different sleeping positions. This descriptive cross-sectional study recruited thirty healthy 18- to 55-year-old men and women with body mass indexes of less than 30 kg/m². Participants tried five different pillows (viscose, fiber, cotton, goose feather, and wool) on a medium-firm hybrid mattress at room temperature with a humidity of 45–55%. Participants tried the pillows first in the supine position, then side-lying, and finally in the prone position. A pressure-mapping system was utilized to measure the pressure distributions of the head and shoulder areas in millimeters of mercury (mmHg) and the amount of support provided by the pillow to these regions in square centimeters (cm²). When the comfort and support parameters of different pillow materials were compared among all participants, for the supine position, Pillow B and Pillow E provided higher head comfort (p < 0.001), while Pillow A and Pillow E provided higher shoulder support (p = 0.044). In the side-lying position, Pillow B provided higher head comfort (p < 0.001) and Pillow C (p = 0.003) higher shoulder comfort. In the prone position, Pillow B and Pillow E provided higher head comfort (p < 0.001), while Pillow E also provided higher shoulder support (p = 0.002). This study showed pillow materials affect the spine comfort and support of the participants, and these values may vary according to different spinal alignments, such as FHP. According to the preferred sleeping position, the pillow material that supports the spine and its comfort and support values may also change.
... Additionally, the sleeping support can be produced fr various materials, such as cotton, polyester, foam, feather, and latex. Different materi impact both sleep time and sleep quality [15]. Future studies may consider evaluating differences between different types or brands of sleeping supports. ...
... Additionally, the sleeping support can be produced from various materials, such as cotton, polyester, foam, feather, and latex. Different materials impact both sleep time and sleep quality [15]. Future studies may consider evaluating the differences between different types or brands of sleeping supports. ...
Simple Summary
Due to technical limitations, few studies on the supine position have focused on spinal curvature measurement. This study used a novel technique to measure spinal curvature in the supine position and obtain intervertebral disc pressures through computational simulation. The results revealed an increased craniocervical height when lying on a soft mattress, leading to significantly increased cervical disc loading. The lumbar lordosis was reduced when using the hard mattress, and contact pressure significantly increased. Thus, a medium mattress appeared to be more suitable to use. In cases where a soft mattress is used, the use of a softer or thinner pillow should be considered.
Abstract
Sleeping support systems can influence spinal curvature, and the misalignment of the spinal curvature can lead to musculoskeletal problems. Previous sleep studies on craniocervical support focused on pillow variants, but the mattress supporting the pillow has rarely been considered. This study used a cervical pillow and three mattresses of different stiffnesses, namely soft, medium, and hard, with an indentation load deflection of 20, 42, and 120 lbs, respectively. A novel electronic curvature measurement device was adopted to measure the spinal curvature, whereby the intervertebral disc loading was computed using the finite element method. Compared with the medium mattress, the head distance increased by 30.5 ± 15.9 mm, the cervical lordosis distance increased by 26.7 ± 14.9 mm, and intervertebral disc peak loading increased by 49% in the soft mattress environment. Considering that the pillow support may increase when using a soft mattress, a softer or thinner pillow is recommended. The head distance and cervical lordosis distance in the hard mattress environment were close to the medium mattress, but the lumbar lordosis distance reduced by 10.6 ± 6.8 mm. However, no significant increase in intervertebral disc loading was observed, but contact pressure increased significantly, which could cause discomfort and health problems.
... Moreover, having a comfortable mattress can reduce stress by allowing the body enough time to recover and repair during deep sleep (Forth, 2023). Furthermore, using the correct pillow can ensure proper spinal alignment, enhancing sleep quality and duration (Radwan et al., 2021). Peters (2024) emphasizes that creating a suitable sleep environment by considering various factors can improve sleep quality, leading to a more productive day. ...
To maintain overall health and well-being, one must practice good sleep hygiene. However, the literature has not sufficiently addressed the relationship between Sleep Hygiene and Mood States. This study evaluated the association between Sleep Hygiene Practices and Mood States, including the influencing factors. This study utilized a descriptive-predictive research design on 350 college students in the chosen University in Davao Region through simple random sampling. The researchers used the Shapiro-Wilk Test, which indicates normally distributed data with a p <0.05. The study analyzed the relationship between Sleep Hygiene and Mood States using Pearson’s Correlation Coefficient, revealing a significant positive correlation coefficient of r =.439 and a p of <.001, suggesting that if the Sleep Hygiene practices of students are high, the Mood States is also high. Furthermore, linear regression revealed that bedroom factors and behaviors that affect sleep are the predictors that contribute to the students’ mood states. The study recommends implementing policies to promote a healthy campus environment, prioritizing healthy sleep habits for students and teachers, and for future researchers to advocate for broader, longitudinal studies to enhance understanding and validity.
... The quality of the six reviewed articles was assessed utilizing the Physical Therapy Evidence Database (PEDro) scale (De Morton, 2009) and the modified PEDro Scale for Ergonomics Research (MPSER; Radwan et al., 2021). The PEDro scale is used as a validated measure for assessing the quality of clinical trials. ...
Risk factors associated with sedentary work and prolonged sitting time can be detrimental to office workers’ health and productivity. Recent literature introduced the concept of active microbreaks and their benefits to sedentary workers. The purpose of this study was to better define active microbreaks and to determine the evidence behind utilizing active microbreaks at work, through a qualitative synthesis of the literature in a systematic review. A comprehensive systematic search was conducted using primarily ergonomics, medicine and allied health databases, in addition to grey literature (CINAHL, Google Scholar, PubMed, and ScienceDirect) and respective ergonomics journals. Six interventional controlled trials (232 total participants) met the inclusion criteria and qualified for the inclusion in this review. The quality of the reviewed articles was deemed to be moderate to high according to the utilized assessment scales. The results of this review may support the use of short active microbreaks (2–3 minutes of light intensity exercises every 30 minutes) due to the observed physical and mental health benefits without negative impact on productivity in the workplace.
... Other studies related to the importance of pillows for patients with musculoskeletal complaints are advised to consider the size of the pillow when buying a new pillow and adjust it to the patient's needs to increase comfort and improve sleep quality. 14,15 The innovations are tailored to end-stage renal disease patients undergoing HD therapy. In addition, patients' comfort is one of the nurse's duties. ...
Background: The hemodialysis process that takes 4 to 5 hours may lead to various problems, including arms' fatigue on the forearm with attached Cimino access. A technique is required to overcome this fatigue.
Technique: By using a supportive hand pillow made by adjusting the position of the elbow and the length of the arm. The pillow is placed under the patient's forearm with Cimino access. Trial usage of this pillow was conducted on two persons for two cycles of hemodialysis. Both stated that arm fatigue was reduced and more comfortable.
Conclusion: Using hand pillows for hemodialysis patients is favorably beneficial to reduce forearm fatigue during the Intradialytic phase.
... However, subjective evaluation is easily affected by age, gender, individual perception, and long-term sleeping habits, which makes the conclusion disputable and unreliable. In addition to subjective evaluation, pillow height has also been shown to affect cervical spine alignment, pressure distribution in the cranial and cervical regions, as well as muscle activity of the neck and shoulder [16]. Firstly, the ideal pillow height can maintain the physiological curvature of the cervical spine by providing adequate support for the head and neck [17]. ...
(1) Background: Sleep problems have become one of the current serious public health issues. Pillow height affects the alignment of the cervical spine and is closely related to the mechanical environment of the cervical spine. An appropriate pillow height can provide adequate support for the head and neck to reduce the stress in the cervical spine and relax the muscles of the neck and shoulder, thereby relieving pain and improving sleep quality. (2) Methods: We reviewed the current trends, research methodologies, and determinants of pillow height evaluation, summarizing the evidences published since 1997. In particular, we scrutinized articles dealing with the physiological and mechanical characteristics of the head-neck-shoulder complex. (3) Results: Through the investigation and analysis of these articles, we presented several quantitative and objective determinants for pillow height evaluation, including cervical spine alignment, body dimension, contact pressure, and muscle activity. The measurement methods and selection criteria for these parameters are described in detail. However, the suggested range for achieving optimal cervical spine alignment, appropriate pressure distribution, and minimal muscle activity during sleep cannot yet be identified considering the lack of sufficient evidence. Moreover, there remain no firm conclusions about the optimal pillow height for the supine and lateral positions. (4) Conclusions: A comprehensive evaluation combining the above determinants provides a unique solution for ergonomic pillow design and proper pillow height selection, which can effectively promote the public sleep health. Therefore, it is necessary to develop a reasonable algorithm to weigh multiple determinants.
Neck pain (NP) is a common worldwide problem. In recent years, neck pain among young people has become especially important. Hypodynamia, biomechanical disorders and incorrect ergonomics of the workplace are common causes of neck pain among office workers and students. Kinesiotherapy is widely used for treatment and prevention of NP. This is a complex therapeutic and preventive measure with combination of gymnastics, ergonomics of work and everyday life taking into account the peculiarities of anatomy and biokinematics. Cervical spine biomechanics is extremely complex. Clinical significance of physical and instrumental examination of cervical spine is limited. Correct posture is optimal balance with minimal stress on musculoskeletal structures. The authors consider ergonomically justified parameters of work at the computer and during sleep, as well as methods of posture modeling. Different exercises have a positive effect on neck pain and disability. Physical training affects all components of pain, not just local source of nociception. At present, no significant differences in effectiveness of different therapeutic physical trainings (TPT) have been found. The proposed complexes of specialized exercises for the neck are speculative in nature and based on some general assumptions that have little correlation with real biokinematics. Available clinical guidelines do not provide specific recommendations regarding the type and dosage of exercise. Adherence to TPT is important for treatment outcomes. Combination of ergonomic interventions and workplace exercise can reduce NP and increase productivity among office workers in long-term period. Prospects for increasing the effectiveness of kinesiotherapy using mobile applications are discussed.
Background
Using an appropriate pillow in terms of shape and content is necessary to maintain the neck’s natural posture and to eliminate biomechanical stresses, particularly uncomfortable muscular activity.
Objectives
This study evaluated four different types of pillows regarding their traditional shapes (rectangular and cylindrical) and contents (memory foam and wool).
Methods
For each of the pillow conditions, bilateral sternocleidomastoid (SCM) and upper trapezius (UT) EMG activity and perceived comfort were recorded from ten healthy participants (5 male and 5 female) during 30-min sleeping tests in each of the supine and lateral positions.
Results
For both materials (wool/memory foam), the rectangular pillows felt more comfortable in the supine position, and the cylindrical ones provided more comfort in the lateral position. A significantly reduced muscular activity for the right UT muscle was recorded during sleep with rectangular pillows in the supine position. In the lateral position, Left UT and bilateral SCM muscles indicated significantly lower EMG values with cylindrical pillows.
Conclusions
The results suggested that pillow shape plays a crucial role in the management of neck muscle activation and perceived comfort according to the sleeping position. Furthermore, wool as a viable alternative to memory foam requires support from additional future studies.
An optimal pillow effectively increases sleep quality and prevents cervical symptoms. However, the influence of body dimension on optimal pillow design or selection strategy has not been clarified quantitatively. This study aims to investigate the individualized optimal pillow height and neck support for side sleepers. Nine healthy subjects were recruited and laid laterally on foam-latex pillow with four height levels (8 cm, 10 cm, 12 cm, 14 cm) and with/without neck support, respectively. Healthiness was evaluated using cervical spine morphology (measured by motion capturing system) and musculoskeletal internal force (simulated by a multi-body model). Comfortability was evaluated by a deviation standardized overall comfort rating. Individualized pillow height was identified by Hφ (calculated by the subject’s shoulder width and absolute pillow height). Correlation analysis and linear mixed model were performed between C1-T1 slope and Hφ. A paired-t test was performed on the cervical curve and comfort score comparisons between neck support pillow and flat pillow. The C1-T1 slope of the cervical curve showed statistically significant correlation to Hφ and was well predicted by Hφ through linear relation (R2 = 0.80 for flat pillow, R2 = 0.82 for neck support pillow). The correlation between comfort score and Hφ was moderate or weak. Medium individualized height pillow (Hφ 9.74–11.76 cm) with neck support showed a cervical curve closest to natural standing and the lowest musculoskeletal internal force. Sub-low individualized height pillow (Hφ 11.76–13.78 cm) with neck support showed the highest average comfort score. For side sleepers, cervical curve morphology and optimal individualized pillow height are well predicted by Hφ. Comfortability perception is not sensitive to Hφ. Sub-low individualized height pillow showed the best comfortability and relatively good healthiness. Medium individualized height pillow with neck support showed the best healthiness.
The fundamental function of an optimal cervical pillow is to provide sufficient support to maintain normal spinal alignment and minimize biological stress on the contact surface throughout sleep. The recent advancements in cervical pillows have mainly focused on the subjective and objective evaluations of support comfort, as well as the relationship between pillow height and cervical vertebrae posture. However, only a few studies have addressed shape design guidelines and mechanical performances of the pillows themselves. In this study, a two-sectional contour cervical pillow comprising an arc and a Bezier curve is designed to support the head and neck. The design of the arc-shaped neck section incorporates the Cobb's angle and Borden value from healthy individuals to reflect the consistency of normal cervical anatomical features. The Bezier curve-based head section takes the head length and neck depth into account as significant individual differences. Static analysis and lattice optimization are performed in ANSYS Workbench to develop a variable-density cellular structure, aimed at improving air permeability and reducing the risk of pressure ulcers associated with the cervical pillow. The rapid prototyping technique fused deposition modeling (FDM) and thermoplastic material polylactic acid (PLA) are employed for fabricating different cellular structures. The results demonstrate that the neck section experiences less stress and greater deformation in comparison to the head section, indicating good comfort and support provided by the designed cervical pillow. Additionally, the compressive, bending, and cushion properties of the 3D-printed cervical pillow with variable-density cellular structure are experimentally validated, further confirming its effectiveness.
The vector forces at the human-mattress interface are not only crucial for understanding the distribution of vertical and shear forces exerted on the human body during sleep but also serves as a significant input for biomechanical models of sleeping positions, whose accuracy determines the credibility of predicting musculoskeletal system loads. In this study, we introduce a novel method for calculating the interface vector forces. By recording indentations after supine and lateral positions using a vacuum mattress and 3D scanner, we utilize image registration techniques to align body pressure distribution with the mattress deformation scanning images, thereby calculating the vector force values for each unit area (36.25 mm × 36.25 mm). This method was validated through five participants attendance from two perspectives, revealing that (1) the mean summation of the vertical force components is 98.67% ± 7.21% body weight, exhibiting good consistency, and mean ratio of horizontal component force to body weight is 2.18% ± 1.77%. (2) the predicted muscle activity using the vector forces as input to the sleep position model aligns with the measured muscle activity (%MVC), with correlation coefficient over 0.7. The proposed method contributes to the vector force distribution understanding and the analysis of musculoskeletal loads during sleep, providing valuable insights for mattress design and evaluation.
Background: Sleep is a critical factor in maintaining good health, and its impact on various diseases has been recognized by scientists. Understanding sleep patterns and quality is crucial for investigating sleep-related disorders and their potential links to health conditions. The development of non-intrusive and contactless methods for analyzing sleep data is essential for accurate diagnosis and treatment. Methods: A novel system called the sleep visual analyzer (VSleep) was designed to analyze sleep movements and generate reports based on changes in body position angles. The system utilized camera data without requiring any physical contact with the body. A Python graphical user interface (GUI) section was developed to analyze body movements during sleep and present the data in an Excel format. To evaluate the effectiveness of the VSleep system, a case study was conducted. The participants’ movements during daytime naps were recorded. The study also examined the impact of different types of news (positive, neutral, and negative) on sleep patterns. Results: The system successfully detected and recorded various angles formed by participants’ bodies, providing detailed information about their sleep patterns. The results revealed distinct effects based on the news category, highlighting the potential impact of external factors on sleep quality and behaviors. Conclusions: The sleep visual analyzer (VSleep) demonstrated its efficacy in analyzing sleep-related data without the need for accessories. The VSleep system holds great potential for diagnosing and investigating sleep-related disorders. The proposed system is affordable, easy to use, portable, and a mobile application can be developed to perform the experiment and prepare the results.
This chapter first discusses what a pillow is, then defines pillow therapy and explains the purpose of sleep posture adjustment. We will explain how orthopedic surgeons and other clinicians should integrate pillow therapy into their daily practice. Conversely, it is important to know the limitations of pillow therapy to understand the correct use.We will also present the timing for determining the effectiveness of pillow therapy, or other possible causes in cases not improved with pillow alone. Pillow therapy has three needs, i.e., social, patient, and physician needs. Even though there are differences in social and medical conditions and diseases in each country or region, these needs for pillow therapy always exist.Next, we compare research on pillow around the world with those in Japan. The term “Cervical Pillow” has been spontaneously created without clear-cut definition and is being overused. We discuss how such research has influenced the currently marketed pillows.We outline the history of our own pillow research and pillow-based empiric therapy and help you to imagine what our outpatient pillow clinic, named “ The Pillow Clinic,” doing the therapy.KeywordsPillowPillow therapyRuth Jackson MDCervical pillowThe pillow clinicEmpiric therapy
Background: Cervical pillows are considered to be part of the therapeutic strategy in cervical spondylosis, but there is little or no convincing scientific evidence on the effectiveness of these pillows in relieving pain and disability in these patients. Hence, this study investigated the effects of ergonomic latex pillow in conjunction with routine physiotherapy versus routine physiotherapy alone on disability and pain intensity in patients with cervical spondylosis.
Methods: 22 patients with cervical spondylosis in a single-blinded pilot study with a pre/post-test design were randomly assigned to experimental and control groups. Both groups received 12 sessions of physiotherapy for four weeks. In the experimental group, participants were given an ergonomic latex pillow to sleep it for four weeks. Participants in the control group slept on their own usual pillow. All the participants filled out the Neck Disability Index questionnaire, and scored their neck pain intensity on the Numerical Pain Rating Scale before and after the intervention. Changes of variables (pain and disability) within and between groups were compared by Paired T-test and the Independent Sample T-test, respectively via SPSS v.20 (p<0.05).
Results: Numerical Pain Rating Scale and Neck Disability Index scores were decreased statistically significant within groups. In the experimental group, neck disability scores were significantly lower than those in the control group (p=0.038). However, pain intensity scores were not significantly different between groups.
Conclusion: Ergonomic latex pillows can significantly decrease disability related to neck pain in patients with cervical spondylosis after four weeks.
[Purpose] The aim of this study was to examine the changes in sternocleidomastoid muscle (SCM) activity when using a cervical support pillow (CSP) and to determine the pillow's effect on satisfaction in asymptomatic participants. [Subjects and Methods] This study followed a cross-over design and the order of the measurements was counterbalanced. Twenty asymptomatic participants were positioned supine for 5 minutes by using either a CSP or a general pillow (GP) while the activity of the SCM was measured using surface electromyography. [Results] The CSP significantly decreased the activity of the SCM compared with the GP, and satisfaction after use of the CSP was significantly greater than that after use of the GP. [Conclusion] This study suggests that the CSP may be effective in preventing unnecessary neck muscle activation during sleep in asymptomatic people.
Background
While appropriate pillow height is crucial to maintaining the quality of sleep and overall health, there are no universal, evidence-based guidelines for pillow design or selection. We aimed to evaluate the effect of pillow height on cranio-cervical pressure and cervical spine alignment.
Methods
Ten healthy subjects (five males) aged 26 ± 3.6 years were recruited. The average height, weight, and neck length were 167 ± 9.3 cm, 59.6 ± 11.9 kg, and 12.9 ± 1.2 cm respectively. The subjects lay on pillows of four different heights (H0, 110 mm; H1, 130 mm; H2, 150 mm; and H3, 170 mm). The cranio-cervical pressure distribution over the pillow was recorded; the peak and average pressures for each pillow height were compared by one-way ANOVA with repeated measures. Cervical spine alignment was studied using a finite element model constructed based on data from the Visible Human Project. The coordinate of the center of each cervical vertebra were predicted for each pillow height. Three spine alignment parameters (cervical angle, lordosis distance and kyphosis distance) were identified.
Results
The average cranial pressure at pillow height H3 was approximately 30% higher than that at H0, and significantly different from those at H1 and H2 (p < 0.05). The average cervical pressure at pillow height H0 was 65% lower than that at H3, and significantly different from those at H1 and H2 (p < 0.05). The peak cervical pressures at pillow heights H2 and H3 were significantly different from that at H0 (p < 0.05). With respect to cervical spine alignment, raising pillow height from H0 to H3 caused an increase of 66.4% and 25.1% in cervical angle and lordosis distance, respectively, and a reduction of 43.4% in kyphosis distance.
Discussion
Pillow height elevation significantly increased the average and peak pressures of the cranial and cervical regions, and increased the extension and lordosis of the cervical spine. The cranio-cervical pressures and cervical spine alignment were height-specific, and they were believed to reflect quality of sleep. Our results provide a quantitative and objective evaluation of the effect of pillow height on the biomechanics of the head-neck complex, and have application in pillow design and selection.
A commonly held view is that extended wakefulness is causal for a broad spectrum of deleterious effects at molecular, cellular, network, physiological, psychological, and behavioral levels. Consequently, it is often presumed that sleep plays an active role in providing renormalization of the changes incurred during preceding waking. Not surprisingly, unequivocal empirical evidence supporting such a simple bi-directional interaction between waking and sleep is often limited or controversial. One difficulty is that, invariably, a constellation of many intricately interrelated factors, including the time of day, specific activities or behaviors during preceding waking, metabolic status and stress are present at the time of measurement, shaping the overall effect observed. In addition to this, although insufficient or disrupted sleep is thought to prevent efficient recovery of specific physiological variables, it is also often difficult to attribute specific changes to the lack of sleep proper. Furthermore, sleep is a complex phenomenon characterized by a multitude of processes, whose unique and distinct contributions to the purported functions of sleep are difficult to determine, because they are interrelated. Intensive research effort over the last decades has greatly progressed current understanding of the cellular and physiological processes underlying the regulation of vigilance states. Notably, it also highlighted the infinite complexity within both waking and sleep, and revealed a number of fundamental conceptual and technical obstacles that need to be overcome in order to fully understand these processes. A promising approach could be to view sleep not as an entity, which has specific function(s) and is subject to direct regulation, but as a manifestation of the process of metaregulation, which enables efficient moment-to-moment integration between internal and external factors, preceding history and current homeostatic needs.
Systematic reviews should build on a protocol that describes the rationale, hypothesis, and planned methods of the review; few reviews report whether a protocol exists. Detailed, well-described protocols can facilitate the understanding and appraisal of the review methods, as well as the detection of modifications to methods and selective reporting in completed reviews. We describe the development of a reporting guideline, the Preferred Reporting Items for Systematic reviews and Meta-Analyses for Protocols 2015 (PRISMA-P 2015). PRISMA-P consists of a 17-item checklist intended to facilitate the preparation and reporting of a robust protocol for the systematic review. Funders and those commissioning reviews might consider mandating the use of the checklist to facilitate the submission of relevant protocol information in funding applications. Similarly, peer reviewers and editors can use the guidance to gauge the completeness and transparency of a systematic review protocol submitted for publication in a journal or other medium.
There are many ways to measure sleep quality, in which sleep disruptive events are included. To improve sleep quality, it is important to reduce sleep disruptive events such as snoring, apnea, and neck pain resulting to waking symptoms. Few studies have researched on both reducing snoring and relieving neck pains on pillow design. Thus the purpose of this paper is to investigate the relationship between pillow shapes and reducing snoring, as well as preventing neck pains, so as to improve sleep quality. 3 anti-snore pillows and neck-pain-relieving pillows are chosen to be tested for 3 nights on the relationship between the pillows’ shapes and the subjects’ sleep quality. Ten males and females aged between 40 to 60 participated in this experiment. The sound of snoring was recorded, and the head and neck motions were monitored by a pressure mat during the whole night. This study used ActiGraph to test the subjects’ objective sleep quality. After subjects woke up, a series of subjective evaluation scale, including the Pittsburgh Sleep Quality Index, Snore Outcomes Survey and the subjective evaluation scale of neck pain, were taken to know the subjects’ subjective sleep quality and neck pain condition. Then I formed a morphological chart based on literature review and used the data got from the pressure mat accompany with a focus group to determine a pillow to enhance the sleep quality of middle-aged groups. After determining a redesigned pillow, I conducted a 6 nights’ experiment to evaluate the product. The method is the same as the first stage experiment. In this experiment, we know our design's pros and cons, and thus provide us with guidelines to determine a pillow revision. This study investigated the sleep quality of particular users and redesigned features of a pillow to enhance the sleep quality of middle-aged groups.
[Purpose] The purpose of this study is to examine changes in pulmonary functions in relation to the sleeping positions of the experimental subjects. [Subjects and Methods] The subjects for this study were twenty randomly selected males and females from K University. Measurements were taken in the supine position at three different pillow heights: 0 cm, 5 cm, and 10 cm. Pulmonary functions (vital capacity, tidal volume, inspiratory reserve volume, and expiratory reserve volume) were evaluated using a Fit mate. [Results] These findings suggest that a pillow height of 5 cm makes a significant difference in vital capacity (VC). When the three pillow heights were compared, significant differences were seen between 0 cm and 5 cm, and between 5 cm and 10 cm, in terms of vital capacity for the pulmonary functions among the three positions. [Conclusion] In conclusion, changing the positions of the subjects produces changes in pulmonary functions. The greatest change occurred in the 5 cm pillow height. Presumably, ventilation is affected by the body structures. The results will provide objective data to establish the most suitable positions for stroke patients when they perform respiratory exercises.
Objective:
To investigate the effect of different pillow heights on the slope of the cervicothoracic spine segments.
Methods:
A prospective analysis of data from 16 asymptomatic adults (aged 20 to 30 years) was carried out. Exclusion criteria were history of injury or accident to the cervicothoracic spine, cervicothoracic spine surgery, or treatment for neck symptoms. We used three different pillow heights: flat (0 cm), 10-cm, and 20-cm pillows. Cervical sagittal parameters, measured with radiography, included; C2-7 Cobb's angle, T1 slope (T1S), thoracic inlet angle (TIA), and neck tilt (NT). Statistical analyses were performed using Spearman correlation coefficients.
Results:
As the height of the pillow increased, the T1S & C2-7 Cobb's angle increased while the NT values tended to decrease. The TIA values, however, remained constant. Additionally, there was a statistically significant sex difference in T1S with the 0-cm pillow (p=0.01), and in NT with the 20-cm pillow (p=0.01).
Conclusion:
From the data obtained in this study, we recommend that the most suitable pillow height is 10 cm, considering the normal cervical lordosis.
Purpose:
Quality of life in women receiving adjuvant endocrine therapy for breast cancer (BC) may be impaired by hot flushes and night sweats. The cool pad pillow topper (CPPT) is a commercial product, promoted to improve quality of sleep disrupted by hot flushes. This study aimed to identify if the CPPT reduces severity of sleep disturbance by minimising effects of hot flushes.
Methods:
This randomised phase II trial, recruited women with BC, on adjuvant endocrine therapy, experiencing hot flushes and insomnia. Participants were randomised (stratified by baseline sleep efficiency score (SES) and menopausal status) to the intervention arm (CPPT + standard care) or control arm (standard care). Participants completed Hospital Anxiety and Depression Scale and Functional Assessment of Cancer Therapy-Breast (FACT-B) questionnaires and fortnightly sleep/hot flush diaries (where responses were averaged over 2-week periods). The primary endpoint was change in average SES from -2 to 0 weeks to 2 to 4 weeks.
Results:
Seventy-four pre- (68.9 %) and post-menopausal (31.1 %) women were recruited. Median age was 49.5 years. Endocrine therapies included tamoxifen (93.2 %). Median SES at weeks 2 to 4 improved in both arms but the increase on the intervention arm was almost twice that on the control arm (p = 0.024). There were significantly greater reductions in hot flushes and HADS depression in the intervention arm (p = 0.09 and p = 0.036, respectively). There were no significant differences in FACT-B or HADS anxiety.
Conclusion:
This study supports the use of the CPPT as an aid to reduce sleep disturbance and the frequency/severity of hot flushes.
The purpose of this study was to evaluate the comfort and the electromyographic (EMG) activity of the neck and mid-upper back of asymptomatic adults using foam pillows of 3 different heights.
Twenty-one asymptomatic adults used foam pillows of 3 different heights (1: 5 cm, 2: 10 cm, and 3: 14 cm). Comfort was assessed using a 100-mm visual analog scale. Electromyographic activity was assessed in the lateral position. We calculated the root mean square (RMS) in 500-millisecond windows of bilateral EMG activity of the sternocleidomastoid and upper and middle trapezius, normalized by maximal isometric contraction of each individual. The RMS of the EMG signals was compared among pillow heights using repeated-measures analysis of variance (P < .05).
The middle trapezius muscle of the down-side showed the highest RMS in height 1 when compared with heights 2 (P = .0163) and 3 (P = .0313), with no statistical significance between pillow heights 2 and 3 for this muscle. There were no statistical differences between pillows 2 and 3 in any muscle activity. Height 2 was considered the most comfortable (P < .001) compared with heights 1 and 3, and height 1 the least comfortable (P < .001) compared with the other heights.
For the participants in this study, there was an association among pillow height, myoelectric activity, and comfort.
Copyright © 2015. Published by Elsevier Inc.
Chronic sleep deficiency, defined as a state of inadequate or mistimed sleep, is a growing and underappreciated determinant of health status. Sleep deprivation contributes to a number of molecular, immune, and neural changes that play a role in disease development, independent of primary sleep disorders. These changes in biological processes in response to chronic sleep deficiency may serve as etiological factors for the development and exacerbation of cardiovascular and metabolic diseases and, ultimately, a shortened lifespan. Sleep deprivation also results in significant impairments in cognitive and motor performance which increase the risk of motor vehicle crashes and work-related injuries and fatal accidents. The American Academy of Sleep Medicine and the Sleep Research Society have developed this statement to communicate to national health stakeholders the current knowledge which ties sufficient sleep and circadian alignment in adults to health.
Purpose: To describe the performance of the pillow that participants usually slept on with respect to retiring and waking cervico-thoracic symptoms, pillow comfort, and sleep quality.
Methods: Participants (n=106) were systematically recruited for a field trial comparing their own pillow and five trial pillows. Participants provided daily retiring and waking symptom reports and sleep-quality and pillow-comfort ratings prospectively for 1 week on each pillow. Linear and logistic regression models were used to investigate the relationship between pillow use, age, gender, sleep quality, pillow comfort, and waking and temporal (overnight) symptom reports.
Results: No waking symptoms were reported by 42.5% of participants on their own pillow. Regular waking symptoms, failure to relieve retiring symptoms, uncomfortable pillows, and/or poor-quality sleep were reported by over 50% of participants. All participants who reported poor sleep quality also reported poor pillow comfort. Pillow-comfort reports were not related to any waking symptom report; however, reports of poor sleep quality were significantly related to waking cervical stiffness (adjusted odds ratio [AOR]=4.3 [Confidence Interval (CI): 1.3–15.6]) and scapula pain (AOR=6.1 [CI: 1.1–31.6]). Feather pillow users provided consistently low reports of pillow comfort and sleep quality.
Conclusion: Many participants appear to have made poor pillow choices, as poor sleep quality, low pillow comfort, and waking symptoms were common. Further research is required to understand why people choose particular pillows to sleep on, as well as to identify the best fit between person and pillow to optimize sleep quality and reduce waking symptoms.
Background
Pillows are intended to support the head and neck in a neutral position to minimize biomechanical stresses on cervical structures whilst sleeping. Biomechanical stresses are associated with waking cervical symptoms. This paper adds to the scant body of research investigating whether different pillow types produce different types and frequencies of waking symptoms in asymptomatic subjects.
Methods
A random-allocation block-design blinded field trial was conducted in a large South Australian regional town. Subjects were side-sleepers using one pillow only, and not receiving treatment for cervicothoracic problems. Waking cervical stiffness, headache and scapular/arm pain were recorded daily. Five experimental pillows (polyester, foam regular, foam contour, feather, and latex) were each trialed for a week. Subjects’ ‘own’ pillow was the control (a baseline week, and a washout week between each experimental pillow trial week). Subjects reported waking symptoms related to known factors (other than the pillow), and subjects could ‘drop out’ of any trial pillow week.
Results
Disturbed sleep unrelated to the pillow was common. Waking symptoms occurring at least once in the baseline week were reported by approximately 20% of the subjects on their ‘own’ pillow. The feather trial pillow performed least well, producing the highest frequency of waking symptoms, while the latex pillow performed best. The greatest number of ‘drop outs’ occurred on the feather pillow. The foam contour pillow performed no better than the foam regular pillow.
Conclusion
‘Own’ pillows did not guarantee symptom-free waking, and thus were a questionable control. The trial pillows had different waking symptom profiles. Latex pillows can be recommended over any other type for control of waking headache and scapular/arm pain.
Background:
In people without cervical pathologies, changing to a latex or polyester pillow is reported to decrease waking cervical symptoms. Whether this also occurs for people with spinal degeneration in the neck is unknown.
Aim:
This pilot study tested recruitment strategies for people with cervical spine degeneration, and the effect of different pillows on cervical waking symptoms, sleep quality, cervical range of motion, neck disability index and quality of life.
Design:
A randomized sequential-block double-blind controlled trial.
Setting:
A community-based study.
Population:
Adult volunteers (18+ years) with regular waking cervical symptoms (headache, cervical pain and/or stiffness, scapular pain), confirmed radiologic evidence of cervical spine degeneration, side sleeper and "usual" use of one pillow.
Methods:
Participants were recruited, through community advertising at medical and physiotherapy practices, local community groups, and via newspaper, radio and websites. After screening for eligibility, they tested latex and polyester pillows for 28 days each, interspersed with 28 days on "usual" pillow for washout, and comparison. Subjects ceased using a trial pillow if it affected sleep quality or waking symptoms. Cervical range of motion, neck disability index and quality of life were measured pre-post each pillow trial, whilst waking symptoms and sleep quality were assessed daily.
Results:
Of 117 local volunteers, 92 had radiologically-confirmed cervical spondylosis, and a further 45 (48.9%) were excluded for medical conditions, sleep position and/or pillow use. Approximately 70% "usual" pillows were polyester. Overall no pillow significantly altered any outcome measure. Considering trends however, the polyester pillow significantly increased side flexion range of movement on waking and showed some effect on nocturnal-waking cervical pain. The latex pillow did not perform well on any outcome measure. Significantly more subjects completed the polyester pillow trial than the latex pillow trial (post-hoc power 80% vs. 55%).
Conclusions:
Well-powered studies to truly detect pillow impact on waking symptoms and sleep quality require 400+ symptomatic subjects.
Clinical rehabilitation impact:
It has previously been reported that using a latex or polyester pillow significantly improves waking cervical symptoms in the general population. This pilot study did not replicate these results in people with known cervical spine degeneration.
Background:
Different types of pillows have been proposed for neck pain, but no previous randomized controlled trial has investigated the effectiveness of a "spring pillow" for adults with chronic nonspecific neck pain.
Objective:
We evaluated the effectiveness of using a pillow made from viscoelastic polyurethane and 60 independent springs compared with an educational intervention in individuals with chronic nonspecific neck pain.
Design:
This was a randomized controlled trial with crossover study design.
Setting:
The setting was the Occupational Medicine Unit, University Hospital, Bologna (Italy).
Participants:
We recruited 70 adults with chronic nonspecific neck pain, of whom 64 completed the trial.
Intervention:
Participants were randomly assigned to 2 groups. One group used the spring pillow for 4 weeks, and the other group followed educational advice for 4 weeks while continuing to use their own pillows. After 4 weeks of treatment and 4 weeks of washout, groups were crossed over. Pain perceived in the neck, thoracic, and shoulder areas and headache were the primary outcome measures. In addition, disability, sleep quality, subjective improvement, and pillow comfort were assessed. Measures were captured at pretreatment, after 4 weeks, after the 4-week washout period, and 4 weeks after crossover. The mean differences (MD) in outcomes between groups were assessed.
Results:
Treatment with the spring pillow appeared to reduce neck pain (MD = -8.7; 95% confidence interval [CI] = -14.7 to -2.6), thoracic pain (MD = -8.4; 95% CI = -15.2 to -1.5), and headache (MD = -16.0; 95% CI = -23.2 to -8.7). Reductions in shoulder pain were not statistically significant between groups (MD = -6.9; 95% CI = -14.1-0.3). Neither the crossover sequence nor the period (first vs second intervention administration) significantly affected the results.
Limitations:
Education may not have been the best comparator for the spring pillow; drug consumption, actual pillow use, and the implementation of the educational suggestions as prescribed were not controlled.
Conclusions:
Use of the spring pillow in this study was more effective than an educational intervention for improving cervical, thoracic, and head pain. Whether a spring pillow is more effective than other ergonomic pillows remains to be tested.
Objective: The aim of this study was to evaluate the effectiveness of 3 dimensional contoured pillow through analyzing contact pressure and to suggest its design guidelines through analyzing the posture of head and neck area. Background: The quality of sleep is a very important factor closely related with human`s health. To improve the quality of sleep, the verification of design factors affecting the posture of the head and neck is needed, and a pillow design that can induce proper posture is required. Method: This study measured the contact pressures of the two reference groups (bead and cotton pillows) as a method to evaluate the design effectiveness of the contoured pillow. This study proposed 3-dimensional design guidelines by drawing anthropometry (head length) affecting cervical curvature angle (CCA) through the measurement of the participants` cervical curvature angles. Results: In the design effectiveness evaluation, the contact pressure of cervical region was higher than that of a reference group (cotton pillow), and contract area increased, and contract pressure decreased in the shape distributing the occipital region`s body pressure. This study proposed pillow`s cervical supporting height by percentile of a head length [head length (%tile) (cervical supporting height) affecting the posture of the head and neck: 14.6cm (5%tile) (6.2cm), 15.5cm (25%tile) (6.7cm), 16.4cm (50%tile) (7.1cm), and 19.3cm (75%tile) (8.9cm)]. Conclusion: This study confirmed the contoured pillow`s design effectiveness maintaining cervical angle comfortable to sleep with the shape supporting the cervical vertebrae and by reducing the contact load of the occipital region. Also, this study proposed pillow design guidelines based on the 3-dimensional contoured pillow design effectiveness, through which the study laid the foundation for pillow design in a systematic method. Application: The results of this study are expected to be utilized as the basis data by which the optimum pillow type and pillow design according to main percentile can be standardized.
Editor's Note: PTJ's Editorial Board has adopted PRISMA to help PTJ better communicate research to physical therapists. For more, read Chris Maher's editorial starting on page 870.
Membership of the PRISMA Group is provided in the Acknowledgments.
This article has been reprinted with permission from the Annals of Internal Medicine from Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. Ann Intern Med. Available at: http://www.annals.org/cgi/content/full/151/4/264. The authors jointly hold copyright of this article. This article has also been published in PLoS Medicine, BMJ, Journal of Clinical Epidemiology, and Open Medicine.
Copyright © 2009 Moher et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Background:
The aim of this intervention study was to determine the effects of a new experimental cervical pillow, on symptomatic adults affected by chronic mechanical neck pain.
Methods:
Twelve recreational athletes of both sexes (mean age 40.5 years; range 35-55), affected by grade II chronic mechanical neck pain, were evaluated with a daily diary type of self- report questionnaire, which incorporated an 11-point Numerical Rating Pain Scale, to collect the primary outcome measures of pre and post-sleep neck pain and with the Neck Pain Disability Scale. Tympanic temperature, Heart Rate Variability Continuous Monitoring during sleep, overnight pillow comfort and sleep quality were assessed.
Results:
Average weekly scores in overall questionnaires, tympanic temperature and the HR Low-Frequency-High Frequency ratio were significantly lower (p< 0.05) after the use of the DM2 pillow than the own pillow. The 80% of participants considered the DM2 "perfectly comfortable" and reported a "good" quality of sleep lying over it.
Conclusions:
The use of an appropriate pillow is a determinant factor in relieving neck pain, improving LF/HF ratio and enhancing-vagal activity, promoting deeper stages during the sleep. The shape of this pillow maintains an appropriate cervical curvature, reduces intra-disc pressure allowing a better distribution of loads between cervical discs. The round shaped portion of the pillow, facilitates breathing and avoids the narrowing of the airway due to the incorrect position during the sleep. The peculiar material of the DM2 pillow, contributed to lower brain temperature promoting dry heat loss from the head to the pillow, reducing sweating.
Sleep quality is an essential factor to human beings for health. The current paper conducted four studies to provide a suitable pillow for promoting sleep quality.
Study 1 investigated the natural positions of 40 subjects during sleep to derive key-points for a pillow design. The results suggested that the supine and lateral positions were alternatively 24 times a night, and the current pillows were too high for the supine position and too low for lateral positions.
Study 2 measured body dimensions related to pillow design of 40 subjects to determine pillow sizes. The results suggested that the pillow height were quite different in supine position and lateral position and needed to take into consideration for a pillow design.
Study 3 created a pillow design based on the results of above studies. The pillow was a U-form in the front of view in which the pillow height in the middle area was lower for the supine position, and both sides were higher for the lateral positions.
Study 4 assessed sleep quality of 6 subjects by using the proposed pillows and the current pillows. The results showed that the newly designed pillow led to significantly higher sleep quality, and the new design received an innovation patent.
Because sleep comprises one-third of a person's life, using an optimal pillow for appropriate neck support to maintain cervical curve may contribute to improve quality of sleep. Design of orthopedic pillow conforms to orthopedic guidelines to ensure the right support of the cervical curve. The aim of this study was to investigate effect of different pillow shape and content on cervical curve, pillow temperature, and pillow comfort. A feather pillow is regarded as a standard pillow, and a memory foam pillow is one of the most popular pillows among pillow users. We, therefore, compared these two pillows with an orthopedic pillow. Twenty healthy subjects (10 men and 10 women; age range, 21-30 years) participated in the study. Each subject was asked to assume the supine position with 3 different pillows for 30 minute in each trial and then cervical curve, pillow temperature, and pillow comfort were measured. When comparing the cervical curve of the 3 different pillows, that of the orthopedic pillow was significantly higher than that of the other 2 pillows (p < 0.001). The degree of temperature increase was significantly lower for the orthopedic pillow than for the memory foam and feather pillows (p < 0.001). The visual analog scale (VAS) score of pillow comfort was significantly higher in orthopedic pillow than the other 2 pillows. This study shows that pillow shape and content plays a crucial role in cervical curve, pillow temperature, and pillow comfort and orthopedic pillow may be an optimal pillow for sleep quality.
Abstract A fall in body temperature due to circadian rhythms causes drowsiness and increases the propensity to sleep from the evening to midnight. As one of the sources of declining body temperature, the occipital region was cooled with a water pillow in this study, and the effect of this cooling technique on the sleep process and subjective ratings of sleep was analyzed. Seven university students whose sleep latency was more than 30 min slept using a pillow with a surface temperature 16°C (iced water condition) or 26°C (room temperature water condition), respectively. The iced water decreased the axilla temperature faster than the water at room temperature. A polysomnogram analysis indicated that sleep latency was significantly shorter when iced water was used compared to when cool water at room temperature was used. In addition, the iced water improved the participants' subjective quality of sleep, including falling asleep and sleep maintenance. These results suggest that cooling the occipital region might be effective in promoting sleep onset and sleep maintenance.
Objective:
Few studies have analyzed the shapes of pillows. The purpose of this study was to investigate the relationship between the pillow shape design and subjective comfort level for asymptomatic subjects.
Methods:
Four basic pillow designs factors were selected on the basis of literature review and recombined into 8 configurations for testing the rank of degrees of comfort. The data were analyzed by the analytic hierarchy process method to determine the most comfortable pillow.
Results:
Pillow number 4 was the most comfortable pillow in terms of head, neck, shoulder, height, and overall comfort. The design factors of pillow number 4 were using a combination of standard, cervical, and shoulder pillows. A prototype of this pillow was developed on the basis of the study results for designing future pillow shapes.
Conclusions:
This study investigated the comfort level of particular users and redesign features of a pillow. A deconstruction analysis would simplify the process of determining the most comfortable pillow design and aid designers in designing pillows for groups.
Neck pain is becoming increasingly common throughout the world. It has a considerable impact on individuals and their families, communities, health-care systems, and businesses. There is substantial heterogeneity between neck pain epidemiological studies, which makes it difficult to compare or pool data from different studies. The estimated 1 year incidence of neck pain from available studies ranges between 10.4% and 21.3% with a higher incidence noted in office and computer workers. While some studies report that between 33% and 65% of people have recovered from an episode of neck pain at 1 year, most cases run an episodic course over a person's lifetime and, thus, relapses are common. The overall prevalence of neck pain in the general population ranges between 0.4% and 86.8% (mean: 23.1%); point prevalence ranges from 0.4% to 41.5% (mean: 14.4%); and 1 year prevalence ranges from 4.8% to 79.5% (mean: 25.8%). Prevalence is generally higher in women, higher in high-income countries compared with low- and middle-income countries and higher in urban areas compared with rural areas. Many environmental and personal factors influence the onset and course of neck pain. Most studies indicate a higher incidence of neck pain among women and an increased risk of developing neck pain until the 35-49-year age group, after which the risk begins to decline. The Global Burden of Disease 2005 Study is currently making estimates of the global burden of neck pain in relation to impairment and activity limitation, and results will be available in 2011.
This article is the first of a series providing guidance for use of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system of rating quality of evidence and grading strength of recommendations in systematic reviews, health technology assessments (HTAs), and clinical practice guidelines addressing alternative management options. The GRADE process begins with asking an explicit question, including specification of all important outcomes. After the evidence is collected and summarized, GRADE provides explicit criteria for rating the quality of evidence that include study design, risk of bias, imprecision, inconsistency, indirectness, and magnitude of effect. Recommendations are characterized as strong or weak (alternative terms conditional or discretionary) according to the quality of the supporting evidence and the balance between desirable and undesirable consequences of the alternative management options. GRADE suggests summarizing evidence in succinct, transparent, and informative summary of findings tables that show the quality of evidence and the magnitude of relative and absolute effects for each important outcome and/or as evidence profiles that provide, in addition, detailed information about the reason for the quality of evidence rating. Subsequent articles in this series will address GRADE's approach to formulating questions, assessing quality of evidence, and developing recommendations.
Does the PEDro scale measure only one construct ie, the methodological quality of clinical trials? What is the hierarchy of items of the PEDro scale from least to most adhered to? Is there any effect of year of publication of trials on item adherence? Are PEDro scale ordinal scores equivalent to interval data?
Rasch analysis of two independent samples of 100 clinical trials from the PEDro database scored using the PEDro scale.
Both samples of PEDro data showed fit to the Rasch model with no item misfit. The PEDro scale item hierarchy was the same in both samples, ranging from the most adhered to item random allocation, to the least adhered to item therapist blinding. There was no differential item functioning by year of publication. Original PEDro ordinal scores were highly correlated with transformed PEDro interval scores (r = 0.99).
The PEDro scale is a valid measure of the methodological quality of clinical trials. It is valid to sum PEDro scale item scores to obtain a total score that can be treated as interval level measurement and subjected to parametric statistical analysis.